scholarly journals Ultrasonic Osteotome Assisted Full-Endoscopic en Block Resection of Thoracic Ossified Ligamentum Flavum: Technical Note and 2 Years Follow-up

2021 ◽  
pp. E239-E248
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Spinal Cord ◽  
Cohort Study ◽  
Back Pain ◽  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Radicular Pain ◽  
Resonance Imaging

BACKGROUND: Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain. OBJECTIVE: To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum. STUDY DESIGN: A prospective cohort study. SETTING: Hospital and outpatient surgery center. METHODS: From January 2017 to March 2018, 15 patients with 1 – 2 segment thoracic ossified ligamentum flavum were treated with ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum under local anesthesia. The magnetic resonance imaging and computed tomography of the thoracic spine was reexamined after the operation to evaluate the completeness of ossified ligamentum flavum resection and spinal cord decompression. The patients were followed up on the visual analogue scale of back pain and radicular pain, Nurick score and mJOA score of neurological function, and Oswestry Disability Index at 1 week, 3 months, 6 months, one year, and 2 years after operation. RESULTS: All operations of 17 segments thoracic ossified ligamentum flavum in 15 patients were successfully completed without intraoperative conversion to open surgery. There were no intraoperative spinal cord injuries, dura tears, postoperative cerebrospinal fluid leakage, postoperative infections, and postoperative spinal cord injury aggravated symptoms. Postoperative thoracic spine magnetic resonance imaging and computed tomography examinations of all patients showed that the spinal cord was fully decompressed without any residual pressure. Back pain and radicular pain were relieved significantly, and spinal cord function (Nurick, mJOA, and Oswestry Disability Index scores) was obviously restored. The mJOA recovery rate at the 2-year follow-up was 78.3% in average. LIMITATIONS: This is an observational cohort study with relative small sample and short-term follow-up. CONCLUSIONS: Ultrasonic assisted full-endoscopic en block resection of ossified ligamentum flavum is a safe and effective minimally invasive spine surgery for thoracic myelography caused by thoracic ossified ligamentum flavum. KEY WORDS: Thoracic myelopathy, ossified ligamentum flavum, full-endoscopic decompression, ultrasonic osteotome, minimally invasive surgery

scholarly journals Solitary thoracic intramedullary spinal neurofibroma microsurgically extirpated via recapping T-saw laminoplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769100
Author(s):  
Mamer Soriano Rosario ◽  
Hideki Murakami ◽  
Satoshi Kato ◽  
Moriyuki Fujii ◽  
Noritaka Yonezawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Spinal Cord ◽  
Back Pain ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anatomic Reconstruction ◽  
Resonance Imaging ◽  
En Bloc ◽  
Intramedullary Spinal Cord

We report the case of a 40-year-old female presenting with back pain that was complicated by a solitary intramedullary spinal cord mass at the T10–11 levels, confirmed by magnetic resonance imaging and computed tomography myelography. Microsurgical en bloc extirpation of the tumor approached through a recapping T-saw laminoplasty of T10 was done, and histopathology findings revealed a diagnosis of neurofibroma. Solitary spinal neurofibroma is one of the rarest tumors involving the spinal cord and is very adherent for the lack of a well-defined capsule, requiring careful dissection under microscope magnification for successful en bloc resection. Recapping T-saw laminoplasty affords both maximal exposure and anatomic reconstruction postextirpation, avoiding most postoperative spinal complications.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

scholarly journals Mucinous Neoplasm of the Appendix as a Mimic of Cystic Adnexal Pathology

2018 ◽  
Vol 8 ◽  
pp. 32 ◽  
Author(s):  
Chris Hutchinson ◽  
Jonathan Lyske ◽  
Vimal Patel ◽  
Gavin Low
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Mucinous Tumor ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Mucinous Neoplasm ◽  
Ultrasound Computed Tomography ◽  
Adnexal Pathology

Pelvic pain presents a common diagnostic conundrum with a myriad of causes ranging from benign and trivial to malignant and emergent. We present a case where a mucinous neoplasm of the appendix acted as a mimic for tubular adnexal pathology on imaging. With the associated imaging findings on ultrasound, computed tomography, and magnetic resonance imaging, we wish to raise awareness of mucinous tumors of the appendix when tubular right adnexal pathology is present both in the presence of pelvic or abdominal pain or when noted incidentally. Tubular pathology such as uncomplicated paraovarian cysts or hydrosalpinx is frequently treated conservatively with long-interval follow-up imaging or left to clinical follow-up. Thus, if incorrectly diagnosed as tubular pathology, an appendix mucocele or mucinous neoplasm of the appendix is likely to be undertreated. We wish to clarify some of the confusion around nomenclature and classification of the multiple entities that are comprised by the terms mucocele and mucinous tumor of the appendix.

Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up

2022 ◽  
Vol 11 (1) ◽  
pp. 27-40
Author(s):  
Bernardo B.C. Lopes ◽  
Go Hashimoto ◽  
Vinayak N. Bapat ◽  
Paul Sorajja ◽  
Markus D. Scherer ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Tricuspid Valve ◽  
Cardiac Computed Tomography ◽  
Resonance Imaging

scholarly journals Computed Tomography Perfusion, Magnetic Resonance Imaging, and Histopathological Findings After Laparoscopic Renal Cryoablation: An In Vivo Pig Model

2016 ◽  
Vol 16 (4) ◽  
pp. 406-413 ◽  
Author(s):  
Tommy Kjærgaard Nielsen ◽  
Øyvind Østraat ◽  
Ole Graumann ◽  
Bodil Ginnerup Pedersen ◽  
Gratien Andersen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Central Zone ◽  
Peripheral Zone ◽  
Scar Tissue ◽  
Resonance Imaging ◽  
Computed Tomography Perfusion ◽  
Laparoscopic Assisted

The present study investigates how computed tomography perfusion scans and magnetic resonance imaging correlates with the histopathological alterations in renal tissue after cryoablation. A total of 15 pigs were subjected to laparoscopic-assisted cryoablation on both kidneys. After intervention, each animal was randomized to a postoperative follow-up period of 1, 2, or 4 weeks, after which computed tomography perfusion and magnetic resonance imaging scans were performed. Immediately after imaging, open bilateral nephrectomy was performed allowing for histopathological examination of the cryolesions. On computed tomography perfusion and magnetic resonance imaging examinations, rim enhancement was observed in the transition zone of the cryolesion 1week after laparoscopic-assisted cryoablation. This rim enhancement was found to subside after 2 and 4 weeks of follow-up, which was consistent with the microscopic examinations revealing of fibrotic scar tissue formation in the peripheral zone of the cryolesion. On T2 magnetic resonance imaging sequences, a thin hypointense rim surrounded the cryolesion, separating it from the adjacent renal parenchyma. Microscopic examinations revealed hemorrhage and later hemosiderin located in the peripheral zone. No nodular or diffuse contrast enhancement was found in the central zone of the cryolesions at any follow-up stage on neither computed tomography perfusion nor magnetic resonance imaging. On microscopic examinations, the central zone was found to consist of coagulative necrosis 1 week after laparoscopic-assisted cryoablation, which was partially replaced by fibrotic scar tissue 4 weeks following laparoscopic-assisted cryoablation. Both computed tomography perfusion and magnetic resonance imaging found the renal collecting system to be involved at all 3 stages of follow-up, but on microscopic examination, the urothelium was found to be intact in all cases. In conclusion, cryoablation effectively destroyed renal parenchyma, leaving the urothelium intact. Both computed tomography perfusion and magnetic resonance imaging reflect the microscopic findings but with some differences, especially regarding the peripheral zone. Magnetic resonance imaging seems an attractive modality for early postoperative follow-up.

scholarly journals Adhesive Arachnoiditis following Inadvertent Epidural Injection of 2% Chlorhexidine in 70% Alcohol—Partial Recovery over the Ensuing Eight Years

2018 ◽  
Vol 46 (6) ◽  
pp. 572-574 ◽  
Author(s):  
I. Mohamed Iqbal ◽  
R. Morris ◽  
M. Hersch
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Back Pain ◽  
Cognitive Function ◽  
Epidural Injection ◽  
Partial Recovery ◽  
Resonance Imaging ◽  
Neurologic Injury ◽  
Nerve Roots ◽  
Severe Back Pain

We report a case of serious neurologic injury due to inadvertent epidural injection of 8 ml of the antiseptic 2% chlorhexidine in 70% alcohol during a procedure aimed to relieve the pain of labour. This resulted in immediate severe back pain, progressive tetraparesis and sphincter dysfunction caused by damage to the spinal cord and nerve roots. Subacute hydrocephalus necessitated drainage, but cranial nerve and cognitive function were spared. Magnetic resonance imaging documented marked abnormality of the spinal cord and surrounding leptomeninges. In the ensuing eight years, there has been clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe.

Adjunctive role of preoperative liver magnetic resonance imaging added to computed tomography among resected pancreatic cancer patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 207-207
Author(s):  
Hyoung Woo Kim ◽  
Jin-Hyeok Hwang ◽  
Jong-chan Lee ◽  
Kyu-hyun Paik ◽  
Jingu Kang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Hepatic Metastases ◽  
Resonance Imaging ◽  
Liver Mri ◽  
Hepatic Recurrence ◽  
Liver Magnetic Resonance Imaging ◽  
Hepatic Lesions

207 Background: Multi-detector computed tomography using pancreatic protocol (pCT) has been a preferred diagnostic imaging modality before resection of the pancreatic ductal adenocarcinoma (PDAC), because an adjunctive role of liver magnetic resonance imaging (MRI) is still unclear. The current study evaluated whether liver MRI added to pCT can help to select proper surgical candidates, and reduce the risk of early recurrence, eventually result in longer survival in resected PDAC patients. Methods: Among 197 PDAC patients who underwent curative-intended surgery, 167 patients who achieved complete resection with no grossly visible tumor were enrolled retrospectively. All patients had no metastatic lesions on pCT and/or MRI, preoperatively. Among them, 102 patients underwent pCT alone (CT group), and 65 patients liver MRI as well as pCT (MRI group). Results: By adding the liver MRI, hepatic metastases were newly discovered in 3 of 58 patients (5.2%) with no hepatic lesions on pCT and in 17 of 53 patients (32.1%) with indeterminate hepatic lesions on pCT. Among 167 patients who achieved R0/R1 resection, the median overall and disease-free survival were 20.1 vs 29.3 months and 8.5 vs 10.0 months in the CT and the MRI group, respectively (p = 0.011 and = 0.012), during median follow-up of 16.4 months. 80 (78.4%) patients in the CT group and 39 (60.0%) in the MRI group experienced recurrence during follow-up. Cumulative initial hepatic recurrence rate was higher in the CT group than in the MRI group (43.7% vs 18.5% at 1yr and 57.4% vs 26.9% at 2yr, p < 0.001), although the other sites recurrence did not differ in both groups. Conclusions: Liver MRI added to pCT has an incremental value in detecting PDAC hepatic metastases. Furthermore, because PDAC patients who underwent resection after liver MRI as well as pCT expect lower rate of hepatic recurrence and better survival than pCT alone, therefore, liver MRI added to pCT is needed to patients who planned curative resection of PDAC.

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