Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus

Objective This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Study Design Retrospective study. Setting University hospital. Methods This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton’s types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. Results The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Conclusions Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Medical Analysis for Surgeryon Patients Complaining of Sciatic Pain

A prospective researchwas performed on 50 patients submitted for radiological screening in Samarra general hospital complaining of chronic backache and sciatica. The study was completed for patients recommended by senior neurosurgeons, orthopedicians, &rheumatologist, to the radiological unit in Samarra public hospital from October 2016 to October 2017. Radiological studies were analyzed by senior radiologists of Samarra public hospital in conjunction with the recommending senior doctors. Patients who are operated on were all proven to have chronic Lateral Recess Syndrome both radiological and surgically.

Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study

Objective To introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH). Methods This retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups. Results A total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups. Conclusion PTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.

Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis

OBJECTIVE Minimally invasive decompression (MID) is an effective procedure for lumbar spinal stenosis (LSS). Long-term follow-up data on reoperation rates are lacking. The objective of this retrospective cohort study was to evaluate reoperation rates in patients with LSS who underwent MID, stratified for degenerative lumbar spondylolisthesis (DLS), with a follow-up between 5 and 15 years. METHODS All consecutive patients with LSS who underwent MID between 2002 and 2011 were included. All patients had neurogenic claudication from central and/or lateral recess stenosis, without or with up to 25% of slippage (grade I spondylolisthesis), and no obvious dynamic instability on imaging (increase in spondylolisthesis by ≥ 5 mm demonstrated on supine-to-standing or flexion-extension imaging). Reoperation rates defined as any operation on the same or adjacent level were assessed. Revision decompression alone was considered if the aforementioned clinical and radiographic criteria were met; otherwise, patients underwent a minimally invasive posterior fusion. RESULTS A total of 246 patients (mean age 66 years) were included. Preoperative spondylolisthesis was present in 56.9%. The mean follow-up period was 8.2 years (range 5.0−14.9 years). The reoperation rates in patients with and without spondylolisthesis were 15.7% and 15.1%, respectively; fusion was required in 7.1% and 7.5%, with no significant difference (redecompression only, p = 0.954; fusion, p = 0.546). For decompression only, the mean times to reoperation were 3.9 years (95% CI 1.8−6.0 years) for patients with DLS and 2.8 years (95% CI 1.3−4.2 years) for patients without DLS; for fusion, the mean times to reoperation were 3.1 years (95% CI 1.0−5.3 years) and 3.1 years (95% CI 1.1−5.1 years), respectively. CONCLUSIONS In highly selected patients with stable DLS and leg-dominant pain from central or lateral recess stenosis, the long-term reoperation rate is similar between DLS and non-DLS patients undergoing MIS decompression.

Sphenoid sinus pneumatization in a sample of Nepalese population: A multidetector computed tomography study.

Introduction: The purpose of study was to assess the prevalence of different types of pneumatization of sphenoid sinus in the Nepalese population as detected in CT scan of paranasal sinus. Materials and Methods: This study included patients attending radiology department for CT scan of paranasal sinus. The CT images of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess and lesser wing extensions. Results: Most common type of pneumatization found in our study was complete sellar type (61.7%) and partial sellar type was second common type (27.4%). Pre-sellar type of pneumatization was seen in 10.9%. There were no patients with conchal type of pneumatization in our study. The clival extension of pneumatization was seen in 64%, lateral extension was found in 35.4%. and lesser wing type of pneumatization was found in 9.7%. Conclusion: Pre-surgical assessment of types and extension of sphenoid sinus pneumatization helps surgeons in surgical planning and to reduce complications during surgery. The variation in prevalence of sphenoid sinus pneumatization was found between our study population and other different population. This confirms that ethnicity influences types and extension of sphenoid sinus pneumatization.

Intra-articular Lipoma of the Knee Joint Located in the Lateral Recess: A Case Report

Introduction: Lipomas are the most common type of soft-tissue tumor, but intra-articular lipomas are very rare. Most cases occur in the knee joint. This is a report of intra-articular lipoma in the knee joint, 8 months after removal with good post-operative outcome. Case Report: A 56-year-old female who presented soft-tissue mass on her right knee. She felt uncomfortable but not in pain. The mass grew gradually and she wanted to be surgically removed. The mass was too large (5 cm × 4 cm × 2 cm) to be removed endoscopically, so arthrotomy was made. The mass was true lipoma histologically. She is living happily without recurrence after surgery. Conclusion: We have described an intra-articular synovial lipoma in the knee of a middle-aged female. Intra-articular lipomas are very rare. The tumor in this case was relatively large but painless, and the chief complaint was discomfort. It grew gradually, so the removal was performed. At present, the patient is living happy without recurrence after surgery. Keywords: Intra-articular lipoma, knee, removal, arthroscopy.

Influence of Lumbar Spinal Canal Dimensions on Neurological Claudication Symptomatology - A Case Control Study

Lumbar spinal stenosis (LSS) is abnormal narrowing of spinal canal of lumbar vertebrae causing compression of neural tissue which leads to a neurologic deficit. LSS is diagnosed based on clinical symptoms of patient and it is confirmed using MRI (Magnetic Resonance Imaging). The aim of the study is to determine the association between MRI lumbar spinal canal and foraminal dimensions in on neurological claudication symptomology. A total of 89 patients (45 males ,44 females, age range: 20-60 years) referred for MRI Lumbar spine were included in this prospective study. Patients were categorized into symptomatic (49 cases) and asymptomatic (40 controls) based on Edinburgh claudication questionnaire (ECQ). The Antero-posterior diameter of dural sac, Transverse diameter of dural sac, Cross sectional area of dural sac, Cross sectional area of lateral recess, Lateral recess depth, Angle of lateral recess, Ligamentous interfacet distance was measured from L3 to S1 on Axial T2 weighted MRI images. The strength of association between MRI measurements and clinical symptoms were assessed using logistic regression analysis and Cramer’s V test. The Phi coefficient value for the lumbar spinal canal, foraminal dimensions with neurogenic claudication symptomology based on ECQ was 0.108 & 0.207 respectively, which showed weak positive correlation. Our study concludes that MRI measurements of lumbar spinal canal and foraminal dimensions denoting LSS were found to show weak positive correlation with clinical symptoms assessed based on Edinburgh claudication questionnaire.