Motion preservation in cervical spine: review.

Cervical disc replacement is an innovative technology that preserves motion at the instrumented level and has evolved as a potential alternative to spinal fusion for the treatment of cervical radiculopathy and myelopathy. Despite the excellent results of anterior cervical discectomy and fusion, arthroplasty allows for motion preservation which may be beneficial. Although the initial and midterm results from the randomized clinical trials demonstrated safety and equivalent clinical success as compared to anterior cervical fusion; the evidence establishing the superiority of arthroplasty over fusion in terms of preventing adjacent segment degeneration/disease is not available at this time.

Minimally invasive retropleural approach for central thoracic disc herniation.

BACKGROUND: The management of symptomatic thoracic disc herniation (TDH) has evolved tremendously ever since the first laminectomy was performed. The last decade has witnessed the evolution of minimally invasive approaches for TDH most of which have been posterior/posterolateral. Traditional anterior approaches involve a thoracotomy or more recently, thoracoscopic techniques. The authors describe a less invasive anterior retropleural surgical approach to address central thoracic disk herniations which is less extensive than a thoracotomy and allows better anterior access than posterior or posterolateral approaches. The retropleural approach allows the use of the operative microscope with a tubular retractor in the anterior thoracic spine. MATERIAL AND METHODS: 7 patients with central disc herniation who were managed with the minimally invasive lateral retropleural approach from 2007-2010 at our institution were included in the study. Surgical technique consisted of a lateral position followed by retro-pleural exposure through tubular retractor system without the need of intraoperative lung collapse. Clinical details including age, sex, clinical presentation, surgical details, complications and outcome at last follow-up were analyzed. RESULTS: Patients age ranged in age from 30 to 70 years (mean: 52 years). The duration of symptoms ranged from 4 days to 3 years. All patients presented with thoracic myleopathy on physical examination. The average length of stay in the hospital was 2.6 days (range: 1-4 days). Follow-up was available for all the patients. Myelopathy was assessed by the Nurick scale. On examination, 3 of 7 patients improved by one point on the Nurick scale. No patient deteriorated after surgery. There were no complications related to the approach. CONCLUSIONS: A minimally invasive retropleural approach using tubular retractor system for central thoracic disc herniation is feasible and may be a less invasive anterior alternative to a thoracotomy.

Endoscopic management of a rare case of nasal glioma in Meckel's cave in an adult: case report.

BACKGROUND: Nasal glioma or glial heterotopia is a rare embryologic anomaly that heralds its presence shortly after birth or in childhood. Nasal glioma in an adult is very rare, often asymptomatic and the occurrence of nasal glioma in Meckel's cave in an adult has not been previously reported. CASE REPORT: The authors encountered a case of an incidentally diagnosed Meckel's cave nasal glioma in a 40-year-old male which was successfully excised by an endonasal endoscopic transmaxillary transpterygoid approach. CONCLUSION: The occurrence of a nasal glioma in Meckel's cave an adult is very rare. Considering the deep skull base location, endonasal endoscopic surgery provides a minimal access technique to reach this location with excellent results.

A rare case of intracranial solitary fibrous tumor of meninges: case report.

The authors report a case of intracranial tumor in a 60 year female, previously asymptomatic presenting with altered sensorium following a road traffic accident. Imaging showed a small left frontotemporal contusion along with a large right frontoparietal extra axial mass lesion suggestive of a meningioma. Patient improved significantly after craniotomy and tumour decompression. Histopathology with immunohistochemical analysis however revealed the presence of a solitary fibrous tumor of meninges. The case is reported in view of its rarity, atypical presentation and need to distinguish from meningiomas which they can mimic radiologically.

Cervical meningomyelocele--an institutional experience.

OBJECTIVE: Cervical myelomeningoceles (CMMC) are a less common but distinct subgroup of myelomeningoceles. Their embryology and clinical characteristics vary from the more common thoracolumbar variant. Only a few small series have been published addressing this lesion in the literature with the largest one of them addressing nine patients. The authors present one of the largest series of cervical myelomeningoceles, review their embryology, clinical features, and their management strategies. METHODS: This study included all the children who were managed for cervical myelomeningocele between Jan 2001 to July 2006 at our center. RESULTS: There were a total of ten children (five boys and five girls) operated on for cervical myelomeningoceles. The ages ranged between 2 months to 14 months. Neurological examination was normal in majority of the children with absence of gross orthopedic deformity in all the children. Three patients had associated hydrocephalus, two had Chiari malformation, and four of them had a syrinx. Surgical excision of the sac was performed for all. CONCLUSION: Cystic dysraphisms of the cervical differ embryologically, clinically, and structurally from thoracolumbar meningomyelocele and have a more favorable outcome. A good pre operative evaluation is recommended to assess any associated anomalies and identify the internal structures. Surgery excision of these lesions with intradural exploration of the sac to release any potential adhesion bands as well as other associated anomalies is recommended.