scholarly journals Combined preoperative traction with instrumented posterior occipitocervical fusion for severe ventral brainstem compression secondary to displaced os odontoideum: technical report of 2 cases

2016 ◽  
Vol 18 (6) ◽  
pp. 724-729 ◽  
Author(s):  
Muhammad M. Abd-El-Barr ◽  
Brian D. Snyder ◽  
John B. Emans ◽  
Mark R. Proctor ◽  
Daniel Hedequist
Keyword(s):  
Craniocervical Junction ◽  
Neurological Function ◽  
Neurological Deficits ◽  
Os Odontoideum ◽  
Surgical Approaches ◽  
Occipitocervical Fusion ◽  
Halo Vest ◽  
Technical Report ◽  
Brainstem Compression

Severe os odontoideum causing ventral brainstem compression is a rare and difficult entity to treat. It is generally accepted that severe os odontoideum causing ventral brainstem compression and neurological deficits warrants surgical treatment. This often requires both anterior and posterior procedures. Anterior approaches to the craniocervical junction are fraught with complications, including infection and risk of injury to neurovascular structures. External traction systems traditionally require long-term bedrest. The authors report 2 cases of severe ventral brainstem compression secondary to displaced os odontoideum and describe their use of extended preoperative halo vest traction to reduce the severe kyphosis and improve neurological function, followed by posterior occipitocervical fusion. Postoperatively both patients showed remarkable improvements in their neurological function and kyphotic deformity. Preoperative halo vest traction combined with posterior occipitocervical fusion appears to be a safe and effective method to treat brainstem compression by severe os odontoideum. It allows for adequate decompression of ventral neural structures and improvement of neurological function, but it is not hindered by the risks of anterior surgical approaches and does not restrict patients to strict bedrest as traditional traction systems. This method of halo vest traction and posterior-only approaches may be transferable to other cervical instability issues with both anterior and posterior pathologies.

Stereotactic Volumetric Resection of Thalamic Pilocytic Astrocytomas

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Yaron A. Moshel ◽  
Michael J. Link ◽  
Patrick J. Kelly
Keyword(s):  
New York ◽  
Residual Tumor ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
New York University ◽  
Total Resection ◽  
Pilocytic Astrocytomas

Abstract OBJECTIVE To describe the surgical approaches, the radiographic and clinical outcomes, and the long-term follow-up of patients harboring thalamic pilocytic astrocytomas after radical resection by means of a stereotactic volumetric technique. METHODS Seventy-two patients with thalamic pilocytic astrocytomas underwent stereotactic volumetric resection by the senior author (PJK) at the Mayo Clinic between 1984 and 1993 (44 patients) and at New York University Medical Center between 1993 and 2005 (28 patients). Patient demographics, presenting symptoms, surgical approaches, neurological outcomes, pathology, initial postoperative status, and long-term clinical and radiographic follow-up were retrospectively reviewed. RESULTS On preoperative neurological examinations, 54 of the 72 patients had neurological deficits; of these, 48 had hemiparesis. Postoperative imaging demonstrated gross total resection in 58 patients and minimal (<6 mm) residual tumor in 13 patients. Tumor resection was aborted in one patient. On immediate postoperative examination, 16 patients had significant improvements in hemiparesis. Six patients had worsening of a preexisting hemiparesis and one had a new transient postoperative hemiparesis. There was one postoperative death. After 13 to 20 years of follow-up in the Mayo group (mean, 15 ± 3 yr) and 1 to 13 years of follow-up in the New York University group (mean, 8 ± 3 yr), 67 patients were recurrence/progression-free, one had tumor recurrence, and three had progression of residual tumor. There were two shunt-related deaths. On long-term neurological follow-up, 27 patients had significant improvements in hemiparesis; one patient with a postoperative worsening of a preexisting hemiparesis remained unchanged. There were no patients with new long-term motor deficits after stereotactic resection. CONCLUSION Gross total removal of thalamic pilocytic astrocytomas with low morbidity and mortality can be achieved by computer-assisted stereotactic volumetric resection techniques. Gross total resection of these lesions confers a favorable long-term prognosis without adjuvant chemotherapy and/or radiation therapy and leads to the improvement of neurological deficits.

Two-Stage Approach for Unstable Pediatric Craniocervical Junction Anomalies with a Halo Vest and Delayed Occipitocervical Fusion: Technical Note, Case Series, and Literature Review

2020 ◽  
Author(s):  
Jorge Tirado-Caballero ◽  
Gloria Moreno-Madueño ◽  
Mónica Rivero-Garvia ◽  
María José Mayorga-Buiza ◽  
Julio Valencia-Anguita ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Craniocervical Junction ◽  
Technical Note ◽  
Two Stage ◽  
Occipitocervical Fusion ◽  
Halo Vest

Transoral-transpharyngeal approach to the anterior craniocervical junction

1988 ◽  
Vol 69 (6) ◽  
pp. 895-903 ◽  
Author(s):  
Arnold H. Menezes ◽  
John C. VanGilder
Keyword(s):  
Effective Means ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Os Odontoideum ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Patients Âgés ◽  
Neurological Improvement ◽  
Clivus Chordoma

✓ The anterior transoral-transpharyngeal operation to correct ventral irreducible compression of the cervicomedullary junction was utilized in 72 individuals. The patients' ages ranged from 6 to 82 years, and 29 were children. The pathology encountered was primary basilar invagination, rheumatoid irreducible cranial settling, secondary basilar invagination due to migration of odontoid fracture fragments, dystopic os odontoideum, granulation masses, clivus chordoma, osteoblastoma, and chondroma of the atlas. Fifteen patients had associated Chiari malformation with basilar invagination. Fifty-two patients required subsequent atlantoaxial or occipitocervical fusion. Neurological improvement was the rule. There were two deaths within 30 days of surgery: one from myocardial infarction 4 weeks after surgery and one from Gram-negative septicemia of urinary tract origin. There was one pharyngeal wound infection. The ventral transoral approach provides a safe, rapid, and effective means for decompression of the abnormal craniovertebral junction.

Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery

2002 ◽  
Vol 97 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Moses Joseph Arunkumar ◽  
Vedantam Rajshekhar
Keyword(s):  
Craniovertebral Junction ◽  
Neurological Deficits ◽  
Retropharyngeal Abscess ◽  
Occipitocervical Fusion ◽  
Limb Weakness ◽  
Long Term Outcome ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

Object. The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical fusion, and antituberculous therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. Methods. In this retrospective study, the authors reviewed the management and outcome in nine consecutive patients in whom features of spinal cord compression were observed and CVJ tuberculosis was diagnosed between 1993 and 1999. They ranged in age from 9 to 55 years. Onset of symptoms was acute or subacute and rapidly progressive (median 4 months, range 1–12 months). Patients presented with neck pain (89%), progressive limb weakness (89%), sensory symptoms (22%), and urinary dysfunction (33%). The mean preoperative functional grade based on the Nurick Scale was 3.4 (range 1–5). The disease caused reducible atlantoaxial dislocation (AAD) in three patients (33%), irreducible AAD in two (22%), basilar impression (BI) in one (11%), AAD with BI in one (11%), and C-2 vertebral body (VB) destruction without dislocation in two (22%). Surgery was performed in all cases. Five patients (56%) underwent transoral odontoidectomy, two (22%) transoral decompression of retropharyngeal abscess and granulation tissue, and two (22%) transoral decompression of abscess and diseased parts of the C-2 VB. All patients then underwent occipitocervical (occiput—C3) fusion in which a contoured Steinmann pin and iliac bone grafts were used. Postoperatively, ATT was prescribed for 18 months. In the immediate postoperative period, function in these patients improved from a mean Nurick grade of 3.4 to 2.3 (p < 0.01). At long-term follow-up examination (median 18.8 months, range 7–46 months) function improved from a mean Nurick grade of 3.4 to 0.3 (range 0–2) (p < 0.001). Conclusions. Patients with CVJ tuberculosis with features of cervical myelopathy are ideally managed with transoral decompressive procedures followed by occipitocervical fusion because this therapy provides immediate neurological improvement, stability, and allows early mobilization. The long-term prognosis in patients with this disease is excellent provided it is treated with appropriate surgical intervention(s) and with adequate duration of ATT.

scholarly journals Clinical presentation and management of proatlas segmentation defect presenting with palatal myoclonus: case report

2015 ◽  
Vol 16 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Raheel Ahmed ◽  
Arnold H. Menezes
Keyword(s):  
Developmental Disorders ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Neurological Deficits ◽  
Palatal Myoclonus ◽  
Clinical Presentations ◽  
Neurological Morbidity

Clinical presentation of craniovertebral junction disorders may range from acute catastrophic neurological deficits to insidious signs and symptoms that may mask the underlying etiology. Prompt recognition and treatment is essential to avert long-term neurological morbidity. Proatlas segmentation disorders are a rare group of developmental disorders involving the craniocervical junction. Abnormal bony segmentation leads to malformed bony structures that can in turn lead to neurological deficits through bony compression of the cervicomedullary junction. This report details a proatlas segmentation defect presenting as palatal myoclonus, a rare movement disorder. The clinical presentation, surgical management, and neuroanatomical basis for the disorder is presented. This report highlights the myriad clinical presentations of craniovertebral disorders and emphasizes a rare but treatable etiology for palatal myoclonus.

Long-term outcomes after meningioma radiosurgery: physician and patient perspectives

1999 ◽  
Vol 91 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Douglas Kondziolka ◽  
Elad I. Levy ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Patient Survey ◽  
Neurological Function ◽  
Neurological Deficits ◽  
Management Approach ◽  
Tumor Control ◽  
Content Type ◽  
Satisfactory Outcome ◽  
Function Preservation ◽  
Fine Print

Object. Stereotactic radiosurgery is a primary or adjuvant management approach used to treat patients with intracranial meningiomas. The goal of radiosurgery is long-term prevention of tumor growth, maintenance of the patient's neurological function, and prevention of new neurological deficits. The object of this study is to report longer-term patient outcomes.Methods. The authors evaluated 99 consecutive patients who underwent radiosurgery for meningioma between 1987 and 1992. Evaluation was performed using serial imaging tests, clinical evaluations, and a patient survey that was administered between 5 and 10 years after radiosurgery. Four patients underwent two radiosurgery procedures for separate meningiomas. The average tumor margin dose was 16 Gy and the median tumor volume was 4.7 ml (range 0.24–24 ml). Fifty-seven patients (57%) had undergone prior resection, of which 12 procedures were considered “total.” Five patients received fractionated radiation therapy before radiosurgery. Eighty-nine patients (89%) had skull base tumors.The clinical tumor control rate (no resection required) was 93%. Sixty-one (63%) of 97 tumors became smaller, 31 (32%) remained unchanged in size, and five (5%) were enlarged. Resection was performed in seven patients (7%), six of whom had undergone prior resection. New neurological deficits developed in five patients (5%) 3 to 31 months after radiosurgery. Twenty-seven (42%) of 65 responding patients were employed at the time of radiosurgery and 20 (74%) of these remained so. Radiosurgery was believed to have been “successful” by 67 of 70 patients who completed an outcomes questionnaire 5 to 10 years later. At least one complication was described by nine patients (14%) and in four patients the complications resolved.Conclusions. Five to 10 years after radiosurgery, 96% of surveyed patients believed that radiosurgery provided a satisfactory outcome for their meningioma. Overall, 93% of patients required no other tumor surgery. Incidences of morbidity in this early experience were usually transitory and relatively mild. Radiosurgery provided long-term tumor control associated with high rates of neurological function preservation and patient satisfaction.

Inflammatory bowel disease and the craniocervical junction

1999 ◽  
Vol 6 (6) ◽  
pp. E12 ◽  
Author(s):  
Timothy Ryken ◽  
Arnold Menezes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fusion ◽  
Long Term Follow Up ◽  
History Of ◽  
Inflammatory Bowel

Rheumatological complications have been described in up to 30% of patients being followed for inflammatory bowel disease. The majority of these complications occur as spondylitic changes in the lumbar spine. Erosive arthritic disease associated with inflammatory bowel disease occurs less frequently, but it can result in ligamentous laxity and joint instability. To highlight the potential significance of the process at the craniocervical junction, the authors describe the long-term follow-up care of a complicated case. A 56-year-old woman, with a long history of ulcerative colitis, presented with atlantoaxial instability and underwent a C1-3 fusion; however, the presence of significant occipitoatlantal instability was not recognized. This resulted in high cervicomedullary quadriplegia, requiring traction reduction and a combined anterior transoral decompressive-posterior occipitocervical fusion. The patient's neurological deficit completely resolved postoperatively.

scholarly journals Management of a Mycotic Aneurysm in a Patient with COVID-19: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 620
Author(s):  
Muzammil H. Syed ◽  
Mark Wheatcroft ◽  
Danny Marcuzzi ◽  
Hooman Hennessey ◽  
Mohammad Qadura
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Mycotic Aneurysm ◽  
Neurological Deficits ◽  
Endovascular Stent ◽  
Endovascular Stents ◽  
Abdominal Aortic ◽  
Short Period

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.

scholarly journals Perinatal neuroprotection update

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1939 ◽  
Author(s):  
Angie C. Jelin ◽  
Kirsten Salmeen ◽  
Dawn Gano ◽  
Irina Burd ◽  
Mari-Paule Thiet
Keyword(s):  
Preterm Delivery ◽  
Significant Risk ◽  
Autism Spectrum ◽  
Neurological Deficits ◽  
Delayed Cord Clamping ◽  
Neurological Outcomes ◽  
Cord Clamping ◽  
Cognitive Delay ◽  
Neurological Risk

Antepartum, intrapartum, and neonatal events can result in a spectrum of long-term neurological sequelae, including cerebral palsy, cognitive delay, schizophrenia, and autism spectrum disorders [1]. Advances in obstetrical and neonatal care have led to survival at earlier gestational ages and consequently increasing numbers of periviable infants who are at significant risk for long-term neurological deficits. Therefore, efforts to decrease and prevent cerebral insults attempt not only to decrease preterm delivery but also to improve neurological outcomes in infants delivered preterm. We recently published a comprehensive review addressing the impacts of magnesium sulfate, therapeutic hypothermia, delayed cord clamping, infections, and prevention of preterm delivery on the modification of neurological risk [2]. In this review, we will briefly provide updates to the aforementioned topics as well as an expansion on avoidance of toxin and infections, specifically the Zika virus.

scholarly journals The Carbamate, Physostigmine does not Impair Axonal Transport in Rat Cortical Neurons

2021 ◽  
Vol 16 ◽  
pp. 263310552110202
Author(s):  
Sean X Naughton ◽  
Wayne D Beck ◽  
Zhe Wei ◽  
Guangyu Wu ◽  
Peter W Baas ◽  
...  
Keyword(s):  
Axonal Transport ◽  
Cortical Neurons ◽  
Acetylcholinesterase Inhibitors ◽  
Neurological Deficits ◽  
Dependent Manner ◽  
Concentration Dependent Manner ◽  
Rat Cortical Neurons ◽  
Toxicological Mechanism

Among the various chemicals that are commonly used as pesticides, organophosphates (OPs), and to a lesser extent, carbamates, are most frequently associated with adverse long-term neurological consequences. OPs and the carbamate, pyridostigmine, used as a prophylactic drug against potential nerve agent attacks, have also been implicated in Gulf War Illness (GWI), which is often characterized by chronic neurological symptoms. While most OP- and carbamate-based pesticides, and pyridostigmine are relatively potent acetylcholinesterase inhibitors (AChEIs), this toxicological mechanism is inadequate to explain their long-term health effects, especially when no signs of acute cholinergic toxicity are exhibited. Our previous work suggests that a potential mechanism of the long-term neurological deficits associated with OPs is impairment of axonal transport (AXT); however, we had not previously evaluated carbamates for this effect. Here we thus evaluated the carbamate, physostigmine (PHY), a highly potent AChEI, on AXT using an in vitro neuronal live imaging assay that we have previously found to be very sensitive to OP-related deficits in AXT. We first evaluated the OP, diisopropylfluorophosphate (DFP) (concentration range 0.001-10.0 µM) as a reference compound that we found previously to impair AXT and subsequently evaluated PHY (concentration range 0.01-100 nM). As expected, DFP impaired AXT in a concentration-dependent manner, replicating our previously published results. In contrast, none of the concentrations of PHY (including concentrations well above the threshold for impairing AChE) impaired AXT. These data suggest that the long-term neurological deficits associated with some carbamates are not likely due to acute impairments of AXT.

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