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.

Prediction of mobility gains in patients with cervical spinal cord injuries

1976 ◽  
Vol 45 (6) ◽  
pp. 677-682 ◽  
Author(s):  
Robert L. Mason ◽  
Richard F. Gunst
Keyword(s):  
Spinal Cord ◽  
Motor Skills ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Neurological Status ◽  
Prediction Equation ◽  
Predictor Variables ◽  
Content Type ◽  
Mobility Score ◽  
Fine Print

✓ A measure of mobility for patients with spinal cord injuries is introduced that is very useful in determining patient recovery. The index is used to obtain a prediction equation for motor skills 1 year after injury. Important predictor variables identified include the patient's sex, rectal status, total reflexes, two treatment combinations, motor and sensory neurological history since injury, neurological status, and initial mobility score. Interpretations are made to explain the meaning of the contributions of these variables and show the usefulness of the prediction equation.

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.

Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization

1999 ◽  
Vol 90 (2) ◽  
pp. 198-205 ◽  
Author(s):  
Kazutoshi Hida ◽  
Yoshinobu Iwasaki ◽  
Katsuya Goto ◽  
Kazuo Miyasaka ◽  
Hiroshi Abe
Keyword(s):  
Surgical Treatment ◽  
Neurological Status ◽  
Conus Medullaris ◽  
Anterior Spinal Artery ◽  
Preoperative Embolization ◽  
Complete Disappearance ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Fine Print

Object. This retrospective study was performed to evaluate the results of surgical treatment and the use of preoperative embolization in managing patients with perimedullary arteriovenous fistulas (AVFs). Methods. The authors studied 20 consecutive patients with perimedullary AVFs who underwent surgical treatment. Arteriovenous shunts were at the level of the cervical spine in five patients, the thoracic spine in 12, and the conus medullaris in three patients. Of the 20 AVFs, three were fed by the anterior spinal artery only, three by the posterior spinal artery, and 14 by both the anterior and posterior spinal arteries. Nine patients had varices that compressed the spinal cord. Eleven patients underwent surgery, and nine patients underwent surgery combined with adjuvant preoperative embolization. Preoperative embolization remarkably reduced blood flow through the AVFs and facilitated subsequent surgical procedures. Postoperative angiography revealed complete disappearance of the AVFs in 16 patients. However, small fistulas persisted in the other four patients, whose large lesions were fed by the anterior spinal artery. Postoperatively, neurological status was improved in 11 patients, unchanged in eight, and worse in one patient. Conclusions. Effective interruption of a spinal arteriovenous shunt was achieved by surgery in all cases, even when the anterior spinal artery was involved. For large and high-flow AVFs, embolization proved to be a useful adjunct to surgery.

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.

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.

Late neurological changes following traumatic spinal cord injury

1988 ◽  
Vol 69 (3) ◽  
pp. 399-402 ◽  
Author(s):  
Joseph M. Piepmeier ◽  
N. Ross Jenkins
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Neurological Status ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.

Modified classification of spinal cord vascular lesions

2002 ◽  
Vol 96 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Robert F. Spetzler ◽  
Paul W. Detwiler ◽  
Howard A. Riina ◽  
Randall W. Porter
Keyword(s):  
Spinal Cord ◽  
Classification System ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Relevant Literature ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

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