Anterior approach to recurrent chordomas of the clivus

1972 ◽  
Vol 36 (5) ◽  
pp. 670-672 ◽  
Author(s):  
A. N. Guthkelch ◽  
R. G. Williams
Keyword(s):  
Soft Palate ◽  
Anterior Approach ◽  
Hard Palate ◽  
Content Type ◽  
Recurrent Tumors ◽  
Mucosal Incision ◽  
Fine Print

✓ A modified transpalatal transclival approach was used for removal of two recurrent tumors of the clivus. New features of the exposure include placing the mucosal incision immediately behind the line of the upper teeth, removal of the posterior third of the hard palate, increased mobilization of the soft palate, and removing the posterior ends of the inferior turbinals.

Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration

1990 ◽  
Vol 72 (3) ◽  
pp. 370-377 ◽  
Author(s):  
Francois Aldrich
Keyword(s):  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Skin Incision ◽  
Posterolateral Approach ◽  
Cervical Disc ◽  
Attractive Alternative ◽  
Disc Space ◽  
Content Type ◽  
Fine Print

✓ The controversy over whether to use a posterior or anterior approach for surgical treatment of soft cervical discs is still largely unsettled. However, although the posterior approach may be underutilized, it has distinct advantages when there are specific indications. Out of a large pool of cases, 53 patients presented with acute monoradiculopathy caused by soft cervical disc herniation. In 36 of these, the disc was sequestered (nonconfined) and was posterolateral to the disc space as seen on computerized tomography-myelography. Distinct motor weakness was a common clinical finding in all 36 cases. These patients were treated by using a 2- to 3-cm skin incision for the posterolateral microsurgical approach. The extent of the lateral facetectomy depended upon the relationship between the nerve root and the disc. All fragments were lateral to the dural sac and were sequestered through the anulus fibrosus and the posterior longitudinal ligament. Sequestrations were removed under direct microscopic vision, but the disc space was not entered. Pain relief and motor-power improvement in the affected radicular distribution were immediate in all patients. Sensory deficit and residual motor loss improved dramatically with normalization at approximately 6 months. No complications occurred and the mean hospital stay was 2 days. The follow-up period varied from 4 to 42 months with a mean of 26 months. Thus far, there have been no recurrences or other associated complications. By using strict selection criteria and a microsurgical posterolateral approach with removal of the sequestered disc fragment, excellent results with normalization of the monoradiculopathy can be obtained. The ease of this technique, low risk, minimal complications, and excellent results make it an attractive alternative to the anterior approach. The clinical presentations, specific indications, surgical technique, and clinical results are discussed; and a prototype of a small cervical self-retaining retractor is described.

Late malignant recurrence of childhood cerebellar astrocytoma

1972 ◽  
Vol 37 (4) ◽  
pp. 470-474 ◽  
Author(s):  
William R. Bernell ◽  
John J. Kepes ◽  
Elson P. Seitz
Keyword(s):  
Clinical Evidence ◽  
Total Excision ◽  
Content Type ◽  
Cerebellar Astrocytoma ◽  
Recurrent Tumors ◽  
Fine Print

✓ Two cases are presented in which childhood cerebellar astrocytomas recurred 20 and 23 years after gross total excision. Both recurrent tumors showed histological or clinical evidence of malignancy. The cases indicate that even two decades of symptom-free follow-up are not necessarily a guarantee of cure with this glioma.

Results and risk factors for anterior cervicothoracic junction surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 12-17 ◽  
Author(s):  
John A. Boockvar ◽  
Matthew F. Philips ◽  
Albert E. Telfeian ◽  
Donald M. O'Rourke ◽  
Paul J. Marcotte
Keyword(s):  
Risk Factors ◽  
Anterior Approach ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Significant Risk ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Four Levels ◽  
Fine Print

Object. Stabilization of the cervicothoracic junction (CTJ) requires special attention to the operative approach and biomechanical requirements of the fixation construct. In this study the authors assess the morbidity associated with the anterior approach to the CTJ and define risks that may lead to construct failure after anterior CTJ surgery. Methods. Data obtained for 14 patients (six men and eight women, mean age 50.1 years) who underwent surgical stabilization of the CTJ via an anterior cervical approach were retrospectively reviewed to assess the anterior approach—related morbidity and the risks of construct failure. The mean follow-up period was 21.1 months. Four patients (29%) had previously undergone CTJ surgery; in 11 patients (64%) more than one motion segment was involved (two levels, six patients; three levels, four patients; four levels, one patient); allograft was placed in three (21%) of 14 graft sites; and anterior plates were used for reconstruction augmentation in eight patients (57%). Postoperatively all patients improved, although four patients had residual deficits or pain. Graft/plate failure, requiring surgical revision and/or halo placement, occurred in five patients (36%). One patient experienced transient recurrent laryngeal nerve palsy. Postoperatively, the authors classified patients into one of two groups: those in whom surgery was successful (nine cases) and those in whom it had failed (five cases). Analysis of the characteristics of these two groups revealed that male sex (p < 0.0365), multiple levels of involvement (p < 0.0378), and the use of allograft as compared with autograft (p < 0.0088) were significant risk factors for construct failure. Prior CTJ surgery (p < 0.053) tended to be associated with graft failure. Conclusions: Findings of this study, in the setting of these factors, indicate that anterior reconstruction alone may not meet the biomechanical needs of this spinal region and that supplementary fixation may be considered to augment stabilization for fusion success.

Lipoma with dumb-bell extradural extension through the intervertebral foramen into the spinal canal

2005 ◽  
Vol 2 (1) ◽  
pp. 69-71 ◽  
Author(s):  
Jin Soo Park ◽  
Isao Shirachi ◽  
Kimiaki Sato ◽  
Noriyuki Ando ◽  
Kensei Nagata
Keyword(s):  
Vertebral Artery ◽  
Spinal Canal ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Intervertebral Foramen ◽  
Nerve Roots ◽  
Content Type ◽  
First Report ◽  
Fine Print

✓ The authors present the case of a 60-year-old woman with a neck lipoma that developed dumb-bell extradural extension, causing radiculopathy. To the best of the authors' knowledge, this is the first report of a lipoma originating in the neck with dumb-bell extradural extension through the intervertebral foramen and into the spinal canal. The lipoma was first excised from the foramen via a posterior approach to allow decompression of the nerve roots. The remaining lipomatous tissue was then resected via an anterior approach to avoid the region around the vertebral artery.

Angle-meter to indicate the proper angle of insertion in anterior percutaneous cervical cordotomy

1971 ◽  
Vol 34 (2) ◽  
pp. 244-247 ◽  
Author(s):  
Philip L. Gildenberg
Keyword(s):  
Anterior Approach ◽  
Needle Electrode ◽  
Content Type ◽  
Percutaneous Cordotomy ◽  
Fine Print

✓ An angle meter has been devised to facilitate the anterior approach to lower cervical percutaneous cordotomy and to afford the operator increased accuracy in placing the needle electrode. A method is described which allows the operator to set the trajectory of the needle electrode accurately at the stage when only the tip of the needle is inserted into the disc. The procedure requires no mathematical calculations and has proved accurate in 40 cases.

Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions

2001 ◽  
Vol 94 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Hiroaki Nakamura ◽  
Yoshiki Yamano ◽  
Masahiko Seki ◽  
Sadahiko Konishi
Keyword(s):  
Anterior Approach ◽  
Spinal Metastasis ◽  
Intercostal Nerve ◽  
Bone Union ◽  
Autogenous Bone ◽  
Anterior Fusion ◽  
Content Type ◽  
Grafting Technique ◽  
Vascularized Rib ◽  
Fine Print

✓ For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion. The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft. A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved. With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.

Experience with calf bone in cervical interbody spinal fusion

1972 ◽  
Vol 36 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Zia E. Taheri ◽  
Monoucher Gueramy
Keyword(s):  
Spinal Fusion ◽  
Clinical Data ◽  
Anterior Approach ◽  
Interbody Fusion ◽  
Operation Time ◽  
Content Type ◽  
X Ray ◽  
Fine Print

✓ In 200 cases following cervical diskectomy, cylindrical dowels of specially processed calf bone were placed in intervertebral holes, bored with a drill of the same size as the dowel. The anterior approach for cervical interbody fusion was used. With use of heterogenous bone, iliac osteotomy is unnecessary, and the hole is filled by a precisely formed, previously prepared, sterile dowel. The results are good, the operation time is shorter, and complications are diminished. The cases were evaluated separately from x-ray and clinical data.

Lateral interscalenic multilevel oblique corpectomies to repair ventral root avulsions after brachial plexus injury in humans: anatomical study and first clinical experience

2001 ◽  
Vol 95 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Henri-Dominique Fournier ◽  
Philippe Mercier ◽  
Philippe Menei
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Anterior Approach ◽  
Cervical Spinal Cord ◽  
Anatomical Study ◽  
Ventral Root ◽  
Anterolateral Approach ◽  
Content Type ◽  
Anterior Aspect ◽  
Fine Print

Object. Because central nervous system white matter exerts a powerful inhibitory effect on axonal growth, implantation of nerve grafts or rootlets into the cervical spinal cord following ventral root avulsion injury should, ideally, be performed directly through the ventral root exit zone (VRExZ), which is located near the anteromedial aspect of the anterior horn; the grafts/rootlets should not be implanted into the white matter of the lateral cord. This is not possible when using a conservative posterior approach. Therefore, the authors have studied the anatomy encountered when using the anterolateral approach and evaluated the technique in the particular case of avulsed ventral nerve roots. They also present a case illustration of the procedure, which is used currently in their department. Methods. Anterior access to the rootlets is obtained using a lateral interscalenic approach; the vertebral artery is exposed and mobilized, and oblique drilling of the vertebral bodies (VBs) is performed. Because the articular processes and half of the VBs are preserved, fusion is not required. The approach allows the surgeon to expose the anterior aspect of the cervical dura and the entire length of the emerging spinal nerves. The anterior aspect of the dura is opened at the desired levels for VRExZ exposure, and the position is ideal for implantation of the graft/rootlets. The interscalenic dissection is mandatory so that the lesions of the supraclavicular plexus can be evaluated and repaired. If necessary, the anterior approach allows for exploration of the infraclavicular plexus during the same procedure. Conclusions. The use of a true anterior approach to the ventral rootlets appears to be a valuable and appropriate approach that avoids extensive laminectomy/facetectomy while reimplantation is performed through the anterolateral sulcus itself. In this approach, however, reimplantation of dorsal roots into the spinal cord remains impossible.

Quantitative anatomical and morphological classification of the iliac vessels anterior to the lumbosacral vertebrae

2005 ◽  
Vol 3 (5) ◽  
pp. 371-374 ◽  
Author(s):  
Do-Sang Cho ◽  
Sang-Jin Kim ◽  
Eui-Kyo Seo ◽  
In-Hyuk Chung ◽  
Chang-Seok Oh
Keyword(s):  
Anterior Approach ◽  
Vascular Anatomy ◽  
Reference Points ◽  
Lumbosacral Spine ◽  
Morphological Classification ◽  
Disc Space ◽  
Content Type ◽  
Mean Width ◽  
Major Vessel ◽  
Fine Print

Object. Anterior surgical approaches to the lumbosacral disc spaces are being undertaken with increasing frequency. This increase and the use of minimally invasive techniques themselves have the potential to raise the incidence of major vessel injuries. The purpose of this study was to determine the variability of the vascular anatomy anterior to the lumbosacral spine and to draw conclusions regarding surgical accessibility of the L5—S1 disc space. Methods. Thirty-five cadavers (age range at the time of death 31–87 years) were obtained to evaluate the anatomical features of iliac vessels with respect to the anterior approach to the lumbosacral spine. Direct measurement and morphological classification regarding the relations of these great vessels to the four arbitrary reference points of the lumbosacral disc space were performed. The mean width and height of the L5—S1 disc were 56.4 mm (range 41.6–65.4 mm) and 18.8 mm (range 10–24 mm), repectively. According to the authors' morphological classification, nine specimens (26%) were found to be Type A (standard), 12 (34%) Type B (narrow), two (6%) Type C (ajar), and 12 (34%) Type D (obstacle). Conclusions. The authors have noted quite a variation in the venous vascular anatomy anterior to the lumbosacral disc. During surgical planning for the anterior approach to the lumbosacral spine when using any technique, it is vital to assess carefully radiographic and neuroimaging studies to minimize potentially disastrous vascular complications.

A transsternoclavicular approach for the anterior decompression and fusion of the upper thoracic spine

2005 ◽  
Vol 2 (2) ◽  
pp. 226-229 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masashi Saito ◽  
Masafumi Machida ◽  
Keiichi Shibasaki
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Anterior Decompression ◽  
Thoracic Region ◽  
Anatomical Structures ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Upper Thoracic ◽  
Anterior Decompression And Fusion ◽  
Fine Print

✓ The anterior approach is commonly used to reach the upper thoracic region to achieve decompression and stabilization; however, upper thoracic lesions are difficult to treat because of the regional anatomical structures, and this approach is associated with risks of complication. The authors evaluated the advantages of using a transsternoclavicular approach to aid in treating upper thoracic lesions. The procedure and surgery-related outcomes are discussed.

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