Sciatica caused by pseudomyxoma peritonei.

Many etiologies may cause sciatica, and intra-abdominal masses usually affect the lumbosacral plexus by local invasion or distal metastases. Lumbosacral plexopathy caused by compression of intra-abdominal tumors instead of invasion is rarely seen. A 67-year-old woman had a 3-month history of progressive neurogenic claudication, lumbago and left L5 radiculopathy with foot drop. Nocturia and progressive abdominal distension with voiding dysfunction were also noted. Imaging studies showed a huge pelvic mass with severe compression of the left lumbosacral trunk. There was no direct invasion of the lumbosacral plexus by the pelvic mass noted in the preoperative imaging studies or intraoperative findings. Bilateral ovarian borderline mucinous cystic tumor with pseudomyxoma peritonei (PMP) was diagnosed, and the sciatica was improved dramatically after subsequent abdominal debulking surgery. Although rare, neural compression caused by PMP and intra-abdominal masses needs to be considered in the differential diagnosis of sciatica.

Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation.

BACKGROUND: A unique method of evacuation of hypertensive putaminal hemorrhage (HPH) using a stainless steel tube as a corridor under the assistance of a rigid endoscope is described. A simplified method to determine the precise location for burr hole placement is also reported. METHODS: From May 2003 to April 2004, 9 patients with HPH underwent endoscopic surgery in our hospital. Two different entry sites (temporal and frontal) were used to approach the hematoma in our series. RESULTS: The hematoma evacuation rate was more than 90% (median 93%) with the frontal approach and 84% with the temporal approach. CONCLUSIONS: Using a combination of a stainless steel tube, rigid endoscope, and coagulation suction with a frontal approach can facilitate optimal evacuation of HPH.

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. There were no surgical complications. Haematoma evacuation rates were greater than 90% (median of 93%). Six patients (87%) regained consciousness within one week. 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.