Asunto(s)
Lesiones Encefálicas/patología , Cuerpos Extraños/patología , Traumatismos Penetrantes de la Cabeza/patología , Mesencéfalo/lesiones , Mesencéfalo/patología , Accidentes de Trabajo , Adulto , Arteria Basilar/anatomía & histología , Arteria Basilar/diagnóstico por imagen , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/fisiopatología , Cerebelo/diagnóstico por imagen , Cerebelo/lesiones , Cerebelo/patología , Círculo Arterial Cerebral/anatomía & histología , Círculo Arterial Cerebral/diagnóstico por imagen , Desbridamiento , Cuerpos Extraños/diagnóstico por imagen , Lóbulo Frontal/lesiones , Lóbulo Frontal/cirugía , Seno Frontal/lesiones , Seno Frontal/cirugía , Traumatismos Penetrantes de la Cabeza/diagnóstico por imagen , Traumatismos Penetrantes de la Cabeza/fisiopatología , Humanos , Masculino , Mesencéfalo/diagnóstico por imagen , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Vértebras Lumbares/anatomía & histología , Paraganglioma/diagnóstico , Paraganglioma/patología , Canal Medular/patología , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/patología , Cromograninas/metabolismo , Femenino , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paraganglioma/metabolismo , Paraganglioma/cirugía , Proteínas S100/metabolismo , Neoplasias de la Columna Vertebral/metabolismo , Neoplasias de la Columna Vertebral/cirugíaAsunto(s)
Adenoma/metabolismo , Hormona Luteinizante/biosíntesis , Hormona Luteinizante/metabolismo , Neoplasias Hipofisarias/metabolismo , Adenoma/patología , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia/metabolismo , Recurrencia Local de Neoplasia/patología , Neoplasias Hipofisarias/patología , Sinaptofisina/metabolismo , Resultado del TratamientoRESUMEN
Gas within the brain parenchyma, known as intracerebral pneumocephalus, has been infrequently reported. Head trauma is the most common cause. A case of intracerebral pneumocephalus resulting from a golf club injury and a review of the literature are presented.
Asunto(s)
Hueso Frontal/lesiones , Neumocéfalo/etiología , Fracturas Craneales/complicaciones , Adulto , Trasplante Óseo , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/cirugía , Golf/lesiones , Humanos , Masculino , Neumocéfalo/cirugía , Equipo Deportivo/efectos adversosAsunto(s)
Neoplasias del Ventrículo Cerebral/diagnóstico , Cefalea/etiología , Neurocitoma/diagnóstico , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Neoplasias del Ventrículo Cerebral/complicaciones , Neoplasias del Ventrículo Cerebral/cirugía , Femenino , Cefalea/cirugía , Humanos , Imagen por Resonancia Magnética , Náusea/etiología , Náusea/cirugía , Neurocitoma/complicaciones , Neurocitoma/cirugía , Resultado del Tratamiento , Vómitos/etiología , Vómitos/cirugíaRESUMEN
OBJECT: There is considerable debate among spine surgeons regarding whether fusion should be used to augment decompressive surgery in patients with symptomatic lumbar spinal stenosis involving Grade I degenerative spondylolisthesis. The authors prospectively evaluated the outcomes of patients treated between 2000 and 2002 at two institutions to determine whether fusion improves functional outcome 1 year after surgery. METHODS: Patients ranged in age from 50 to 81 years. They presented with degenerative Grade I (3- to 14-mm) spondylolisthesis and lumbar stenosis without gross instability (< 3 mm of motion at the level of subluxation). Those in whom previous surgery had been performed at the level of subluxation were excluded. Each patient completed Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires preoperatively and at 6 to 12 months postoperatively. Some patients underwent decompression alone (20 cases), whereas others underwent decompression and posterolateral instrumentation-assisted fusion (14 cases), at the treating surgeon's discretion. Baseline demographic data, radiographic features, and ODI and SF-36 scores were similar in both groups. The 1-year fusion rate was 93%. Both forms of surgery independently improved outcome compared with baseline status, based on ODI and SF-36 physical component summary (PCS) results (p < 0.001). Decompression combined with fusion led to an improvement in ODI scores of 27.5 points, whereas decompression alone was associated with a 13.6-point increase (p = 0.02). Analysis of the SF-36 PCS data also demonstrated a significant intergroup difference (p = 0.003). CONCLUSIONS: Surgery substantially improved 1-year outcomes based on established outcomes instruments in patients with Grade I spondylolisthesis and stenosis. Fusion was associated with greater functional improvement.
Asunto(s)
Descompresión Quirúrgica , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Estenosis Espinal/cirugía , Espondilolistesis/cirugía , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Estudios Prospectivos , Análisis de Regresión , Fusión Vertebral/instrumentaciónRESUMEN
STUDY DESIGN: Complete cervical disc complex extrusion, defined as the extrusion of both cartilaginous end-plates, the entire nucleus pulposus, and portions of the anulus fibrosus, is rare. A case of complete cervical disc complex extrusion with spinal cord injury in the absence of facet dislocation or subluxation in an obtunded patient is reported. OBJECTIVE: To report an unusual presentation of spinal cord injury and the occurrence of complete traumatic cervical disc complex extrusion in the absence of facet dislocation and normal plain radiographic findings. SUMMARY OF BACKGROUND DATA: Traumatic cervical disc herniation occurs in 54% to 80% of patients with facet dislocation. A report of complete extrusion of a cervical intervertebral disc complex (cartilaginous endplate, anulus, and nucleus pulposus) with spinal cord injury in the absence of dislocation has not been described, to the best of the authors' knowledge. METHODS: A clinical and radiographic review of such a case of complete traumatic cervical disc complex herniation in the absence of dislocation was performed. RESULTS: Plain radiographic imaging did not show any injury. A nondisplaced fracture of the left inferior facet joint was evident on computed tomography. The diagnosis of C4-C5 intervertebral disc extrusion was made only after magnetic resonance imaging. The vacuum effect of complete disc extrusion created a "white-out" appearance to the disc space on the sagittal T2 magnetic resonance image. The patient underwent anterior cervical discectomy and fusion with additional posterior cervical fusion. He subsequently regained functional strength against gravity in two of four limbs. He remains completely paraparetic in the left upper extremity and partially paraparetic in the left lower extremity. CONCLUSION: The case report highlights the occurrence of complete traumatic cervical disc extrusion in the absence of facet dislocation with normal plain radiographic findings and consequent spinal cord injury, which can accompany such an injury.