Laminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis

2004 ◽  
Vol 100 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Yoshihiro Mukai ◽  
Noboru Hosono ◽  
Hironobu Sakaura ◽  
Takahiro Ishii ◽  
Tsuyoshi Fuchiya ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Content Type ◽  
Subaxial Subluxation ◽  
Fine Print

Object. Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of laminoplasty in such cases. To discuss indications for laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent laminoplasty for subaxial lesions. Methods. Thirty patients (11 men and 19 women) underwent laminoplasty for rheumatoid subaxial lesions. The patients were divided into those with mutilating-type rheumatoid arthritis (RA) and those with nonmutilating-type RA according to the number of eroding joints. As of final follow-up examination laminoplasty resulted in improvement of myelopathy in 24 patients (seven with mutilating- and 17 with nonmutilating-type RA) and transient or no improvement in six (five with mutilating- and one with nonmutilating-type RA). In the group with mutilating-type RA, significantly poorer results were displayed (p < 0.05). In most patients preoperative radiographs demonstrated vertebral slippage less than or equal to 5 mm at only one or two levels. Postlaminoplasty deterioration of subaxial subluxation and unfavorable alignment change occurred significantly more often in patients with mutilating-type RA (p < 0.05). Conclusions. Patients with nonmutilating-type RA can benefit from laminoplasty for myelopathy due to subaxial lesions.

An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment

1979 ◽  
Vol 50 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Takashi Yoshimoto ◽  
Keita Uchida ◽  
Uichi Kaneko ◽  
Takamasa Kayama ◽  
Jiro Suzuki
Keyword(s):  
Surgical Treatment ◽  
Postoperative Results ◽  
Content Type ◽  
Poor Condition ◽  
Follow Up Study ◽  
Normal Life ◽  
Definitive Surgery ◽  
Fine Print ◽  
Saccular Aneurysms

✓ The authors report a follow-up review of 1000 cases of intracranial definitive surgery for saccular aneurysms. The prognosis for such surgical cases is discussed. Postoperative results at least 6 months after discharge from the hospital were analyzed in 876 (93.3%) of the 939 surviving patients. The longest follow-up period was 14 years and 5 months, with an average of 3 years and 7 months. At the time of discharge, there were 543 excellent results, 186 good, 117 fair, 93 poor, and 61 deaths. The chief findings were as follows: 1) Most of the patients determined as “excellent” or “good” at discharge were able to return to normal life; most of the deaths or instances of worsened condition found in the follow-up study were due to new lesions. 2) Fully 62% of the cases determined as “fair” at discharge were found in an improved state at the follow-up study, having returned to normal life. 3) Only 19% of cases determined as “poor” at discharge had improved to the point where a return to normal life was possible, the majority having died or remaining in poor condition.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

The influence of transoral odontoid resection on stability of the craniovertebral junction

1992 ◽  
Vol 77 (4) ◽  
pp. 525-530 ◽  
Author(s):  
Curtis A. Dickman ◽  
Jacqueline Locantro ◽  
Richard G. Fessler
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Destruction ◽  
Craniovertebral Junction ◽  
Transoral Surgery ◽  
Posterior Decompression ◽  
Radiographic Evidence ◽  
Content Type ◽  
Surgical Interventions ◽  
Fine Print

✓ Twenty-seven cases of craniovertebral junction compression treated with transoral surgery were reviewed to assess the influences of pathological processes and surgical interventions on spinal stability. All patients presented with signs and symptoms of spinal-cord or brain-stem dysfunction. Pathology included rheumatoid arthritis in 11 patients, congenital osseous malformations in 11, spinal fractures in two, plasmacytoma in one, osteomyelitis in one, and a gunshot injury in one. Instability was defined as clear radiographic evidence of mobile subluxation in conjunction with clinical assessment. Of 19 patients (70%) requiring internal fixation, nine underwent upper cervical fusion and 10 had occipitocervical fusion. When instability occurred, all subluxations were at the C1–2 level. There were no occipitoatlantal subluxations. Eight patients (30%) had preoperative instability of the craniovertebral junction due solely to their pathology, 11 patients (40%) suffered instability after transoral surgery, and eight (30%) were without clinical or radiographic evidence of instability (mean follow-up period 14 months). Craniovertebral junction instability predominated among patients with rheumatoid arthritis: 91% required fusion and 45% presented with pre-existing instability. Among individuals with congenital osseous malformations, 45% required fusion and only one patient (9%) had pre-existing instability. Patients who required subsequent posterior decompression of a Chiari malformation were at risk for developing instability; three of four became unstable after posterior decompression. Transoral resection of the dens, the anterior arch of C-1, and the lower clivus does not fully destabilize the spine; however, this operation may potentiate incipient pathological instability. The primary determinants of instability are the extent of pathological bone destruction, ligamentous weakening, and operative bone removal. Long-term follow-up monitoring is needed after transoral surgery to detect cases of late instability.

Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine

1972 ◽  
Vol 37 (4) ◽  
pp. 493-497 ◽  
Author(s):  
Michael H. Sukoff ◽  
Milton M. Kadin ◽  
Terrance Moran
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Transoral Approach ◽  
Anterior Decompression ◽  
Posterior Decompression ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

✓ A case of rheumatoid cervical myelopathy that responded to posterior decompression and fusion is presented. Progression of the disease ultimately required anterior decompression through a transoral approach.

Intracranial aneurysm in infancy

1977 ◽  
Vol 46 (6) ◽  
pp. 832-834 ◽  
Author(s):  
Robert J. Morelli ◽  
Frederick Laubscher
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Intracranial Aneurysm ◽  
Anterior Cerebral Artery ◽  
Content Type ◽  
Long Term Follow Up ◽  
Surgical Cure ◽  
Fine Print

✓ Angiography demonstrated an aneurysm of the left anterior cerebral artery in a 4-month-old baby who was admitted for subarachnoid hemorrhage. A surgical cure with long-term follow-up course was achieved. Clinical and pathogenetic aspects are presented. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

Association between a black band on the inner membrane of a chronic subdural hematoma on T2*-weighted magnetic resonance images and enlargement of the hematoma

2003 ◽  
Vol 99 (5) ◽  
pp. 824-830 ◽  
Author(s):  
Toshio Imaizumi ◽  
Yoshifumi Horita ◽  
Toshimi Honma ◽  
Jun Niwa
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Chronic Subdural Hematoma ◽  
Magnetic Resonance Images ◽  
Mr Images ◽  
Inner Membrane ◽  
Content Type ◽  
Black Band ◽  
Fine Print

Object. The cause and indication for enlargement of chronic subdural hematomas (CSDHs) have remained unresolved. The authors observed a black band on the inner membrane of a CSDH on T2*-weighted magnetic resonance (MR) images obtained in patients with symptoms. After surgical treatment, the band disappeared. The T2*-weighted sequence of MR imaging is an excellent diagnostic tool for detecting ferromagnetic substances, but it is rarely performed in cases of a CSDH. The authors speculate that the black band may be associated with the development of CSDH. Methods. To investigate how the black band observed on T2*-weighted MR images contributes to the development of a CSDH, 59 lesions in 50 patients with CSDH (41 men and nine women, mean age 70 ± 11 years [range 48–93 years]) were investigated prospectively. The incidence of black bands on the first T2*-weighted MR image obtained in patients with symptomatic CSDH was 97% (31 of 32 CSDHs), which was significantly higher than that associated with asymptomatic CSDH (11% [three of 27 CSDHs], p < 0.001). The black bands associated with symptomatic CSDH disappeared soon after surgical treatment in 31 CSDHs and became fainter in another. In two instances the CSDH recurred with reappearance of the band. Twenty-four of 27 asymptomatic CSDHs had no accompanying black band. Follow-up MR images demonstrated a later formation of bands in two of 24 asymptomatic CSDHs that enlarged to symptomatic size. Logistic regression analysis revealed that the heterogeneity and thickness of the CSDH on computerized tomography scans were independently and significantly associated with the black band. Conclusions. The dynamics of the black band may depend on the enlargement or shrinkage of the CSDH.

Arteriovenous malformation in the basal ganglia

1974 ◽  
Vol 41 (2) ◽  
pp. 244-247
Author(s):  
Ivan I. Ribaric
Keyword(s):  
Surgical Treatment ◽  
Basal Ganglia ◽  
Arteriovenous Malformation ◽  
Operative Approach ◽  
Content Type ◽  
Fine Print

✓ The author reports the successful surgical treatment of an arteriovenous malformation of the basal ganglia. Follow-up angiography verified that the single supplying artery had been clipped. The operative approach to the malformation is discussed.

Long-term results of the surgical treatment of 129 intramedullary spinal gliomas

1981 ◽  
Vol 54 (3) ◽  
pp. 323-330 ◽  
Author(s):  
Beniamino Guidetti ◽  
Sandro Mercuri ◽  
Roberto Vagnozzi
Keyword(s):  
Surgical Treatment ◽  
Late Results ◽  
Long Term Results ◽  
Postoperative Results ◽  
Content Type ◽  
Fine Print ◽  
Spinal Gliomas

✓ The authors report the late results of surgical treatment of 129 intramedullary gliomas (48 ependymomas, 53 astrocytomas, 13 spongioblastomas, five glioblastomas, one oligodendroglioma, and nine others), with follow-up periods ranging from 1 to 27 years. The value of surgical treatment is considered in relation to the postoperative results.

Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy

1973 ◽  
Vol 38 (6) ◽  
pp. 684-692 ◽  
Author(s):  
Charles A. Fager
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Decompression ◽  
Content Type ◽  
Spondylotic Cervical Myelopathy ◽  
Dentate Ligament ◽  
Fine Print

✓ The author reports his experience with 35 cases of spondylotic myelopathy treated by extensive laminectomy and section of the dentate ligament. After a follow-up of 1 to 7 years, 24 patients have maintained distinct improvement; in nine the disability has not improved and in two it has become worse. The technique is described, and postoperative myelograms are used to demonstrate the improvement.

Late seizures and morbidity after subdural empyema

1983 ◽  
Vol 58 (4) ◽  
pp. 569-573 ◽  
Author(s):  
Richard Cowie ◽  
Bernard Williams
Keyword(s):  
Surgical Treatment ◽  
Visual Field ◽  
Speech Disorders ◽  
Acute Stage ◽  
Subdural Empyema ◽  
Content Type ◽  
Neurological Morbidity ◽  
Early Seizures ◽  
Fine Print

✓ A survey of 89 patients with subdural empyema was conducted to assess the incidence of late seizures and morbidity in this disease. Twenty-four patients died during the acute stage of the illness and, of the 65 survivors, 13 were lost or had incomplete follow-up review. Hemiparesis occurred in 48 of the survivors during the acute stage, and all but nine recovered completely. Thirteen patients had a visual field deficit and all recovered; in three of these 13 who had speech disorders the deficits persisted. Recovery from neurological morbidity was not related to the type of surgical treatment; however, the mortality rate was improved by craniotomy. The same incidence of early seizures occurred in those who died (62%) as in those who survived (63%). Of those who had no early seizures, 42% had late seizures, the majority appearing within 16 months. Of those who had early seizures, 71% did not have subsequent attacks. The highest incidence of seizures occurred in patients who had their empyema in the second and third decades of life. The incidence of late seizures was not influenced by the method of surgical treatment, the degree of deterioration of consciousness during the acute stage of the illness, nor by occurrence of early seizures. A significantly increased incidence of early seizures was associated with paranasal sepsis, but not with late seizures.

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