[Costotransversectomy and interbody fusion for treatment of thoracic dyscopathy]. / Costotransversectomia ze spondylodeza miedzytrzonowa w leczeniu dyskopatii piersiowej. ocena metody.

INTRODUCTION: Surgical treatment of a thoracic discopathy comprises 4% of all surgeries performed for discopathy. Therefore, analysis of efficacy of particular operative methods used in that scope is limited. We present our analyze modification of costotransversectomy with policarbone cage interbody fusion as the contribution to discussion on optimal operative treatment of thoracic discopathy. MATERIAL AND METHODS: Results of the operative treatment of 14 cases of a thoracic discopathy are analyzed. In 12 cases neurological examination revealed radiculopathy and in 2 cases upper motor neuron involvement. All patients underwent MRI for estimation of level and morphology of discopathy. In one case there was two-level dyscopathy and in the other cases there was one-level discopathy localized in the region between fifth and twelve thoracic vertebrae. The follow up period was of 10 months to 6 years (mean 2 years and four months). During the surgery lateral upper aspect of the intervertebral disc on a one side was exposed. It was accomplished by removal of the head of the rib and the upper aspect of the pedicle located caudally to the intervertebral disc. The policarbone cage was introduced into the intervertebral space after discectomy. RESULTS: In the case with sudden preoperative deterioration of the lower extremities strength there was further postoperative deterioration. During follow up, continuous improvement was observed. In the 12th postoperative month the weakness was minimal. In the other cases immediate postoperative resolution of the pain syndrome and neurological deficits was observed. Postoperative imaging studies reveled appropriate decompression of the spinal canal and localization interbody implant. CONCLUSIONS: 1. Costotransversectomy approach leads to sufficient exposition of the anterior aspect of the spinal canal. 2. Our modification of interbody fusion with policarbone cage gives good results in fusion of compromised motion unit. It makes the approach more attractive in the light of remote surgery effects.

[Endoscope-guided placement of the ventriculoperitoneal shunt: technique and applications]. / Metoda endoskopowego umieszczania drenu komorowego zastawki--technika i zastosowanie.

INTRODUCTION: The routine surgical procedure for placement of the ventricular shunt catheter is straightforward. However, the topography of the ventricular system in complex hydrocephalus is so distorted that orientation on the basis of standard external topographic points does not ensure satisfactory positioning of the drain. AIMS: 1. To test the clinical efficiency of endoscope-guided placement of the ventricular catheter in cases of complex hydrocephalus. 2. To present and popularize the surgical technique of endoscope-guided placement of the ventricular shunt catheter which hitherto was not published in the Polish literature. MATERIAL AND METHODS: This study was done in 38 patients aged 2 days to 45 years (mean 7 years and 5 months). Multiloculated hydrocephalus was found in 7, lateral ventricle isolation in 14, fourth ventricle isolation in 3, intraventricular cyst accompanied hydrocephalus in 6, and adherent ventricular catheter of the shunt implanted previously in 8 cases. Endoscopy was performed through coronal or occipital burr hole. Peelaway sheath was used for placement of the catheter in the desired position. Computerized tomography was performed within 24 hours after surgery, after 6 months, and subsequently every 12 months during follow-up. The time of follow-up ranged from 1 to 5 years (mean 27 months). There were eight cases (15.78%) of postoperative occlusion of the ventricular catheter. In two of them, occlusion was caused by catheter tip displacement. In the remaining cases, occlusion was caused by growing membranes of the multiloculated hydrocephalus (four cases) or by infection (two cases) and was not related to the catheter position. There were no cases of catheter position change during follow-up. DISCUSSION: In complex hydrocephalus, proper placement of the ventricular catheter without direct visual control is very difficult if not impossible. Therefore, use of the endoscope facilitates proper catheter placement in multiloculated hydrocephalus, hydrocephalus complicated by isolation of the ventricle or intraventricular cyst. CONCLUSIONS: 1. The technique of endoscope-guided placement of the ventricular catheter is relatively simple and useful for reliable positioning of the drain in the right location. 2. Our cases show that the method is clinically effective. However, comparison with the conventional method will require a controlled and matched trial.

Endoscopic aqueductal stent placement for the treatment of a trapped fourth ventricle.

OBJECT: Endoscopic aqueductal stent therapy has evolved into an important technique in the treatment of a trapped fourth ventricle (TFV). The authors analyzed five cases of symptomatic TFV treated by endoscopic aqueductal stent therapy and, on the basis of intraoperative findings, discuss aspects of TFV formation. METHODS: Patients' ages ranged from 2 to 17 years (mean 9.2 years). Two patients underwent endoscopy via a coronal bur hole approach and three via a small suboccipital craniectomy. The mean follow-up period was 30 months (range 24-38 months). In four cases, a membrane occluding the orifice of the aqueduct and covering part of the walls of the ventricle was observed. Despite slit ventricles in four cases, there was no intraoperative evidence of aqueduct wall collapse. All procedures were successful, and all patients experienced positive outcomes. In one patient, Parinaud syndrome, rotatory nystagmus, and abducent nerve palsy developed postoperatively; these deficits resolved after a preexisting supratentorial shunt was upgraded. There were no cases of aqueduct reocclusion during the follow-up period. CONCLUSIONS: Aqueductal stent therapy is an effective method of TFV treatment. Because it prevents aqueduct reocclusion by chronic inflammatory processes in postinflammatory hydrocephalus, it has been shown to be more efficient than aqueductoplasty alone and to be an important alternative to the placement of a fourth ventricle shunt. Intraventricular processes leading to membrane formation play an important role in occlusion of the cerebral aqueduct orifices and final isolation of the fourth ventricle in postinflammatory hydrocephalus.

[Endoscopic revision of adherent ventricular catheter. Evaluation of the method]. / Endoskopowo wspomagana rewizja uwieznietego drenu komorowego ukladu zastawkowego. Ocena metody.

BACKGROUND AND PURPOSE: To evaluate the method of endoscopic-assisted revision of adherent ventricular catheters. MATERIAL AND METHODS: 29 cases (26 patients) of endoscopic revision of adherent ventricular catheter were analyzed. The cause of hydrocephalus was intraventricular hemorrhage in 17 cases, myelomeningocele in 3 cases, ventriculitis in 4 cases, aqueductal stenosis in 1 case and holoprosencephaly in 1 case. Multiloculated hydrocephalus comprised 38.5% (10 patients) of cases. Depending on the catheter location, an approach through its burr hole, a new burr hole on the same side or opposite side was used. The mean time of follow up was 12 months. RESULTS: In 13 cases ventricular catheter was tethered in the choroid plexus, in 7 cases -- under the ependyma and in 9 cases -- in septum pellucidum. In 5 cases it was adherent to the blood vessel. An entity of active ingrowth of choroid plexus, ependyma and subependymal elements into the catheter lumen was observed. Reocclusion of the catheter occurred in 3 cases. In all these cases there was multiloculated hydrocephalus. In the remaining cases there were no signs of shunt malfunction during the time of follow up. CONCLUSIONS: The use of endoscope during revision of adherent ventricular catheter reduces the risk of bleeding. Due to a possibility of direct observation of catheter surroundings, a decision regarding catheter replacement and its placement in an optimal position can be taken. This method gives better results than traditional methods used during revisions of occluded, adherent ventricular catheters.

Posterior cervical lateral mass fixation for the management of insufficient anterior stabilization.

PURPOSE: There are clinical situations when anterior fixation alone is not sufficient to adequately stabilize the cervical spine at the level of operation. In vitro biomechanical studies revealed the substantial role of posterior stabilization in such situations. However, no clinical studies of this problem have been published. The usefulness of posterior cervical lateral mass fixation when anterior stabilization failed to offer sufficient spine stability was assessed in the present study. MATERIAL AND METHODS: We enrolled 15 patients who underwent additional posterior fixation due to destabilization of the anterior one. There were five patients with rheumatoid arthritis, six with cervical discopathy, three with cervical trauma, and one with spine tumor. Improvement after posterior fixation was noted in all but one patient. RESULTS: Posterior cervical lateral mass fixation significantly improved cervical spine stability in cases with insufficiency of anterior stabilization. Further investigations on criteria helpful to predict insufficiency of anterior stabilization in cases of multisegmental cervical spine disease are needed.