Neurology India最新文献

Background: Anterior cervical corpectomy and fusion (ACCF) involves placement of a graft/implant to ensure fusion and stabilization along with neural decompression. We share our experience with a subset of ACCF patients in whom graft/implant could not be placed post decompression for varying reasons but had a favorable long-term outcome. The necessity for routine fusion after corpectomy is critically analyzed, and the feasibility of an alternative surgical option without graft/implant is discussed.

Material and methods: A retrospective observational study of long-term outcomes of five patients with cervical compressive myelopathy who underwent neural decompression alone without an in situ graft/implant was done. All the patients underwent the modified cervical corpectomy technique, involving a smaller wedge size (12 × 15 mm) corpectomy. Pre- and postoperative clinical, radiological, electrophysiological, and operative findings were meticulously evaluated and analyzed.

Results: This retrospective observational study reviewed records of 124 patients who underwent ACCF between 1998 and 2012. The surgical procedure involved a wedge median cervical corpectomy. In seven patients, graft/implant could not be placed or had to be removed for various reasons. Long-term follow-up was available for five of these patients who were included in the study. In two patients, the graft could not be placed intraoperatively due to hemodynamic complications. In one patient, the graft had to be removed due to postoperative infection, and in two patients, the graft had to be removed due to graft extrusion. Four patients showed marked improvement, and one patient showed minimal improvement on long-term follow-up in clinical, radiological, and electrophysiological parameters.

Conclusion: This small case series suggests that a modified cervical corpectomy technique, involving a smaller wedge size (12 × 15 mm), may be considered in selected cases without radicular symptoms. This approach helps to provide neural decompression without compromising stability and avoids graft-related complications. While promising, further research, including prospective randomized-controlled trials, is essential to validate the biomechanical properties and clinical outcomes of this modified technique compared to traditional ACCF.

Background: Schwannomas of C1 are rare tumors. Because of the wide variation in their anatomy, and presentation and their rarity, there is no proper understanding of their pathological anatomy nor their optimal management.

Methods: A retrospective study of the C1 schwannomas operated by the author between 2000 and 2020 and a PubMed-based search of English literature were done to analyze data on the location and extent of the lesions, surgical approaches used, and operative outcomes. Using this data, a classification system was created indicating the location and extent of these lesions, depending on whether they were extradural (E) or intradural (I); with further subdivisions based on their relation to the vertebral artery, and cervicomedullary junction (CMJ).

Results: Six patients with C1 schwannoma were operated by the author in the said period. Literature search yielded 44 cases in 16 publications. The details of location and extent of tumor were available in 22 patients including six of this article. Most of the tumors were intradural (13/22), with six in intradural and extradural compartments. Specific growth patterns were identified and a theory for this is proposed. Different surgical approaches were used; the far lateral and the posterolateral in 9 patients each, and the posterior midline in 7 of 25 patients. Using the available data, preferred surgical approaches are also presented.

Conclusions: C1 schwannomas are a rare and complex group of tumors. The classification presented will help in understanding the growth pattern and pathological anatomy and choose the preferred surgical approach.

Sporadic late-onset nemaline rod myopathy is a rare, acquired, sub-acute, adult-onset myopathy characterized by proximal muscle weakness and nemaline rods in the myofibers. In contrast to its congenital form, the prevalence in adult population is comparatively rare. Herein, we report a case of 60-year-old male who presented with insidious onset proximal muscle weakness with myopathic pattern on electromyography. Histopathological examination showed type 1 and 2 muscle fiber atrophy with minimal chronic inflammatory cell infiltrate. Modified Gomori trichrome staining revealed granular deposits in the myofibers. Ultrastructure examination showed numerous nemaline rods in the myofibers; hence, the diagnosis of sporadic late-onset nemaline myopathy was rendered. Its association with monoclonal protein has been reported in the past. One should be aware of this rare entity as without correct diagnosis, there can be treatment failure and unfavorable outcome.

Background: A variety of processes, ranging from blood-brain barrier disruption to circulating biomarkers, contributes to reperfusion injury in acute stroke treatment.

Objective: We aimed to investigate the effects of thrombolytic therapy and endovascular thrombectomy therapy on serum S100 calcium-binding protein B, ischemia-modified albumin and thiol-disulfide balance in patients who arrived within the first 6 h of acute ischemic stroke.

Material and methods: The study considered 66 patients with the diagnosis of acute ischemic stroke who underwent thrombolytic therapy or EVT in the first 6 h, as well as 32 healthy volunteers. Venous blood samples were collected before tPA and EVT and 24 h after treatment. S100B, native thiol, disulfide, total thiol, and Ischemia-modified albumin (IMA) levels were measured.

Results: The S100B, total thiol, and native thiol values of the patients in the tPA group before and after the treatment showed statistical significance (P < 0.001). S100B, total thiol, and native thiol values were shown to be lower. The disulfide and IMA values of the patients in the tPA group did not differ significantly (respectively, P = 0.302, P = 0.054). However, disulfide and IMA levels were found to increase after treatment compared to pretreatment. The patients in the EVT group showed a significant difference in terms of S100B values (P < 0.001) and IMA values (P = 0.024).

Conclusions: Determining how to protect the brain from free radical damage is important. More research should be carried out on treatments that prevent free radical damage in ischemia-reperfusion injury, as well as treatments for acute ischemic stroke.