Surgical neurology international
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The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically. ⋯ Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies.
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Meningioma firmness is a critical factor that influences ease of resection and risk, notably when operating on tumors intimate with neurovascular structures such as the mesial sphenoid wing. This study develops a predictive tool using preoperative magnetic resonance imaging (MRI) characteristics to determine meningioma consistency. ⋯ This tool using T1 and T2 series predicts meningioma consistency. Such knowledge should assist the surgeon in preoperative planning and counseling.
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Case Reports
Traumatic retroclival epidural hematoma in pediatric patient-Case report and review of literature.
Retroclival epidural hematoma (REDH) is a very rare entity in the practical field of neurosurgery. Only a few cases have been reported in literature. The authors present to you case of a 12-year-old female, a victim of road traffic accident (RTA), who had presented to us with loss of consciousness and seizures. ⋯ Very few cases of REDH have been reported in pediatric population to date. It should be suspected in children with head and neck injuries who have been a victim of RTAs. Most likely underdiagnosed due to its rarity; therefore, MRI should be considered when the suspicion is high. Atlanto-occipital dislocation should always be kept under consideration in all cases, and therefore should be managed and monitored very cautiously. In this report, the authors also present concise review of the literature pertaining to the pathogenesis and management of this rare clinical entity which has a high likelihood to be encountered and underdiagnosed by neurosurgeons in Emergency Room.
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Although the frequency of spinal surgical procedures has been increasing, particularly in patients of age 65 and over (geriatric), multiple overlapping comorbidities increase their risk/complication rates. Nevertheless, sometimes these high-risk geriatric patients are considered for "unnecessary", too much (instrumented fusions), or too little [minimally invasive surgery (MIS)] spine surgery. ⋯ Increasingly, spine operations in geriatric patients with multiple comorbidities are sometimes "unnecessary", offer too much surgery (instrumentation), or too little surgery (MIS).