Pub Date : 2016-05-01DOI: 10.1097/WNQ.0000000000000133
Zhongxiao Cong, Xianhao Shao, Lei Zhang, Duanyun Zhao, Xudong Zhou, Chiling Yi, Y. Shao
Background:Increasing literature data suggest that cranioplasty at early stage of skull defects may lead to better rehabilitation outcome. This study was conducted to explore the relationship between the timing of cranioplasty and neurological rehabilitation in patients with traumatic skull injury (TSI). Methods:A total of 77 patients were admitted as a result of TSI, assessed on rehabilitation measures, and grouped by the intervals between skull injury and cranioplasty. All patients underwent cranioplasty between 20 and 500 days after TSI. Neurological function and general wellbeing of the patients before and after cranioplasty were assessed as per National Institute of Health Stroke Score (NIHSS) and Karnofsky Performance Status (KPS) scales, respectively. Results:Cranioplasty led to significant improvement in functioning, with all the patients demonstrating clinically meaningful gains. There were approximately 80%, 50%, and 20% reduction in postcranioplasty NIHSS in patients who underwent cranioplasty within 90 days (group 1, P<0.01), 90 to 180 days (group 2, P<0.05), and beyond 180 days (group 3, P<0.05) after TSI, respectively. The postcranioplasty KPS scores significantly improved in all the patients compared with those before cranioplasty (P<0.05). The KPS improvement rate was significantly higher in group 1 compared with those in groups 2 and 3 (P<0.05), with no difference between groups 2 and 3. A reciprocal relationship between the intervals from TSI to cranioplasty and the KPS improvement rate was observed. Conclusions:Cranioplasty improved neurological rehabilitation and general wellbeing in patients with TSI, with the optimal surgical time no more than 90 days after skull injuries.
{"title":"Early Cranioplasty Improved Rehabilitation in Patients With Traumatic Skull Injuries","authors":"Zhongxiao Cong, Xianhao Shao, Lei Zhang, Duanyun Zhao, Xudong Zhou, Chiling Yi, Y. Shao","doi":"10.1097/WNQ.0000000000000133","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000133","url":null,"abstract":"Background:Increasing literature data suggest that cranioplasty at early stage of skull defects may lead to better rehabilitation outcome. This study was conducted to explore the relationship between the timing of cranioplasty and neurological rehabilitation in patients with traumatic skull injury (TSI). Methods:A total of 77 patients were admitted as a result of TSI, assessed on rehabilitation measures, and grouped by the intervals between skull injury and cranioplasty. All patients underwent cranioplasty between 20 and 500 days after TSI. Neurological function and general wellbeing of the patients before and after cranioplasty were assessed as per National Institute of Health Stroke Score (NIHSS) and Karnofsky Performance Status (KPS) scales, respectively. Results:Cranioplasty led to significant improvement in functioning, with all the patients demonstrating clinically meaningful gains. There were approximately 80%, 50%, and 20% reduction in postcranioplasty NIHSS in patients who underwent cranioplasty within 90 days (group 1, P<0.01), 90 to 180 days (group 2, P<0.05), and beyond 180 days (group 3, P<0.05) after TSI, respectively. The postcranioplasty KPS scores significantly improved in all the patients compared with those before cranioplasty (P<0.05). The KPS improvement rate was significantly higher in group 1 compared with those in groups 2 and 3 (P<0.05), with no difference between groups 2 and 3. A reciprocal relationship between the intervals from TSI to cranioplasty and the KPS improvement rate was observed. Conclusions:Cranioplasty improved neurological rehabilitation and general wellbeing in patients with TSI, with the optimal surgical time no more than 90 days after skull injuries.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"103–108"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882864","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000148
Idris S. Torun, N. Balak, U. Ozdemir
Background:Both transcranial and spinal cerebrospinal fluid (CSF) leaks are serious and potentially fatal conditions. Reparative surgery fails in 6% to 25% of cases. The so-called “super glue” cyanoacrylate is an acrylic resin that rapidly polymerizes in the presence of water, specifically hydroxide ions. The reaction proceeds rapidly and a strong bond is formed within seconds. Cyanoacrylate glues have been reported for their possible usefulness in the treatment of CSF leaks. Methods:In this report, the records of 1 female and 2 male patients aged between 43 and 68 years with low-pressure CSF leaks were retrospectively reviewed. The causes of fistulas were head trauma in 1 case and iatrogenicity during surgery for lumbar disc herniation in 2 cases. Results:In the 2 patients who underwent spinal surgery, primary repair was unsuccessful. The leaks were therefore sealed with cyanoacrylate glue packed between a cellulose-based hemostat and a fat plug. In the head injury case, the leak was treated with a periosteal graft attached to the injured dura with sutures. A cellulose-based hemostat followed by cynoacrylate glue was then applied. The patients have been followed up for between 3 and 6 years with no CSF leakage, infection, or neurological problems. Conclusion:Cyanoacrylate adhesive seems to be an efficient and safe alternative for the prevention of low-pressure CSF leaks.
{"title":"Household Cyanoacrylate is an Efficient and Safe Adhesive for Urgent Repair of Cerebrospinal Leaks","authors":"Idris S. Torun, N. Balak, U. Ozdemir","doi":"10.1097/WNQ.0000000000000148","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000148","url":null,"abstract":"Background:Both transcranial and spinal cerebrospinal fluid (CSF) leaks are serious and potentially fatal conditions. Reparative surgery fails in 6% to 25% of cases. The so-called “super glue” cyanoacrylate is an acrylic resin that rapidly polymerizes in the presence of water, specifically hydroxide ions. The reaction proceeds rapidly and a strong bond is formed within seconds. Cyanoacrylate glues have been reported for their possible usefulness in the treatment of CSF leaks. Methods:In this report, the records of 1 female and 2 male patients aged between 43 and 68 years with low-pressure CSF leaks were retrospectively reviewed. The causes of fistulas were head trauma in 1 case and iatrogenicity during surgery for lumbar disc herniation in 2 cases. Results:In the 2 patients who underwent spinal surgery, primary repair was unsuccessful. The leaks were therefore sealed with cyanoacrylate glue packed between a cellulose-based hemostat and a fat plug. In the head injury case, the leak was treated with a periosteal graft attached to the injured dura with sutures. A cellulose-based hemostat followed by cynoacrylate glue was then applied. The patients have been followed up for between 3 and 6 years with no CSF leakage, infection, or neurological problems. Conclusion:Cyanoacrylate adhesive seems to be an efficient and safe alternative for the prevention of low-pressure CSF leaks.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"125–128"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883839","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000160
J. Matsuyama, K. Kubota, S. Okuyama, T. Watabe, Shinjitsu Nishimura, M. Tomii, T. Matsushima, J. Mizuno
Objective and Importance:Sylvian aqueduct syndrome (SAS) is associated with a complex clinical picture, which suggests global rostral midbrain dysfunction. Clinical Presentation:A 34-year-old woman developed SAS and Parkinsonism secondary to aqueductal stenosis and was treated by endoscopic third ventriculostomy (ETV) as an initial treatment, which led to the successful resolution of the symptoms. At admission, she exhibited only memory disturbance, slight cognitive impairment and urinary incontinence after recent childbirth. Magnetic resonance imaging (MRI) revealed aqueductal stenosis with the enlargement of the third and lateral ventricle with normal sized fourth ventricle. Several days later, the patient displayed upward gaze paralysis (Parinaud’s syndrome), Parkinsonian hands tremor, and somnolent confusional state. An MRI revealed abnormal intensity in the midbrain and upper pons as well as bulging of the posterior portion of the third ventricle. The dramatic resolution of the patient’s Parinaud’s syndrome, Parkinsonian tremor, and drowsy state after ETV was accompanied by the disappearance of the abnormal intensity in the midbrain and posterior bulging of the third ventricle. This characteristic change, which occurred simultaneously in both the clinical and MRI findings, revealed the lesion responsible for the SAS and Parkinsonism. A drastic change in the ventricular size or transtentorial pressure gradient might have also caused distortion and stretching of the midbrain. Conclusions:The simultaneous resolution of the clinical symptoms and abnormal MRI findings after ETV revealed the lesion responsible for this patient’s SAS and Parkinsonism. Early ETV allowed the reversal of the SAS and Parkinsonism and should be considered as the first-line treatment.
{"title":"Sylvian Aqueduct Syndrome and Parkinsonism in Aqueduct Stenosis: Improvement in Global Rostral Midbrain Dysfunction Associated With Resolution of Abnormal Hyperintensity on MRI","authors":"J. Matsuyama, K. Kubota, S. Okuyama, T. Watabe, Shinjitsu Nishimura, M. Tomii, T. Matsushima, J. Mizuno","doi":"10.1097/WNQ.0000000000000160","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000160","url":null,"abstract":"Objective and Importance:Sylvian aqueduct syndrome (SAS) is associated with a complex clinical picture, which suggests global rostral midbrain dysfunction. Clinical Presentation:A 34-year-old woman developed SAS and Parkinsonism secondary to aqueductal stenosis and was treated by endoscopic third ventriculostomy (ETV) as an initial treatment, which led to the successful resolution of the symptoms. At admission, she exhibited only memory disturbance, slight cognitive impairment and urinary incontinence after recent childbirth. Magnetic resonance imaging (MRI) revealed aqueductal stenosis with the enlargement of the third and lateral ventricle with normal sized fourth ventricle. Several days later, the patient displayed upward gaze paralysis (Parinaud’s syndrome), Parkinsonian hands tremor, and somnolent confusional state. An MRI revealed abnormal intensity in the midbrain and upper pons as well as bulging of the posterior portion of the third ventricle. The dramatic resolution of the patient’s Parinaud’s syndrome, Parkinsonian tremor, and drowsy state after ETV was accompanied by the disappearance of the abnormal intensity in the midbrain and posterior bulging of the third ventricle. This characteristic change, which occurred simultaneously in both the clinical and MRI findings, revealed the lesion responsible for the SAS and Parkinsonism. A drastic change in the ventricular size or transtentorial pressure gradient might have also caused distortion and stretching of the midbrain. Conclusions:The simultaneous resolution of the clinical symptoms and abnormal MRI findings after ETV revealed the lesion responsible for this patient’s SAS and Parkinsonism. Early ETV allowed the reversal of the SAS and Parkinsonism and should be considered as the first-line treatment.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"166–169"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884496","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000151
Vedat Uruç, R. Özden, Aydıner Kalacı, Y. Doğramacı, Seyit K. Başarslan
The entrapment of pudendal nerve generally results with severe pain in the perineum. Although the relationship between sacrotuberous ligament (STL) and pudendal nerve entrapment (PNE) syndrome is well known, to the best of our knowledge, there has been no previously reported case of fully ossified STL, presenting with PNE syndrome. We present the case of a 61-year-old male with complaints of pain and burning on perineum. There was no history of trauma or other predisposing factors. The pain relief by local anesthetic blockage of the pudendal nerve supported the diagnosis of PNE syndrome. The plain radiograph revealed complete ossification of STL. Three-dimensional computed tomography clearly demonstrated the completely ossified STL. The ossified STL was totally excised with transgluteal incision. Ten days after surgery the patient’s complaints were particularly regressed and 1 month after surgery the patient was completely healed. In conclusion, completely ossified STL is a very rare cause of PNE syndrome, but it must be taken into consideration in the differential diagnosis of perineal ache. Plain radiography, anamnesis, and physical examination are sufficient for diagnosis. Three-dimensional computed tomography is useful for preoperative planning. Surgical treatment with transgluteal approach is a good choice for
{"title":"Unilateral Complete Ossification of Sacrotuberous Ligament: An Unusual Cause of Pudendal Nerve Entrapment Syndrome","authors":"Vedat Uruç, R. Özden, Aydıner Kalacı, Y. Doğramacı, Seyit K. Başarslan","doi":"10.1097/WNQ.0000000000000151","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000151","url":null,"abstract":"The entrapment of pudendal nerve generally results with severe pain in the perineum. Although the relationship between sacrotuberous ligament (STL) and pudendal nerve entrapment (PNE) syndrome is well known, to the best of our knowledge, there has been no previously reported case of fully ossified STL, presenting with PNE syndrome. We present the case of a 61-year-old male with complaints of pain and burning on perineum. There was no history of trauma or other predisposing factors. The pain relief by local anesthetic blockage of the pudendal nerve supported the diagnosis of PNE syndrome. The plain radiograph revealed complete ossification of STL. Three-dimensional computed tomography clearly demonstrated the completely ossified STL. The ossified STL was totally excised with transgluteal incision. Ten days after surgery the patient’s complaints were particularly regressed and 1 month after surgery the patient was completely healed. In conclusion, completely ossified STL is a very rare cause of PNE syndrome, but it must be taken into consideration in the differential diagnosis of perineal ache. Plain radiography, anamnesis, and physical examination are sufficient for diagnosis. Three-dimensional computed tomography is useful for preoperative planning. Surgical treatment with transgluteal approach is a good choice for","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"185-187"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884216","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000147
Zhiqiang Li, Z. Quan, Ning Zhang, Jun Zhao, Dongqing Shen
Objective:Traumatic brain injury (TBI) is a significant cause of mortality and morbidity. Intraventricular and intraparenchymal intracranial pressure (ICP) monitors are most widely used in clinical practice. There has been little investigation into the comparison between these 2 ICP monitoring sites. Methods:Patients with severe TBI were admitted in this prospective study. Data on demographics and injury characteristics were registered. Glasgow Outcome Scale Extended 6 months after injury, intensive care unit (ICU) length of stay, and monitoring-related complications were registered. Results:Intraparenchymal ICP monitoring group had a shorter duration of ICP monitoring (4.1±3.6 vs. 7.6±5.8 d, P<0.01). The ICU length of stay was similar in the 2 groups (15.6±11.8 vs. 17.9±13.2 d, P=0.15). Device-related complications were lower in the intraparenchymal group (10.7% vs. 32.8%, P<0.01), although more patients received surgical decompression (32% in intraventricular vs. 40.1 in intraparenchymal group, P=0.04). On multivariate logistic analysis, age, initial Glasgow Coma Scale score, and size of midline shift were independent predictors for mortality and unfavorable survival. Conclusions:Intraparenchymal pressure monitoring in patients with severe TBI is associated with shorter ICP monitoring, hospital length of stay, and less device-related complications compared with the intraventricular method.
目的:外伤性脑损伤(TBI)是导致死亡和发病的重要原因。脑室内和脑实质内颅内压(ICP)监测仪在临床应用最为广泛。对这两个ICP监测点的比较调查很少。方法:本前瞻性研究纳入重度脑外伤患者。登记了人口统计学和损伤特征数据。格拉斯哥结局量表记录受伤后延长6个月，重症监护病房(ICU)住院时间和监测相关并发症。结果:肝实质内ICP监测组ICP监测时间短(4.1±3.6 d vs. 7.6±5.8 d, P<0.01)。两组患者ICU住院时间相似(15.6±11.8 d vs. 17.9±13.2 d, P=0.15)。脑实质组器械相关并发症较低(10.7% vs. 32.8%， P<0.01)，但更多患者接受手术减压(脑室内组32% vs.脑实质组40.1,P=0.04)。在多变量逻辑分析中，年龄、初始格拉斯哥昏迷量表评分和中线移位大小是死亡率和不良生存率的独立预测因子。结论:与脑室内方法相比，重度TBI患者的脑实质内压监测与更短的颅内压监测、住院时间和更少的器械相关并发症相关。
{"title":"Comparison Between Intraventricular and Intraparenchymal Intracranial Pressure Monitoring in Asian Patients With Severe Traumatic Brain Injury","authors":"Zhiqiang Li, Z. Quan, Ning Zhang, Jun Zhao, Dongqing Shen","doi":"10.1097/WNQ.0000000000000147","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000147","url":null,"abstract":"Objective:Traumatic brain injury (TBI) is a significant cause of mortality and morbidity. Intraventricular and intraparenchymal intracranial pressure (ICP) monitors are most widely used in clinical practice. There has been little investigation into the comparison between these 2 ICP monitoring sites. Methods:Patients with severe TBI were admitted in this prospective study. Data on demographics and injury characteristics were registered. Glasgow Outcome Scale Extended 6 months after injury, intensive care unit (ICU) length of stay, and monitoring-related complications were registered. Results:Intraparenchymal ICP monitoring group had a shorter duration of ICP monitoring (4.1±3.6 vs. 7.6±5.8 d, P<0.01). The ICU length of stay was similar in the 2 groups (15.6±11.8 vs. 17.9±13.2 d, P=0.15). Device-related complications were lower in the intraparenchymal group (10.7% vs. 32.8%, P<0.01), although more patients received surgical decompression (32% in intraventricular vs. 40.1 in intraparenchymal group, P=0.04). On multivariate logistic analysis, age, initial Glasgow Coma Scale score, and size of midline shift were independent predictors for mortality and unfavorable survival. Conclusions:Intraparenchymal pressure monitoring in patients with severe TBI is associated with shorter ICP monitoring, hospital length of stay, and less device-related complications compared with the intraventricular method.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"120–124"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883730","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000198
R. Shrestha, R. Pradhan, C. You
To the Editor: Multiple cerebral aneurysms have been increasing in frequency of discovery with the recent development of improved diagnostic techniques. They now account for about 10% to 30% of all cerebral aneurysms; dumbbell aneurysm remain extremely rare as reported in the literature. These aneurysms are technically difficult to approach, hence multidisciplinary teams require overcoming the challenge. Multiple aneurysms require special care in both diagnosis and surgical management. Dumbbell aneurysms often need individualized techniques for both. The magnetic resonance angiography, 3D-CT angiography, or rotatory digital subtraction angiography may be appropriate for detecting dumbbell aneurysms.
{"title":"Dumbbell-shaped Aneurysm: A Rare Entity","authors":"R. Shrestha, R. Pradhan, C. You","doi":"10.1097/WNQ.0000000000000198","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000198","url":null,"abstract":"To the Editor: Multiple cerebral aneurysms have been increasing in frequency of discovery with the recent development of improved diagnostic techniques. They now account for about 10% to 30% of all cerebral aneurysms; dumbbell aneurysm remain extremely rare as reported in the literature. These aneurysms are technically difficult to approach, hence multidisciplinary teams require overcoming the challenge. Multiple aneurysms require special care in both diagnosis and surgical management. Dumbbell aneurysms often need individualized techniques for both. The magnetic resonance angiography, 3D-CT angiography, or rotatory digital subtraction angiography may be appropriate for detecting dumbbell aneurysms.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"192-193"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61887129","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000138
S. Boyaci, K. Aksoy
Currently microdiscectomy is the standard treatment for the herniated lumbar disks. The aim of this study is to compare the long-term outcome of microdiscectomy versus sequestrectomy/free fragmentectomy for lumbar disk herniation and the effect of disk herniation type to reherniation. Disk herniations are classified into 3 categories: (a) fragment-fissure herniations, (b) fragment-defect herniations, and (c) fragment-contained herniations. Reherniation rate, annular competence, perioperative complications, operating time, the preoperative and postoperative Visual Analog Scale, Oswestry Disability Questionnaire, and the use of analgesics at the time of follow-up were compared. A total of 170 (78 sequestrectomy, 92 microdiscectomy) patients covered the inclusion criteria for study, and follow-up examinations were conducted completely. Reherniation rates did not differ significantly (2.56%, sequestrectomy; 4.34%, microdiscectomy; P>0.05). The highest recurrence rate was observed in the fragment-defect herniations group that received discectomy (10.8%). Self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, although they rather improved after sequestrectomy. Outcome measures at 2 years pointed in favor of sequestrectomy, with results being significant. Outcome after microdiscectomy seems to worsen over time, whereas it remains stable after sequestrectomy. The degree of annular competence seems to have effect on reoperation rate.
{"title":"Long-term Clinical Outcome of the Lumbar Microdiscectomy and Fragmentectomy: A Prospective Study","authors":"S. Boyaci, K. Aksoy","doi":"10.1097/WNQ.0000000000000138","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000138","url":null,"abstract":"Currently microdiscectomy is the standard treatment for the herniated lumbar disks. The aim of this study is to compare the long-term outcome of microdiscectomy versus sequestrectomy/free fragmentectomy for lumbar disk herniation and the effect of disk herniation type to reherniation. Disk herniations are classified into 3 categories: (a) fragment-fissure herniations, (b) fragment-defect herniations, and (c) fragment-contained herniations. Reherniation rate, annular competence, perioperative complications, operating time, the preoperative and postoperative Visual Analog Scale, Oswestry Disability Questionnaire, and the use of analgesics at the time of follow-up were compared. A total of 170 (78 sequestrectomy, 92 microdiscectomy) patients covered the inclusion criteria for study, and follow-up examinations were conducted completely. Reherniation rates did not differ significantly (2.56%, sequestrectomy; 4.34%, microdiscectomy; P>0.05). The highest recurrence rate was observed in the fragment-defect herniations group that received discectomy (10.8%). Self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, although they rather improved after sequestrectomy. Outcome measures at 2 years pointed in favor of sequestrectomy, with results being significant. Outcome after microdiscectomy seems to worsen over time, whereas it remains stable after sequestrectomy. The degree of annular competence seems to have effect on reoperation rate.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"109–115"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883289","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000136
A. Spina, N. Boari, F. Gagliardi, P. Mortini
Spontaneous intracranial hemorrhage is a major complication of anticoagulant therapy, with a report of 0.3% to 0.7% per year. Spontaneous posterior fossa acute subdural hematomas are very rare; to the best of our knowledge, only 10 cases have been previously reported in the literature. We report a further case with unusual radiologic findings in a thrombocytopenic and anticoagulated patient. We review the pertinent literature and discuss athe current management of this patho-
{"title":"Bilateral spontaneous acute subdural hematoma of the posterior fossa: Case report","authors":"A. Spina, N. Boari, F. Gagliardi, P. Mortini","doi":"10.1097/WNQ.0000000000000136","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000136","url":null,"abstract":"Spontaneous intracranial hemorrhage is a major complication of anticoagulant therapy, with a report of 0.3% to 0.7% per year. Spontaneous posterior fossa acute subdural hematomas are very rare; to the best of our knowledge, only 10 cases have been previously reported in the literature. We report a further case with unusual radiologic findings in a thrombocytopenic and anticoagulated patient. We review the pertinent literature and discuss athe current management of this patho-","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"154-157"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883596","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000139
Bekir Şanal, Mehmet Korkmaz, F. Can, E. Kacar, M. Işik, Y. Özkan
Herniated nucleus pulposus is the most commonly encountered condition in lumbar region. Herniated disk frequently occurs in the anterior epidural region. However, posterior migration of disk body is very rare because of the anatomic structure. When a mass is detected in the posterior epidural region, various etiological factors such as tumors, abscess, and cysts are generally taken into consideration in differential diagnosis other than disk herniation; however, posterior migration of the disk herniation has also similar appearance to these mentioned conditions. In this case report, we aimed to discuss differential diagnosis of 2 patients with sequestrated disk herniation in whom posterior epidural mass was observed in magnetic resonance imaging and to review the literature.
{"title":"Posterior Migration of Sequestrated Disk Herniation Mimicking Epidural Mass: 2 Case Reports","authors":"Bekir Şanal, Mehmet Korkmaz, F. Can, E. Kacar, M. Işik, Y. Özkan","doi":"10.1097/WNQ.0000000000000139","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000139","url":null,"abstract":"Herniated nucleus pulposus is the most commonly encountered condition in lumbar region. Herniated disk frequently occurs in the anterior epidural region. However, posterior migration of disk body is very rare because of the anatomic structure. When a mass is detected in the posterior epidural region, various etiological factors such as tumors, abscess, and cysts are generally taken into consideration in differential diagnosis other than disk herniation; however, posterior migration of the disk herniation has also similar appearance to these mentioned conditions. In this case report, we aimed to discuss differential diagnosis of 2 patients with sequestrated disk herniation in whom posterior epidural mass was observed in magnetic resonance imaging and to review the literature.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"158–161"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883343","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 : 2016-05-01DOI: 10.1097/WNQ.0000000000000142
R. Dolci, Marcelo Scapuccin, A. C. Cassanti, P.M.M. Filho, Américo Rubens Leite dos Santos, P. Lazarini
Brain abscess after rhinosinusitis is uncommon in clinical practice today, as a result of improvement in diagnosis as well as the increased use and efficacy of antibiotic treatment of rhinosinusitis. The role of expanded endoscopic endonasal approaches in treating skull base pathologies has significantly increased over the last decade, along with greater knowledge of the ventral anatomy of this region, offering a new method of brain abscess treatment. We present the case of a 24-year-old man with brain abscess secondary to acute sinusitis that was drained with an endoscopic endonasal approach. We discuss the pathogenesis, diagnosis, and appropriate treatment available in the literature.
{"title":"Endoscopic Endonasal Drainage of Cerebral Abscess: A Case Report and Revision of the Literature","authors":"R. Dolci, Marcelo Scapuccin, A. C. Cassanti, P.M.M. Filho, Américo Rubens Leite dos Santos, P. Lazarini","doi":"10.1097/WNQ.0000000000000142","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000142","url":null,"abstract":"Brain abscess after rhinosinusitis is uncommon in clinical practice today, as a result of improvement in diagnosis as well as the increased use and efficacy of antibiotic treatment of rhinosinusitis. The role of expanded endoscopic endonasal approaches in treating skull base pathologies has significantly increased over the last decade, along with greater knowledge of the ventral anatomy of this region, offering a new method of brain abscess treatment. We present the case of a 24-year-old man with brain abscess secondary to acute sinusitis that was drained with an endoscopic endonasal approach. We discuss the pathogenesis, diagnosis, and appropriate treatment available in the literature.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"223 1","pages":"162-165"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883454","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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