Acta neurochirurgica
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Acta neurochirurgica · Nov 2009
Significance of serial S100b and NSE serum measurements in surgically treated patients with spondylotic cervical myelopathy.
Predicting functional outcome following surgery performed for spinal cord compression is still a considerable problem. Recent observations, though, strongly suggest that with serial measurements of serum S100b, this might be possible in patients with subacute spinal cord compression. The aim of this study was to examine whether this potential significance of S100b applies as well to patients with spondylotic cervical myelopathy. A further purpose was to assess the value of NSE in this regard, another biochemical marker widely used to monitor cerebral lesions. ⋯ Serial S100b serum measurements do not permit prediction of functional outcome in patients with spondylotic cervical myelopathy in case of an uncomplicated postoperative course. In complicated courses with postoperative deterioration, such measurements reflect postoperative events with possibly prognostic relevance. NSE does not have any significance in these patients with chronic lesions of the spinal cord.
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Acta neurochirurgica · Nov 2009
Case ReportsMultidrug-resistant Acinetobacter baumannii ventriculitis: successful treatment with intraventricular colistin.
Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. ⋯ We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.
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Acta neurochirurgica · Nov 2009
Herniated nucleus pulposus in isthmic spondylolisthesis: higher incidence of foraminal and extraforaminal types.
The purpose of this study was to evaluate the pattern of disc herniation and to investigate the associated symptoms in cases of isthmic spondylolisthesis. It is well known that the pathogenesis of degenerative spondylolisthesis associates with disc degeneration, followed by facet laxity and ligamentum flavum hypertrophy, which result in severe spinal canal stenosis. But isthmic spondylolisthesis is known to have a different pathogenesis. In isthmic spondylolisthesis, pseudodisc bulging is easily identified, and canal stenosis is comparatively rare. Therefore, we propose that isthmic spondylolisthesis has a different pattern of disc herniation from degenerative spondylolisthesis. We studied the type, incidence of disc herniation and clinical symptoms related to isthmic spondylolisthesis. ⋯ As expected, pseudodisc bulging without disc herniation was the most common type in isthmic spondylolisthesis. However, in cases of disc herniation, extreme lateral disc herniation occasionally occurs; therefore, every isthmic spondylolisthesis patient should be examined carefully for extreme lateral disc herniation with thin-cut axial CT or MRI, especially when the patients complain of lateralizing symptom.
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Acta neurochirurgica · Nov 2009
Case ReportsTraumatic anterior communicating artery pseudoaneurysm with cavernous sinus fistula.
A traumatic carotid-cavernous fistula and an intracranial pseudoaneurysm are uncommon but well-known complications of head trauma. A rare subtype of arteriovenous fistula may occur from a pseudoaneurysm of the anterior communicating artery (AcoA) instead of the internal carotid artery. We describe a patient with a traumatic pseudoaneurysm of the AcoA with a cavernous sinus fistula treated with endovascular treatment. ⋯ The AcoA, left anterior cerebral artery and part of the pseudoaneurysm were obliterated by coil embolization. A postoperative angiogram showed no flow through the pseudoaneurysm and the cavernous sinus fistula. A traumatic AcoA pseudoaneurysm with a cavernous sinus fistula may occur as an extremely rare complication of head injury.
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Acta neurochirurgica · Nov 2009
Simple identification of the third segment of the extracranial vertebral artery by extreme lateral inferior transcondylar-transtubercular exposure (ELITE).
The exposure of the third segment of the extracranial vertebral artery (V3) is an important step in the extreme lateral inferior transcondylar-transtubercular exposure (ELITE) approach. The muscular suboccipital triangle provides one of the landmarks to identify the V3 segment; however, identification of this triangle and dissection of the V3 segment is not always straightforward in the actual surgery. Blind dissection below the level of the foramen magnum can lead to vertebral artery injury. While the surgeon may be able to readily define the V3 segment of the vertebral artery by feeling its pulse, it is important to have a safe systematic approach to finding the V3 segment when the vessel is illusive. We propose a simple method to identify the V3 segment avoiding accidental injury of the vertebral artery. ⋯ Identification of the V3 segment of the vertebral artery by systematically detecting the four anatomical points defined above is simple and much safer than a direct dissection below the foramen magnum.