Neurosurgery
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Case Reports
Preliminary experiences with brachial plexus exploration in children: birth injury and vehicular trauma.
The application of microsurgical techniques to the peripheral nervous system has made possible the reconstruction of the brachial plexus after vehicular and penetrating injuries. We now report our preliminary experiences utilizing these same techniques in the microsurgical management of brachial plexus birth injury. In contrast to other authors and in distinction from our own experiences with vehicular trauma in children, we did not find lesions requiring reconstruction by grafting or neurotization in any of seven plexus explorations for birth injury. ⋯ All children with birth injuries of the brachial plexus require careful, repeated neurological evaluation during the first few months of life. Although the great majority make a rapid and satisfactory spontaneous recovery, the minority who do not recover are destined to suffer significant, life-long disability. Microsurgical brachial plexus exploration may benefit this select group of patients.
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A sneeze caused acute left arm pain in a 36-year-old woman with a lumboperitoneal (LP) shunt that had been placed 3 years earlier for relief of headaches caused by pseudotumor cerebri. Numbness progressed up the left arm, neck, and back of the head and finally into the left face along with weakness of the hand and arm. Magnetic resonance imaging (MRI) and computed tomography revealed new tonsillar herniation and a large eccentric syrinx extending from C2 to T6. ⋯ Pain lessened and motor function improved slightly. MRI revealed complete resolution of the syrinx and resolution of the tonsillar herniation. Theories of syringomyelia formation, the relationship to Chiari I malformation, and the implications of this case are discussed.
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A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. ⋯ The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.