Percutaneous radiofrequency denervation of spinal facets

1975 ◽  
Vol 43 (4) ◽  
pp. 448-451 ◽  
Author(s):  
C. Norman Shealy
Keyword(s):  
Neurological Complications ◽  
Content Type ◽  
Radiofrequency Denervation ◽  
Fine Print

✓ A technique for radiofrequency localization and coagulation of articular nerves supplying the spinal facets is described and results are reported from a series of 207 patients followed 6 to 21 months (mean 13 months). Relief of pain was achieved in 79% of previously unoperated patients, in 41% of those with laminectomy but no fusion, and in 27% of those with an earlier fusion. No neurological complications were encountered.

A proposed grading system for arteriovenous malformations

1986 ◽  
Vol 65 (4) ◽  
pp. 476-483 ◽  
Author(s):  
Robert F. Spetzler ◽  
Neil A. Martin
Keyword(s):  
Venous Drainage ◽  
Neurological Complications ◽  
Management Decision ◽  
Grading System ◽  
Content Type ◽  
Treatment Techniques ◽  
Clinical Series ◽  
Management Decision Making ◽  
Eloquent Cortex ◽  
Fine Print

✓ An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

Acute meningeal reaction following Pantopaque myelography

1971 ◽  
Vol 34 (3) ◽  
pp. 396-404 ◽  
Author(s):  
William E. Mayher ◽  
Ernest F. Daniel ◽  
Marshall B. Allen
Keyword(s):  
Hypersensitivity Reaction ◽  
Contrast Material ◽  
Neurological Complications ◽  
Content Type ◽  
Incomplete Removal ◽  
Fine Print

✓ Severe neurological complications including one death followed Pantopaque myelography in three cases in a series of 6000 myelograms over a 10-year period. In each of the three cases there was incomplete removal of the contrast material at the end of the procedure. The literature is reviewed and similar cases cited. The possibility that the acute meningeal reaction may be due to a hypersensitivity reaction is discussed.

Calcified cervical intervertebral discs in children

1977 ◽  
Vol 46 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Richard A. Smith ◽  
M. Darius Vohman ◽  
Joseph H. Dimon ◽  
James E. Averett ◽  
James H. Milsap
Keyword(s):  
Spontaneous Recovery ◽  
Neurological Complications ◽  
Intervertebral Discs ◽  
Pathological Findings ◽  
Content Type ◽  
Distinct Disease ◽  
Benign Course ◽  
Fine Print

✓ Calcified cervical intervertebral discs in children are manifestations of an uncommon, distinct disease of unknown cause. Acute symptoms are usually followed by a benign course of spontaneous recovery, frequently culminating in resorption of the calcium. Rarely herniation of the disc may cause neurological complications. Two cases are presented as examples of the typical syndrome. A third case was operated on because of herniation with radiculopathy; the clinical, radiographic, and pathological findings are reported in detail.

Multiple intracranial aneurysms in sickle cell anemia

1985 ◽  
Vol 62 (3) ◽  
pp. 430-434 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Review Of The Literature ◽  
Hemoglobin S ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Fine Print

✓ Neurological complications of sickle cell anemia occur in 18% to 29% of patients with homozygous hemoglobin S disease. A review of the literature yielded reports of two cases, both treated conservatively, of multiple intracranial aneurysms occurring in patients with sickle cell anemia. The authors report two cases of subarachnoid hemorrhage secondary to multiple intracranial aneurysms in patients with sickle cell anemia. One of the two patients underwent three craniotomies for ablation of six intracranial aneurysms. The techniques used in the treatment of these patients are presented.

Intracranial esthesioneuroblastoma associated with unilateral visual loss

1980 ◽  
Vol 53 (6) ◽  
pp. 836-840 ◽  
Author(s):  
Yochanan Goldhammer ◽  
Menachem Sadeh ◽  
Rina Tadmor ◽  
George Leventon
Keyword(s):  
Nasal Cavity ◽  
Visual Loss ◽  
Neurological Complications ◽  
Olfactory Mucosa ◽  
Rare Tumor ◽  
Content Type ◽  
Intracranial Mass ◽  
Fine Print

✓ Esthesioneuroblastoma is a rare tumor that arises from the olfactory mucosa and presents usually as a mass in the nasal cavity. Neurological complications occur in about 20% of these cases. Nine cases have been recorded so far in which the neoplasm manifested initially as an intracranial mass. These cases are reviewed and another patient, presenting with progressive unilateral visual loss, is reported.

Surgical treatment of recurrent carotid artery stenosis

1994 ◽  
Vol 80 (5) ◽  
pp. 781-787 ◽  
Author(s):  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
Nicolee C. Fode
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Neurological Complications ◽  
Artery Stenosis ◽  
Intraluminal Thrombus ◽  
Content Type ◽  
Interposition Graft ◽  
Patch Graft ◽  
Organized Thrombus ◽  
Fine Print

✓ Ninety-two surgical procedures were performed in 82 patients for recurrent carotid artery stenosis. The etiology was recurrent atherosclerosis in 45 cases, myointimal hyperplasia in 20, organized thrombus without a significant underlying plaque in 20, and scarring along the proximal arteriotomy site in seven. The operations included a repeat endarterectomy in 66 cases and reconstruction with an interposition graft in 22. All five major neurological complications occurred in symptomatic patients, and included three instances of intraoperative embolization during exposure of the carotid artery. The majority of neurological complications occurred in symptomatic patients who had intraluminal thrombus confirmed at surgery. There were four perioperative deaths, due to cerebral hemorrhage in two patients and myocardial infarction in two. In the patients whose original surgery was performed at the Mayo Clinic, the risk of recurrent carotid artery stenosis was 3.1% with a primary closure compared to 1.6% when a patch graft was used. These results indicate that surgery for recurrent carotid artery stenosis is technically more difficult and carries a significantly higher risk than surgery for primary disease. The difficulty is due to the friable recurrent plaque associated with intraluminal thrombus, which increases the risk of embolization during carotid artery exposure. In the majority of patients with recurrent atherosclerosis, a repeat endarterectomy can be achieved. However, in some patients, there is scarring without a definite plane of cleavage between the recurrent disease and the underlying media, making an endarterectomy difficult. In these cases, excision of the diseased segment and reconstruction with an interposition graft is the best treatment. The findings presented here also suggest that closure of the original arteriotomy with a patch graft decreases the risk of recurrent carotid artery stenosis.

Open reduction of pediatric atlantoaxial rotatory fixation: long-term outcome study with functional measurements

2004 ◽  
Vol 100 (3) ◽  
pp. 235-240 ◽  
Author(s):  
John E. Crossman ◽  
Karoly David ◽  
Richard Hayward ◽  
H. Alan Crockard
Keyword(s):  
Open Reduction ◽  
Facial Asymmetry ◽  
Axial Rotation ◽  
Neurological Complications ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Atlantoaxial Rotatory Fixation ◽  
Rotatory Fixation ◽  
Fine Print

Object. Atlantoaxial rotatory fixation (AARF) is an uncommon disorder of childhood in which resolution usually occurs spontaneously or after traction therapy. In a minority of children irreducible or chronic fixation develop, and the natural history then usually involves restriction of head on neck movement, abnormal head position, and progressive facial asymmetry. The conventional management in these cases has been a posterior fusion. Methods. The authors performed an open reduction via the extreme-lateral approach without adjunctive fixation surgery in 13 children who ranged in age from 4 to 11 years. Postoperatively, halo jacket therapy was undertaken for 8 to 12 weeks. There were no neurological complications despite damage to one vertebral artery and one wound infection. Functional outcome was assessed after a minimum of 24 months (range 29–72 months). Facial asymmetry markedly improved. Sagittal movements were similar to those observed in control individuals. Axial rotation, although reduced compared with that in controls, was present but usually asymmetrical. Conclusions. In the authors' opinion, open reduction provides the best possibility of normal facial development and return of axial movement in cases of AARF.

Neurological complications of ankylosing spondylitis

1993 ◽  
Vol 78 (6) ◽  
pp. 871-878 ◽  
Author(s):  
Mark W. Fox ◽  
Burton M. Onofrio ◽  
John E. Kilgore
Keyword(s):  
Ankylosing Spondylitis ◽  
Spinal Column ◽  
Spinal Fractures ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Successful Outcome ◽  
Spinal Instability ◽  
Spinal Disorders ◽  
Content Type ◽  
Fine Print

✓ Thirty-three patients with ankylosing spondylitis with or without spinal neurological symptoms requiring surgical intervention were identified in a retrospective review of all cases of spinal disorders treated at the Mayo Clinic during the period from 1984 to 1989. Spinal fractures (traumatic or pseudoarthroses), progressive spinal deformity, rotary instability secondary to atlanto-occipital or atlantoaxial subluxation, and spinal stenosis with associated neurological deficit, pain, or spinal instability were the most common indications for surgery. Of the 41 operations performed, there were 17 cervical, 14 thoracic, and 10 lumbar procedures. Eight patients had two or more disorders at separate spinal levels that required surgery. Preoperative neurological deficits were recorded in 13 patients: these improved following surgery in nine and stabilized in four. This review emphasizes the fragility of the ankylosed spinal column and its inherent susceptibility to fracture with attendant neurological compromise. It also identifies the variety of spinal disorders observed in these patients and discusses their surgical management. The experience with this series suggests that thorough radiological evaluation, extreme caution with endotracheal intubation and with halo-vest applications, early surgical spinal immobilization, and aggressive postoperative mobilization of patients are necessary for a successful outcome. It is concluded that outcomes in these patients can be favorable when managed appropriately.

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization

1984 ◽  
Vol 60 (4) ◽  
pp. 777-785 ◽  
Author(s):  
Alex Berenstein ◽  
Wise Young ◽  
Joseph Ransohoff ◽  
Vallo Benjamin ◽  
Henry Merkin
Keyword(s):  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Arteriovenous Malformations ◽  
Therapeutic Embolization ◽  
Neurological Complications ◽  
Anterior Spinal Artery ◽  
Spinal Angiography ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

Stereotactic radiosurgery for brainstem arteriovenous malformations: factors affecting outcome

2004 ◽  
Vol 100 (3) ◽  
pp. 407-413 ◽  
Author(s):  
Keisuke Maruyama ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Radiation Effects ◽  
Three Dimensional ◽  
Neurological Complications ◽  
Long Term Results ◽  
Management Options ◽  
Content Type ◽  
Dose Planning ◽  
Fine Print

Object. Management options for arteriovenous malformations (AVMs) of the brainstem are limited. The long-term results of stereotactic radiosurgery for these disease entities are poorly understood. In this report the authors reviewed both neurological and radiological outcomes following stereotactic radiosurgery for brainstem AVMs over 15 years of experience. Methods. Fifty patients with brainstem AVMs underwent gamma knife surgery between 1987 and 2002. There were 29 male and 21 female patients with an age range of 7 to 79 years (median 35 years). Anatomical locations of these AVMs included the midbrain (39 lesions), pons (20 lesions), and medulla oblongata (three lesions). The radiation dose applied to the margin of the AVM varied from 12 to 26 Gy (median 20 Gy). Forty-five patients were followed up from 5 to 176 months (mean 72 months). The angiographically confirmed actuarial obliteration rate was 66% at the final follow-up examination. Two patients experienced a hemorrhage before obliteration. The annual hemorrhage rate was 1.7% for the first 3 years after radiosurgery and 0% thereafter. Patients who had received irradiation at two or fewer isocenters had higher obliteration rates (80% compared with 44% for > two isocenters, p = 0.006), and this was related to a more spherical nidus shape. The rate of persistent neurological complications in patients treated using magnetic resonance imaging—based dose planning after 1993 was 7%, compared with 20% in patients treated before 1993. An older patient age, a lesion located in the tectum, and a higher radiosurgery-based score were significantly associated with greater neurological complications. Conclusions. Stereotactic radiosurgery provided complete obliteration of AVMs in two thirds of the patients with a low risk of latency-interval hemorrhage. Better three-dimensional imaging studies and conformal dose planning reduced the risk of adverse radiation effects. Younger patients harboring more spherical AVMs that did not involve the tectal plate had the best outcomes.

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