Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Spontaneous chronic spinal subdural hematoma associated with spinal arachnoiditis and syringomyelia.
Spontaneous chronic spinal subdural hematoma is rare. We describe a case of spontaneous chronic spinal subdural hematoma associated with arachnoiditis and syringomyelia in a 76-year old woman who presented with a 14-year history of progressive myelopathy. MRI scan revealed a thoraco-lumbar subdural cystic lesion and a thoracic syrinx. ⋯ Pathological examination revealed features consistent with chronic subdural membrane. This report attempts to elucidate the pathogenesis of chronic spinal subdural hematoma. We discuss possible etiological factors in light of the current literature and pathogenesis of both spinal subdural hematoma and syrinx formation.
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Case Reports
A stainless steel sheath for endoscopic surgery and its application in surgical evacuation of putaminal haemorrhage.
A stainless steel tube was used as an endoscope sheath in combination with a working channel endoscope to evacuate hypertensive putaminal intracerebral haematoma (ICH). A frontal entry point ipsilateral to the haematoma was selected for insertion of the sheath. From January to June 2004, seven patients with putaminal ICH underwent endoscopic surgery in our hospital. ⋯ Six patients, including four who had no residual disability and two who had moderate disability, were able to function independently. One patient remained in a persistent vegetative state at clinical follow-up after 6 months. Use of a stainless steel endoscopic sheath combined with working channel endoscopy via a frontal approach facilitates evacuation of putaminal ICH.
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To document the value of cingulotomy for pain relief, a series of 22 patients with medically intractable pain, including 15 with cancer pain and seven with non-cancer pain, underwent stereotactic bilateral anterior cingulotomy, between August 2001 and December 2002. Of the 15 patients with cancer pain, significant or meaningful pain relief was achieved in 67% of patients at one month follow-up, which decreased to 58% at three months and 50% at six months. Of the seven patients with intractable pain from non-neoplastic origin, four achieved significant pain relief, one obtained meaningful relief, and two reported no change at one year follow-up. ⋯ Two patients developed transient confusion and another two had mild gastrointestinal bleeding. No clinically evident personality or emotional changes were noted. However, subtle cognitive impairment, especially attentional deficits, were detected through detailed neuropsychological evaluation.