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1.
Eur Spine J ; 31(5): 1260-1272, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35325298

RESUMEN

PURPOSE: Our study aimed to evaluate non-inferiority of ProDisc-C to anterior cervical discectomy and fusion (ACDF) in terms of clinical outcomes and incidence of adjacent segment disease (ASD) at 24-months post-surgery in Asian patients with symptomatic cervical disc disease (SCDD). METHODS: This multicentre, prospective, randomized controlled trial was initiated after ethics committee approval at nine centres (China/Hong Kong/Korea/Singapore/Taiwan). Patients with single-level SCDD involving C3-C7-vertebral segments were randomized (2:1) into: group-A treated with ProDisc-C and group-B with ACDF. Assessments were conducted at baseline, 6-weeks, 3/6/12/18/24-months post-surgery and annually thereafter till 84-months. Primary endpoint was overall success at 24-months, defined as composite of: (1) ≥ 20% improvement in neck disability index (NDI); (2) maintained/improved neurologic parameters; (3) no implant removal/revision/re-operation at index level; and (4) no adverse/severe/life-threatening events. RESULTS: Of 120 patients (80ProDisc-C,40ACDF), 76 and 37 were treated as per protocol (PP). Overall success (PP) was 76.5% in group-A and 81.8% in group-B at 24-months (p = 0.12), indicating no clear non-inferiority of ProDisc-C to ACDF. Secondary outcomes improved for both groups with no significant inter-group differences. Occurrence of ASD was higher in group-B with no significant between-group differences. Range of motion (ROM) was sustained with ProDisc-C but lost with ACDF at 24-months. CONCLUSION: Cervical TDR with ProDisc-C is feasible, safe, and effective for treatment of SCDD in Asians. No clear non-inferiority was demonstrated between ProDisc-C and ACDF. However, patients treated with ProDisc-C demonstrated significant improvement in NDI, neurologic success, pain scores, and 36-item-short-form survey, along with ROM preservation at 24-months. Enrolment difficulties resulted in inability to achieve pre-planned sample size to prove non-inferiority. Future Asian-focused, large-scale studies are needed to establish unbiased efficacy of ProDisc-C to ACDF.


Asunto(s)
Degeneración del Disco Intervertebral , Fusión Vertebral , Reeemplazo Total de Disco , Pueblo Asiatico , Vértebras Cervicales/cirugía , Discectomía/métodos , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/etiología , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral , Estudios Prospectivos , Rango del Movimiento Articular , Fusión Vertebral/métodos , Reeemplazo Total de Disco/métodos , Resultado del Tratamiento
2.
Acta Neurochir (Wien) ; 154(7): 1179-87, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22476796

RESUMEN

BACKGROUND: To clarify the most beneficial treatment of the management modality based on our experience with adult moyamoya disease (MMD). METHODS: From 1998 to 2010, clinical results of 142 patients (ischemic, 98; hemorrhagic, 44) with adult MMD were investigated according to management modality. Revascularization surgery (direct, indirect, and combined bypass) was performed in 124 patients. We observed the clinical course of 18 patients who were treated conservatively. Clinical outcome, angiographic features, hemodynamic change, and incidence of recurrent stroke were investigated pre- and postoperatively. RESULTS: In patients with ischemic MMD, direct and combined bypasses were more effective treatments to prevent recurrent ischemic stroke than indirect bypass surgery (P < 0.05). In patients with hemorrhagic MMD, rebleeding was less likely to occur in patients who had undergone bypass surgery. However, no significant difference was observed in the rebleeding rate between patients with and without revascularization surgery (P > 0.05). An angiogram after bypass surgery comparing the extent of revascularization and reduction of moyamoya vessels in patients treated with direct, indirect, and combined bypass showed a significant difference (P < 0.05) in favor of direct and combined bypass. Postoperative angiographic changes and SPECT results demonstrated significant statistical correlation (P < 0.05). CONCLUSION: Revascularization surgery was effective in further ischemic stroke prevention to a statistically significant extent. Direct and combined bypasses were more effective to prevent recurrent ischemic stroke than indirect bypass. However, there is still no clear evidence that revascularization surgery significantly prevents rebleeding in adult MMD patients. More significant angiographic changes were observed in direct and combined bypasses compared with indirect bypass.


Asunto(s)
Revascularización Cerebral/métodos , Enfermedad de Moyamoya/cirugía , Complicaciones Posoperatorias/etiología , Accidente Cerebrovascular/etiología , Adulto , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/cirugía , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/cirugía , Evaluación de la Discapacidad , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/diagnóstico por imagen , Examen Neurológico , Complicaciones Posoperatorias/diagnóstico por imagen , Recurrencia , Accidente Cerebrovascular/diagnóstico por imagen
3.
Cell Transplant ; 27(2): 310-324, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29637817

RESUMEN

Cell therapy has been shown to be a key clinical therapeutic option for central nervous system diseases or damage. Standardization of clinical cell therapy procedures is an important task for professional associations devoted to cell therapy. The Chinese Branch of the International Association of Neurorestoratology (IANR) completed the first set of guidelines governing the clinical application of neurorestoration in 2011. The IANR and the Chinese Association of Neurorestoratology (CANR) collaborated to propose the current version "Clinical Cell Therapy Guidelines for Neurorestoration (IANR/CANR 2017)". The IANR council board members and CANR committee members approved this proposal on September 1, 2016, and recommend it to clinical practitioners of cellular therapy. These guidelines include items of cell type nomenclature, cell quality control, minimal suggested cell doses, patient-informed consent, indications for undergoing cell therapy, contraindications for undergoing cell therapy, documentation of procedure and therapy, safety evaluation, efficacy evaluation, policy of repeated treatments, do not charge patients for unproven therapies, basic principles of cell therapy, and publishing responsibility.


Asunto(s)
Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Humanos , Regeneración Nerviosa/fisiología , Control de Calidad
4.
Clin Neurol Neurosurg ; 109(2): 125-31, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16872739

RESUMEN

OBJECTIVE: We retrospectively reviewed the pediatric patients with moyamoya disease (MMD) who underwent bypass surgery at our institution to compare the surgical results according to the surgical procedures. PATIENTS AND METHODS: There were 24 total patients (age range: 2-15 years; mean age: 8.2 years). Twelve patients underwent encephalo-duro-arterio-synangiosis (EDAS) on 16 sides, 5 patients underwent encephalo-duro-arterio-myo-synangiosis (EDAMS) on 8 sides and 7 patients underwent combined superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis with EDAMS (STA-MCA-EDAMS) on 12 sides. The postoperative results were evaluated between 4 months and 5 years following surgery in terms of the angiographic revascularization and the clinical outcome. RESULTS: EDAMS, regardless of the combined STA-MCA anastomosis, was significantly effective for achieving a good extent of the postoperative angiographic revascularization as compared with simple EDAS (P<0.05). STA-MCA-EDAMS tended to be better with respective to the relief of preoperative ischemic symptoms as compared with simple EDAS, although there was no significant statistical difference. CONCLUSION: These results suggest that EDAMS with or without the combination of STA-MCA anastomosis was very useful for the formation of collateral circulation in comparison with simple EDAS for treating the pediatric patients with MMD, although these findings were not well correlated with the clinical outcomes.


Asunto(s)
Angiografía Cerebral , Revascularización Cerebral/métodos , Enfermedad de Moyamoya/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/cirugía , Niño , Preescolar , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/cirugía , Masculino , Enfermedad de Moyamoya/diagnóstico por imagen , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos
5.
Surg Neurol ; 67(3): 303-7, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17320646

RESUMEN

BACKGROUND: We report a case of an adult with MMD who presented initially with left visual field defect that had suddenly progressed to bilateral cortical blindness 1 year and 9 months later. CASE DESCRIPTION: A 33-year-old male presented with visual blurring and mild right hemiparesis that developed suddenly. He was regarded as having MMD based on an imaging study. An inverted encephalodurogaleosynangiosis using the left occipital artery and inverted encephaloduroarteriogaleosynangiosis with the parietal branch of the superficial temporal artery were done. The postoperative course was uneventful and without any complication. Several months later, he visited again because of sudden bilateral blindness preceded by repeated transient blindness in both eyes for 4 days. The right posterior temporal artery, which was well visualized at the time of the first postoperative follow-up angiography, was no longer seen on repeated 4-vessel angiography. Biochemical analysis including prothrombin and thrombin time, activated partial thromboplastin time, fibrinogen, d-dimer, plasminogen, antithrombin, platelet, protein C and S, lupus anticoagulant, and cardiolipin antibodies; VDRL was within the reference range. CONCLUSION: The authors suggest abnormal thromboembolism as a presumed mechanism of the pathogenesis of MMD in this patient.


Asunto(s)
Ceguera Cortical/complicaciones , Ceguera Cortical/diagnóstico , Embolia Intracraneal/etiología , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico , Adulto , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/patología , Humanos , Embolia Intracraneal/diagnóstico , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Paresia/diagnóstico , Paresia/etiología , Radiofármacos , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X
6.
J Clin Neurosci ; 14(11): 1135-9, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17420130

RESUMEN

Pituitary abscess is a rare and potentially lethal condition. Pituitary abscess in a pregnant woman has not been previously described. A 38-year-old pregnant woman (34 weeks gestation) with a pituitary mass complained of a progressive headache and sudden visual impairment. She was afebrile and had no inflammatory symptoms on admission. On MRI, the preoperative diagnosis was pituitary adenoma with sphenoid sinusitis. She underwent an uncomplicated transsphenoidal procedure for removal of the pituitary mass. The next day, labor commenced and a healthy preterm baby was delivered. Pathologic examination of the intrasellar mass showed polymorphonuclear cells, debris and no tumor cells. The sellar contents were cultured and Streptococcus viridans was grown. To our knowledge this is the first case of pituitary abscess reported during pregnancy. Although the patient was pregnant, the transsphenoidal approach was safe for the mother and the fetus. Surgical drainage and antibiotic therapy are required for the definitive treatment of this condition.


Asunto(s)
Absceso Encefálico/microbiología , Absceso Encefálico/cirugía , Enfermedades de la Hipófisis/microbiología , Enfermedades de la Hipófisis/cirugía , Complicaciones Infecciosas del Embarazo , Adulto , Absceso Encefálico/patología , Descompresión Quirúrgica , Femenino , Humanos , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos , Enfermedades de la Hipófisis/patología , Embarazo , Resultado del Embarazo
7.
Clin Neurol Neurosurg ; 162: 59-66, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28938108

RESUMEN

OBJECTIVE: The purpose of this study is to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (CTDR) as revision surgeries for symptomatic adjacent segment degeneration (ASD) in cases with previous ACDF. PATIENTS AND METHODS: Between 2010 and 2014, 41 patients with previous cervical fusion surgery underwent ACDF or CTDR for symptomatic ASD. Twenty-two patients in the ACDF group underwent 26 ACDFs, and 19 patients in the CTDR group underwent 25 arthroplasties for symptomatic ASD. Clinical outcomes were assessed by a visual analogue scale (VAS) for arm pain, the neck disability index (NDI) and Odom's criteria. Radiological evaluations were performed preoperatively and postoperatively to measure changes in the range of motion (ROM) of the cervical spine and adjacent segments and arthroplasty level. The radiological change of ASD was assessed in radiographs. RESULTS: Clinical outcomes as assessed with VAS for arm pain and Odom's criteria were significantly improved in both groups. The CTDR group showed better NDI improvement after surgery (P<0.05). The mean C2-7 ROM of the CTDR group revealed faster recovery than did that of the ACDF group and the preoperative values were recovered at the last follow-up visit. There was a significant difference in the ROM of the inferior adjacent segment between the ACDF and CTDR groups (P<0.05). The ACDF group had a higher incidence of radiological changes in the adjacent segment compared with the CTDR group (P<0.05). CONCLUSIONS: The 2-year clinical results of CTDR for symptomatic ASD are safe and are comparable to the outcomes of ACDF in terms of arm pain relief and functional recovery. The CTDR group showed better NDI improvement, faster C2-7 ROM recovery, less of an increase in ROM in the inferior adjacent segment, and a lower incidence of adjacent segment degeneration than did the ACDF group.


Asunto(s)
Vértebras Cervicales/cirugía , Discectomía/métodos , Degeneración del Disco Intervertebral/cirugía , Evaluación de Resultado en la Atención de Salud/métodos , Reoperación/métodos , Fusión Vertebral/métodos , Reeemplazo Total de Disco/métodos , Adulto , Anciano , Vértebras Cervicales/patología , Femenino , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
8.
J Korean Neurosurg Soc ; 60(6): 676-683, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29142627

RESUMEN

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. METHODS: Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. RESULTS: Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. CONCLUSION: The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.

9.
J Neurosurg ; 104(3): 444-7, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16572661

RESUMEN

Neurocutaneous melanosis (NCM) associated with Dandy-Walker malformation is a very rare congenital neurodysplasia with the same origin. Primary intracranial melanocytic and dermoid tumors are also benign congenital lesions that usually arise from the leptomeninges and are formed by the inclusion of cutaneous ectoderm at the time of neural tube closure. The authors describe a patient with coexisting intracranial meningeal melanocytoma, NCM with Dandy-Walker malformation, and intraventricular dermoid tumor.


Asunto(s)
Síndrome de Dandy-Walker/complicaciones , Quiste Dermoide/patología , Melanoma/patología , Melanosis/complicaciones , Neoplasias Meníngeas/patología , Neoplasias Cutáneas/patología , Adulto , Comorbilidad , Quiste Dermoide/congénito , Humanos , Masculino , Melanoma/congénito , Melanosis/congénito , Neoplasias Meníngeas/congénito , Neoplasias Cutáneas/congénito
10.
Surg Neurol ; 66(4): 389-94; discussion 395, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17015118

RESUMEN

BACKGROUND: We evaluated the efficacy of combined STA-MCA anastomosis and EDAGS using inverted STAGF and STAGP for the treatment of adult MMD. METHODS: This study included 8 patients with nonhemorrhagic MMD. There were 6 women and 2 men who were between 23 and 62 years old (mean = 37.8 years) in the sample. The combined surgery was performed on 12 sides in the 8 patients. The surgical results were assessed for clinical outcome, angiographic revascularization, and hemodynamic change on HMPAO brain SPECT. The follow-up period ranged from 6 to 62 months (mean = 27 months). RESULTS: Clinical symptoms and signs were improved or stabilized, and the extent of revascularization evident on external carotid angiograms was excellent in all 8 patients. The CBF on HMPAO SPECT also improved in all 12 sides that were operated on with the combined surgery, except for the preexisting infarcted area, on the basal as well as Diamox stimulation studies. One patient had a transient speech disturbance after surgery, and another patient had delayed wound healing. CONCLUSIONS: The combined STA-MCA anastomosis and EDAGS using inverted STAGF/P seems to be one of the most effective surgical modalities for the treatment of nonhemorrhagic MMD in adults.


Asunto(s)
Revascularización Cerebral/métodos , Arteria Cerebral Media/cirugía , Enfermedad de Moyamoya/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Arterias Temporales/cirugía , Adulto , Angiografía Cerebral , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/fisiopatología , Infarto Cerebral/prevención & control , Circulación Cerebrovascular/fisiología , Duramadre/anatomía & histología , Duramadre/fisiología , Duramadre/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/patología , Arteria Cerebral Media/fisiopatología , Enfermedad de Moyamoya/diagnóstico , Enfermedad de Moyamoya/fisiopatología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Cintigrafía , Cuero Cabelludo/anatomía & histología , Cuero Cabelludo/irrigación sanguínea , Cuero Cabelludo/cirugía , Colgajos Quirúrgicos/fisiología , Telencéfalo/irrigación sanguínea , Telencéfalo/diagnóstico por imagen , Telencéfalo/fisiopatología , Arterias Temporales/anatomía & histología , Arterias Temporales/fisiología , Resultado del Tratamiento
11.
Korean J Neurotrauma ; 11(2): 191-4, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27169093

RESUMEN

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.

12.
J Cerebrovasc Endovasc Neurosurg ; 16(3): 200-8, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25340021

RESUMEN

OBJECTIVE: According to the development of endovascular technique and devices, larger aneurysms on the distal internal carotid artery (ICA) can be treated using a less invasive method. The authors report on clinical and angiographic outcomes of these aneurysms treated using an endovascular technique. MATERIALS AND METHODS: Data on 21 patients with large aneurysms at distal ICA treated by endovascular method between January 2005 and December 2012 were included in this retrospective analysis. RESULTS: Clinical outcome of patients showed strong correlation with the initial neurologic status (p < 0.05). Aneurysm morphology showed saccular, fusiform, and wide-neck in 12, six and three patients. Six patients underwent stent assisted coiling and the other 15 patients underwent simple coiling. Aneurysm occlusion was performed immediately after embolization with near-complete (Raymond class 1-2) in 20 patients (95.2%) and incomplete (Raymond class 3) in one patient (4.8%). Delayed thrombotic occlusion occurred in two patients and their clinical result was fatal. Another five patients died in the hospital, from massive brain edema and/or increased intracranial pressure due to initial subarachnoid hemorrhage. Overall mortality was 30% (seven out of 21). Fatal complication related to the endovascular procedure occurred in two patients with thrombosis at middle cerebral artery (one with stent, the other without it). CONCLUSION: Recent developed endovascular device and technique is safe enough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization of large distal ICA aneurysms (with or without stenting) is effective and safe.

13.
Korean J Neurotrauma ; 10(2): 134-6, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27169049

RESUMEN

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.

14.
Clin Neurol Neurosurg ; 115(8): 1238-44, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23266265

RESUMEN

OBJECTIVE: To evaluate the effects and safety of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in the early stage after an acute ischemic event and the improvement of present symptoms in patients with intracranial atherosclerotic occlusive disease with stroke/stroke in progress. METHODS: From 2006 to 2010, 20 patients (15 males and five females) with atherosclerotic cerebrovascular disease were treated with an STA-MCA bypass. All of the patients presented with an acute ischemic stroke or stroke in progress despite maximal medical treatment. The patients underwent an STA-MCA bypass within 7 days from symptom onset. The clinical outcome and hemodynamic study of the 20 patients were preoperatively and postoperatively investigated. A pooled analysis was performed, and the results were compared with those obtained from other delayed STA-MCA bypass studies. RESULTS: Among the 20 patients who underwent an early STA-MCA bypass, fourteen (70%) patients achieved a good functional outcome (mRS 0, n=3; mRS 1, n=9; mRS 2, n=2). Prior to surgery, the mean basal regional cerebral blood flow (rCBF) and cerebrovascular reserve capacity (CVR) in the symptomatic hemisphere were 37.3±4.3 ml/100 g/min and -1.68±2.9%. The mean basal rCBF and CVR had significantly increased postoperatively, and no reperfusion-induced hemorrhage had occurred. In the pooled analysis, no significant differences were observed in the clinical outcome (P=0.328) or in the incidence of postoperative complications (P=0.516) between patients who underwent an early STA-MCA bypass and in patients who underwent a delayed STA-MCA bypass in previous studies. CONCLUSIONS: In this study, which consisted of 20 carefully selected patients with acute ischemic stroke, an early STA-MCA bypass was safely and effectively performed, and in some cases, an early STA-MCA bypass resulted in rapid neurological improvement. An early STA-MCA bypass was beneficial in select patients who had acute ischemic stroke with imaging evidence of a small infarction.


Asunto(s)
Isquemia Encefálica/cirugía , Arteria Cerebral Media/cirugía , Procedimientos Neuroquirúrgicos/métodos , Accidente Cerebrovascular/cirugía , Arterias Temporales/cirugía , Adulto , Anciano , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/patología , Circulación Cerebrovascular/fisiología , Interpretación Estadística de Datos , Femenino , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Hemodinámica/fisiología , Humanos , Procesamiento de Imagen Asistido por Computador , Infarto de la Arteria Cerebral Media/patología , Infarto de la Arteria Cerebral Media/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patología , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento , Adulto Joven
15.
J Cerebrovasc Endovasc Neurosurg ; 15(3): 191-9, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24167799

RESUMEN

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.

16.
J Korean Neurosurg Soc ; 52(5): 452-8, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23323165

RESUMEN

OBJECTIVE: In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD). METHODS: Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed. RESULTS: Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed. CONCLUSION: Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.

17.
J Neurosurg Spine ; 16(2): 127-9, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22117141

RESUMEN

Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe, and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. Formation of a spinal epidural hematoma is an extremely rare complication after ESWL for kidney stone removal. The authors present the case of a 61-year-old man in whom a large spinal epidural hematoma developed after ESWL. They discuss the possible pathogenic mechanism of such a complication.


Asunto(s)
Hematoma Espinal Epidural/etiología , Litotricia/efectos adversos , Vértebras Torácicas , Urolitiasis/terapia , Descompresión Quirúrgica , Hematoma Espinal Epidural/patología , Hematoma Espinal Epidural/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad
18.
J Korean Neurosurg Soc ; 48(3): 294-7, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21082064

RESUMEN

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.

19.
J Korean Neurosurg Soc ; 48(1): 37-45, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20717510

RESUMEN

OBJECTIVE: Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. METHODS: Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. RESULTS: Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. CONCLUSION: The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.

20.
World Neurosurg ; 73(1): 50-2; discussion e4, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20452868

RESUMEN

BACKGROUND: The size of the spinal canal is a factor that contributes to the neurologic deficits associated with cervical OPLL and CSM. We investigate the development of neurologic deterioration after minor trauma and the clinical results of decompressive surgery in cervical spinal stenosis retrospectively. METHOD: We treated 200 cases (98 cervical OPLLs and 102 CSMs) of cervical spinal stenosis for 8 years. There were 63 (33.5%) minor trauma cases to the cervical spine in 200 patients. Of these 63 patients, 18 developed myelopathy, 13 showed deterioration of preexisting myelopathy, and no neurologic change was observed in 32 patients. The neurologic status was assessed by the JOA score. The patients were divided into 2 groups according to the residual cervical spinal canal diameter: group I (<10 mm cervical spinal canal) and group II (> or =10 mm cervical spinal canal). RESULTS: Neurologic outcome depended on the diameter of the residual spinal canal; 22 of the 25 patients in group I developed neurologic deterioration, whereas that occurred in 8 of the 38 patients in group II (P < .05). After surgical decompression, 8 patients in group I and 30 patients in group II came out with an improved JOA score of more than 50% (P < .05). CONCLUSION: Even indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal. It may be beneficial to check lateral radiograph of the cervical spine as a screening tool for early detection of cervical spinal stenosis especially in Asian people older than 40 years.


Asunto(s)
Vértebras Cervicales , Descompresión Quirúrgica , Osificación del Ligamento Longitudinal Posterior/cirugía , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Estenosis Espinal/cirugía , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osificación del Ligamento Longitudinal Posterior/diagnóstico , Osificación del Ligamento Longitudinal Posterior/etiología , Recuperación de la Función , Estudios Retrospectivos , Traumatismos de la Médula Espinal/diagnóstico , Estenosis Espinal/diagnóstico , Estenosis Espinal/etiología , Resultado del Tratamiento
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