Extremity arteriovenous malformations involving the bone: therapeutic outcomes of ethanol embolotherapy.

PURPOSE: To assess retrospectively the therapeutic results, complications, and therapeutic approach to ethanol embolotherapy of extremity arteriovenous malformations (AVMs) involving the bone. MATERIALS AND METHODS: From December 1996 to May 2009, 22 patients (12 male, 10 female; eight children, 14 adults; age range, 1-64 years) with extremity AVMs involving the bone underwent staged ethanol embolotherapy (range, 1-12 procedures; mean, 4.4 procedures) under general anesthesia. Four patients had pure bone AVMs and 18 had mixed bone and soft-tissue AVMs. Pulmonary artery pressure and arterial blood pressure were monitored as ethanol was injected. Ethanol embolotherapy was performed by direct puncture and/or transcatheter approach. Therapeutic outcomes were established by evaluation of the clinical response of symptoms and signs, as well as the degree of devascularization at follow-up angiography or computed tomography. RESULTS: Ninety-six ethanol embolotherapy procedures were performed in 22 patients. Four (18%) were cured, 14 (64%) showed improvement, three (14%) showed no change, and one (4%) experienced treatment failure and amputation of the affected extremity. Ethanol embolotherapy was considered effective (ie, combined cure and improvement outcomes) in 18 patients (82%). Ten patients (45%) experienced complications. Twelve minor complications (skin and transient peripheral nerve injury; 13%) and one major complications (longstanding nerve palsy; 1%) occurred in 96 procedures. CONCLUSIONS: Ethanol embolotherapy of extremity AVMs involving the bone has the potential to eliminate or improve symptoms in a high percentage of patients, with an acceptable risk of minor and major complications.

TWIK-Related Spinal Cord K⁺ Channel Expression Is Increased in the Spinal Dorsal Horn after Spinal Nerve Ligation.

PURPOSE: The TWIK-related spinal cord K⁺ channel (TRESK) has recently been discovered and plays an important role in nociceptor excitability in the pain pathway. Because there have been no reports on the TRESK expression or its function in the dorsal horn of the spinal cord in neuropathic pain, we analyzed TRESK expression in the spinal dorsal horn in a spinal nerve ligation (SNL) model. MATERIALS AND METHODS: We established a SNL mouse model by using the L5-6 spinal nerves ligation. We used real-time polymerase chain reaction and immunohistochemistry to investigate TRESK expression in the dorsal horn and L5 dorsal rot ganglion (DRG). RESULTS: The SNL group showed significantly higher expression of TRESK in the ipsilateral dorsal horn under pain, but low expression in L5 DRG. Double immunofluorescence staining revealed that immunoreactivity of TRESK was mostly restricted in neuronal cells, and that synapse markers GAD67 and VGlut2 appeared to be associated with TRESK expression. We were unable to find a significant association between TRESK and calcineurin by double immunofluorescence. CONCLUSION: TRESK in spinal cord neurons may contribute to the development of neuropathic pain following injury.

Diffusion MR imaging of postoperative bilateral acute ischemic optic neuropathy.

A 57-year-old woman experienced bilateral acute ischemic optic neuropathy after spine surgery. Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves. A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath. Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves. Although MR findings of T2-weighted and contrast enhanced T1-weighted images may be nonspecific, the DWI finding of cytotoxic edema of bilateral optic nerves will be helpful for the diagnosis of acute ischemic optic neuropathy after spine surgery.

Breakage of a thoracic epidural catheter during its removal -A case report-.

The breakage of an epidural catheter is a rare complication during the removal of a thoracic epidural catheter. There are many causes to breakage of an epidural catheter, such as the characteristics of the catheter itself, patient's factors (anatomy, position during insertion and removal of the catheter, and the BMI), and the difficulty of the procedure. Surgical removal is considered if there is a possibility that the retained catheter might cause neurological problems. We experienced a breakage of an epidural catheter during its removal, which led to surgical intervention. To prevent the catheter breakage during its removal, the catheter should be withdrawn without excessive tension. In addition, an understanding of the patient's anatomy is essential.

Fluoroscopy-guided pudendal nerve block and pulsed radiofrequency treatment : A case report.

Pudendal nerve block (PNB) is performed for differential diagnosis and treatment of chronic pelvic and perineal pain. Several block methods, such as transvaginal, transperineal, computerized tomography-, ultrasound- and fluoroscopy-guided approach are currently under practice. Compared to others, a fluoroscopy-guided approach has several advantages, such as its relatively low cost, facility and ease of landmark recognition. We depicted a fluoroscopy-guided PNB technique to selectively block and elaborate a pulsed radiofrequency treatment in a 51-year-old man with chronic pelvic and perineal pain. The patient had undergone a ganglion of impar block with a limited pain relief. Thereafter, a PNB was performed and the pain was relieved significantly for 2 weeks. Further PNB with a pulsed radiofrequency treatment reduced the pain for more than 8 weeks. The pain relief sustained up to the time of this report. The fluoroscopy-guided PNB and pulsed radiofrequency treatment allowed simplicity in manipulation and precision in performing the procedures with a favorable outcome.