Acta neurochirurgica
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Acta neurochirurgica · Oct 2010
Blunt craniocervical artery injury in cervical spine lesions: the value of CT angiography.
The awareness of traumatic craniocervical artery injuries has increased over the last years, and the detection rate varies in published trauma series. These injuries are often associated with cervical spinal and cranial trauma. The purpose of this prospective study was to determine the frequency and injury characteristics of blunt traumatic cervical artery injuries in patients suffering from cervical spine injuries by using a standardized CT angiography (CTA) protocol of the craniocervical vessels. ⋯ Craniocervical vessel injury is a life-threatening and underdiagnosed event in cases of cervical spine injury. CTA of the craniocervical vessels offers a fast, safe, and feasible method for detecting vascular injuries of the craniocervical region and allows prompt further treatment if necessary to reduce the risk of cerebral infarction. CTA of the craniocervical vessels is strongly indicated in cases of cervical spine trauma and in trauma mechanisms involving the cervical spine. Our data underscore the need for screening of blunt carotid and vertebral injury especially in injured cervical spine.
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Acta neurochirurgica · Oct 2010
An alternative projection for fluoroscopic-guided needle insertion in the foramen ovale: technical note.
Puncture of the ganglion Gasseri through the foramen ovale and subsequent thermocoagulation, balloon compression, or glycerin injection is a well-established technique to treat trigeminal neuralgia. However, direct puncture of the foramen is sometimes difficult. Here, the authors present a simple technique of improved biplane fluoroscopic control for insertion of the needle into the foramen ovale. ⋯ Experimentally and clinically, the new projection demonstrated three distinct advantages over the standard submental projection: Firstly, the foramen ovale can be better visualized independent of the patient's position. Secondly, needle correction or insertion can be performed much easier because of the direct fluoroscopic control. Thirdly, the correct needle position in the foramen ovale is more reliably determined than with the submental projection due to projection geometry. Further studies are needed to give evidence that the needle insertion into the foramen ovale is easier achieved with the coaxial projection than with the standard technique.
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Acta neurochirurgica · Oct 2010
Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy.
The neurological outcome of cervical spondylotic myelopathy (CSM) may depend on multiple factors, including age, symptom duration, cord compression ratio, cervical curvature, canal stenosis, and factors related to magnetic resonance (MR) signal intensity (SI). Each factor may act independently or interactively with others. To clarify the factors in prognosis, we prospectively analyzed the outcomes of patients with myelopathy caused by soft disc herniation in correlation with magnetic resonance imaging (MRI) findings and other clinical parameters. ⋯ Among the variables tested, preoperative neurological status and intramedullary signal intensity were significantly related to neurological outcome. The better the preoperative neurological status was, the better the post-operative neurological outcome. The SI grade on the preoperative T2WI was negatively related to neurological outcome. Hence, the severity of SI change and preoperative neurological status emerged as significant prognostic factors in post-operative CSM.
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Acta neurochirurgica · Sep 2010
A modified Roland-Morris disability scale for the assessment of sciatica.
The Roland-Morris disability scale (RMS) for disability secondary to low back pain is a validated and popular instrument in clinical practice and research. We have made a simple modification to the questionnaire to increase sensitivity to sciatica (RMS-L) and validated this in patients with lumbar disc prolapse and radiculopathy. ⋯ The original and modified RMS can discriminate disability due to low back pain and sciatica, respectively. Separate assessment of these symptoms and their contribution to functional impairment is useful in assessing suitability for surgery and predicting outcome.
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Acta neurochirurgica · Sep 2010
Case ReportsAdenocarcinoma of the prostate involving the lumbosacral plexus: MRI evidence to support direct perineural spread.
Prostate adenocarcinoma, which may recur despite aggressive treatment, has the potential to spread to the lumbosacral plexus. This intraneural involvement is not widely known and is thought to be from direct perineural spread. We hypothesized that high-resolution imaging could provide supportive evidence for this mechanism. ⋯ The potential for prostate adenocarcinoma to spread to the lumbosacral plexus has, to our knowledge, not been readily appreciated. Because the imaging findings are often subtle, we believe that intraneural lumbosacral plexus involvement may not be uncommon. This study, with the use of high-resolution MRI and PET/CT studies, supports the direct perineural spread of prostate adenocarcinoma via the pelvic plexus to the lumbosacral plexus. This mechanism could also explain cases of leptomeningeal and/or dural-based prostate metastases.