Pub Date : 2024-01-01Epub Date: 2024-03-13DOI: 10.4103/jcvjs.jcvjs_138_23
Devon LeFever, Thomas Hanks, Rakesh Kumar, Philip Louie, Jean-Christophe Leveque
Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient's right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord. Surgical intervention addressed a high-flow arteriovenous fistula involving the right vertebral artery and an epidural vein, necessitating sacrifice of the artery. Posterior fusion and laminectomy were performed, resulting in stable neurological status postoperatively and significant improvement in sensory loss and weakness at three months. This case underscores the importance of a tailored posterior-only approach, involving dural fold release, to allow the spinal cord to relocate to a less tense position, thus demonstrating effective decompression in complex NF1 cases with concurrent kyphotic deformity and vertebral artery AVF.
{"title":"Correction of cervical kyphoscoliosis, bisected spinal cord, and vertebral artery to epidural vein fistula in neurofibromatosis type 1.","authors":"Devon LeFever, Thomas Hanks, Rakesh Kumar, Philip Louie, Jean-Christophe Leveque","doi":"10.4103/jcvjs.jcvjs_138_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_138_23","url":null,"abstract":"<p><p>Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient's right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord. Surgical intervention addressed a high-flow arteriovenous fistula involving the right vertebral artery and an epidural vein, necessitating sacrifice of the artery. Posterior fusion and laminectomy were performed, resulting in stable neurological status postoperatively and significant improvement in sensory loss and weakness at three months. This case underscores the importance of a tailored posterior-only approach, involving dural fold release, to allow the spinal cord to relocate to a less tense position, thus demonstrating effective decompression in complex NF1 cases with concurrent kyphotic deformity and vertebral artery AVF.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11029105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_110_23
A. Kulkarni, Priyambada Kumar, Aditya R. S. S. Chadalavada, Yogesh M. Adbalwad
Study Design: The study design was a retrospective study. Objective: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the “Insert Flip Technique” of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively. Methods: IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded). The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis. Results: There was a significant improvement seen in the postoperative Cobb's angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb's angle and disc height. Conclusion: This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.
{"title":"“Insert flipping technique:” An effective way of restoring segmental lordosis and disc height with tall bullet cages","authors":"A. Kulkarni, Priyambada Kumar, Aditya R. S. S. Chadalavada, Yogesh M. Adbalwad","doi":"10.4103/jcvjs.jcvjs_110_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_110_23","url":null,"abstract":"Study Design: The study design was a retrospective study. Objective: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the “Insert Flip Technique” of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively. Methods: IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded). The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis. Results: There was a significant improvement seen in the postoperative Cobb's angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb's angle and disc height. Conclusion: This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139331363","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}
Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments.
Patients and methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images.
Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043).
Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.
{"title":"The effect of cage type on local and total cervical lordosis restoration and global spine alignment in single-level anterior cervical discectomy and fusion based on EOS<sup>®</sup> imaging: A comparison between standalone conventional interbody polyether ether ketone cage and integrated cage and plate (Perfect-C<sup>®</sup>).","authors":"Mohammadreza Chehrassan, Farshad Nikouei, Mohammadreza Shakeri, Javad Moeini, Farrokhlagha Hosseini, Ebrahim Ameri Mahabadi, Hasan Ghandhari","doi":"10.4103/jcvjs.jcvjs_108_23","DOIUrl":"10.4103/jcvjs.jcvjs_108_23","url":null,"abstract":"<p><strong>Background: </strong>There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments.</p><p><strong>Patients and methods: </strong>Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C<sup>®</sup>). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS<sup>®</sup> images.</p><p><strong>Results: </strong>Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (<i>P</i> = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (<i>P</i> = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (<i>P</i> = 0.043).</p><p><strong>Conclusion: </strong>In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_111_23
Daniel Encarnacion, Gennady E Chmutin, Ismail Bozkurt, Jack Wellington, Emmanuel Batista Geraldino, Bipin Chaurasia
Background: Multiple Myeloma is a B-cell malignancy which can cause variety of lesions of the spine and spinal cord. The management of patients with spinal cord compression (SCC), and the efficacy and security of minimally invasive therapeutic approaches, are the main topics of discussion. Methods: To systematically review the scientific literature on neurosurgical aspects of MM spinal cord lesion management, a search was conducted among scientific papers in the databases ScienceDirect, Cochrane Library, and PubMed using keywords and Boolean operators. These comprise MM and lesions of the spine and spinal cord. Each database was searched from the earliest available article to January 2017. Results: According to the literature, low-dose radiotherapy, antimyeloma medications, and bisphosphonates comprise the mainstay management for symptomatic spinal lesions. The decision to operation is based on presence of myelopathy and degree of spinal cord compression. Conclusions: As a result of the analysis, the following conclusions may be drawn: (1) surgery is a valuable option for MM patients with symptomatic spinal involvement who experience rapid neurological deterioration with SCC and/or mechanical instability and (2) it is important to ensure that the benefits of surgical treatment outweigh the risks, as patients with MM are susceptible to infections.
背景：多发性骨髓瘤是一种 B 细胞恶性肿瘤：多发性骨髓瘤是一种 B 细胞恶性肿瘤，可引起脊柱和脊髓的各种病变。脊髓压迫症（SCC）患者的治疗以及微创治疗方法的有效性和安全性是讨论的主要话题。方法：为了系统回顾有关 MM 脊髓病变治疗的神经外科方面的科学文献，我们使用关键字和布尔运算符对科学文献数据库 ScienceDirect、Cochrane Library 和 PubMed 中的科学论文进行了检索。其中包括 MM 以及脊柱和脊髓病变。每个数据库的检索时间都是从最早的文章到 2017 年 1 月。结果：根据文献，低剂量放疗、抗骨髓瘤药物和双膦酸盐是治疗无症状脊柱病变的主要方法。是否手术取决于脊髓病变的存在和脊髓受压的程度。结论：通过分析，可以得出以下结论：(1)对于有症状的脊柱受累的 MM 患者来说，手术是一个有价值的选择，因为这些患者的神经功能会迅速恶化，并伴有 SCC 和/或机械不稳定性；(2)由于 MM 患者易受感染，因此必须确保手术治疗的益处大于风险。
{"title":"Lesions of the spinal cord caused by multiple myeloma: A systematic review and meta-analysis regarding the neurosurgical aspects of patient management","authors":"Daniel Encarnacion, Gennady E Chmutin, Ismail Bozkurt, Jack Wellington, Emmanuel Batista Geraldino, Bipin Chaurasia","doi":"10.4103/jcvjs.jcvjs_111_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_111_23","url":null,"abstract":"Background: Multiple Myeloma is a B-cell malignancy which can cause variety of lesions of the spine and spinal cord. The management of patients with spinal cord compression (SCC), and the efficacy and security of minimally invasive therapeutic approaches, are the main topics of discussion. Methods: To systematically review the scientific literature on neurosurgical aspects of MM spinal cord lesion management, a search was conducted among scientific papers in the databases ScienceDirect, Cochrane Library, and PubMed using keywords and Boolean operators. These comprise MM and lesions of the spine and spinal cord. Each database was searched from the earliest available article to January 2017. Results: According to the literature, low-dose radiotherapy, antimyeloma medications, and bisphosphonates comprise the mainstay management for symptomatic spinal lesions. The decision to operation is based on presence of myelopathy and degree of spinal cord compression. Conclusions: As a result of the analysis, the following conclusions may be drawn: (1) surgery is a valuable option for MM patients with symptomatic spinal involvement who experience rapid neurological deterioration with SCC and/or mechanical instability and (2) it is important to ensure that the benefits of surgical treatment outweigh the risks, as patients with MM are susceptible to infections.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328897","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_73_23
Ferhat Harman, Volkan Oglin, Mehmet Ozgur Yilmaz, Omer Orhun, Oguz Baran, Seyma Boyukyilmaz, Y. Gezercan, S. Dalbayrak, Adnan Dagcinar
Objective: In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to neural structures and the presence of the high-riding vertebral artery (VA), these techniques are complicated. The risk of VA damage can be decreased by mobilizing the VA. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw placement with VA mobilization and a novel C2 inferior corpus screw placement technique. Methods: In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then, muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a surgical microscope. Each specimen and entire stages of the dissections were recorded photographically. After cadaver dissections, screw placement was performed with three different techniques. Finally, radiological imaging was done with fluoroscopy. Results: After dissection, the lateral mass of the C2 vertebra was observed, and lateral to it, the transverse process and foramen were detected with the help of a hook. Next, the posterior wall of the VA groove was removed using a 1 mm thin plate Kerrison rongeur until the VA loop could partially be observed the VA. This enables us to find the top of the loop of the VA and mobilize it inferiorly using a dissector. Following this step, the C1-2 transarticular, C2 pedicle, and the novel C2 inferior corpus screw placement can be performed safely by directly visualizing the artery. Conclusions: Due to the nearby neurologic and vascular structures, placing the C2 pedicle and C1-2 transarticular screw is a challenging procedure, especially in high-riding VA cases. However, it is possible to place the C2 pedicle, C1-2 transarticular, and novel C2 inferior corpus screw after the mobilization of the VA. This study aimed to show all of them together on a cadaver for the first time, to understand the anatomy of the C2 vertebra, and to use screw placement techniques to minimize the risk of complications.
{"title":"Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection","authors":"Ferhat Harman, Volkan Oglin, Mehmet Ozgur Yilmaz, Omer Orhun, Oguz Baran, Seyma Boyukyilmaz, Y. Gezercan, S. Dalbayrak, Adnan Dagcinar","doi":"10.4103/jcvjs.jcvjs_73_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_73_23","url":null,"abstract":"Objective: In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to neural structures and the presence of the high-riding vertebral artery (VA), these techniques are complicated. The risk of VA damage can be decreased by mobilizing the VA. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw placement with VA mobilization and a novel C2 inferior corpus screw placement technique. Methods: In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then, muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a surgical microscope. Each specimen and entire stages of the dissections were recorded photographically. After cadaver dissections, screw placement was performed with three different techniques. Finally, radiological imaging was done with fluoroscopy. Results: After dissection, the lateral mass of the C2 vertebra was observed, and lateral to it, the transverse process and foramen were detected with the help of a hook. Next, the posterior wall of the VA groove was removed using a 1 mm thin plate Kerrison rongeur until the VA loop could partially be observed the VA. This enables us to find the top of the loop of the VA and mobilize it inferiorly using a dissector. Following this step, the C1-2 transarticular, C2 pedicle, and the novel C2 inferior corpus screw placement can be performed safely by directly visualizing the artery. Conclusions: Due to the nearby neurologic and vascular structures, placing the C2 pedicle and C1-2 transarticular screw is a challenging procedure, especially in high-riding VA cases. However, it is possible to place the C2 pedicle, C1-2 transarticular, and novel C2 inferior corpus screw after the mobilization of the VA. This study aimed to show all of them together on a cadaver for the first time, to understand the anatomy of the C2 vertebra, and to use screw placement techniques to minimize the risk of complications.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139329017","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_98_23
Atallah Oday, Amr Badary, N. El-Ghandour, Yasser F. Almealawy, A. Wireko, Nikolaos Syrmos, G. Umana, Mohammad Al-Barbarawi, Anil Ergen, Prabin Shrestha, Bipin Chaurasia
Introduction: The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods: All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results: The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions: In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.
{"title":"Cystic dilatation of the ventriculus terminalis: A narrative review","authors":"Atallah Oday, Amr Badary, N. El-Ghandour, Yasser F. Almealawy, A. Wireko, Nikolaos Syrmos, G. Umana, Mohammad Al-Barbarawi, Anil Ergen, Prabin Shrestha, Bipin Chaurasia","doi":"10.4103/jcvjs.jcvjs_98_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_98_23","url":null,"abstract":"Introduction: The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods: All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results: The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions: In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139330266","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_163_23
Atul Goel, Sasha Blaskovich
{"title":"Rotatory and translatory “central or axial” atlantoaxial instability – Role of dynamic imaging","authors":"Atul Goel, Sasha Blaskovich","doi":"10.4103/jcvjs.jcvjs_163_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_163_23","url":null,"abstract":"","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139330004","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_109_23
R. Reinas, Óscar L. Alves, D. Kitumba, A. Baptista
Spinal epidural empyema (SEE) is a severe infectious disease of the spine which may cause significant morbidity and mortality. Surgical drainage of the empyema is a key feature. However, approach-related morbidity may be significant in very extensive collections. We present the case of a 55-year-old female with an empyema due to methicillin-susceptible Staphylococcus aureus spawning from C2 to S1. She underwent drainage of the pus through skip-level laminectomies and catheter epidural saline irrigation. The technique described was both safe and effective at treating the SEE, and the patient returned to normal life.
脊柱硬膜外水肿（SEE）是一种严重的脊柱感染性疾病，可导致严重的发病率和死亡率。手术引流是其主要特征。然而，对于大面积的积水，手术相关的发病率可能会很高。我们介绍了一例 55 岁女性的病例，她因甲氧西林易感的金黄色葡萄球菌从 C2 到 S1 产卵而导致肺水肿。她通过跳级椎板切除术和导管硬膜外盐水冲洗引流了脓液。所述技术在治疗 SEE 方面既安全又有效，患者恢复了正常生活。
{"title":"Surgical treatment of an all-spine epidural empyema","authors":"R. Reinas, Óscar L. Alves, D. Kitumba, A. Baptista","doi":"10.4103/jcvjs.jcvjs_109_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_109_23","url":null,"abstract":"Spinal epidural empyema (SEE) is a severe infectious disease of the spine which may cause significant morbidity and mortality. Surgical drainage of the empyema is a key feature. However, approach-related morbidity may be significant in very extensive collections. We present the case of a 55-year-old female with an empyema due to methicillin-susceptible Staphylococcus aureus spawning from C2 to S1. She underwent drainage of the pus through skip-level laminectomies and catheter epidural saline irrigation. The technique described was both safe and effective at treating the SEE, and the patient returned to normal life.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139326821","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_59_23
Rachael K. Han, John K. Chae, Andrew L. A. Garton, Amanda Cruz, Rodrigo Navarro-Ramirez, Ibrahim Hussain, Roger Härtl, Jeffrey P Greenfield
Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.
背景：枕颈融合术（OCF）中过度屈曲或伸展可导致术后并发症，如吞咽困难、呼吸困难、视线问题和颈部疼痛，但后窝减压术（PFD）和枕颈融合术需要不同的体位，因此需要术中操作。研究目的本研究旨在描述具有颅颈不稳（CCI）症状的Chiari畸形（CM）患者的定量透视形态测量，并演示如何在术中应用这些测量结果实现中性颅颈对齐，同时利用梅菲尔德头钳锁定机制实现单轴运动。方法：对 2015 年 3 月至 2020 年 10 月期间在一家单中心机构接受 PFD 和 OCF 的 CM 1 和 1.5 且具有 CCI 特征的患者进行回顾性队列研究。研究分析了患者的人口统计学特征、术前表现、影像学形态测量、手术细节、并发症和临床结果。结果：共有39名患者符合纳入标准，其中37名患者（94.9%）在PFD和OCF术后无需再进行翻修手术。在这批未接受翻修手术的患者中，术前与术后枕骨与C2的夹角（O-C2a）（13.5° ± 10.4° vs. 17.5° ± 10.1°，P = 0.047）和最窄口咽气道间隙（nPAS）（10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm，P = 0.007）显著增加。在两名因术后吞咽困难而需要进行翻修手术的患者中，这些测量值有所下降（O C2a 的平均差异为 16.6°°，枕骨和外耳道与轴线的角度为 12.8°°）。根据这些结果，在术中对这些透视形态测量进行评估，利用锁定梅菲尔德头钳复位手法，在从枕骨板到颈椎螺钉的杆置入之前优化颅颈对位。结论建立可靠的术前透视形态测量基线可指导外科医生在术中对患者进行适当的复位，从而避免术后并发症的发生。
{"title":"Intraoperative occipital to C2 angle and external acoustic meatus-to-axis angular measurements for optimizing alignment during posterior fossa decompression and occipitocervical fusion for complex Chiari malformation","authors":"Rachael K. Han, John K. Chae, Andrew L. A. Garton, Amanda Cruz, Rodrigo Navarro-Ramirez, Ibrahim Hussain, Roger Härtl, Jeffrey P Greenfield","doi":"10.4103/jcvjs.jcvjs_59_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_59_23","url":null,"abstract":"Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139327910","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 : 2023-10-01DOI: 10.4103/jcvjs.jcvjs_75_23
F. Corrivetti, Raffaelino Roperto, R. Sufianov, G. Cacciotti, Arslan Musin, Albert Sufianov, L. Mastronardi
Objective: Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. Materials and Methods: In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1–C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. Results: The mean age was 50 years (range 13–74), the follow-up mean duration was 30 ± 8.5 (range 24–72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Conclusions: Neurosurgical treatment of C1–C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1–C2 schwannomas.
目的：第一和第二神经根的许旺瘤是罕见的神经外科实体瘤，具有特殊的手术特征，使手术切除特别具有挑战性，值得进行专门研究。本研究回顾性分析了在罗马圣菲利波-内里医院（San Filippo Neri Hospital）和特尤门联邦神经外科中心（Federal Centre of Neurosurgery of Tjumen）两个不同神经外科中心接受手术的 14 名患者。材料和方法：在过去 6 年中，有 14 名患者在两个不同的神经外科中心接受了高颈（C1-C2）裂隙瘤神经外科切除术。对患者的临床表现、放射学检查结果和手术结果进行了回顾性分析。结果显示患者平均年龄为 50 岁（13-74 岁不等），平均随访时间为 30 ± 8.5（24-72 个月不），不同肿瘤位置（硬膜内、硬膜外和哑铃型）之间无明显差异。手术效果非常好：所有病例都实现了大体全切除，没有术中并发症或术后死亡。除一名患者病情保持稳定外，所有患者术后临床症状均有所改善。在最后一次随访中，卡诺夫斯基（Karnofsky）表现状态证实了整体临床改善。无椎动脉（VA）损伤，也未发生脊柱不稳；有一例报告了神经根牺牲。结论从切除范围和神经功能来看，C1-C2裂隙瘤的神经外科治疗效果良好。特别是，哑铃状和VA受累并不限制肿瘤的完全切除和良好的临床疗效。总之，显微手术是治疗 C1-C2 裂神经瘤的首选方法。
{"title":"Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series","authors":"F. Corrivetti, Raffaelino Roperto, R. Sufianov, G. Cacciotti, Arslan Musin, Albert Sufianov, L. Mastronardi","doi":"10.4103/jcvjs.jcvjs_75_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_75_23","url":null,"abstract":"Objective: Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. Materials and Methods: In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1–C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. Results: The mean age was 50 years (range 13–74), the follow-up mean duration was 30 ± 8.5 (range 24–72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Conclusions: Neurosurgical treatment of C1–C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1–C2 schwannomas.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328082","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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