Valve-controlled chronic subdural hematoma drainage: A feasibility study.

Introduction: Pneumocephalus after chronic subdural hematoma (CSDH) evacuation is a potential predictor of hematoma recurrence. Research question: To study the feasibility and safety of a novel CSDH evacuation technique using a valve-controlled method to avoid pneumocephalus. Material and methods: In a retrospective case series, we evacuated CSDH using very low-pressure valve-controlled drains and recorded the neurological, radiological, and functional outcomes. Patients with primary CSDH, without previous neurosurgical intervention, and who did not receive antiplatelet or anticoagulant therapy the week prior to the index surgery, were included in the study. Exclusion criteria were the evacuation with other treatment techniques and incomplete data files. Patients were assessed according to the Bender grading system to record the neurological status. The hematoma volume was estimated using the formula for ellipsoid volumes. Results: Thirty-six patients with a mean age of 73 years (±9 years) fulfilled our eligibility criteria. Our technique was effective since it decreased the CSDH volume from 141 â€‹ml (IQR 97 â€‹ml) to 20.6 â€‹ml (IQR 26.59 â€‹ml; p â€‹< â€‹0.001) and improved the neurological status according to the Bender grading system from two (IQR 0.25) to 1 (IQR 0). However, pneumocephalus and hematoma recurrence occurred in one case each (2.8%). At six months, all patients returned to their previous status, except for two patients (5.6%) who died due to irrelevant pathologies. Conclusions: Valve-controlled CSDH evacuation aiming to decrease the postoperative pneumocephalus and hematoma recurrence constitutes an effective and safe alternative. However, larger randomized controlled studies are required to establish its role in CSDH management.

Instrumented posterior lumbar fusion outcomes for lumbar degenerative disorders in a southern European, semirural population.

STUDY DESIGN: Prospective, clinical study. OBJECTIVE: This study compares the preoperative and postoperative status of patients with degenerative lumbar spine disorders, who underwent instrumented posterior lumbar fusion (IPLF), from the functional, economic and psychologic perspectives in a semirural population. SUMMARY OF BACKGROUND DATA: IPLF is a common procedure in the treatment of a more common disorder, lumbar spine degeneration. It has been postulated that both the disorder and the surgical procedure may affect many aspects of patients' life. METHODS: During a 2 years period, 46 patients underwent IPLF for degenerative disorders of the lumbar spine. The surgical procedure included posterior decompression of the affected segment(s) and stabilization by means of pedicle screws and rods in every case, and interbody implants in selected cases. The outcome measures included the Greek versions of (a) Visual Analogue Scale (VAS) for pain assessment, (b) Oswestry Disability Index (ODI) for back-related disability, (c) Prolo Scale for the functional and economic status and (d) Zung Depression Scale to screen for depression. Measurements were taken 1-week preoperatively, and 3 years after the procedure. The comparison of the preoperative and postoperative results was done using the paired-samples t test. RESULTS: Thirty-nine patients (25 females, 14 males) with a mean age of 59 years were eligible for our study. Half of them worked in the agricultural sector. All developed solid, lumbar fusions. Instrumented posterior lumbar fusion decreased patient's somatic pain, as shown by the VAS (P<0.001) and improved function as indicated by the ODI (P<0.001), and allowed return to work (P<0.001). Nevertheless, the Zung Depression Scale revealed that the incidence of depression increased postoperatively (P<0.001). CONCLUSIONS: IPLF in the treatment of degenerative disorders of the lumbar spine improves function and promotes the patients' complete or partial return to work. In contrast, degenerative lumbar spine disorders are chronic conditions and may negatively affect patients' psychology.

Cervical spinal cord intramedullary teratoma.

We present the case of a 62-year-old patient suffering from the presence of a cervical spinal cord intramedullary teratoma and treated operatively. The purpose of this case report is to describe the highly unusual localization of the intramedullary teratoma associated with other vertebral malformations. A review of the literature is also presented.

Post-operative combined radiation and chemotherapy with temozolomide and irinotecan in patients with high-grade astrocytic tumors. A phase II study with biomarker evaluation.

BACKGROUND: Clinical studies have shown that temozolomide (TMZ) and irinotecan demonstrate activity in high grade astrocytic tumors (HGAT). However, the optimal schedule of administration is unknown. PATIENTS AND METHODS: In the present study, a total of 45 HGAT patients, 38 with glioblastoma multiforme (GBM) and 7 with anaplastic astrocytoma (AA), were treated with TMZ, 150 mg/m(2) on days 1-5, followed by irinotecan, 150 mg/m(2) on days 6 and 17, every 4 weeks for 6 cycles or until the occurrence of unacceptable toxicity or disease progression. Radiation therapy (60 Gy) was initiated on the first day of treatment. RESULTS: Twenty-two patients completed six cycles of treatment. Most frequently recorded side-effects included neutropenia (37%), nausea/vomiting (66%), diarrhea (31%) and infection (44%). Five episodes of vaso-occlusive disease, all of them fatal, were observed. After a median follow-up of 49.8 months, median progression-free survival for patients with GBM was 7.7 months, while median overall survival was 12.8 months. There were six long-term survivors, three of them with GBM. Two out of the five biomarkers studied, epidermal growth factor receptor (EGFR) and vascular endothelial growth factor-C (VEGF-C), were found to be overexpressed in 74% of the tumors, however they had no predictive value for progression-free or overall survival. CONCLUSION: The combination of TMZ and irinotecan, as administered in this study, was accompanied by high rates of toxicity, especially myelotoxicity and infection. Further development of this regimen in the treatment of HGAT is not recommended.

Retroclival epidural hematoma secondary to a longitudinal clivus fracture.

Retroclival epidural hematomas (RCEDH) make part of posterior fossa epidural hematomas (PFEDH) and represent an extremely rare entity not always easily diagnosed with computerized tomography (CT) due to beam hardening artifacts. The authors present a case of a child-to our knowledge-the first reported until now-featured the rare combination of a longitudinal clivus fracture associated with concomitant epidural hematoma treated conservatively with favorable outcome of the patient.