Spinal angiolipomas: A puzzling case and review of a rare entity.

Patients with spinal epidural abscesses (SEAs) may have a variable presentation. Such an infection has a typical appearance on magnetic resonance imaging (MRI) and enhances with gadolinium. We present a case that was a diagnostic challenge where pre- and intra-operative findings resulted in conflicting impressions. The mimicker was a spinal angiolipoma (SAL). The authors then provide a thorough review of this rare spinal neoplasm. A 55-year-old man presented with back pain, paresis, paresthesia, and urinary retention. MRI was indicative of a longitudinal epidural thoracic mass with a signal homogeneous to nearby fat, curvilinear vessels, and lack of enhancement. Although at emergent surgery, the lesion was found to contain abundant purulent material. Microbiology was positive for methicillin-resistant Staphylococcus aureus and consistent with SEA without evidence of neoplasia. While the imaging features were suggestive of an angiolipoma, the findings at surgery made SEA more likely, which were validated histopathologically. The diagnosis of SEA is often clear-cut, and the literature has reported only a few instances in which it masqueraded as another process such as lymphoma or myelitis. The case highlights SEA masquerading as an angiolipoma, and further demonstrates to clinicians that obtaining tissue diagnosis plays a crucial role diagnostically and therapeutically. SALs, on the other hand, are slow-growing tumors that can be infiltrating or noninfiltrating. They typically present with chronic symptoms and T1-MRI shows an inhomogeneous picture. Complete surgical excision is standard of care and patients tend to do well afterward.

Low intensity pulsed ultrasound (LIPUS) for the treatment of intervertebral disc degeneration.

Discogenic back pain presents a major public health issue, with current therapeutic interventions limited to short-term symptom relief without providing regenerative remedies for diseased intervertebral discs (IVD). Many of these interventions are invasive and can diminish the biomechanical integrity of the IVDs. Low intensity pulsed ultrasound (LIPUS) is a potential treatment option that is both non-invasive and regenerative. LIPUS has been shown to be a clinically effective method for the enhancement of wound and fracture healing. Recent in vitro studies have shown that LIPUS stimulation induces an upregulation functional matrix proteins and downregulation of inflammatory factors in cultured IVD cells. However, we do not know the effects of LIPUS on an in vivo model for intervertebral disc degeneration. The objective of this study was to show technical feasibility of building a LIPUS system that can target the rat tail IVD and apply this setup to a model for acute IVD degeneration. A LIPUS exposimetry system was built using a 1.0 MHz planar transducer and custom housing. Ex vivo intensity measurements demonstrated LIPUS delivery to the center of the rat tail IVD. Using an established stab-incision model for disc degeneration, LIPUS was applied for 20 minutes daily for five days. For rats that displayed a significant injury response, LIPUS treatment caused significant upregulation of Collagen II and downregulation of Tumor Necrosis Factor - α gene expression. Our preliminary studies indicate technical feasibility of targeted delivery of ultrasound to a rat tail IVD for studies of LIPUS biological effects.

Frameless deep brain stimulation surgery: a community hospital experience.

OBJECTIVE: Frame-based stereotaxy has regularly been utilized for deep brain stimulation (DBS) surgery. More recently, frameless neuronavigation has revealed similar outcomes for functional neurosurgical operations. Such comparable outcomes have been described by tertiary referral centers, but whether such excellent surgical outcomes are attainable in a community setting has yet to be reported. METHODS: Eighteen patients received frameless DBS surgery, 11 with subthalmic nucleus (STN) implantation for Parkinson's disease (PD) and 7 with ventral intermediate nucleus (Vim) implantation for essential tremor (ET). Their data was collected and analyzed, including the Unified Parkinson's Disease Rating Scale (UPDRS) and tremor scores. RESULTS: There was a 58% reduction in UPDRS III and a 47% reduction in overall levodopa dose in those with STN DBS (p<0.0001 and p<0.0005, respectively) and those with Vim DBS had a 76% improvement in their overall tremor rating score (p<0.002) at mean follow-up (8.2 and 10.1 months, respectively). No intraoperative complications occurred. Two subjects developed wound dehiscence post-operatively and another had fall-induced lead fracture, all treated with uncomplicated hardware replacement. CONCLUSIONS: Frameless DBS for PD and ET can be safely performed in a community setting with similar excellent outcomes as those of larger academic centers as well as clinical results comparable to frame-based surgery. Patients living in community or rural areas may not need to travel across city or even state lines to receive this surgical option, especially if they have the opportunity to receive it closer to home.