Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct.
The treatment of C1 Jefferson fractures is controversial. Non-surgical treatment with halo fixation always bears the risk of insufficient healing with further instability and increasing neck pain. However, a C1-2 fusion can markedly decrease the rotatory motion of the neck. ⋯ We used open reduction and C1 fixation using a bilateral C1 lateral mass screw construct. The screws were connected with a rod and nuts to reduce lateral spread of the lateral masses. This method is an alternative surgical option for C1 Jefferson fractures in select patients and can maintain important C1-2 joint motion.
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Case Reports
An endoscopic endonasal approach for the surgical repair of transsphenoidal cephalocele in children.
Transsphenoidal cephalocele is a rare lesion traditionally managed by either an intracranial approach or by a combined intracranial and extracranial approach. A two-year-old boy presented with a transsphenoidal cephalocele manifesting as apneic-cyanotic spells accompanied by breathing difficulties due to nasal obstruction after birth. Neuroimaging revealed a cystic mass extending from the pituitary fossa into the nasopharynx through the sphenoid sinus. ⋯ The patient developed mild diabetes insipidus after surgery. Follow-up evaluation demonstrated resolution of the preoperative symptoms without lasting morbidity. This procedure is safe, less time consuming than the transcranial approach, and efficacious.
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Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively. ⋯ Multivariate analysis showed that a history of coronary artery bypass/stent procedure, chronic renal disease or preoperative opioid use had a significant impact on length of stay and hospital charges in unemployed spine surgery patients. Thus, unemployment in spinal surgery candidates is associated with higher comorbidity rates with a significant impact on healthcare cost. More research is needed into the relationship between unemployment and consumption of healthcare resources.
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Dural arteriovenous fistulas (DAVF) of the cavernous sinus most commonly present with ocular symptoms and can be observed or treated with endovascular approaches, surgery, or radiosurgery. Combined surgical-endovascular approaches have been used for fistulas that are not amenable to standard endovascular approaches. A 40-year-old man presented with ocular symptoms from a cavernous sinus DAVF. ⋯ Subsequently he underwent coiling and onyx embolization of the DAVF. The intervention resulted in effective obliteration of the fistula. If a cavernous sinus DAVF is refractory to treatment, surgical exposure and cannulation of a cortical draining vein can facilitate transvenous endovascular treatments.