Journal of neurosurgery
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Journal of neurosurgery · Sep 2002
Case ReportsDe novo formation and rupture of an aneurysm. Case report.
The authors describe a case of de novo formation and rupture of an aneurysm located at the junction of the left internal carotid artery and the superior hypophyseal artery in a middle-aged woman 2 months after another aneurysm, located on the anterior communicating artery, had been clipped. This case is rare because of the short interval between the last angiographic study performed at the first operation and the diagnosis of the de novo aneurysm; in this case the interval was only 47 days, compared with other cases in the literature in which the intervals were 3 to 34 years. Aneurysms can enlarge considerably in 2 to 4 weeks and can rupture at or soon after their formation. This case provides insight into aneurysm formation and rupture.
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Journal of neurosurgery · Sep 2002
Fractures of the thoracolumbar spine complicating ankylosing spondylitis.
In this clinical review of ankylosing spondylitis, the authors emphasize the fragility of the spine and the degree of neurological deficit that can result from minor injury. The management of thoracolumbar fractures complicating ankylosing spondylitis is discussed. ⋯ Patients with ankylosing spondylitis are at risk of injury, particularly extension fractures of the thoracic and lumbar spine. The incidence of trauma-induced neurological deficit is by no means negligible. Management consists of surgery in patients with vertebral instability and neural compression, and recumbency in those with stable fractures.
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Journal of neurosurgery · Sep 2002
Case ReportsThoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult. Case report.
Diastematomyelia is a rare entity in which some portion of the spinal cord is split into two by a midline septum. Most cases occur in childhood, but some develop in adulthood. A variety of concurrent spinal anomalies may be found in patients with diastematomyelia. ⋯ Numerous spinal lesions can be found in conjunction with diastematomyelia. To the authors' knowledge, this is the first case in which a thoracic epidermoid cyst and cervical syrinx occurred concurrently with an upper thoracic diastematomyelia. Thorough neuraxis radiographic evaluation and surgical treatment are usually indicated.
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Journal of neurosurgery · Sep 2002
Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system.
The authors studied a consecutive series of patients with spinal stenosis in whom surgery was performed by a single surgeon who used a microscopic tubular retractor system (METRx-MD); patients underwent prospective evaluation involving radiography and magnetic resonance (MR) imaging. The objective was to assess the feasibility and surgery-related efficacy of performing unilateral-approach bilateral decompression and utilization of METRx-MD instrumentation in patients with spinal stenosis. ⋯ Minimally invasive bilateral decompression and instrumentation-assisted fusion can be successfully performed via a unilateral approach in patients with acquired spinal stenosis; the procedure can be undertaken on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity rates.
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Journal of neurosurgery · Sep 2002
Case ReportsDe novo dissecting aneurysm in a patient with a ruptured saccular lesion. Case report.
Formation of a new saccular aneurysm after successful treatment of ruptured aneurysm has recently raised significant clinical concerns; however, de novo formation and rupture of a dissecting aneurysm has not been discussed. The authors report on a 42-year-old man who initially sought treatment for a ruptured saccular aneurysm of the right middle cerebral artery, which was successfully eliminated by surgical clipping of the aneurysm neck. Two years later, the patient presented with another subarachnoid hemorrhage and was found to have a dissecting aneurysm of the right vertebral artery, which arose from a previously angiographically documented normal artery. This rare association sheds light on the causes and growth of two distinct types of aneurysms, both clinically and pathologically.