Neurosurgery
-
To evaluate the applicability of low-field intraoperative magnetic resonance imaging (iMRI) during transsphenoidal surgery of pituitary macroadenomas. ⋯ The PoleStar N20 low-field iMRI navigation system is a promising tool for safe, minimally invasive, endonasal, transsphenoidal pituitary macroadenomas resection. It enables neurosurgeons to control the extent of tumor resection, particularly for suprasellar tumors, ensuring surgical accuracy and safety, and leading to a decreased likelihood of repeat surgeries. However, this technology is still not satisfying in estimating the amount of the parasellar residual tumor invading into cavernous sinus, given the false or uncertain images generated by low-field iMRI in this region, which are difficult to discriminate between tumor remnant and blood within the venous sinus.
-
We present a case of syringomyelia attributed to a transverse thoracic arachnoid web at T4. The cerebrospinal fluid pressure caudal to the web was higher than the cerebrospinal fluid pressure rostral to the web, causing a syrinx in the thoracic and cervical spinal cord above the web. ⋯ In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of a transverse arachnoid web. Surgical resection of a transverse thoracic arachnoid web with syringomyelia can result in resolution of the syringomyelia and improvement in neurological function. Syrinx formation in patients with these webs may occur in the area of the spinal cord where there is lower cerebrospinal fluid pressure, which may be either rostral or caudal to the arachnoid web. We evaluate this hypothesis by comparing our case with other published cases.
-
Developmental venous anomalies (DVAs), formerly known as venous angiomas, have become the most frequently diagnosed intracranial vascular malformation. DVAs are currently considered congenital cerebrovascular anomalies with mature venous walls that lack arterial or capillary elements. They are composed of radially arranged medullary veins, which converge in an enlarged transcortical or subependymal collector vein, and have characteristic appearances (caput medusae) on magnetic resonance imaging and angiography. ⋯ DVAs can coexist with cavernous malformations and arteriovenous malformations. Such combination or transitional forms of malformations might suggest common pathways in pathogenesis. Recent data support a key role for DVAs in the pathogenesis of mixed vascular malformations.
-
To evaluate the efficacy of radicular decompression in lumbar spinal stenosis using a microendoscopic technique. ⋯ Data indicate that, in our experience, on midterm follow-up, microendoscopic laminectomy decompression is an effective technique for the treatment of lumbar spinal stenosis.
-
The X-Stop Interspinous Process Decompression System (St. Francis Medical Technologies, Concord, CA) is an interspinous device used with increasing frequency in the treatment of degenerative lumbar spine conditions. To date, limited data are available on complications observed in association with X-Stop procedures, and even less information exists on their underlying causes. The aim of this study was to analyze a series of complications occurring at a single institution and their potential causes and propose an anatomic scoring system that may help to classify patients and prevent complications. ⋯ This is the first study focusing on interspinous distractor complications and the anatomic features of the SP and interspinous areas of the patients, which could potentially be the underlying causes for those complications. The X-Stop can be an effective treatment option, but it is not a panacea for all patients with degenerative lumbar spine conditions. Not only do the clinical indications deserve attention, but also, and most importantly, the patient's anatomic characteristics.