OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.
The medical charts of 162 patients who had been subjected to brain tumor surgery between 1997 and 2005 in the Institute of Neurology Deolindo Couto were reviewed. Of the 162 patients subjected to cranial intervention, 5 (3.8%) had presented criteria for the dysembryoplastic neuroepithelial tumor. Two patients had tumor in the frontal lobe, 2 in the parietal lobe, and 1 in the temporal area. The age at seizure onset ranged from 2 to 17 years. The average duration of active epilepsy preoperatively was 4 to 22 years. A review of the literature was carried out and the histologic and radiologic aspects were commented upon. Correct histologic diagnosis is important, because dysembryoplastic neuroepithelial tumor presents an excellent prognosis, and they can be confused with other tumors. D ysembryoplastic neuroepithelial tumor (DNT) was first described in 1988, 1 and has been included in the revised World Health Organization (WHO) histologic classification of brain tumors in the category ''neuronal and mixed neuronoglial tumors,'' corresponding histologically to grade I. 2 The morphologic variant that was first described is characterized by (1) cortical topography; (2) multinodular architecture with nodules resembling astrocytomas, oligodendrogliomas, or oligoastrocytomas; (3) the presence of a specific glioneural element composed of columnar structures made of bundles of axons and oligodendroglial processes directed toward the axons, oriented in a pattern perpendicular to the cortical surface, and surrounded by an eosinophilic interstitial fluid (Fig. 1); and (4) foci of dysplastic cortical disorganization. 3 Two variants of DNT are described: the complex form, which was described previously, and the simple form, in which the specific glioneural element is the single component of the mass. There is also discussion about a nonspecific histologic form, in which the specific glioneural element does not exist, but in which all the following criteria must be associated: (1) partial seizures, with or without secondary generalization, beginning before age 20 years; (2) no neurologic deficit or presence of a stable and likely congenital neurologic deficit; (3) cortical topography of the lesion; and (4) no mass effect on computed tomography (CT) or magnetic resonance image (MRI), except if related to a cyst. 3 It is clinically a benign tumor, but some DNTs show signs of histologic malignancy (necrosis, mitosis, nuclear atypias, and cellular monstrosities); despite this, they maintain extremely benign biologic behavior. The characteristic presentation occurred in a young man (<20 y), with long-standing partial seizures, which were mostly of the partial complex type, drug-resistant, and disabling. 4 The histologic alterations produce thickening of the gyrus and grow into the white matter, forming a megagyrus, but not infiltrating the white matter. 4 The tumor is mainly located in the supratentorial area: 50% of the occurrence is in the temporal lobe, followed in frequency by the frontal lobe. It has been described in other locat...
Resumo Objetivo: O presente trabalho propõe uma técnica para realização de cranioplastia com metilmetacrilato em formas pré-moldadas e esterilizadas visando evitar cranioplastia com prototipagem pré-moldada. Método: Conforme rotina apresentada, o flap ósseo realizado para craniotomia descompressiva é armazenado em recipientes com formol e enviado para o serviço de patologia do hospital. Quando realizamos a cranioplastia, utilizamos o flap ósseo armazenado para realização dos moldes que serão utilizados na cranioplastia. Resultado: O resultado estético é muito bom e os índices de complicação e infecção são baixos. Conclusão: Apresenta resultados estéticos semelhantes aos casos de prototipagem com baixo custo na confecção.
Back surgery is an important treatment option yet a significant percentage have a poor outcome and may require either additional surgery, interdisciplinary treatment, or implantable devices to manage ensuing pain.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.