Background: The ventrally located intradural meningiomas in the thoracic spine are still considered a challenge for all spine surgeons. Many surgical approaches were developed to excise the lesion without violating the neural structures. They differ in their invasiveness, safety, and efficacy. One of these approaches is the postero-lateral combined transpedicular-transarticular approach (TPA-TAA). Patients and Methods: From January 2016 to December 2018, all patients with ventrally located thoracic meningiomas were operated on using the combined TPA-TAA. We evaluated all the patients preoperatively, immediate postoperative, and 6 months later. Clinical and functional outcomes were assessed using the muscle strength grade and the Nurick grading system. Magnetic resonance imaging was obtained for all patients postoperative and at 6 months later. Results: After 6 months, all patients experienced clinical and functional improvement. The mean muscle strength grade rose from 3.8 preoperatively to 4.8 after 6 months. According to the Nurick grading system, the mean preoperative grade was 4.4 and dropped to 1.8 after 6 months. Minor transient complications such as superficial wound infection and the cerebrospinal fluid leak were observed in 1 patient for each. Gross total tumor excision was achieved in all patients. No cases of tumor recurrence were noted during the follow-up period. Conclusions: This combined TPA-TAA is considered a safe and effective approach in excising ventrally located intradural thoracic meningiomas with minimal postoperative morbidities.
Background: Lower cranial nerve palsies, or Collet-Sicard syndrome, can be caused by many different etiologies including head trauma, basilar occipital fractures, tumors, and interventions. Few reports describe different presentations of this condition, and we present here a case study to increase awareness of and add to the variable spectrum. Case Description: A 56-year-old who had been hit while diving was admitted to our department. On examination, he was conscious without any signs of lateralization but presented with severe neck pain. CT brain and cervical spine revealed a C1 fracture with bilateral symmetrical fracture of the anterior and posterior arches (Jefferson’s fracture) and slight bilateral joint dislocation C1-C2 discreetly predominant on the left. One week later, he presented with dysarthria, dysphonia, swallowing disorder, anisocoria, tongue deviation, and palate deviation (XII, IX, and X). CT Angiography showed dissection of the internal carotid artery immediately after the carotid bulb. He has been treated conservatively with curative anticoagulants with stable symptoms. No surgical intervention had been proposed. Conclusion: Adding to the literature, delayed Collet-Sicard syndrome and lower cranial affection can be caused by missed carotid wall hematoma following severe craniocervical trauma associated with Jefferson’s fracture.
Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases. Patients and Methods: From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed. Results: Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up. Conclusions: The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
Background Data: Safe surgical resection of intradural schwannomas in the lumbar region is considered challenging. This is due to the proximity and sometimes the adhesiveness of these lesions to the cauda equina rootlets. Purpose: This article aims to evaluate the safety and efficacy of surgical excision of solitary lumbar intradural schwannomas with the excision of the affected rootlet. Study Design: A retrospective descriptive clinical case study. Patients and Methods: From January 2016 to January 2019, 20 patients presented with intraspinal intradural lumbar schwannoma were retrospectively included in this study. We evaluated all the patients preoperatively, immediately postoperatively, and after one month. The clinical and radiological outcomes were assessed. Results: The mean age of presentation was 39.45 years. The mean duration of preoperative complaint was 4.15 months. All patients presented with localized low back pain associated with radicular pain along the lower limbs according to the affected level, with some sort of voiding difficulties. The mean preoperative VAS was 8.95. No preoperative motor deficit was observed. Moreover, all lesions were solitary. Total gross resection with the division of the parent rootlet was achieved in 19 cases, and the patients showed postoperative significant pain reduction without any neurological deficit. Subtotal resection was achieved in 1 patient who had unsatisfactory pain relief. Minor complications were observed in the form of transient CSF leak in 1 case and transient superficial wound infection in 2 cases. Conclusion: Total microsurgical excision of solitary intradural intraspinal schwannoma below the level of thoracolumbar junction with the resection of the parent rootlet is considered safe and effective. (2021ESJ232)
BACKGROUND:The cornerstone of definitive therapy of cerebral mass lesions is accurate diagnosis. Stereotactic brain biopsy is a commonly used tool for diagnosis of cerebral intra-axial mass lesions with reported high diagnostic yield. OBJECTIVE:The aim of the study was to assess the diagnostic yield and accuracy of stereotactic brain biopsy (SBB) in individuals with intra-axial mass lesions. METHODS:This study comprised 200 individuals (128 males and 72 females) with intra-axial mass lesions (170 single lesions and 30 multiple lesions) with an average age of 52.8 years. Between 2005 and 2014, stereotactic image-guided (126 magnetic resonance imaging (MRI) and 74 computerized tomography (CT)) biopsies for histological verification were done at
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