Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.05.016
Andrew R. Hsu BS , Lewis C. Hou MD , Anand Veeravagu BS , Patrick D. Barnes MD , Stephen L. Huhn MD
Background
Syringomyelia is an abnormal cystic dilatation of the spinal cord caused by excessive accumulation of CSF. Patients can develop various neurologic deficits secondary to untreated syringomyelia, some of which can be permanent despite surgical intervention.
Case Description
The authors present a patient with syringomyelia, aortic coarctation, and tethered cord syndrome. Serial radiographic imaging demonstrated initial significant reduction of the thoracic syrinx after coarctation repair and release of tethered cord. However, subsequent follow-up imaging revealed partial recurrence.
Conclusion
This case provides evidence of a possible cause-effect relationship between syringomyelia and tethered cord. It demonstrates the indication of surveillance imaging of the entire spine to ensure that all potential etiologies of syringomyelia are identified and treated. Furthermore, it illustrates the complex dynamic nature of syrinx physiology and reinforces the importance of serial follow-up studies after surgical intervention.
{"title":"Resolution of syringomyelia after release of tethered cord","authors":"Andrew R. Hsu BS , Lewis C. Hou MD , Anand Veeravagu BS , Patrick D. Barnes MD , Stephen L. Huhn MD","doi":"10.1016/j.surneu.2009.05.016","DOIUrl":"10.1016/j.surneu.2009.05.016","url":null,"abstract":"<div><h3>Background</h3><p>Syringomyelia is an abnormal cystic dilatation of the spinal cord caused by excessive accumulation of CSF. Patients can develop various neurologic deficits secondary to untreated syringomyelia, some of which can be permanent despite surgical intervention.</p></div><div><h3>Case Description</h3><p>The authors present a patient with syringomyelia, aortic coarctation, and tethered cord syndrome. Serial radiographic imaging demonstrated initial significant reduction of the thoracic syrinx after coarctation repair and release of tethered cord. However, subsequent follow-up imaging revealed partial recurrence.</p></div><div><h3>Conclusion</h3><p>This case provides evidence of a possible cause-effect relationship between syringomyelia and tethered cord. It demonstrates the indication of surveillance imaging of the entire spine to ensure that all potential etiologies of syringomyelia are identified and treated. Furthermore, it illustrates the complex dynamic nature of syrinx physiology and reinforces the importance of serial follow-up studies after surgical intervention.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 657-661"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.05.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.wneu.2009.09.016
James I. Ausman MD, PhD ((Editor))
{"title":"What will you do with the rest of your life?","authors":"James I. Ausman MD, PhD ((Editor))","doi":"10.1016/j.wneu.2009.09.016","DOIUrl":"10.1016/j.wneu.2009.09.016","url":null,"abstract":"","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Page 642"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.wneu.2009.09.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report 8 rare cases of paired ANs involving fenestrated vertebrobasilar junction and demonstrate the flow patterns of the paired ANs by qualitative CFD analysis in 5 cases.
Methods
Two-dimensional and 3-dimensional angiographic features of 8 cases were reviewed. Nine patient-specific geometries of CFD models in 5 cases were created for flow analysis.
Results
All 8 cases had 2 ANs, one large and the other small, projecting to the opposite sides at the proximal end of fenestrated vertebrobasilar junction. The different angiographic findings between right VA and left VA suggested the different hemodynamic characteristics of the respective VAs. Computational fluid dynamics analysis also demonstrated that the inflows of these paired ANs were different between right VA and left VA. Flow simulations by CFD were consistent with angiographic findings.
Conclusion
Intrinsic wall defects at fenestrated vertebrobasilar junction and specific hemodynamic stresses from 2 inflows may contribute to the formation of a pair of dumbbell-shaped ANs.
{"title":"Vertebrobasilar junction fenestration with dumbbell-shaped aneurysms formation: computational fluid dynamics analysis","authors":"Yuang-Seng Tsuei MD , Yasushi Matsumoto MD , Makoto Ohta PhD , Toshio Nakayama PhD , Masayuki Ezura MD , Akira Takahashi MD","doi":"10.1016/j.surneu.2009.05.026","DOIUrl":"10.1016/j.surneu.2009.05.026","url":null,"abstract":"<div><h3>Background</h3><p>We report 8 rare cases of paired ANs involving fenestrated vertebrobasilar junction and demonstrate the flow patterns of the paired ANs by qualitative CFD analysis in 5 cases.</p></div><div><h3>Methods</h3><p>Two-dimensional and 3-dimensional angiographic features of 8 cases were reviewed. Nine patient-specific geometries of CFD models in 5 cases were created for flow analysis.</p></div><div><h3>Results</h3><p>All 8 cases had 2 ANs, one large and the other small, projecting to the opposite sides at the proximal end of fenestrated vertebrobasilar junction. The different angiographic findings between right VA and left VA suggested the different hemodynamic characteristics of the respective VAs. Computational fluid dynamics analysis also demonstrated that the inflows of these paired ANs were different between right VA and left VA. Flow simulations by CFD were consistent with angiographic findings.</p></div><div><h3>Conclusion</h3><p>Intrinsic wall defects at fenestrated vertebrobasilar junction and specific hemodynamic stresses from 2 inflows may contribute to the formation of a pair of dumbbell-shaped ANs.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S11-S19"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.05.026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40020563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.07.041
Johnny B. Delashaw Jr. MD
{"title":"Commentary","authors":"Johnny B. Delashaw Jr. MD","doi":"10.1016/j.surneu.2009.07.041","DOIUrl":"https://doi.org/10.1016/j.surneu.2009.07.041","url":null,"abstract":"","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Page 689"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.07.041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137325897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.06.028
Elad I. Levy MD, L. Nelson Hopkins MD
{"title":"Commentary","authors":"Elad I. Levy MD, L. Nelson Hopkins MD","doi":"10.1016/j.surneu.2009.06.028","DOIUrl":"https://doi.org/10.1016/j.surneu.2009.06.028","url":null,"abstract":"","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Page 606"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137326063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.04.002
Liang Chen MD, PhD , Yao Zhao MD, PhD , Zheng Chen MD , May Tee MD , Ying Mao MD, PhD , Liang-Fu Zhou MD
Background
Cavernous malformations have generally been viewed as fairly benign vascular lesions with low potential for causing massive hemorrhage.
Case Description
We present an interesting case of multiple CMs, several of which were formed de novo and exhibited aggressive biological behavior resulting in recurrent episodes of intracranial hemorrhage over a 10-year period. This case illustrates a dynamic and aggressive form of CMs. Recent advances in our understanding of the molecular pathogenesis of CMs implicate genetics as an important pathogenic factor, which is the most likely etiology of this patient's presentation.
Conclusion
Special challenges exist in managing young children with multiple, highly aggressive CMs.
{"title":"Multiple dynamic cavernous malformations in a girl: long-term follow-up","authors":"Liang Chen MD, PhD , Yao Zhao MD, PhD , Zheng Chen MD , May Tee MD , Ying Mao MD, PhD , Liang-Fu Zhou MD","doi":"10.1016/j.surneu.2009.04.002","DOIUrl":"10.1016/j.surneu.2009.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Cavernous malformations have generally been viewed as fairly benign vascular lesions with low potential for causing massive hemorrhage.</p></div><div><h3>Case Description</h3><p>We present an interesting case of multiple CMs, several of which were formed de novo and exhibited aggressive biological behavior resulting in recurrent episodes of intracranial hemorrhage over a 10-year period. This case illustrates a dynamic and aggressive form of CMs. Recent advances in our understanding of the molecular pathogenesis of CMs implicate genetics as an important pathogenic factor, which is the most likely etiology of this patient's presentation.</p></div><div><h3>Conclusion</h3><p>Special challenges exist in managing young children with multiple, highly aggressive CMs.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 728-732"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.04.011
Navneet Singla MCh, Suresh N. Mathuriya MCh, Sandeep Mohindra MCh, Alok A. Umredkar MCh, Sachin Adhikari MS, Sunil K. Gupta MCh, Vivek Gupta MD
{"title":"Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm","authors":"Navneet Singla MCh, Suresh N. Mathuriya MCh, Sandeep Mohindra MCh, Alok A. Umredkar MCh, Sachin Adhikari MS, Sunil K. Gupta MCh, Vivek Gupta MD","doi":"10.1016/j.surneu.2009.04.011","DOIUrl":"10.1016/j.surneu.2009.04.011","url":null,"abstract":"","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 770-771"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.07.012
Muhammad Shahzad Shamim MBBS, MCPS, MRCS (Glasgow), FCPS (Neurosurgery) , Syed Ather Enam MBBS, MD, PhD, FRCS (Ire), FRCS (SN, CAN), DABS, FACS , Uvais Qidwai BE, ME, PhD
Background
Despite a lot of research into patient selection, a significant number of patients fail to benefit from surgery for symptomatic lumbar disk herniation. We have used Fuzzy Logic-based fuzzy inference system (FIS) for identifying patients unlikely to improve after disk surgery and explored FIS as a tool for surgical outcome prediction.
Methods
Data of 501 patients were retrospectively reviewed for 54 independent variables. Sixteen variables were short-listed based on heuristics and were further classified into memberships with degrees of membership within each. A set of 11 rules was formed, and the rule base used individual membership degrees and their values mapped from the membership functions to perform Boolean Logical inference for a particular set of inputs. For each rule, a decision bar was generated that, when combined with the other rules in a similar way, constituted a decision surface. The FIS decisions were then based on calculating the centroid for the resulting decision surfaces and thresholding of actual centroid values. The results of FIS were then compared with eventual postoperative patient outcomes based on clinical follow-ups at 6 months to evaluate FIS as a predictor of poor outcome.
Results
Fuzzy inference system has a sensitivity of 88% and specificity of 86% in the prediction of patients most likely to have poor outcome after lumbosacral miscrodiskectomy. The test thus has a positive predictive value of 0.36 and a negative predictive value of 0.98.
Conclusion
Fuzzy inference system is a sensitive method of predicting patients who will fail to improve with surgical intervention.
{"title":"Fuzzy Logic in neurosurgery: predicting poor outcomes after lumbar disk surgery in 501 consecutive patients","authors":"Muhammad Shahzad Shamim MBBS, MCPS, MRCS (Glasgow), FCPS (Neurosurgery) , Syed Ather Enam MBBS, MD, PhD, FRCS (Ire), FRCS (SN, CAN), DABS, FACS , Uvais Qidwai BE, ME, PhD","doi":"10.1016/j.surneu.2009.07.012","DOIUrl":"10.1016/j.surneu.2009.07.012","url":null,"abstract":"<div><h3>Background</h3><p>Despite a lot of research into patient selection, a significant number of patients fail to benefit from surgery for symptomatic lumbar disk herniation. We have used Fuzzy Logic-based fuzzy inference system (FIS) for identifying patients unlikely to improve after disk surgery and explored FIS as a tool for surgical outcome prediction.</p></div><div><h3>Methods</h3><p>Data of 501 patients were retrospectively reviewed for 54 independent variables. Sixteen variables were short-listed based on heuristics and were further classified into memberships with degrees of membership within each. A set of 11 rules was formed, and the rule base used individual membership degrees and their values mapped from the membership functions to perform Boolean Logical inference for a particular set of inputs. For each rule, a decision bar was generated that, when combined with the other rules in a similar way, constituted a decision surface. The FIS decisions were then based on calculating the centroid for the resulting decision surfaces and thresholding of actual centroid values. The results of FIS were then compared with eventual postoperative patient outcomes based on clinical follow-ups at 6 months to evaluate FIS as a predictor of poor outcome.</p></div><div><h3>Results</h3><p>Fuzzy inference system has a sensitivity of 88% and specificity of 86% in the prediction of patients most likely to have poor outcome after lumbosacral miscrodiskectomy. The test thus has a positive predictive value of 0.36 and a negative predictive value of 0.98.</p></div><div><h3>Conclusion</h3><p>Fuzzy inference system is a sensitive method of predicting patients who will fail to improve with surgical intervention.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 565-572"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.07.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28655694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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