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.

Outlining the cervical spinal cord with tantalum powder: application to percutaneous cordotomy

1973 ◽  
Vol 38 (2) ◽  
pp. 257-260 ◽  
Author(s):  
Roderick Smith
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Cervical Spinal Cord ◽  
Tantalum Powder ◽  
Electrode Placement ◽  
Content Type ◽  
Anterior Aspect ◽  
Percutaneous Cordotomy ◽  
Fine Print

✓ Powdered tantalum introduced into the subarachnoid space at C-2 clearly outlines the anterior aspect of the cord and dentate ligaments. Accurate electrode placement for percutaneous intramedullary cordotomy is made easier by the presence of a radiopaque target.

Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord

2002 ◽  
Vol 96 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Kazutoshi Hida ◽  
Yoshinobu Iwasaki ◽  
Satoshi Ushikoshi ◽  
Shin Fujimoto ◽  
Toshitaka Seki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Anterior Approach ◽  
Cervical Spinal Cord ◽  
Neurological Status ◽  
Complete Disappearance ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Closure ◽  
Iliac Bone Graft ◽  
Fine Print

Object. In this report, the authors describe five consecutive patients with cervical perimedullary arteriovenous fistulas (AVFs) that were successfully treated using a corpectomy performed via an anterior approach. Methods. Five patients with cervical perimedullary AVF underwent corpectomy via an anterior approach. There were four women and one man who ranged in age from 34 to 62 years (median 55 years). Four patients presented with subarachnoid hemorrhage and one with intramedullary hemorrhage. All five AVFs were located on the anterior surface of the cervical spinal cord and fed by the anterior spinal artery. All patients underwent an anterior approach with 1.5- or two-level corpectomy, opening of the dura mater, and coagulation of the fistula. After dural closure, an iliac bone graft was inserted. Four patients were treated by surgery alone and one patient by embolization and surgery. Postoperative angiography revealed complete disappearance of the AVF in all patients. Neurological status improved in two cases and stabilized in the other three. There were no surgery-related complications. Conclusions. Safe and effective interruption of cervical AVFs can be accomplished by an anterior-approach corpectomy.

Herniation of the spinal cord into an iatrogenic meningocele

1973 ◽  
Vol 39 (4) ◽  
pp. 533-536 ◽  
Author(s):  
Cully Cobb ◽  
George Ehni
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ The authors describe a case in which the cervical spinal cord became incarcerated in the mouth of an iatrogenic meningocele or “pseudocyst.”

Cruciate paralysis

1986 ◽  
Vol 65 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Daniel Dumitru ◽  
James E. Lang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rare Case ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Vehicle Accident ◽  
Cord Injury ◽  
Fine Print

✓ A rare case of cruciate paralysis is reported in a 39-year-old man following a motor-vehicle accident. The differentiation of this syndrome from a central cervical spinal cord injury is delineated.

Deformation of the cervicomedullary junction and spinal cord in a surgically treated adult Chiari I hindbrain hernia associated with syringomyelia: a magnetic resonance microscopic and neuropathological study

1996 ◽  
Vol 85 (4) ◽  
pp. 701-708 ◽  
Author(s):  
Emile A. M. Beuls ◽  
Marie-Anne M. Vandersteen ◽  
Linda M. Vanormelingen ◽  
Peter J. Adriaensens ◽  
Gerard Freling ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Magnetic Resonance Microscopy ◽  
Type I ◽  
Additional Advantage ◽  
Content Type ◽  
Hindbrain Hernia ◽  
Fine Print

✓ The lower brainstem and cervical spinal cord from an ordinarily treated case of Chiari Type I hindbrain hernia associated with syringomyelia was examined using high-resolution magnetic resonance microscopy and standard neuropathological techniques. Magnetic resonance microscopy allows total screening and visualizes the disturbed internal and external microanatomy in the three orthogonal planes with the resolution of low-power optical microscopy. An additional advantage is the in situ visualization of the shunts. Afterwards the intact specimen is still available for microscopic examination. Part of the deformation of the medulla is caused by chronic tonsillar compression and molding inside the foramen magnum. Other anomalies, such as atrophy caused by demyelination, elongation, and unusual disturbances at the level of the trigeminal and solitary nuclear complexes contribute to the deformation. At the level of the syrinx-free upper part of the cervical cord, anomalies of the dorsal root and the dorsal horn are demonstrated.

Cervical spinal cord in experimental hydrocephalus

1972 ◽  
Vol 37 (5) ◽  
pp. 538-542 ◽  
Author(s):  
George J. Dohrmann
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Cervical Spinal Cord ◽  
Central Canal ◽  
Content Type ◽  
Experimental Hydrocephalus ◽  
Physiological Pressure ◽  
The Brain ◽  
Shunting Procedure ◽  
Fine Print

✓ Adult dogs were rendered hydrocephalic by the injection of kaolin into the cisterna magna. One group of dogs was sacrificed 1 month after kaolin administration, and ventriculojugular shunts were performed on the other group. Hydrocephalic dogs with shunts were sacrificed 1 day or 1 week after the shunting procedure. All dogs were perfused with formalin at physiological pressure, and the brain stem and cervical spinal cord were examined by light microscopy. Subarachnoid granulomata encompassed the superior cervical spinal cord and dependent surface of the brain stem. Rarefaction of the posterior white columns and clefts or cavities involving the gray matter posterior to the central canal and/or posterior white columns were present in the spinal cords of both hydrocephalic and shunted hydrocephalic dogs. Predominantly in the dogs with shunts, hemorrhages were noted in the spinal cord in association with the clefts or cavities. A mechanism of ischemia followed by reflow of blood is postulated to explain the hemorrhages in the spinal cords of hydrocephalic dogs with shunts.

Pathological findings in acute experimental spinal cord trauma

1971 ◽  
Vol 35 (6) ◽  
pp. 700-708 ◽  
Author(s):  
Thomas B. Ducker ◽  
Glenn W. Kindt ◽  
Ludwig G. Kempe
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Clinical Improvement ◽  
Spinal Cord Trauma ◽  
Pathological Findings ◽  
Pathological Changes ◽  
Content Type ◽  
Acute Trauma ◽  
Central Gray ◽  
Fine Print

✓ This study shows that spinal cord pathology secondary to acute trauma in monkeys evolves with stepwise sequential changes. The acute damage is more central than peripheral. Depending on the amount of trauma, the subacute damage may be limited to central gray necrosis or may progress or evolve to include the neighboring white matter. These pathological changes may be taking place even in the presence of clinical improvement.

Intramedullary cervical spinal cord abscess

1982 ◽  
Vol 57 (2) ◽  
pp. 270-273 ◽  
Author(s):  
J. Bob Blacklock ◽  
Terry W. Hood ◽  
Robert E. Maxwell
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Critical Factors ◽  
Laboratory Findings ◽  
Content Type ◽  
Prompt Diagnosis ◽  
Fine Print

✓ A case of spontaneous intramedullary cervical spinal cord abscess is presented. The clinical and laboratory findings in cases of spinal cord abscess vary. Prompt diagnosis and drainage are stressed as critical factors in effectively managing the disease.

Presence and significance of CD-95 (Fas/APO1) expression after spinal cord injury

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Mercedes Zurita ◽  
Jesús Vaquero ◽  
Isabel Zurita
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
White Matter ◽  
Gray Matter ◽  
Spinal Cord Tissue ◽  
Injured Spinal Cord ◽  
Content Type ◽  
Cord Injury ◽  
Positive Immunostaining ◽  
Fine Print

Object. A glycoprotein, CD95 (Fas/APO1) is widely considered to be implicated in the development of apoptosis in a number of tissues. Based on the hypothesis that apoptosis is related to cell death after spinal cord injury (SCI), the authors studied the presence and distribution of CD95 (Fas/APO1)-positive cells in injured spinal cord tissue for the purpose of determining the significance of this protein during the early phases of SCI. Methods. The presence and distribution of cells showing positive immunostaining for CD95 (Fas/APO1) were studied 1, 4, 8, 24, 48, and 72 hours and 1, 2, and 4 weeks after induction of experimental SCI in rats. Studies were conducted using a monoclonal antibody to the CD95 (Fas/APO1) protein. Positivity for CD95 (Fas/APO1) was observed in apoptotic cells, mainly in the gray matter, 1 hour after trauma, and the number of immunostained cells increased for the first 8 hours, at which time the protein was expressed in both gray and white matter. From 24 to 72 hours postinjury, the number of immunostained cells decreased in the gray matter, but increased in the white matter. From then on, there were fewer CD95 (Fas/APO1)-positive cells, but some cells in the white matter still exhibited positive immunostaining 1 and 2 weeks after injury. At 4 weeks, there remained no CD95 (Fas/APO1)-positive cells in injured spinal cord. Conclusions. These findings indicate that CD95 (Fas/APO1) is expressed after SCI, suggesting a role for this protein in the development of apoptosis after trauma and the possibility of a new therapeutic approach to SCI based on blocking the CD95 (Fas/APO1) system.

Identification and management of high-risk patients with Klippel-Feil syndrome

1984 ◽  
Vol 61 (3) ◽  
pp. 523-530 ◽  
Author(s):  
Mahmoud G. Nagib ◽  
Robert E. Maxwell ◽  
Shelley N. Chou
Keyword(s):  
Spinal Cord ◽  
High Risk ◽  
Cervical Spinal Cord ◽  
Neurological Injury ◽  
Content Type ◽  
High Risk Patients ◽  
Cervicomedullary Junction ◽  
Risk Patients ◽  
Salient Features ◽  
Fine Print

✓ Patients with Klippel-Feil syndrome are often at high risk for neurological injury. The cervicomedullary junction and cervical spinal cord are especially vulnerable. Twenty-one patients examined and treated over a 20-year period are reviewed. The salient features of the syndrome are identified, and an approach to management is proposed.

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