Acta neurochirurgica
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Acta neurochirurgica · May 2003
Case Reports"Approaches and surgical results in the treatment of ventral thoracic meningiomas. Review of our experience with a postero-lateral combined transpedicular-transarticular approach.".
The surgical treatment of anterior thoracic meningiomas provides a set of technical difficulties: the access is obstructed by the spinal cord posteriorly, thoracic cage and musculature laterally, mediastinum and pleural cavity anteriorly. It is fundamental to avoid any manipulation of the compressed, but also undamaged spinal cord: this shows significant plastic capabilities. Any effort should be directed to maximizing the contribution of the plasticity in order to obtain a good functional recovery. ⋯ We found this surgical exposure very helpful in the treatment of anterior thoracic meningiomas. The related morbidity and risk of instability are minimal. The combined postero-lateral approach offers a good surgical access to ventral, lateral and dorsal aspects of the thoracic spinal canal without manipulation of the spinal cord. Exposure is obtained by avoiding damage to the pleura and manipulation of the lungs and mediastinum and may be a feasible alternative in elderly patients, too.
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Spinal subdural haematoma is a rare condition usually associated with several precipitating factors including coagulopathy, lumbar puncture, trauma, vascular malformation and previous spinal surgery. In this paper we report spinal subdural haematoma related to cranial surgery which is a previously unknown precipitating factor. ⋯ Spinal subdural haematoma is a rare but possible complication of cranial surgery. It should be considered in patients with back pain and radiculopathy in the lower extremity developing after surgery for intracranial lesions. Unlike spontaneous spinal subdural haematoma with other precipitating factors, spinal subdural haematoma developing after cranial surgery takes a benign clinical course and resolves spontaneously over several days to 2 weeks without surgical intervention.