Comparison of unilateral hemilaminotomy and bilateral hemilaminotomy according to dural sac area in lumbar spinal stenosis.

INTRODUCTION: Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability. METHODS: We retrospectively analyzed 18 cases with degenerative lumbar spinal stenosis (LSS) with BLH or ULH that was performed in 11 and 7 cases, respectively. Magnetic resonance imaging (MRI) was performed at the follow-up examination and dural sac area (DSA) was calculated on T(2)-weighted MRI images and then compared statistically. In addition, the economic and functional status of the patients were evaluated with the Prolo scale. RESULTS: The mean preoperative values on the visual analogue scale (VAS) were 7.1 for lumbalgia and 7.0 for leg pain, respectively. These values were calculated as 4.8 and 4.4 at the follow-up, respectively. The VAS was significantly improved after operation compared to preoperative values (p=0.001). The mean value of the DSA was 84 (+/-32) mm(2) before the operation and 126 (+/-35) mm(2) at the follow-up and the comparison was statistically significant (p=0.001). No statistical correlation was found between VAS and DSA or between VAS and ULH-BLH groups, however, DSA of the BLH cases was significantly higher than in the ULH group (p=0.035). There was a significant negative correlation between VAS scores (back and leg pain) and Prolo status. However, there was no significant difference between DSA and Prolo scores, and between ULH or BLH groups in terms of Prolo scores. CONCLUSION: A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.

Orbitocerebral injury by a knife: case report.

Orbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.

Orbitocerebral injury by a knife: case report

Orbital penetrating injuries may cause significantharm to the optic nerves and eyeball as well as to thebrain and cerebral vessels. Management of orbitalforeign bodies should include prompt recognition of theextent of the injury, broad-spectrum parenteral antibiotics,tetanus prophylaxis, anticonvulsant medicationand early surgical intervention under direct vision toremove the foreign body and to avoid immediate andlong-term complications. We report a penetrating orbitalinjury caused by a bread knife that extended fromthe orbit to the tegmental dura mater of the temporalbone. The knife’s main trajectory coursed through thetemporal lobe. Adjacent cerebral structures were exploredbefore removal of the knife (AU)

Los traumatismos perforantes orbitarios suelencausar un daño importante al nervio óptico y globoocular, así como al cerebro y vasos cerebrales. Laórbita permite un acceso fácil hacia la cavidad cranealdebido a que tiene una pared ósea delgada y a la presenciadel agujero óptico. El enfoque terapéutico de lostraumatismos orbitarios por cuerpo extraño dependefundamentalmente del tipo de traumatismo y delcuerpo extraño. El tratamiento de este tipo de lesionesincluirá un rápido diagnostico de la magnitud del dañoocasionado, el empleo por vía parenteral de antibióticosde amplio espectro, profilaxis del tétanos, medicaciónanticonvulsivante y cirugía urgente que permita, bajovisión directa, la extracción del cuerpo extraño, a fin de evitar complicaciones inmediatas o a largo plazo. Presentamosel caso de un traumatismo perforante ocularocasionado por un cuchillo de pan que se extendíadesde la órbita hasta el tegmentum del hueso temporal.El cuchillo seguía una trayectoria directa a través dellóbulo temporal. Se practicó una exploración quirúrgicade las estructuras cerebrales adyacentes para poderextirpar el cuchillo. Se revisan y analizan las opcionesde tratamiento de los traumatismos perforantes de laórbita (AU)