HRUS confirms clinically diagnosed CTS in about half of the patients with normal NCS.

No abstract

AIm:The study aimed to examine the position of three-dimensional (3D) neurosonography and the advantages and disadvantages of ultrasound-based neuronavigation in spinal cord tumour surgery. mAterIAl and methOds: During the period July, 2007-February 2011 patients with spinal cord tumours were operated in our neurosurgical clinic. All patients underwent intraoperative 3D neurosonography by means of SonoWandTM and SonoWand InviteTM ultrasound-based neuronavigation systems.results: Intraoperative 3D neurosonography was used for 6 intramedullary tumours (5 ependymomas and 1 astrocytoma) and 22 extramedullary tumours (8 neurinomas, 10 meningiomas and 4 filum terminale ependymomas). During the performed spinal tumour surgery, snapshots of the 3D images of the surgical situation were obtained. Post-operative results, based on the control MRI findings and the patients' score on Karnofsky Performance Scale, were evaluated during the third month after the surgery. COnClusIOn:Ultrasound-based neuronavigation is a promising tool in extramedullary tumour surgery, especially of meningiomas and neurinomas, ensuring better control on the extent of tumour excision. In patients with intramedullary tumours, however, the use of 3D neurosonography for more precise control on the extent of radical tumour excision is not possible. In general, ultrasound-based neuronavigation has not added much to the surgical management of spinal cord tumors. sOnuÇ: Ultrason tabanlı nöronavigasyon özellikle menenjiyomlar ve nörinomlar olmak üzere ekstramedüller tümör cerrahisinde ümit vadeden bir araçtır ve tümör eksizyonu miktarının daha iyi kontrolünü mümkün kılar. Ancak intramedüller tümörlü hastalarda 3D ultrasonografinin radikal tümör eksizyonunun daha iyi kontrol edilmesi için kullanılması mümkün değildir. Genel olarak ultrason tabanlı nöronavigasyon omurilik tümörlerinin cerrahi tedavisine fazla katkıda bulunmamıştır.AnAhtAr sÖZCÜKler: Omurilik cerrahisi, Omurilik tümörleri, İntraoperatif üç boyutlu (3D) nörosonografi, SonoWand ultrason tabanlı nöronavigasyon sistemi

Objective: To compare the effect of epidural steroid injections (ESI) in patients with discogenic sciatica (Sci) versus patients with lumbar canal stenosis (LSS), not controlled by conservative treatment. Materials and methods: In our study, 80 patients with Sci and 66 with LSS were included. A single ESI (10 mg dexamethasone in 3 cc 0.25% bupivacaine) was applied under fluoroscopic control: one level above the highest stenotic level, in the posterior epidural space, via interlaminar approach in LSS and at the prolapse level, in the anterior epidural space, via transforaminal route in Sci. Pain intensity was assessed by VAS at baseline and on days 1, 15 and 30 after intervention. Results: The procedure was successful in 78 Sci and 63 LSS patients. Patients with Sci responded significantly better. At one month, pain reduction over 50% was achieved in 63% (52.3–73.7% at p = 0.95) of Sci but only in 35% (23.2–46.8%) of LSS (p = 0.03). Return to pre-intervention level happened in 47% (34.7–59.3%) of LSS versus 14% (6.3–21.7%) of Sci patients (p = 0.01). In 5 patients the procedure failed, without resulting morbidity. Conclusion: ESI are more effective in patients with Sci than in single level LSS. In multiple level LSS, results are disappointing.

We report a 40-year-old female patient presenting with isolated left spinal accessory neuropathy that developed insidiously over 6 years. She complained of ill-defined deep neck and shoulder pain. On examination, prominent sternocleidomastoid and trapezoid muscle weakness and atrophy, shoulder instability, and lateral scapular winging were observed. MRI identified a small mass of the cisternal portion of the spinal accessory nerve. Its appearance was typical of schwannoma. Surgical treatment was not offered because of the small tumor size, lack of mass effect and the questionable functional recovery in the presence of muscular atrophy.Isolated spinal accessory neuropathy (SAN) is not uncommon after iatrogenic surgical injury of the accessory nerve (AN) during various procedures in the posterior triangle of the neck [1,2]. Less frequent aetiologies include traction injury, blunt or penetrating trauma, neuralgic amyotrophy, infection, or tumors involving the AN along its complicated course (intraaxially; intradurally in the high cervical segment of the spinal canal and at the foramen magnum; extradurally but intracranially, at the skull base/jugular foramen; extracranially, distal to the jugular foramen in the neck) [1,2]. Schwannomas of the AN are very rare and occur extracranially [3] or intracranially. The intracranial ones are further divided by location into intrajugular and intracisternal. Intrajugular masses result in jugular foramen syndrome and only occasionally present as isolated SAN [4].Intracisternal AN schwannomas are exceedingly rare and usually manifest by the mass effects they produce [3]. The patient we report is -to the best of our knowledge -the first with this type of neoplasm to present with isolated SAN.A 40-year-old female patient presented with poorly localized deep pain in the neck and left shoulder of 6 years duration. Her complaints were stationary over the last years, and she denied any other symptoms. There was no history of surgery or trauma to the neck. Examination showed prominent atrophy of the left trapezius and sternocleidomastoid (SCM) muscles (Fig. 1), drooping of the left shoulder and lateral scapular winging, accentuated by shoulder abduction.Muscle power testing (MRC scale) was 4/5 for the trapezius and 3/ 5 for the SCM. Abduction of the left arm was limited to 90 degrees. The rest of her neurological examination was normal. In particular, there was no evidence of tongue atrophy or asymmetry, the soft palate and uvula were symmetrical with preserved gag reflexes. Direct laryngoscopy was normal. Formal gustometry was not performed, but the patient denied any changes in taste sensation and testing for sour of the posterior third of the tongue (citric acid strip 16.5%) revealed no loss of taste. Clinical impression was of an isolated left spinal accessory neuropathy (SAN).Nerve conduction studies revealed normal latencies but markedly reduced compound muscle action potential amplitude of the left trapezius muscle (0.4 mV versus 6 mV on the right) (Fig. 2).Needle EMG examination...