RESUMO
This case of a 68-year-old woman with a low-thoracic intramedullary neurenteric cyst is notable for clinical presentation, cyst location, intraoperative findings, and imaging characteristics. The patient's postoperative course was complicated by neurological deterioration and a neuropathic pain syndrome. Potential causes of these complications are discussed, as are possible ways to reduce the risk of their occurrence.
Assuntos
Bulbo , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/cirurgia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Doenças do Sistema Nervoso/etiologia , Defeitos do Tubo Neural/patologia , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias , Doenças da Medula Espinal/patologia , Vértebras TorácicasRESUMO
OBJECT: Spine surgeons have used intraoperative cortical and subcortical somatosensory evoked potential (SSEP) monitoring to detect changes in spinal cord function when intraoperative procedures can be performed to prevent neurological deterioration. However, the reliability of SSEP monitoring as applied to anterior thoracic vertebral body resections has not been rigorously assessed. METHODS: The authors retrospectively reviewed hospital charts and operating room records obtained between August 1993 and December 1998 and found that SSEP monitoring was used in 44 surgical procedures involving an anterior approach for thoracic vertebral body resections. There were no patients in whom SSEP changes did not return to baseline during the surgical procedure. Patients in four cases, despite their stable SSEP recordings throughout the procedure, were noted immediately postoperatively to have experienced significant neurological deterioration. The false-negative rate in SSEP monitoring was 9%. Sensitivity was determined to be 0%. CONCLUSIONS: It is important to recognize high false-negative rates and low sensitivity of SSEP monitoring when it is used to record spinal cord function during anterior approaches for thoracic vertebrectomies. The insensitivity of SSEPs for motor deterioration during anterior thoracic vertebrectomies is likely due to the limitation of SSEPs, which monitor only posterior column function whereas motor paths are conveyed in the anterior and anterolateral spinal cord. The authors believe that SSEPs can not be relied on to detect reversible spinal damage during anterior thoracic vertebrectomies.
Assuntos
Potenciais Somatossensoriais Evocados/fisiologia , Complicações Intraoperatórias/fisiopatologia , Monitorização Intraoperatória , Medula Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Córtex Somatossensorial/fisiopatologia , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
Previous reports describe the intraventricular, subarachnoid, and intraparenchymal use of thrombolytic agents. However, the use of thrombolytic agents in the management of extraaxial hematomas has not been described. Following the evacuation of a subacute subdural hematoma, this 48-year-old woman experienced declining neurologic function due to the reaccumulation of blood in the subdural space. Urokinase was administered via a subdural drain. The patient experienced rapid clinical improvement and radiographic resolution of the recrudescent subdural hematoma. If repeat surgical evacuation of a subdural hematoma is not possible, urokinase may be instilled into the subdural space to enhance drainage of a subdural hematoma.
Assuntos
Fibrinolíticos/uso terapêutico , Hematoma Subdural/tratamento farmacológico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Feminino , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/fisiopatologia , Humanos , Pessoa de Meia-Idade , Sistema Nervoso/fisiopatologia , Recidiva , Tomografia Computadorizada por Raios XRESUMO
Familial intracranial arteriovenous malformations (AVMs) are rare. We describe a father and son both presenting in childhood with cerebral AVMs. Both patients underwent successful surgical extirpation of the AVM. Familial AVMs present at a young age and tend to be multiple, as was the case in one of our patients. Imaging of asymptomatic family members may detect previously undiagnosed AVMs, and we recommend screening of the relatives of patients with a strong family history of such lesions.
Assuntos
Malformações Arteriovenosas/genética , Adolescente , Adulto , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors describe a case of paraspinal calcinosis in a 65-year-old woman with progressive systemic sclerosis. Although calcinosis occurs in up to 27% of cases of progressive systemic sclerosis, symptomatic paraspinal calcinosis is extremely rare. In the case reported here, multiple cervical facet joints were compromised by progressive calcinosis, leading to glacial spinal instability. Internal fixation was indicated to correct the instability and decompress the spinal canal. Medical therapy was instituted to arrest or reverse the ongoing calcinosis.
Assuntos
Calcinose/etiologia , Vértebras Cervicais , Escleroderma Sistêmico/complicações , Idoso , Calcinose/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Radiografia , Escleroderma Sistêmico/diagnóstico por imagemRESUMO
The authors report the case of a 55-year-old woman who developed a symptomatic craniopharyngioma within 2 years of obtaining a normal magnetic resonance image of her brain. Craniopharyngiomas are histologically benign tumors. They are thought to arise from embryonic remnants of Rathke's pouch and sac and to manifest themselves clinically after a steady growth that commences in fetal life. To the authors' knowledge, this is the first report that documents a tumor arising de novo in the sixth decade of life. This report appears to challenge the concept of the origin and natural history of craniopharyngiomas.
Assuntos
Craniofaringioma/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Craniofaringioma/patologia , Craniofaringioma/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgiaRESUMO
Six patients presented with either entrapped fourth ventricles or noncommunicating cerebrospinal fluid collections of the posterior fossa requiring drainage. These collections were treated with shunt systems whose proximal catheter was placed into the fourth ventricle via a coronal burr hole using an endoscope guided by Eleckta's ISG Viewing Wand. The technique and its advantages are described as are the complications and early outcomes.