Evaluation and treatment of atlas burst fractures (Jefferson fractures)

1991 ◽  
Vol 75 (2) ◽  
pp. 213-220 ◽  
Author(s):  
Lee Kesterson ◽  
Edward Benzel ◽  
William Orrison ◽  
James Coleman
Keyword(s):  
State University ◽  
Content Type ◽  
X Ray ◽  
Jefferson Fracture ◽  
Louisiana State University ◽  
Burst Fractures ◽  
Long Term Result ◽  
Atlas Fractures ◽  
Fine Print

✓ Although several large series of atlas fractures have been reported recently, none has concentrated on the evaluation and treatment of atlas burst fractures (Jefferson fractures). The treatment of this fracture is challenging. Its diagnosis may easily be missed due to concerns about associated trauma and absence of neurological signs. In addition, the open-mouth anteroposterior x-ray study, which is usually pathognomonic for the diagnosis, is often inadequate or not obtained. In order to clarify the diagnosis and treatment of this disorder, 17 cases of Jefferson fracture treated between 1982 and 1989 at the Louisiana State University Affiliated Hospitals are presented. The diagnosis was delayed in three patients because of a low index of suspicion and inadequate x-ray films. Four patients were noted to have unstable Jefferson fractures; all of these had an associated Type II odontoid fracture and were treated with occiput-C-2 wiring and fusion. The remainder of the patients had stable Jefferson fractures and were managed with Minerva jackets or rigid collar stabilization. No significant complications related to the treatment of the Jefferson fracture occurred in this series. One patient died from associated injuries: however, the remaining patients enjoyed an excellent long-term result with the acquisition of spinal stability and the resolution of subjective complaints.

Impaction fracture of the lumbar vertebrae with dural tear

1980 ◽  
Vol 53 (6) ◽  
pp. 765-771 ◽  
Author(s):  
Carole A. Miller ◽  
Richard C. Dewey ◽  
William E. Hunt
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina ◽  
Lumbar Vertebrae ◽  
Dural Tear ◽  
Mechanism Of Injury ◽  
Content Type ◽  
X Ray ◽  
Jefferson Fracture ◽  
Vertical Impaction ◽  
Fine Print

✓ The authors describe a lumbar spine fracture that is characterized on anteroposterior x-ray views by separation of the pedicular shadows. It is almost invariably associated with posterior interlaminar herniation of the cauda equina through a dorsal dural split, and anterolateral entrapment or amputation of the nerve root. The fracture is unstable and requires internal fixation and fusion at the time of neurolysis. Fractures meeting these criteria should be explored as soon as the patient's condition permits. Myelography is usually unnecessary and may be contraindicated in some cases. The postulated mechanism of injury is hyperextension with vertical impaction and rupture of the ring made up of the lamina, pedicle, and vertebral body. The ring is fractured in several places in a manner similar to that seen in “Jefferson fracture” of C-1. The special anatomical relationships of the thoracolumbar junction and the plane of the lumbar facets are also discussed.

A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center

2005 ◽  
Vol 102 (2) ◽  
pp. 246-255 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
Gregory Moes ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Surgical Techniques ◽  
Neurofibromatosis Type ◽  
Health Sciences ◽  
High Morbidity ◽  
State University ◽  
Content Type ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. This is a retrospective review of 397 benign and malignant peripheral neural sheath tumors (PNSTs) that were surgically treated between 1969 and 1999 at the Louisiana State University Health Sciences Center (LSUHSC). The surgical techniques and adjunctive treatments are presented, the tumors are classified with respect to type and prevalence at each neuroanatomical location, and the management of malignant PNSTs is reviewed. Methods. There were 361 benign PNSTs (91%). One hundred forty-one benign lesions were brachial plexus tumors: 54 schwannomas (38%) and 87 neurofibromas (62%), of which 55 (63%) were solitary neurofibromas and 32 (37%) were neurofibromatosis Type 1 (NF1)—associated neurofibromas. Among the brachial plexus lesions supraclavicular tumors predominated with 37 (69%) of 54 schwannomas; 34 (62%) of 55 solitary neurofibromas; and 19 (59%) of 32 NF1-associated neurofibromas. One hundred ten upper-extremity benign PNSTs consisted of 32 schwannomas (29%) and 78 neurofibromas (71%), of which 45 (58%) were sporadic neurofibromas and 33 (42%) were NF1-associated neurofibromas. Twenty-five benign PNSTs were removed from the pelvic plexus. Lower-extremity PNSTs included 32 schwannomas (38%) and 53 neurofibromas (62%), of which 31 were solitary neurofibromas and 22 were NF1-associated neurofibromas. There were 36 malignant PNSTs: 28 neurogenic sarcomas and eight other sarcomas (fibro-, spindle cell, synovial, and perineurial sarcomas). Conclusions. The majority of tumors were benign PNSTs from the brachial plexus region. Most of the benign PNSTs in all locations were neurofibromas, with sporadic neurofibromas predominating. Similar numbers of schwannomas were found in the upper and lower extremities, whereas neurofibromas were more prevalent in the upper extremities. Despite aggressive limb-ablation or limb-sparing surgery plus adjunctive therapy, malignant PNSTs continue to be associated with high morbidity and mortality rates.

Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils

1999 ◽  
Vol 91 (2) ◽  
pp. 284-293 ◽  
Author(s):  
Gerhard Bavinzski ◽  
Volkan Talazoglu ◽  
Monika Killer ◽  
Bernd Richling ◽  
Andreas Gruber ◽  
...  
Keyword(s):  
Blood Clot ◽  
Fibrous Tissue ◽  
Guglielmi Detachable Coils ◽  
Open Spaces ◽  
Content Type ◽  
Long Term Result ◽  
Detachable Coils ◽  
Fine Print

Object. The histopathological characteristics of aneurysms obtained at autopsy or surgery 3 days to 54 months after being treated with Guglielmi detachable coils (GDCs) were assessed.Methods. Seventeen aneurysms were obtained at autopsy and one was removed at surgery. Fourteen were examined histologically with the coils in situ. Naked coils embedded in an unorganized thrombus were found in those aneurysms that had been treated with coils within 1 week earlier. An incomplete replacement of the intraluminal blood clot by fibrous tissue and a partial membranous covering at the aneurysm orifice were observed in those aneurysms that had been treated with coils between 2 and 3 weeks prior to examination. One small aneurysm treated 6 weeks before harvesting showed formation of an endothelium-lined layer of connective tissue at the orifice. Collagen-rich vascularized tissue surrounding the coils was found in an aneurysm removed at surgery 54 months after coil implantation. Interestingly, six (50%) of 12 aneurysms (two small, three large, and one giant) that had been deemed 100% occluded on initial angiography showed tiny open spaces between the coils at the neck on gross examination.Conclusions. Endothelialization of the aneurysm orifice following placement of GDCs can occur; however, it appears to be the exception rather than the rule. In large aneurysms the process of intraaneurysm clot organization seems to be delayed and incomplete; tiny open spaces between the coils and an incomplete membranous covering in the region of the neck are frequently encountered. Further longitudinal studies are required to establish the spectrum of healing profiles that may direct our efforts in modifying the GDC system to produce a more stable long-term result.

A series of 146 peripheral non—neural sheath nerve tumors: 30-year experience at Louisiana State University Health Sciences Center

2005 ◽  
Vol 102 (2) ◽  
pp. 256-266 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
Gregory Moes ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Surgical Techniques ◽  
Health Sciences ◽  
Benign Tumors ◽  
State University ◽  
Pelvic Plexus ◽  
Content Type ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. This is a retrospective review of 146 surgically treated benign and malignant peripheral non—neural sheath tumors (PNNSTs). Tumor classifications with patient numbers, locations of benign PNNSTs, and surgical techniques and adjunctive treatments are presented. The results of a literature review regarding tumor frequencies are presented. Methods. One hundred forty-six patients with 111 benign and 35 malignant PNNSTs were treated between 1969 and 1999 at the Louisiana State University Health Sciences Center (LSUHSC). The benign tumors included 33 ganglion cysts, 16 cases of localized hypertrophic neuropathy, 12 lipomas, 12 tumors of vascular origin, and 11 desmoid tumors. There were four each of lipofibrohamartomas, myositis ossificans, osteochondromas, and ganglioneuromas; two each of meningiomas, cystic hygromas, myoblastoma or granular cell tumors, triton tumors, and lymphangiomas; and one epidermoid cyst. The locations of benign PNNSTs were the following: 33 in the brachial plexus region, 39 in an upper extremity, one in the pelvic plexus, and 38 in a lower extremity. The malignant PNNSTs included 35 surgically treated carcinomas, 15 of which originated in the breast and nine in the lung. There were two melanomas metastatic to nerve and one tumor each that had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus. Conclusions. There were more benign PNNSTs than malignant ones. Benign tumors were relatively equally distributed in the brachial plexus region and upper and lower extremities, with the exception of the pelvic plexus, which had only one tumor.

Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

2003 ◽  
Vol 98 (5) ◽  
pp. 1005-1016 ◽  
Author(s):  
Daniel H. Kim ◽  
Yong-Jun Cho ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Gunshot Wounds ◽  
Neurological Status ◽  
Health Sciences ◽  
State University ◽  
Content Type ◽  
Lower Trunk ◽  
Louisiana State University ◽  
Fine Print

Object. Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines. Methods. Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumors (16%), 160 thoracic outlet syndromes (TOSs, 16%), 118 gunshot wounds (12%), and 71 lacerations (7%). Many features of clinical presentation, including prior treatment, patient's neurological status, results of electrophysiological studies, intraoperative findings, and postoperative level of function, were studied. The minimum follow-up period was 18 months and the mean follow-up period was 42 months. Repairs were best for injuries located at the C-5, C-6, and C-7 levels, the upper and middle trunk, the lateral cord to the musculocutaneous nerve, and the median and posterior cords to the axillary and radial nerves. Conversely, results were poor for injuries at the C-8 and T-1 levels, and for lower trunk and medial cord lesions, with the exception of injuries of the medial cord to the median nerve. Outcomes were most favorable when patients were carefully evaluated and selected for surgery, although variables such as lesion type, location, and severity, as well as time since injury also affected outcome. This was true also of TOSs and tumors arising from the plexus, especially if they had not been surgically treated previously. Conclusions. Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.

Tentorial meningiomas: surgical experience with 61 cases and long-term results

1988 ◽  
Vol 69 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Beniamino Guidetti ◽  
Pasquale Ciappetta ◽  
Maurizio Domenicucci
Keyword(s):  
Clinical History ◽  
Long Term Results ◽  
Surgical Experience ◽  
Content Type ◽  
X Ray ◽  
Suboccipital Craniectomy ◽  
Lesion Topography ◽  
The Mean ◽  
Fine Print

✓ The authors report their experience and long-term results in the surgical treatment of 61 tentorial meningiomas. These cases were operated on between 1951 and 1985 and represented 4.8% of all intracranial meningiomas operated on in that period. The mean duration of clinical history was 29 months, except for cases of meningioma of the posteromedial border, for which it was 5 years. Plain x-ray films and cerebral angiograms were obtained in all cases. Computerized tomography, performed in the last 20 cases (32.7%), supplied much better lesion topography and early diagnosis. The tumor site was posterolateral in 26 cases (42.6%), anterolateral in 14 (22.9%), posteromedial in eight (13.1%), at the free border in seven (11.4%), and in the tentorium itself in six (9.8%). Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was reserved for meningiomas with subtentorial involvement only. In meningiomas with both supra- and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. The mortality rate was 9.8%. Of the remaining 42 patients, who were followed for at least 5 years, long-term results were good in 26 cases (61.9%), fair in 11 (26.2%), and poor in five (11.9%). Postoperative complications arose in 34% of the patients, but cleared in 27%.

Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases

2004 ◽  
Vol 100 (6) ◽  
pp. 989-996 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Femoral Nerve ◽  
Gunshot Wounds ◽  
Nerve Lesion ◽  
Cystic Lesions ◽  
State University ◽  
Nerve Lesions ◽  
Content Type ◽  
Louisiana State University ◽  
Injury Mechanisms ◽  
Fine Print

Object. The authors present a retrospective analysis of 119 surgically treated femoral nerve lesions at intrapelvic and thigh levels seen at the Louisiana State University Health Sciences Center. Methods. Femoral nerve lesions treated between 1967 and 2000, (89 traumatic injuries and 30 tumors and cystic lesions) were evaluated for injury mechanisms, resulting lesions, surgical management, and postoperative functional outcomes by using retrospective chart reviews. The most common injury mechanism was iatrogenic (52 cases), which occurred after hernia and hip operations (10 each), followed by arterial bypass and gynecological procedures (eight each), angiography (seven), abdominal surgery (five), appendectomy (two), a laparoscopy, and a lumbar sympathectomy. Other injury mechanisms included hip or pelvic fractures (19), gunshot wounds (10), and lacerations (eight). The 30 femoral nerve tumors and cystic lesions consisted of neurofibromas (16), schwannomas (nine), ganglionic cysts (two), neurogenic sarcomas (two), and a leiomyosarcoma. Forty-four patients underwent neurolysis. Some had recordable nerve action potentials (NAPs) across their lesions in continuity, despite severe distal loss. Others with recordable NAPs had mild loss, but also experienced a pain problem, which was helped in some by neurolysis. In 36 patients, in whom repairs were performed using long sural grafts for mostly proximal pelvic-level injuries, recovery of useful function occurred. Eight of nine thigh-level suture repairs led to improvement to good functional levels. Most of the tumors and cystic lesions were resected, with preservation of preoperative function. Conclusions. The majority of femoral nerve injuries resulted in lesions in continuity, and intraoperative NAP recordings were essential in evaluating axonal regeneration across these lesions. Despite severe and frequently proximal injury levels requiring repairs with long grafts, femoral nerve lesion repairs resulted in good functional recovery.

Axillary nerve repair in 99 patients with 101 stretch injuries

2003 ◽  
Vol 99 (4) ◽  
pp. 630-636 ◽  
Author(s):  
David G. Kline ◽  
Daniel H. Kim
Keyword(s):  
Nerve Repair ◽  
Axillary Nerve ◽  
Fracture Dislocation ◽  
State University ◽  
Shoulder Injury ◽  
Focal Lesions ◽  
Content Type ◽  
Louisiana State University ◽  
Operative Exploration ◽  
Fine Print

Object. The purpose of this paper was to analyze outcomes in patients at the Louisiana State University Health Sciences Center (LSUHSC) who presented with contusion—stretch injuries to the axillary nerve. These injuries resulted from shoulder injury either with or without fracture/dislocation. Although recovery of deltoid function can occur spontaneously, this was not always the case. Methods. Severe deficits persisting for several months led the patients to undergo surgery. Operative categories included isolated axillary palsy (56 procedures), combined axillary and suprascapular palsies (11 procedures), axillary and radial palsies (14 procedures), and axillary palsy with another deficit, usually infraclavicular plexus loss (20 procedures). Deltoid function was evaluated pre- and postoperatively by applying the LSUHSC grading system. An anterior infraclavicular approach was usually followed during surgery, but in three patients an additional posterior approach was used. Axillary lesions usually began in the proximal portion of the posterior cord. Although several patients had distraction of the nerve, lesions in continuity were found in more than 90% of cases. Intraoperative nerve action potential (NAP) recordings were performed to determine the need for resection. Most repairs were made using grafts, although in three patients with relatively focal lesions suture was used. When an NAP was recorded across the lesion and neurolysis was performed, recovery was judged to be a mean Grade 4 according to the LSUHSC in 30 cases. Recovery following suture repairs was a mean Grade 3.8, whereas recovery after 66 graft repairs was a mean Grade 3.7. In cases in which suprascapular palsies were associated with axillary injuries, the former recovered but the latter did not necessarily do so without surgery. If the radial nerve was also injured, recovery of the triceps and brachioradialis muscles and wrist extension was usually obtained, but it was far more difficult to reverse the loss of finger and thumb extension. Although few in number, complications did occur and they are important. Conclusions. Operative exploration of axillary contusion—stretch lesions is worthwhile in carefully selected cases. If indicated by inspection and intraoperative electrical studies, nerve repair can lead to useful function.

Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Sciences Center

2001 ◽  
Vol 95 (1) ◽  
pp. 51-60 ◽  
Author(s):  
Aruna Ganju ◽  
Norbert Roosen ◽  
David G. Kline ◽  
Robert L. Tiel
Keyword(s):  
Brachial Plexus ◽  
Health Sciences ◽  
Consecutive Series ◽  
State University ◽  
Palpable Mass ◽  
Content Type ◽  
Presenting Symptoms ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. The authors conducted a retrospective study of 107 consecutive patients with 111 brachial plexus tumors surgically treated at the Louisiana State University Health Sciences Center (LSUHSC). Methods. During a 12-year period, from 1986 to 1998, 371 patients with lesions of the brachial plexus underwent surgery at LSUHSC. Among this group, 107 patients harbored 111 tumors of the brachial plexus. Neural sheath tumors were the most commonly found and included 33 neurofibromas (20 of which were associated with von Recklinghausen disease), 36 schwannomas, and 12 malignant neural sheath tumors. Of the non—neural sheath tumors, 13 were benign and 17 were malignant. Presenting symptoms included pain (59%), palpable mass (52%), paresthesias (30%), and paresis (29%). Anterior supraclavicular (82%) or posterior subscapular (18%) approaches were used to achieve gross-total (79%) or subtotal (21%) resection of tumor. The average follow-up period was 38.3 months or 3.2 years. Seventy percent of patients with benign neural sheath tumors became free from pain postoperatively or reported improvement in their preoperative pain status. Function remained intact or improved in 50% and remained stable postoperatively in another 20% of cases. Preservation of function was more likely in patients who presented intact and in those who had not undergone a previous attempted biopsy procedure or resection than in those in whom such manipulation had occurred. Conclusions. Resection of most plexal tumors is technically feasible and associated with acceptable morbidity and mortality rates.

Surgical management and outcomes in patients with median nerve lesions

2001 ◽  
Vol 95 (4) ◽  
pp. 584-594 ◽  
Author(s):  
Daniel H. Kim ◽  
Andrew C. Kam ◽  
Padmavathi Chandika ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Median Nerve ◽  
Suture Repair ◽  
State University ◽  
Content Type ◽  
Louisiana State University ◽  
Internal Neurolysis ◽  
Common Causes ◽  
End To End ◽  
Grade 3 ◽  
Fine Print

Object. One hundred sixty-seven of 250 patients with median nerve (MN) lesions, excluding carpal tunnel syndrome and nerve sheath tumors, at the levels of the arm, elbow, forearm, and wrist, underwent surgical treatment at Louisiana State University Health Sciences over a 30-year period. The most common causes of MN injuries were laceration, fracture-associated stretch and contusion, gunshot wound, compression, and injection injuries. In this study, surgically treated patients were followed and evaluated retrospectively for favorable functional outcomes. Methods. Lesions not in continuity required primary or secondary end-to-end suture or graft repairs. With the aid of direct intraoperative recording of nerve action potentials (NAPs), MN injuries in which the lesion was in continuity underwent external or internal neurolysis, or resection of the lesion, followed by end-to-end suture or graft repair. A minimum of 12 months follow-up review (mean 18 months) was available in 85% of the surgically treated patients. For lesions in continuity, a functional recovery of Grade 3 or better was seen in 72 (95%) of 76 patients who underwent neurolysis, 18 (86%) of 21 who received suture repair, and 21 (75%) of 28 who received graft repair. In lesions not in continuity, favorable results (Grade ≥ 3) were seen in 10 (91%) of 11 patients who received primary suture repair, seven (78%) of nine who received secondary suture repair, and 15 (68%) of 22 who received graft repair. Conclusions. Surgical intervention for MN injuries with complete or severe deficits achieved favorable outcomes.

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