Cirsoid aneurysm of the scalp is one of the rarest occurrences in neurosurgery. It is an aneurysmal tumor formed by arteriovenous fistula of the arteries and veins of the scalp. 1 Atriovenous malformation (AVM) is formed due to abnormal communication between feeding arteries and draining veins with an absence of intervening capillary bed. It is predominantly congenital, but becomes apparent after a minor trauma, surgery (hair transplant, craniotomies) and scalp vein infusions. 2 Here, we present a case of cirsoid aneursym in a woman after trauma.
Background: Paresthesia is an abnormal dermal sensation with no apparent physical cause. One of the everyday practices in any oral surgery setup is the extraction of the impacted mandibular third molars surgically. Precise measurement of the bone present for support of the implant coronal to the inferior alveolar nerve (IAN) canal is the pertinent way to prevent IAN injuries. Objective: To assess the frequency of paresthesia due to IAN damage after mandibular third molar’s surgical extraction in patients with darkening of root on orthopantomogram. Material & Methods: It was a descriptive case series study which took place in the department of Oral and Maxillofacial Surgery at Sharif Medical and Dental College, Lahore in a time frame of 6 months i.e. from December 2020 till May 2021. After meeting the inclusion/exclusion criteria, 200 patients were made part of the study program. Informed consent and demographic information was recorded. Surgical procedure of all these patients was done. Assessment was done post-operatively first after one week when patient came for suture removal by inquiring about the subjective perception of abnormal feeling or sensation on lower lip and chin area. Patients were then reappointed for a follow-up visit after 1 month as well. Results: Patients’ mean age was 28.05±3.94 years. There were 104 (52%) males and 96 (48%) females in the study population. There were 38 (19%) patients of distoangular impaction, 39 (19.5%) had horizontal impaction, 55 (27.5%) had mesioangular impaction while 68 (34%) had vertical impaction. The IAN paresthesia after 1st month of surgery was found in 13 (6.5%) patients. Conclusion: According to this study, the frequency of paresthesia after 1st month of surgery was 6.5% due to IAN injury after mandibular third molar surgery in patients with darkening of root as observed on orthopantomogram. Keywords: Inferior Alveolar Nerve, Orthopantomogram, Paresthesia, Third Molar Surgery.
Yellow coloured, i.e. xanthochromic cerebrospinal fluid, with hypercoagulability and high protein con- tent is pathognomic of Froin's syndrome. We present a case of Froin's syndrome in a patient with spinal paraganglioma. A 55-year-old male patient presented with urinary hesitancy, numbness in lower limbs and difficulty in walking. During spinal anaesthesia, the anaesthetist noticed xanthochromic spinal fluid. Upon mag- netic resonance imaging lumbosacral, an intradural focal lesion of abnormal signal intensity extend- ing from T12-L1 vertebral level was seen. Laminectomy with excision of the mass was performed and a fleshy encapsulated mass was excised. Histopathology report showed the specimen to be a neoplastic lesion, and immuno-histochemical studies confirmed the mass to be a paraganglioma. This case emphasizes that in case of Froin's syndrome, one should think of spinal cord tumours while evaluating the patient. A magnetic resonance imaging of the spine should also be done to look for spinal pathology along with other investigations.
ABSTRACT… Objectives:In this study we analyze and study the effectiveness of pedicle screw and rod fixation for the management of unstable fractures of the thoracolumbar spine. The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 to September 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: N= 35 patients were operated at our institute and included in the study. The inclusion criteria was all those patients who presented to us with unstable fractures of the thoracolumbar spine via the accident and emergency department of the hospital, and were operated upon and gave full informed consent to partake in the research were included in this study. All the patients were operated under general anesthesia. The short segment fixation with pedicle screw rod fixation using the posterior approach was the technique utilized for treatment. Rehabilitation was started immediately after the surgical procedure. Data was analyzed using SPSS version 23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) were males and n= 10 (28.57%) were females, the mean age of the study population was 33.5 years. A history of fall from height was the most common cause of injury in n= 26 (74.28%) of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture was the most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O post operatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittal index values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (final follow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%) showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n= 1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show any improvement. The mean duration between injury and surgical intervention was 5.5 days with a range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. The most common complication observed was pressure sores in n= 4 (11.42%) and urinary tract infections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%) patients. Conclusion: According to the results of our study unstable burst fractures was the most prevalent type of fracture observed, there was a marked improvement in the radiological parameters post operatively, while the neurological improvement was decent. The technique of pedicle screw rod and fixation using the posterior approach provides good surgical outcome and better stabilization, with a fair amount of neurological improvement for these patients. Key words:Fractures; Pedicle screw fixation; rod instrumentation; thoracolumbar spine; traumatic injury. Article Citation: Jabbar FA, Hashim M, Khan AA, Ahmed S, Shah RA. Fracture of spine; Unstable fracture of the thoracolumbar spine, to determine the effectiveness of pedicle screw and rod fixation for manag...
Objectives: The aim of our study is to determine the outcome of cervical pediclescrew fixation for fractures/dislocations of the cervical spine at our set up in Karachi, Pakistan.Study Design: A prospective case series. Period: 04 years duration from January 2013 toDecember 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patientswho were included in the study signed a full informed consent. The inclusion criterion was allthe patients who cervical spine fracture/dislocation, presented to us within 24 hours of injuryand were operated at our set up. Data was collected in a predesigned proforma which includeda complete history and physical examination, age, gender, cause of injury, co morbidities, preoperativeradiological findings, past medical and surgical history. Serial X rays, MRI and CTscans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion andany complication such as deformity. The American Spinal Cord Injury Association impairmentscale was utilized in all the patients at follow ups to determine the sensory and motor functionimprovement post operatively. Data was analyzed using IBM SPSS for windows version 21.Results: The study population consisted of n= 40 patients of which n= 28 were male andn= 12 were female with a mean age of 45.2 years. The various types of injuries sustained bythe patients were as follows, n= 6 (15%) cases of cases had compression fractures (vertical),n=15 (37.5%) had flexion rotation injury and n=19 (47.5%) had flexion compression fracturesrespectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) hadcervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracturewith dislocation bilaterally along with compression fracture of the vertebral body, n= 14 (35%)patients had facet joint fracture with dislocation bilaterally and n= 6 (15%) had unilateral fracturedislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerveroot were not observed in any of the patients in this series, all the patients achieved full bonyfusion at the 6 month follow up as observed on radiographic images. We also did not find anyincidence of screw penetration into the pedicle, similarly no incidence of screw breakage orloosening was observed. N=24 patients with incomplete injury of the spinal cord showedimprovements in their ASIA impairment scale, the patients n= 15 who had a complete spinalcord injury failed to show any improvement post operatively, but reported some decrease in painand numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine thecervical pedicle screw is a reliable and effective method and provides good stability and bonyfusion. However the technique is dependent on surgeons experience and the extensive use ofpre-operative imaging to select the best insertion site of the screws as individualized for everypatient accordingly.
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