Axillary nerve entrapment in the quadrilateral space

1987 ◽  
Vol 66 (6) ◽  
pp. 932-934 ◽  
Author(s):  
H. Carson McKowen ◽  
Rand M. Voorhies
Keyword(s):  
Upper Extremity ◽  
Shoulder Pain ◽  
Posterior Approach ◽  
Axillary Nerve ◽  
Nerve Entrapment ◽  
Neutral Position ◽  
Circumflex Artery ◽  
Content Type ◽  
Radiographic Features ◽  
Fine Print

✓ The quadrilateral space syndrome is a recently established entity with seemingly consistent pathological and radiographic features. An example of this syndrome is reported. In this patient, entrapment of the axillary nerve by fibrous bands in the quadrilateral space caused shoulder pain with paresthesias in the upper extremity. Subclavian angiography provided the diagnosis by demonstrating that the posterior humeral circumflex artery, which was normal when the arm was in a neutral position, was occluded when the arm was abducted and externally rotated. Axillary neurolysis through a posterior approach resulted in relief of symptoms.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

Fourth ventricular schwannoma

1990 ◽  
Vol 73 (5) ◽  
pp. 777-781 ◽  
Author(s):  
Gary Redekop ◽  
Kost Elisevich ◽  
Joseph Gilbert
Keyword(s):  
Fourth Ventricle ◽  
Content Type ◽  
Radiographic Features ◽  
Unusual Location ◽  
Pontomedullary Junction ◽  
Fine Print

✓ A schwannoma arising from the dorsum of the pontomedullary junction and presenting as an exophytic mass in the fourth ventricle is described. A ventricular schwannoma has not previously been reported in the literature. The presenting clinical and radiographic features and the pathology of this tumor are summarized, and an explanation is sought for its unusual location.

Superficial peroneal nerve entrapment

1981 ◽  
Vol 55 (6) ◽  
pp. 991-992 ◽  
Author(s):  
Timir Banerjee ◽  
Dexter D. Koons
Keyword(s):  
Differential Diagnosis ◽  
Peroneal Nerve ◽  
Nerve Entrapment ◽  
Leg Pain ◽  
Superficial Peroneal Nerve ◽  
Content Type ◽  
Fine Print

✓ Two cases of entrapment of the superficial peroneal nerve are presented. This is an unusual cause for leg discomfort and should be considered in the differential diagnosis of leg pain.

Transparaspinal exposure of dumbbell tumors of the spine

1998 ◽  
Vol 88 (1) ◽  
pp. 106-110 ◽  
Author(s):  
Stephen T. Onesti ◽  
Ely Ashkenazi ◽  
W. Jost Michelsen
Keyword(s):  
Surgical Technique ◽  
Posterior Approach ◽  
Tumor Resection ◽  
Paraspinal Muscles ◽  
Transverse Incision ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Single Posterior Approach ◽  
Fine Print

✓ The authors present a surgical technique for resection of dumbbell tumors of the spine. The transparaspinal exposure combines laminectomy and sectioning of the paraspinal muscles through a transverse incision. The procedure allows total tumor resection by means of a single posterior approach in selected patients, thus obviating the need for a combined anteroposterior operation. The advantages and disadvantages of the transparaspinal approach compared with the more extensive lateral extracavitary approach are discussed.

Decussation of hind-limb and fore-limb fibers in the monkey corticospinal tract: relevance to cruciate paralysis

1991 ◽  
Vol 75 (6) ◽  
pp. 935-940 ◽  
Author(s):  
Conrad T. E. Pappas ◽  
Alan R. Gibson ◽  
Volker K. H. Sonntag
Keyword(s):  
Upper Extremity ◽  
Hind Limb ◽  
Corticospinal Tract ◽  
Underlying Mechanism ◽  
Nerve Fibers ◽  
Content Type ◽  
Gray Area ◽  
Anatomical Basis ◽  
Central Gray ◽  
Fine Print

✓ Cruciate paralysis is a clinical entity in which patients with trauma to the anterior cervicomedullary junction present with weakness of the upper extremity greater than that of the lower extremity. The underlying mechanism of this paralysis is commonly thought to be selective damage affecting the upper-extremity nerve fibers in the pyramidal decussation. The authors examined the anatomical basis of cruciate paralysis in six New World squirrel monkeys and two Old World cynomolgus monkeys. No evidence for a differential decussation of fore-limb and hind-limb fibers was found. Thus, there is no obvious anatomical explanation for cruciate palsy. The results do suggest two alternative explanations for cruciate paralysis: 1) selective damage to neural areas involving the internuncial cells, the central gray area, and the cuneate nucleus, or 2) injury to the ventral corticospinal tract.

Oscillating field stimulation for complete spinal cord injury in humans: a Phase 1 trial

2005 ◽  
Vol 2 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Scott Shapiro ◽  
Richard Borgens ◽  
Robert Pascuzzi ◽  
Karen Roos ◽  
Michael Groff ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Phase 1 ◽  
Wilcoxon Test ◽  
Content Type ◽  
Cord Injury ◽  
Asia Score ◽  
The Mean ◽  
Fine Print

Object. An electrical field cathode (negative pole) has trophic and tropic effects on injured spinal cord axons in in vitro and in vivo models of sea lamprey, rodent, and canine spinal cord injury (SCI) and it improves functional outcome. A human oscillating field stimulator (OFS) was built, a Food and Drug Administration (FDA) exemption number was obtained, and institutional review board approval was given for a Phase 1 trial to study 10 humans with complete motor and sensory SCI. Methods. Entry criteria were complete SCI between C-5 and T-10 in patients 18 to 65 years of age and no transection demonstrated on magnetic resonance imaging. All participants received the National Acute Spinal Cord Injury Study (NASCIS) III methylprednisilone protocol. Cord compression and/or vertebral instability was treated before study entry. After treatment complete SCI (according to the American Spinal Injury Association [ASIA] score) remained in all patients with no somatosensory evoked potentials (SSEPs) below the injury level after surgery or for 48 hours. All patients underwent implantation of the OFS within 18 days. Patients underwent evaluation every 2 weeks postimplantation; the OFS was explanted at 15 weeks. Independent neurological status was assessed based on the ASIA score, visual analog scale (VAS) pain score, and SSEPs at 6 weeks, 6 months, and 1 year. Statistical analyses were performed using the two-tailed Wilcoxon test and analysis of variance (ANOVA). There were no complications at insertion of the OFS; there was one case of wound infection after explantation (5% infection rate). One patient was lost to follow up after 6 months. In all 10 patients the mean VAS pain score was 8 at implantation, 2 at 6 months, and in the nine attending follow up for 1 year it remained 2. At 1 year, the mean improvement in light touch was 25.5 points (ANOVA p < 0.001, Wilcoxon test p = 0.02), the mean improvement in pinprick sensation was 20.4 points (ANOVA p < 0.001, Wilcoxon test p = 0.02), and the mean improvement in motor status was 6.3 points (ANOVA p < 0.01, Wilcoxon test p = 0.02). Of five cases involving cervical cord injuries, bilateral upper-extremity SSEPs were normal in one, unilateral upper-extremity SSEPs were recovered in four, bilateral upper-extremity SSEPs were recovered in one, and abnormal lower-extremity SSEPs resolved in one case. In one of the five cases involving thoracic injuries an abnormal lower-extremity SSEP resolved. Conclusions. The use of OFS treatment in patients with SCI is safe, reliable, and easy. Compared with the outcomes obtained in compliant NASCIS III plegic patients, the results of the present study indicate efficacy, and the FDA has given permission for enrollment of 10 additional patients.

Compartmentation of the jugular foramen

1972 ◽  
Vol 36 (3) ◽  
pp. 340-343 ◽  
Author(s):  
Robert Shapiro
Keyword(s):  
Jugular Foramen ◽  
Complete Separation ◽  
Content Type ◽  
Radiographic Features ◽  
Fine Print

✓ The radiographic anatomy of the jugular foramen is described. Normal variations in size and configuration are discussed and principal pathological configurations listed. The radiographic features of complete separation of the jugular foramen into separate neural and vascular components are presented.

Spinal Cord Herniation

2005 ◽  
Vol 3 (6) ◽  
pp. 508-509
Author(s):  
Laurence Marshman
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Posterior Approach ◽  
Direct Manipulation ◽  
Dural Repair ◽  
Content Type ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord ◽  
Fine Print

Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Use of an aiming device in posterior atlantoaxial transarticular screw fixation

2002 ◽  
Vol 97 (1) ◽  
pp. 123-127 ◽  
Author(s):  
Masashi Neo ◽  
Mutsumi Matsushita ◽  
Tadashi Yasuda ◽  
Takeshi Sakamoto ◽  
Takashi Nakamura
Keyword(s):  
Posterior Approach ◽  
Screw Fixation ◽  
Guide Wire ◽  
Posterior Part ◽  
Cannulated Screw ◽  
Atlantoaxial Joint ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

✓ Posterior atlantoaxial transarticular screw fixation is an excellent procedure associated with high fusion rates. There is, however, the potential risk of vertebral artery (VA) injury. The authors designed a special aiming device that allows a cannulated screw to be inserted accurately in the most posterior part of the C1–2 joint via the most posterior and medial part of the isthmus of C-2; this screw pathway most safely avoids VA injury. The instruments include an aiming device and a flexible screw-inserting system. The tip of the aiming device is placed on the ridge of the C-2 isthmus just posterior to the atlantoaxial joint. The guide wire should then pass 1 mm below the device tip. The system consists of flexible guide wires, a drill, a tap, and a screwdriver, and the screw is inserted easily via a posterior approach in which the patient's back is not obstructive. Ten patients with atlantoaxial subluxation or osteoarthritis underwent surgery in which the device was used. In all cases, the screws were inserted safely without causing VA injury, although preoperative computerized tomography (CT) reconstructions revealed a high-risk high-riding unilateral VA in three patients. Postoperative CT reconstructions demonstrated that all screws but one were inserted as planned, and successfully cleared the vertebral groove. In conclusion, this newly designed device is practical and useful for the accurate insertion of screws, thus avoiding VA injury during atlantoaxial transarticular screw fixation.

Risk factors for surgical site infection in spinal surgery

2003 ◽  
Vol 98 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Margaret A. Olsen ◽  
Jennie Mayfield ◽  
Carl Lauryssen ◽  
Louis B. Polish ◽  
Marilyn Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Morbid Obesity ◽  
Spinal Fusion ◽  
Spinal Surgery ◽  
Posterior Approach ◽  
Tumor Resection ◽  
Content Type ◽  
Independent Risk Factors ◽  
Postoperative Incontinence ◽  
Fine Print

Object. The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion. Methods. The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients. Risk factors for SSI were determined using univariate analyses and multivariate logistic regression. The spinal surgery—related SSI rate (incisional and organ space) during the 4-year study period was 2.8%. Independent risk factors for SSI identified by multivariate analysis were postoperative incontinence (odds ratio [OR] 8.2, 95% confidence interval [CI] 2.9–22.8), posterior approach (OR 8.2, 95% CI 2–33.5), procedure for tumor resection (OR 6.2, 95% CI 1.7–22.3), and morbid obesity (OR 5.2, 95% CI 1.9–14.2). In patients with SSI the postoperative hospital length of stay was significantly longer than that in uninfected patients (median 6 and 3 days, respectively; p < 0.001) and were readmitted to the hospital for a median additional 6 days for treatment of their infection. Repeated surgery due to the infection was required in the majority (73%) of infected patients. Conclusions. Postoperative incontinence, posterior approach, surgery for tumor resection, and morbid obesity were independent risk factors predictive of SSI following spinal surgery. Interventions to reduce the risk for these potentially devastating infections need to be developed.

Sign in / Sign up

Export Citation Format

Share Document