Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.02.008
C. Benjamin Newman MD , Sassan Keshavarzi MD , Henry E. Aryan MD
Background
When the management of sacral tumors requires partial or complete sacrectomy, the spinopelvic apparatus must be reconstructed. This is a challenging and infrequently performed operation, and as such, many spine surgeons are unfamiliar with techniques available to carry out these procedures.
Case Description
A 34-year-old man presented with severe low back pain, mild left ankle dorsiflexion weakness, and left S1 paresthesias. Imaging revealed a large sacral mass extending into the L5/S1 and S1/S2 neural foramina as well as the presacral visceral and vascular structures. Needle biopsy of this mass demonstrated a low-grade chondrosarcoma. A 2-stage anterior/posterior en bloc sacrectomy with a novel modification of the Galveston L-rod pelvic ring reconstruction was carried out. Our modification takes advantage of new materials and implant technology to offer another alternative in reconstruction of the spinopelvic junction.
Conclusion
Understanding the anatomy and biomechanics of the spinopelvic apparatus and the lumbosacral junction, as well as having a familiarity with the various techniques available for carrying out sacrectomy and pelvic ring reconstruction, will enable the spine surgeon to effectively manage sacral tumors.
背景:当治疗骶骨肿瘤需要部分或全部切除时，必须重建脊柱盆腔。这是一项具有挑战性且很少进行的手术，因此，许多脊柱外科医生不熟悉执行这些手术的技术。病例描述一名34岁男性，表现为严重的腰痛，轻度左踝关节背屈无力，左S1感觉异常。影像学显示一个大的骶骨肿块延伸到L5/S1和S1/S2神经孔以及骶前内脏和血管结构。肿块穿刺活检显示为低级别软骨肉瘤。我们进行了两期前/后整体骶骨切除术，并对Galveston l -棒骨盆环重建进行了新的修改。我们的改良利用了新材料和植入技术，为脊柱骨盆连接处的重建提供了另一种选择。结论了解脊柱骨盆和腰骶交界处的解剖和生物力学，熟悉骶骨切除术和骨盆环重建术的各种技术，将有助于脊柱外科医生有效地处理骶骨肿瘤。
{"title":"En bloc sacrectomy and reconstruction: technique modification for pelvic fixation","authors":"C. Benjamin Newman MD , Sassan Keshavarzi MD , Henry E. Aryan MD","doi":"10.1016/j.surneu.2009.02.008","DOIUrl":"10.1016/j.surneu.2009.02.008","url":null,"abstract":"<div><h3>Background</h3><p>When the management of sacral tumors requires partial or complete sacrectomy, the spinopelvic apparatus must be reconstructed. This is a challenging and infrequently performed operation, and as such, many spine surgeons are unfamiliar with techniques available to carry out these procedures.</p></div><div><h3>Case Description</h3><p>A 34-year-old man presented with severe low back pain, mild left ankle dorsiflexion weakness, and left S1 paresthesias. Imaging revealed a large sacral mass extending into the L5/S1 and S1/S2 neural foramina as well as the presacral visceral and vascular structures. Needle biopsy of this mass demonstrated a low-grade chondrosarcoma. A 2-stage anterior/posterior en bloc sacrectomy with a novel modification of the Galveston L-rod pelvic ring reconstruction was carried out. Our modification takes advantage of new materials and implant technology to offer another alternative in reconstruction of the spinopelvic junction.</p></div><div><h3>Conclusion</h3><p>Understanding the anatomy and biomechanics of the spinopelvic apparatus and the lumbosacral junction, as well as having a familiarity with the various techniques available for carrying out sacrectomy and pelvic ring reconstruction, will enable the spine surgeon to effectively manage sacral tumors.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 752-756"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.02.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40020898","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.2009.06.015
Serkan Simsek MD, PhD, Kazim Yigitkanli MD, Hakan Seckin MD, PhD, Çetin Akyol MD, Deniz Belen MD, Murad Bavbek MD
Background
Although C1 lateral mass fixation technique is frequently performed in upper cervical instabilities, it requires the guidance of fluoroscopic imaging. The fluoroscopy guidance is time-consuming and has the risks of accumulative radiation. Biplane fluoroscopy is also difficult in upper cervical pathologic conditions because of the use of cranial fixations. This study aimed to demonstrate that unicortical C1 lateral mass screws could be placed safely and rapidly without fluoroscopy guidance.
Methods
Between 2002 and 2008, 32 C1 lateral mass screws were inserted in 17 consecutive patients with various pathologic conditions involving either atlantoaxial or occipitocervical instability.
Results
C1 screw lengths ranged from 18 to 32 mm. The atlantoaxial fixation was performed in 13 patients, and C1 lateral mass screws were added to the occipitocervical construct in 3 patients, to the posterior cervical construct in 2 patients, and to the cervicothoracic construct in 1 patient. In 2 patients, because C1 lateral mass screws could not be inserted unilaterally, C1 pedicle screw analogs were inserted. There were no screw malpositions or neurovascular complications related to screw insertion. Operation time and intraoperative bleeding of the isolated atlantoaxial fixations were retrospectively evaluated. The mean follow-up was 32.3 months (range, 7-59 months). No screw loosening or construct failure was observed within this period. Postoperatively, 4 patients complained of hypoesthesia, whereas one patient had superficial wound infection.
Conclusion
C1 lateral mass screws may be used safely and rapidly in upper cervical instabilities without intraoperative fluoroscopy guidance and the use of the spinal navigation systems. Preoperative planning and determining the ideal screw insertion point, the ideal trajections, and the lengths of the screws are the most important points.
{"title":"Freehand C1 lateral mass screw fixation technique: our experience","authors":"Serkan Simsek MD, PhD, Kazim Yigitkanli MD, Hakan Seckin MD, PhD, Çetin Akyol MD, Deniz Belen MD, Murad Bavbek MD","doi":"10.1016/j.surneu.2009.06.015","DOIUrl":"10.1016/j.surneu.2009.06.015","url":null,"abstract":"<div><h3>Background</h3><p>Although C1 lateral mass fixation technique is frequently performed in upper cervical instabilities, it requires the guidance of fluoroscopic imaging. The fluoroscopy guidance is time-consuming and has the risks of accumulative radiation. Biplane fluoroscopy is also difficult in upper cervical pathologic conditions because of the use of cranial fixations. This study aimed to demonstrate that unicortical C1 lateral mass screws could be placed safely and rapidly without fluoroscopy guidance.</p></div><div><h3>Methods</h3><p>Between 2002 and 2008, 32 C1 lateral mass screws were inserted in 17 consecutive patients with various pathologic conditions involving either atlantoaxial or occipitocervical instability.</p></div><div><h3>Results</h3><p>C1 screw lengths ranged from 18 to 32 mm. The atlantoaxial fixation was performed in 13 patients, and C1 lateral mass screws were added to the occipitocervical construct in 3 patients, to the posterior cervical construct in 2 patients, and to the cervicothoracic construct in 1 patient. In 2 patients, because C1 lateral mass screws could not be inserted unilaterally, C1 pedicle screw analogs were inserted. There were no screw malpositions or neurovascular complications related to screw insertion. Operation time and intraoperative bleeding of the isolated atlantoaxial fixations were retrospectively evaluated. The mean follow-up was 32.3 months (range, 7-59 months). No screw loosening or construct failure was observed within this period. Postoperatively, 4 patients complained of hypoesthesia, whereas one patient had superficial wound infection.</p></div><div><h3>Conclusion</h3><p>C1 lateral mass screws may be used safely and rapidly in upper cervical instabilities without intraoperative fluoroscopy guidance and the use of the spinal navigation systems. Preoperative planning and determining the ideal screw insertion point, the ideal trajections, and the lengths of the screws are the most important points.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 676-681"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28428923","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.2009.06.027
Brian L. Alexander MD , Howard A. Riina MD
Background
A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.
Methods
The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.
Results
Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.
Conclusions
Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.
{"title":"The combined approach to intracranial aneurysm treatment","authors":"Brian L. Alexander MD , Howard A. Riina MD","doi":"10.1016/j.surneu.2009.06.027","DOIUrl":"10.1016/j.surneu.2009.06.027","url":null,"abstract":"<div><h3>Background</h3><p>A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.</p></div><div><h3>Methods</h3><p>The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.</p></div><div><h3>Results</h3><p>Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.</p></div><div><h3>Conclusions</h3><p>Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 596-606"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28429439","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.2009.04.007
Hakan Seçkin MD, PhD, Nirav Patel MD, Emel Avcı MD, Robert J. Dempsey MD, Mustafa K. Başkaya MD
Background
We report on a patient with trigeminal neuralgia caused by an extraaxial cavernous malformation (CM) located within Meckel's cave. The lesion was removed via a pterional extradural approach with a modified temporalis muscle dissection technique, which was first described by Heros and Lee. Cadaveric dissections were performed to demonstrate the wider exposure gained by this approach.
Methods
A 56-year-old man presented with a history of episodic shocklike, right-sided facial pain for 10 years. Neurologic examination revealed diminished sensation in the mandibular division of the right trigeminal nerve. Magnetic resonance imaging showed an ipsilateral enhancing lesion in Meckel's cave.
Results
After placement of a lumbar drain, a right extradural pterional approach was undertaken. By reflecting the temporalis muscle posterolaterally, the craniotomy was extended so that the line of sight was level with the floor of the middle fossa. This allowed access to the lesion without needing to remove the zygoma. The lesion was resected with microsurgical technique. The patient's pain improved significantly after resection, and histopathologic examination confirmed the diagnosis of CM.
Conclusions
Extraaxial middle fossa CMs arising solely from Meckel's cave are rare. These lesions are safely and simply approached by posteriorly deflecting the temporalis muscle during a pterional craniotomy, avoiding excessive elevation of the anterior temporal lobe or further bony removal.
{"title":"Removal of cavernous malformation of the Meckel's cave by extradural pterional approach using Heros muscle dissection technique","authors":"Hakan Seçkin MD, PhD, Nirav Patel MD, Emel Avcı MD, Robert J. Dempsey MD, Mustafa K. Başkaya MD","doi":"10.1016/j.surneu.2009.04.007","DOIUrl":"10.1016/j.surneu.2009.04.007","url":null,"abstract":"<div><h3>Background</h3><p>We report on a patient with trigeminal neuralgia caused by an extraaxial cavernous malformation (CM) located within Meckel's cave. The lesion was removed via a pterional extradural approach with a modified temporalis muscle dissection technique, which was first described by Heros and Lee. Cadaveric dissections were performed to demonstrate the wider exposure gained by this approach.</p></div><div><h3>Methods</h3><p>A 56-year-old man presented with a history of episodic shocklike, right-sided facial pain for 10 years. Neurologic examination revealed diminished sensation in the mandibular division of the right trigeminal nerve. Magnetic resonance imaging showed an ipsilateral enhancing lesion in Meckel's cave.</p></div><div><h3>Results</h3><p>After placement of a lumbar drain, a right extradural pterional approach was undertaken. By reflecting the temporalis muscle posterolaterally, the craniotomy was extended so that the line of sight was level with the floor of the middle fossa. This allowed access to the lesion without needing to remove the zygoma. The lesion was resected with microsurgical technique. The patient's pain improved significantly after resection, and histopathologic examination confirmed the diagnosis of CM.</p></div><div><h3>Conclusions</h3><p>Extraaxial middle fossa CMs arising solely from Meckel's cave are rare. These lesions are safely and simply approached by posteriorly deflecting the temporalis muscle during a pterional craniotomy, avoiding excessive elevation of the anterior temporal lobe or further bony removal.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 733-736"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309977","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}
Although surgical resection is the first treatment choice in patients with cystic lymphangioma, the complete resection of orbital lymphangioma is often difficult. After partial resection of the cyst wall, some cystic lymphangiomas recur. The injection of tissue fibrin glue may prevent the recurrence of orbital lymphangioma.
Case Description
We present a 2-year-old girl with left progressive exophthalmos. Magnetic resonance imaging revealed a cystic mass lesion behind the left eyeball. At the first operation, the cyst wall was partially resected, and all cyst fluid was totally removed by suction. One week after the first operation, the cyst showed regrowth. At a second procedure, we injected tissue fibrin glue into the cyst. The cyst was completely sealed, and there was no recurrence.
Conclusion
Tissue fibrin glue is adhesive and hemostatic and highly useful in the treatment of orbital cystic lymphangioma.
{"title":"Successful treatment of intraorbital lymphangioma with tissue fibrin glue","authors":"Aiko Hayasaki MD, Hideo Nakamura MD, PhD, Tadashi Hamasaki MD, PhD, Keishi Makino MD, PhD, Shigetoshi Yano MD, PhD, Motohiro Morioka MD, PhD, Jun-ichi Kuratsu MD, PhD","doi":"10.1016/j.surneu.2009.04.013","DOIUrl":"10.1016/j.surneu.2009.04.013","url":null,"abstract":"<div><h3>Background</h3><p>Although surgical resection is the first treatment choice in patients with cystic lymphangioma, the complete resection of orbital lymphangioma is often difficult. After partial resection of the cyst wall, some cystic lymphangiomas recur. The injection of tissue fibrin glue may prevent the recurrence of orbital lymphangioma.</p></div><div><h3>Case Description</h3><p>We present a 2-year-old girl with left progressive exophthalmos. Magnetic resonance imaging revealed a cystic mass lesion behind the left eyeball. At the first operation, the cyst wall was partially resected, and all cyst fluid was totally removed by suction. One week after the first operation, the cyst showed regrowth. At a second procedure, we injected tissue fibrin glue into the cyst. The cyst was completely sealed, and there was no recurrence.</p></div><div><h3>Conclusion</h3><p>Tissue fibrin glue is adhesive and hemostatic and highly useful in the treatment of orbital cystic lymphangioma.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 722-724"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28438282","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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