Background:
Chordomas are malignant tumors that arise from the remnants of the notochord. Complete en bloc radical resection with postoperative radiation therapy is currently considered the gold standard. Here, we performed a 360-staged approach to manage a C3-C4 chordoma that involved the right vertebral artery.
Case Description:
A 40-year-old woman presented with a C3-C4 chordoma that invaded the right vertebral artery. She responded well to a circumferential approach including resection and stabilization.
Conclusion:
A 40-year-old woman with a C3-C4 spinal chordoma was optimally managed with a combined anterior/posterior surgical approach including decompression/fusion.
Introduction: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. Materials and Methods: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA; we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. Results: As a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 -75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity we found major prevalence of affection in the PA group. We didn't report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p < 0.05); and presented improvement compared with presurgical period (p < 0.001
Introduction. Stroke is the fourth leading cause of death in the United States and the leading cause of disability. Of these, carotid artery disease is responsible for up to 15% to 30% of strokes. The objetive is knowing the risk factors and their impact on four possible scenarios in the diagnosis and treatment of carotid artery disease. 1: significant stenosis measured by ultrasound Doppler carotid, 2: significant stenosis measured by diagnostic cerebral angiography, 3: plaque ulceration measured by angiography, and 4: carotid stent placement. Material and Methods. A retrospective study was carried out with 29 patients, 12 patients to whom was placed a carotid stent and 17 control patients, Odds ratio was calculated for risk factors: high blood pressure, diabetes, cancer, smoking and dyslipidemia. And then multivariate analysis was performed with the same variables. Results. For the risk factors with statistical significance for carotid ulcer were dyslipidemia and cancer, and for stent placement, smoking, and clinically presented as a transient ischemic attack. For the multivariate analysis, the only factor associated with stent placement was smoking. Conclusions. Of the entire range of risk factors associated with cerebrovascular disease, tobacco use is the factor most strongly associated with a patient with carotid disease ending up in endovascular treatment. So prevention or lifestyle modification is the best tool to avoid these outcomes.
Background:
Before the introduction of high-resolution MR, few disc fragments were misdiagnosed as meningiomas.
Case Description:
A 63-year-old female presented with a 6-month history of mild to moderate pain in the left arm, weakness 4/5 in the left arm C5-C6 distribution, and a loss of the left biceps reflex response. Although the MR study was read as showing a C5-C6 level probable spinal meningioma, this proved to be a sequestrated disc fragment at surgery.
Conclusion:
Rarely, cervical disc herniations may be misdiagnosed on MR studies as spinal meningiomas.
Background:
Choroid plexus papillomas (CPPs) are benign extra-axial tumors that originate from the choroid plexus; these tumors rarely have metastases, being at the spinal level the location with few reported cases.
Case Description:
We report the case of a 48-year-old man with a history of atypical fourth ventricular CPP and gross total resection (GTR) in 2008. In 2015, he presented with radicular pain, decreased strength, and paresthesia in the left leg. Magnetic resonance imaging revealed a well-defined intradural ovoid lesion in the vertebral canal at the level of the L3-L4 intersomatic space. Subtotal resection of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit. A literature research few cases of CPP metastasis in adults. We describe here a fifth-decade male patient with a lumbar neoplasm, which according to the histopathologic characteristics and location is the first case of an atypical papilloma implant of the choroid plexus at this spinal level.
Conclusion:
GTR of primary lesions and associated implants remains the gold standard for surgical treatment of CPP. Radiotherapy, stereotactic radiosurgery, and chemotherapy are adjuvant therapies for CPP but there is no definitive protocol for the management of implants. Proper follow-up of these patients is essential since spinal drop can appear many years after the initial presentation of CPP.
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