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1.
Acta Neurochir (Wien) ; 164(10): 2563-2572, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35867183

RESUMO

BACKGROUND: Treatments for symptomatic or unstable basilar invagination (BI) include posterior decompression, distraction/fusion, trans-nasal or trans-oral anterior decompression, and combined techniques, with the need for occipitocervical fusion based on the degree of craniocervical instability. Variations of the far lateral transcondylar approach are described in limited case series for BI, but have not been widely applied. METHODS: A single-institution, retrospective review of consecutive patients undergoing a far lateral transcondylar approach for odontoidectomy (± resection of the inferior clivus) followed by occipitocervical fusion over a 6-year period (1/1/2016 to 12/31/2021) is performed. Detailed technical notes are combined with images from cadaveric dissections and patient surgeries to illustrate our technique using a lateral retroauricular incision. RESULTS: Nine patients were identified (3 males, 6 females; mean age 40.2 ± 19.6 years). All patients had congenital or acquired BI causing neurologic deficits. There were no major neurologic or wound-healing complications. 9/9 patients (100%) experienced improvement in preoperative symptoms. CONCLUSIONS: The far lateral transcondylar approach provides a direct corridor for ventral brainstem decompression in patients with symptomatic BI. A comprehensive knowledge of craniovertebral junction anatomy is critical to the safe performance of this surgery, especially when using a lateral retroauricular incision.


Assuntos
Platibasia , Fusão Vertebral , Adulto , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia , Platibasia/complicações , Platibasia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/métodos , Adulto Jovem
2.
Clin Imaging ; 76: 160-165, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33607420

RESUMO

BACKGROUND: Epidural venous congestion secondary to inferior vena cava (IVC) stenosis is a well-documented cause of low back pain and radiculopathy secondary to compressive effects from the epidural veins, decreased tissue perfusion, and resultant ischemia. METHODS: Single patient case report. CASE DESCRIPTION: We report a unique case of a 62-year-old male with low back pain secondary to IVC stenosis from a chronically occluded IVC filter. The patient's pain resolved with endovascular removal of the occluded filter and recanalization of the IVC. CONCLUSION: We demonstrated that by treating the underlying cause of secondary epidural venous engorgement (occluded IVC filter in this case), the patient experienced resolution of back pain and radiculopathy.


Assuntos
Dor Lombar , Radiculopatia , Filtros de Veia Cava , Trombose Venosa , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Radiculopatia/terapia , Terapia Trombolítica , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
3.
J Neurosurg Pediatr ; 23(4): 480-485, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30717055

RESUMO

OBJECTIVE: Various surgical techniques have been described to treat subdural fluid collections in infants, including transfontanelle aspiration, burr holes, subdural drain, subduroperitoneal shunt, and minicraniotomy. The purpose of this study was to describe a modification of the minicraniotomy technique that avoids the implantation of external drainage catheters and potentially carries a higher success rate. METHODS: In this retrospective study, the authors describe 11 cases involving pediatric patients who underwent parietal minicraniotomies for the evacuation of subdural fluid collections. In contrast to cases previously described in the literature, no patient received a drain; instead, a subgaleal pocket was created such that the fluid could flow from the subdural to the subgaleal space. Preoperative and postoperative data were reviewed, including neurological examination findings, radiological findings, complications, hospital length of stay, and findings on follow-up examinations and imaging. The primary outcome was failure of the treatment strategy, defined as an increase in subdural fluid collection requiring further intervention. RESULTS: Eleven patients (8 boys and 3 girls, median age 4.5 months) underwent the described procedure. Eight of the patients had complete resolution of the subdural collection on follow-up imaging, and 2 had improvement. One patient had a new subdural collection due to a second injury. Only 1 patient underwent aspiration and subsequent surgical repair of a pseudomeningocele after the initial surgery. Notably, no patients required subduroperitoneal shunt placement. CONCLUSIONS: The authors describe a new surgical option for subdural fluid collections in infants that allows for more aggressive evacuation of the subdural fluid and eliminates the need for a drain or shunt placement. Further work with more patients and direct comparison to other alternative therapies is necessary to fully evaluate the efficacy and safety of this new technique.


Assuntos
Craniotomia/métodos , Hematoma Subdural Crônico/cirurgia , Espaço Subdural/cirurgia , Resultado do Tratamento , Feminino , Humanos , Lactente , Masculino , Nascimento Prematuro/fisiopatologia , Nascimento Prematuro/cirurgia , Estudos Retrospectivos , Derrame Subdural/etiologia , Derrame Subdural/cirurgia
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