Trans-Pars Interarticularis Approach for Lumbar Interbody Fusion: An Efficient, Straightforward, and Minimally Invasive Surgery for Lumbar Spondylolisthesis and Stenosis.

PURPOSE: Lumbar interbody fusion is a commonly applied surgical treatment for spondylolisthesis. For this procedure, various minimally invasive approaches have been developed, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), oblique lumbar interbody fusion, and anterior lumbar interbody fusion. OBJECTIVE: In this study, we characterized the features of a minimally invasive (MIS) trans-pars interarticularis approach for lumbar interbody fusion (TPLIF) and compared its surgical outcomes with those of MIS-TLIF. METHODS: This study included 89 and 44 patients who had undergone MIS-TPLIF and MIS-TLIF, respectively, between September 2016 and December 2022. The following clinical outcomes were analyzed: operative time, blood loss, and hospitalization duration. RESULTS: For the MIS-TPLIF and MIS-TLIF groups, the average operative time, blood loss, and hospitalization duration were, respectively 98.28 and 191.15 min, 41.97 and 101.85 mL, and 5.8 and 6.9 days. CONCLUSION: The MIS-TPLIF approach for lumbar spondylolisthesis or other degenerative diseases involves the use of the commonly available and cost-effective instrument Taylor retractor, thus enabling posterior lumbar interbody fusion to be performed with minimal invasion. This approach also confers the benefits of a short learning curve and an intuitive approach. Our results suggest that although MIS-TPLIF is noninferior to MIS-TLIF, it is easier to learn and perform than MIS-TLIF.

Combining Laminoplasty With Artificial Disc Replacement for the Treatment of Cervical Spondylotic Myelopathy With Congenital Cervical Stenosis.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a very common and devastating spinal disease. Congenital cervical stenosis (CCS) is the most common cause. We aimed to elucidate the security, effectivity, and feasibility of surgery combining laminoplasty with artificial disc replacement (ADR) to treat CSM patients with radiculopathy, especially for preserving the range of motion (ROM) of the cervical spine. METHOD: Between August 2008 and April 2019, 39 patients with multiple CSM caused by CCS were enrolled in the present study. All patients received laminoplasty first and then ADR. We used a retrospective collection of data for evaluating the functional and radiologic outcomes, especially regarding preservation of ROM. RESULTS: Each patient underwent at least a 2-year postoperative follow-up. The Japanese Orthopedic Association score showed great improvements at 6 months. The ADR index-level ROM was preserved during follow-up. The subaxial Cobb angle could also be retained in the whole cervical spine, and the spinal canal diameter could be expanded by more than 52.6%. There were no severe complications or side effects, and no patients needed secondary surgery. CONCLUSIONS: We aimed to treat multiple levels of CSM with adequate decompression without too many intervertebral disc replacements. We were able to expand the spinal canal directly for these patients with CCS and needed only 1- or 2-level ADR to treat them with associated radiculopathy. This combined surgical strategy was secure, effective, and was able to preserve the ROM of the cervical spine.

Brain abscess caused by Parvimonas micra: A rare case report and literature review.

Brain abscesses mostly develop due to direct infection caused by a nearby infectious lesion or hematogenous spread and are rarely caused by an odontogenic infection. We report a 47-year-old woman who presented with high fever, disturbed consciousness, headache, and neck pain. Imaging studies revealed a ring-shaped enhanced mass in the left frontal lobe causing a mass effect and midline shift. Magnetic resonance spectroscopy revealed a peak alanine concentration of 1.5 ppm. Supraorbital keyhole surgery with abscess removal was performed, and a bacterial culture confirmed a diagnosis of Parvimonas micra infection. After undergoing 6-week antibiotic treatment, the patient's symptoms resolved completely. No recurrence of abscess was observed during the follow-up period. Although brain abscess caused by P. micra has rarely been reported, an odontogenic origin should be investigated, especially when a patient has a history of periodontal infection or tooth extraction.

Cystic artery pseudoaneurysm: A case report.

BACKGROUND: Cystic artery pseudoaneurysm is a condition rarely encountered by clinicians; this, its etiology and presentation as well as appropriate treatments are not well studied. Although it is treated by removal of the diseased gallbladder and cystic artery, such surgery can be difficult and risky if acute inflammation with bleeding occurs, and not every patient can tolerate the surgery. CASE SUMMARY: An 81-year-old man complained of epigastric pain and tarry stool passage that lasted for 3 d. He had a medical history of poor cardiopulmonary function. The computed tomographic scan of abdomen showed cystic artery pseudoaneurysm and dilatation of gallbladder. Because of high adverse outcomes related to general anesthesia, the patient was successfully managed with endovascular embolization for this cystic artery pseudoaneurysm and percutaneous drainage for the distended gallbladder. CONCLUSION: A patient with cystic artery pseudoaneurysm may quickly deteriorate with the occurrence of concurrent arterial bleeding and sepsis. This report presents the case of a patient who did not undergo surgery due to multiple cardiopulmonary comorbidities and whose condition was managed successfully with embolization and biliary drainage. Endovascular embolization and biliary drainage may provide an alternative option to manage this complicated condition.

Supratentorial hemangioblastoma: A rare case report and literature review.

Hemangioblastomas are rare and benign tumors of the central nervous system. They account for 1.5%-2.5% of all intracranial tumors and have an incidence of 3.2%. The resemblance of hemangioblastomas to other tumors renders preoperative diagnosis and management challenging. Herein, we report a case of a supratentorial hemangioblastoma accompanied by extensive reactive gliosis and diagnosed through magnetic resonance imaging. In addition, we review the relevant literature.

Two-dimensional C-arm robotic navigation system (i-Navi) in spine surgery: a pilot study.

PURPOSE: Pedicle screws placement is very common procedure in spinal surgery. Robotic assisted surgery has been widely used in this operation. We assessed the accuracy of thoracolumbar spine trans-pedicle screws (TPS) implantation utilizing a noval robotic navigation system (i-Navi robotic navigation system) by planning with two-dimensional (2-D) C-arm. METHODS: This study was approved by the Institutional Review Board of the Cathay General Hospital on June 21, 2018 (IRB number: CGH-P 106,092), and written informed consents were obtained from all the patients. There are 18 patients were enrolled in the study. All the patients received the posterior fusion with TPS insertion under the assistant of our robotic navigation system. RESULTS: There are 18 patients were included into our study, there are 2 patients were quitted from the study due to the equipment setup was not complete. Other 16 patients completed the entire procedure successfully. There is total 88 pedicle screws were inserted through i-Navi robotic navigation system. There are 79 of 88 screws were graded A, and 9 screws were graded B; no screws were graded C or D. No vascular or nerve injuries were noted after the operations. CONCLUSION: We present our i-Navi robotic navigation system, by planning with 2-D C-arm imaging and pre-operative CT scans. According to the results of study, we think it can provide a reliable and easy tool to perform the TPS in thoracic lumbar spine surgery.

Pneumatosis intestinalis after systemic chemotherapy for colorectal cancer: A case report.

BACKGROUND: Pneumatosis intestinalis (PI), also known as intramural gas in the small intestine, is a rare condition encountered by patients with cancer after receiving chemotherapy. CASE SUMMARY: A 78-year-old man with a history of colorectal cancer developed epigastric pain and diarrhea after receiving combination chemotherapy of fluorouracil, leucovorin, irinotecan, and cetuximab. Abdomen radiography revealed intramural air in the small intestinal wall. A computed tomography scan of the abdomen revealed the features of PI with air expanding into the mesentery. After surgery, the patient remained symptom-free throughout a 9 mo follow-up period during which he received chemotherapy of fluorouracil, leucovorin, and irinotecan. CONCLUSION: Although chemotherapy-induced PI is rare among patients with cancer, the differential diagnosis of PI and fulminant complications (such as ischemia, infarction, and perforation of the gastrointestinal tract) should be conducted, in which case an urgent surgical intervention is required.

Extrahepatic pseudocyst in an adult.

Ventriculoperitoneal (VP) shunts are commonly used in neurosurgical procedures to treat hydrocephalus. Although shunt-associated abdominal complications are well documented, extrahepatic pseudocysts are a rare shunt complication in adult patients. Therefore, we herein report the case of a 54-year-old male patient who presented with a bulging mass around the previous surgical site at the right upper quadrant of the abdomen. He had a 4-year history of VP shunt surgery for posthemorrhagic hydrocephalus. A computed tomographic scan revealed a large extrahepatic pseudocsyt. Our case represented a rare entity of extrahepatic pseudocyst in adult patients underwent VP shunt surgery. The clinical presentation, diagnostic tools, and treatment methods were discussed.

Accuracy and Safety of Using Customized Guiding Templates for Cervical Pedicle Screw Insertion in Severe Cervical Deformity, Fracture, and Subluxation: A Retrospective Study of 9 Cases.

OBJECTIVE: To assess accuracy and safety of self-developed customized guiding templates for cervical pedicle screw (CPS) insertion surgery. METHODS: From July 2016 to December 2017, 57 screws were implanted in 9 patients with the assistance of customized guiding templates. Customized guiding templates were manufactured from acrylonitrile-butadiene-styrene plastic material using a three-dimensional printer after establishing pedicle screw trajectories for each vertebra with the assistance of a virtual surgical planning software program, developed by our team, for the insertion of CPSs. RESULTS: CPSs were evaluated using the following grading system: grade 0 (contained), grade 1 (exposure), grade 2 (perforation), and grade 3 (penetration). Each patient underwent postoperative computed tomography to evaluate accuracy of screw position. Of 57 screws, 54 were graded 0, and 3 were graded 1; no screws were graded 2 or 3. No vascular or nerve injuries were noted after the operations. CONCLUSIONS: CPSs, which provide strong biologic strength, are especially suitable for treating osteoporosis and severe deformity. However, CPS insertion remains a challenging procedure with high incidences of vascular and nerve injuries reported. The results of this study indicate that use of customized guiding templates can improve safety of CPS insertion surgery.

Impact of Intraoperative 3-Dimensional Volume-Rendering Rotational Angiography on Clip Repositioning Rates in Aneurysmal Surgery.

OBJECTIVE: Three-dimensional (3D) rotational angiography (RA), a gold standard imaging tool for the evaluation of cerebral aneurysms after clipping, can currently be performed intraoperatively in a hybrid operating room (OR). However, its role in intraoperative aneurysmal surgery is unclear. We aimed to study the value of intraoperative 2-dimensional digital subtraction angiography (2D-DSA) and 3D-RA for the evaluation of aneurysms after clipping, in terms of clip repositioning. METHODS: We included patients with cerebral aneurysms who were treated with microsurgical clipping in a hybrid OR. After aneurysmal clipping and indocyanine green video angiography assessment, intraoperative 2D-DSA and 3D-RA with volume-rendering (VR) images of the clipped aneurysm were obtained. The incidence rate of clip repositioning was determined, and aneurysm-related factors associated with suboptimal clipping that required clip revision after intraoperative angiography evaluation were analyzed. RESULTS: Between September 2016 and August 2017, 24 consecutive patients with 35 aneurysms were treated with microsurgical clipping. A clip repositioning rate of 17.1% was revealed after intraoperative 3D-VR imaging and initial indocyanine green-video angiography. 3D-VR was able to demonstrate all aneurysmal remnants, whereas 2D-DSA helped confirm flow stagnation in compromised vessels. Challenging aneurysms of size >7 mm (P = 0.043) and neck width >4 mm (P = 0.012) were significantly associated with a higher incidence of suboptimal aneurysmal clipping. CONCLUSIONS: A hybrid OR, with angiography facilities for high-resolution 2D-DSA and 3D-VR images, allows neurosurgeons to perform high-quality surgery. The routine use of intraoperative 3D-RA may not be necessary; however, it is invaluable for treating challenging aneurysms.

Polygala tenuifolia extract inhibits lipid accumulation in 3T3-L1 adipocytes and high-fat diet-induced obese mouse model and affects hepatic transcriptome and gut microbiota profiles.

Obesity, the excessive accumulation of lipids in the body, is closely associated with many prevalent human disorders. Continued efforts to identify plant extracts that exhibit anti-obesity effects have drawn much attention. This study investigated whether a Polygala tenuifolia extract (PTE) possesses anti-obesity activity and how PTE may affect liver gene expression and gut microbiota. We used 3T3-L1 adipocytes and a high-fat diet-induced obese mouse model to determine the effects of PTE on lipid accumulation. Next-generation sequencing analysis of liver gene expression and gut microbiota profiles following PTE treatment were conducted to elucidate possible mechanisms. We found that treatment of fully differentiated 3T3-L1 adipocytes with PTE inhibited lipid accumulation in the cells through reducing lipid formation and triglyceride content and by increasing lipase activity. No cytotoxicity was observed from the PTE treatment. After 5 weeks of treatment with PTE, the increased body weight, elevated serum triglyceride content, and liver steatosis in the high-fat diet-induced obese mice were each reduced. Liver transcriptomic analysis revealed that expression of genes involved in lipid and cholesterol metabolism was significantly altered. The low-grade chronic inflammation of obesity caused by a high-fat diet was also decreased after PTE treatment. In addition, treatment with PTE improved the relatively low Bacteroidetes/Firmicutes ratio in the gut of high-fat diet-fed mice through enrichment of the Proteobacteria population and reduction of the Deferribacteres population. In conclusion, treatment with PTE inhibited lipid accumulation by inducing the expression of the master transcription factor PPARα, attenuated the low-grade chronic inflammation of obesity, and also altered gut microbiota profiles. These results indicate that PTE has the potential to be developed into an anti-obesity food supplement and therapy. Abbreviations: Abcg5: ATP-binding cassette subfamily G member 5; ALT: alanine aminotransferase; AMPK: adenosine monophosphate-activated protein kinase; AST: aspartate aminotransferase; B/F: Bacteroidetes to Firmicutes [ratio]; C/EBPα: CCAAT/enhancer-binding protein alpha; CR: creatinine; Cyp51: cytochrome P450 family 51; DMEM: Dulbecco's modified Eagle's medium; Fabp5: fatty acid-binding protein 5; FBS: fetal bovine serum; Fdps: farnesyl diphosphate synthase; Glc: Glucose; HFD: high-fat diet; GO: gene ontology; HPRT: hypoxanthine guanine phosphoribosyl transferase; IBMS: 3-isobutyl-1-methylxanthine; Idi1: isopentenyl-diphosphate delta isomerase 1; IL-1ß: interleukin-1-beta; Lpin1: phosphatidic acid phosphohydrolase; LPS: lipopolysaccharide; Mvd: mevalonate diphosphate decarboxylase; ND: normal diet; OTU: operational taxonomic units; Pcsk9: proprotein convertase subtilisin/kexin 9; Pctp: phosphatidylcholine transfer protein; PPARα: peroxisome proliferator-activated receptor alpha; PPARγ: peroxisome proliferator-activated receptor gamma; PTE: Polygala tenuifolia extract; Saa1: serum amyloid A1; SD: standard deviation; SEM: standard error of the mean; Serpina12: serpin family member 12; Sqle: squalene monooxygenase; SREBP1C: sterol regulatory element-binding protein 1C; TCHO: total cholesterol; TG: triglyceride.

Contralateral acute subdural hematoma occurring after evacuation of subdural hematoma with coexistent contralateral subdural hygroma.

Burr-hole craniostomy with closed-system drainage is a safe and effective method for the management of chronic subdural hematoma. However, contralateral acute subdural hematoma has been reported to be a rare and devastating complication. Only 3 cases have been described in the literature. Herein, we reported an 80-year-old male with chronic subdural hematoma and contralateral subdural hygroma. The burr-hole craniostomy with closed-system drainage was initially performed to treat the chronic subdural hematoma. Three days after surgery, weakness of the extremities developed, and contralateral acute subdural bleeding within the previous subdural hygroma was diagnosed by CT scan of the brain. The pathophysiological mechanism of this rare complication was discussed, and the relevant literature was also reviewed.

Intradural lumbar cystic schwannoma.

Intradural lumbar cystic schwannomas are a very rare entity and only 10 case reports have been reported in the literature. The diagnosis and management remains a challenge for clinical physicians. Herein, we report a 51-year-old female presenting with lower back pain and radiating pain at the left upper thigh. Magnetic resonance images of lumbar spine demonstrated an intradural cystic mass approximately 18 x 17 x 35 mm in size occupying L4 to L5, which appeared as the same signal intensity as CSF. At operation, a well encapsulated cystic mass was found. The pathological examination confirmed a diagnosis of schwannoma. The relevant literature was also reviewed.

Textiloma as a complication of transsphenoidal surgery.

Transsphenoidal surgery is the mainstream in the management of sellar and anterior fossa diseases. However, textiloma, as known as cotton left behind during an operation, is rarely reported as a complication of transsphenoidal surgery. In this paper, we present a case of textiloma after transsphenoidal surgery. The patient had been suffering progressive blurred vision and she received transsphenoidal surgery for the diagnosis of pituitary tumor. However, the intermittent headaches persisted for half a year after the surgery. The subsequent images revealed a rim-like enhanced tumor in the sellar region. The retained cotton material was found when she underwent transcranial surgery. The etiology and management of textiloma are discussed, and the relevant literature also reviewed.

Successful treatment of metastatic brain tumor by CyberKnife: a case report.

Stereotactic radiosurgery plays an important role in management of metastatic brain tumors, especially when the tumor has recurred after treatment with previous whole brain radiotherapy. Most metastatic brain tumors less than 1 cm(3) show a complete response after stereotactic radio-surgery. However, there are few reports of a dramatic change in the complete response of large metastatic brain tumors. Here, we report a case of adenocarcinoma of lung that had metastasized to the brain. Because the recurrence of the metastatic brain tumor measured approximately 3 cm in diameter, the tumor was previously treated with two prior craniotomies followed by whole brain radiation to the resection cavity. The tumor subsequently recurred and was treated with stereotactic radiosurgery (CyberKnife). A dramatic response was noted 3 months after radiosurgery with complete disappearance of the recurrent tumor.

Peritumoral edema after stereotactic radiosurgery for meningioma.

Peritumoral edema induced by radiosurgery after the treatment of intracranial meningioma has been reported and its mechanism remains unclear. A 65-year-old woman presented with a history of intermittent dizziness. A CT scan and MRI of the brain revealed an extra-axial space-occupying lesion in the left frontal region. She was treated by stereotactic radiosurgery (SRS). Seven months later, the patient began experiencing general weakness and drowsiness. She developed peritumoral edema around the left frontal tumor. Similarly, a 55-year-old woman complained of unstable gait and dizziness 1 month prior to admission. A CT scan and MRI of the brain revealed an extra-axial space-occupying lesion in the right posterior temporal region. Six months after SRS, this patient experienced deteriorated consciousness and general weakness. Peritumoral edema in the right temporal region was noted. We report these two patients, discuss possible causes and review the relevant literature.