World Neurosurg
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Case Reports
A case of laterally extended high-positioned chordoma treated using the high cervical retropharyngeal approach.
Several surgical approaches for the treatment of pathologies of the craniovertebral junction (CVJ) and high cervical regions have been reported. For the best postoperative results, selection of a surgical route to treat such pathologies should be based on a complete understanding of the approach. ⋯ Our results indicate that the high cervical retropharyngeal approach is a reasonable option for pathologies located in the anterior or anterolateral portions of high cervical regions. This approach is an alternative to the transoral approach to the ventral CVJ and high cervical regions.
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Case Reports
Cross-modal recruitment of auditory and orofacial areas during sign language in a deaf subject.
Modern sign languages used by deaf people are fully expressive, natural human languages that are perceived visually and produced manually. The literature contains little data concerning human brain organization in conditions of deficient sensory information such as deafness. ⋯ The intraoperative setup for sign language mapping with intraoperative electrical stimulation in deaf-mute patients is similar to the setup described in patients with oral language. To elucidate the type of language errors, a sign language interpreter in close interaction with the neuropsychologist is necessary. Sign language is perceived visually and produced manually; however, this case revealed a cross-modal recruitment of auditory and orofacial motor areas.
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Spinal subdural hematoma is a rare clinical entity marked by the onset of pain and paralysis, which is usually associated with hemorrhagic disorders, trauma, and iatrogenic causes such as lumbar puncture or epidural anesthesia. ⋯ We report an extremely rare case of chronic spinal subdural hematoma associated with antiplatelet therapy. Spinal subdural hematoma should be considered as the differential diagnosis of gait disturbance in patients undergoing antiplatelet therapy. Early diagnosis and identification of the extent of the hematoma are necessary for successful treatment.
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Sex differences in various diseases recently have been recognized as an important factor in the approach to more efficient preventive and therapeutic medicine. We clarified sex differences in the clinical characteristics of chronic subdural hematoma (CSDH) by comparing men and women with CSDH, as there is a well-known male predominance in the prevalence of CSDH. ⋯ We demonstrated sex differences in the clinical characteristics of CSDH. In the future, management of patients with CSDH with regard to sex differences in disease characteristics could be expected to improve the outcomes of women, which have been worse than in men.
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The choice of appropriate treatment of discogenic low back pain (DLBP) frequently is difficult. This study sought to identify the clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty (PELAN) to treat patients with DLBP and to investigate prognostic clinical or radiologic variables. ⋯ PELAN provided favorable outcomes in patients with DLBP who were refractory to conservative treatments. Flexion pain was good prognostic, and Modic change was a poor prognostic variable.