Delayed presentation of a thoracic aortic injury is an extremely rare complication after spine surgery. We report a case of delayed presentation of a thoracic aortic injury with a vertebral pedicle screw after posterior spinal surgery without periaortic hematoma, hemorrhage or pseudoaneurysm formation and review the relevant literature.
urgical access to the paraclinoid segment of the internal carotid artery is important to know for surgical treatment of aneurysms of the paraclinoid, carotid-ophthalmic and/or anterior cavernous segments of the inter
A 46-year-old woman presented a rare case of far-out syndrome caused by osteophyte formation between the transverse process and the sacral ala. Three-dimensional computed tomography demonstrated foraminal entrapment of the L5 nerve root through the osteophytes. The patient underwent posterior decompression by resection of the osteophytes and experienced good relief of radicular pain. Far-out syndrome should be considered in the presence of strong clinical symptoms of L5 radiculopathy which cannot be explained by L4-L5 disk herniation.F ar-out syndrome is caused by L5 nerve root entrapment at the L5-S1 extraforaminal area. 1 Extraforaminal entrapment of the fifth lumbar spinal nerve may be caused by various factors: lumbosacral ligaments, osteophythes of the vertebral bodies of the lumbosacral spine, or root compression between the transverse process of the last lumbar segment and the sacral ala. 2 Here, we present a 46-year-old woman in whom magnetic resonance imaging (MRI) findings showed L5-S1 foraminal stenosis and lumbar disk herniation at the same level, however, the detailed clinical and radiologic examination revealed to be a far-out syndrome. CASE REPORTA 46-year-old woman was admitted to our outpatient clinic with a 6-month history of left-sided severe leg pain in the distribution of the L5 nerve root. On neurological examination, she had 4/5 motor function of left extensor hallucis longus and hipoestesia of L5 dermatome. Tendon reflexes were normal. There was no incontinence of gaita or the urinary bladder.MRI revealed left L5-S1 posterolateral disk protrusion minimally compressing the left S1 root and right L5-S1 foraminal stenosis (Figs. 1A, B).Multiplanner-reformatted computed tomography (CT) scan showed moderate rotoscoliosis and fusion with the left transverse process of L5 with the sacral ala (Fig. 2).Surgical intervention was performed using a midline incision. It was noticed that the L5 transverse process and sacral ala were fused on the left side. Subtotal excision of the left L5-S1 facet joint was performed. The L5 root was explored and followed through its course outside the foramen. The peripheral bony structures were decompressed, partial drilling of the transverse process, inferior lateral part of the pedicle, and lateral sacral ala resection was performed (Fig. 3). Immediate pain relief was observed postoperatively. The postoperative course of the patient was uneventful; she was discharged 2 days after the operation. She returned to daily activities on the 16th day. DISCUSSIONFar-out syndrome, in which the L5 spinal nerve is pinched between the L5 transverse process and the sacral ala in spondylolisthesis, was first reported in 1984. 1 Anatomically, the L5 spinal nerve root can be compressed frequently by adjacent structures, osteophytes, or disk in the lateral and subarticular recesses of the spinal canal and intervertebral foramina. 3 In the present case, extreme degenerative changes with osteophyte formation occurred at the articulation between the transverse process of a transitional ...
Akciğer kanserinde gelişen sistemik tedavi seçenekleri nedeniyle yaşam süresi uzamakta ve bu nedenle beyin metastazı insidansı da giderek artış göstermektedir. Stereotaktik radyocerrahinin tek ve oligo (iki-dört adet) beyin metastazı tedavisinde kullanılmaya başlanması bu konuda hızlı bir tedavi alternatifi olmasını sağlamıştır. Takip ettiğimiz akciğer kanserine bağlı beyin metastazlı olgularda retrospektif olarak stereotaktik radyocerrahi tedavisi etkinliğini, stereotaktik radyocerrahi tedavisine yanıtın difüzyon manyetik rezonans görüntüleme (MRG) ile değerlendirmenin konvansiyonel MRG'ye ek yararını ve klinik parametreler arası ilişkileri değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Kliniğimizde akciğer kanseri tanısı ile takip edilen, Batı Kooperatif Onkoloji Grubu (ECOG) performans statüleri 0-1 ve 1-4 arası beyin metastazı olan, Ocak 2016-Aralık 2017 tarihleri arasında stereotaktik radyocerrahi gören 79 olgunun verileri retrospektif olarak incelendi. BULGULAR: Hastaların medyan tanı yaşı 59 yıl (43-78) bulundu. Difüzyon MRG'nin tedavi yanıtını değerlendirmede ek yararı saptanmadı. Küçük hücreli ve küçük hücreli dışı akciğer kanseri alt gruplarında istatistiksel anlamlı mortalite farkı görülmemiştir. Beyin dışı diğer organlara metastaz varlığı tüm sağ kalım süresini azaltmış ve istatistiksel olarak anlamlı bulunmuştur (p=0,042). TARTIŞMA ve SONUÇ: Akciğer kanserine bağlı gelişen beyin metastazlı olgular genetik ve histopatolojik olarak heterojen bir hasta grubundan oluşmaktadır. Çalışmamızda, sadece stereotaktik radyocerrahi uygulanan olgularda, çok değişkenli analiz sonucu beyin metastazı dışı metastaz varlığının tüm sağ kalım süresini olumsuz etkilediğini göstermiştir.
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