Electrophysiological Assessment of Paresthesia in Patients Following Radial Angiography: A Prospective Study.

BACKGROUND: Radial angiography, preferred for its safety and comfort in percutaneous coronary interventions, occasionally leads to paresthesia-a tingling or numbing sensation in the hand. This study aimed to investigate the presence of nerve damage in patients experiencing paresthesia post-radial angiography through electrophysiological examination. METHODS: This prospective study involved 77 patients who developed hand paresthesia following radial angiography. Excluded were those with malignancy, pregnancy, pace-makers, or recent angiography. Nerve conduction studies were performed using the Neuropack MEB 9102K EMG device, assessing sensory and motor amplitudes, latencies, and velocities of median, ulnar, and radial nerves. RESULTS: The study included 77 patients (23 females, 54 males; average age 58.39 ± 10.44 years). In 11 diabetic patients, polyneuropathy was detected. For the remaining 66 patients, electrophysiological evaluations showed no significant pathological findings. Comparative analysis of both upper extremities revealed no significant differences in nerve conduction parameters between the side where angiography was performed and the other side. Despite paresthesia complaints, no electrophysiological evidence of nerve damage was found, suggesting that symptoms might be due to local irritation rather than direct nerve injury. This aligns with the safety profile of radial angiography and underscores the importance of distinguishing between transient paresthesia and serious nerve complications. CONCLUSION: Paresthesia post-radial angiography, while clinically notable, is not typically associated with nerve damage. This study is significant as it is the first in the literature to demonstrate that radial angiography does not cause nerve damage.

Spinal Schwannomas: A Proposal for a New Classification to Aid Surgical Planning.

Background The treatment of spinal schwannomas, which is the most common nerve sheath tumor, is total microsurgical resection. The localization, size and relationship with the surrounding structures of these tumors are crucial in terms of preoperative planning. A new classification method is presented in this study for the surgical planning of spinal schwannoma. Methods All patients who underwent surgery for spinal schwannoma between 2008 and 2021 were reviewed retrospectively, along with radiological images, clinical presentation, surgical approach, and postoperative neurological status. Results A total of 114 patients, 57 male, and 57 females were included in the study. Tumor localizations were cervical in 24 patients, cervicothoracic in one patient, thoracic in 15 patients, thoracolumbar in eight patients, lumbar in 56 patients, lumbosacral in two patients, and sacral in eight patients. All tumors were divided into seven types according to the classification method. Type 1 and Type 2 groups were operated on with a posterior midline approach only, Type 3 tumors were operated on with a posterior midline approach and extraforaminal approach, and Type 4 tumors were operated on with only an extraforaminal approach. While the extraforaminal approach was sufficient in type 5 patients, partial facetectomy was required in 2 patients. Combined surgery including hemilaminectomy and extraforaminal approach was performed in the type 6 group. A posterior midline approach with partial sacrectomy/corpectomy was performed in Type 7 group. Conclusion Effective treatment of spinal schwannoma depends on preoperative planning, which includes correctly classifying tumors. In this study, we present a categorization scheme that covers bone erosion and tumor volume for all spinal localizations.

Short-Term Results of Simpson Grade 2 Resection in Spinal Meningiomas.

BACKGROUND: Spinal meningiomas are benign and slow-growing intradural tumors. Surgery is the choice of treatment. In this retrospective study, results of minimally invasive Simpson grade 2 resection and its impact on recurrence in 44 spinal meningiomas are reviewed. METHODS: Clinical data of 44 cases who underwent surgery for spinal meningiomas between 2010 and 2020 have been reviewed retrospectively. Demographics, preoperative and postoperative clinical states, pathologic type, location of the meningioma relative to the spinal cord, resection amount of the tumor according to Simpson's grading scale, postoperative complications, recurrence rate, and correlation between preoperative and intraoperative data and recurrence were analyzed. RESULTS: The tumor was located in the thoracic spine in 31 cases, in the cervical spine in 12 cases, and in the lumbar spine in one case. Dural attachment of tumor was ventral to the spinal cord in 15 cases, lateral to the spinal cord in 15 cases, and posterior to the spinal cord in 14 cases. All cases underwent microsurgical Simpson grade 2 resection. Two cases were recurrent and reoperated. Recurrences were observed in cases younger than 18 years old, in cervical spines and in cases with long dural tails. CONCLUSIONS: Simpson grade 2 resection is safe and effective in spinal meningiomas. Patients younger than 18 year old, and those with cervical location and long dural tail may be under risk of recurrence after Simpson grade 2 resection.

Surgical Treatment of Spinal Arachnoid Cysts: Cyst Excision or Fenestration?

AIM: Arachnoid cysts in the spinal canal account for 1%-3% of all spinal canal lesions. There is no consensus on surgical treatment yet. Dural defect repair is crucial in surgical treatment patients with an extradural component. Fenestration or total resection of the spinal arachnoid cyst is among the preferred methods. This study aimed to examine a series of surgically treated spinal arachnoid cysts in light of the literature. MATERIAL AND METHODS: This was a retrospective study of patients treated in the Istanbul Umraniye Training and Research Hospital Neurosurgery Clinic. A total of 18 patients with spinal arachnoid cysts underwent surgical treatment between 2012 and 2021. All patients were assessed before and after surgery for muscle strength, pain, sensory changes, and bowel-bladder symptoms. All patients underwent magnetic resonance imaging and computed tomography for diagnosis and treatment. RESULTS: Among the 18 patients, 8 were men and 10 were women, with a mean age of 43.7 (25-66) years. Congenital conditions were discovered in 15 of the patients, 2 after lumbar drainage and 1 after spinal anesthesia. Intradural extramedullary and intra-extradural cysts were found in 17 patients and 1 patient, respectively. The cyst was smaller than level 3 in 14 patients and greater than level 3 in 4 patients. Cyst excision and cyst fenestration were performed in 11 and 7 patients, respectively. Cyst excision was performed in four of the patients who underwent cyst fenestration because their complaints did not improve. CONCLUSION: Surgery should be considered in patients with symptomatic spinal arachnoid cysts. Fenestration may be a suitable alternative, especially if magnetic resonance imaging reveals no intracystic adhesion or trabeculation. Residual and recurrence rates are high in patients with a history of intradural intervention, adhesions, or trabeculation. When there is trabeculation, the best option is cyst removal.

Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors.

OBJECTIVE: The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors. METHODS: This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach. RESULTS: The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean=41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%. CONCLUSION: Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Management of Spinal Lymphomas: Spinal Instability Assessment Using the Spinal Instability Neoplastic Score and a Proposed Treatment Algorithm.

AIM: To propose a treatment algorithm, and to assess spinal instability in patients diagnosed with spinal lymphoma. MATERIAL AND METHODS: Demographics, symptoms, tumor level and location, and presence of spinal instability were reviewed in 22 patients with spinal lymphomas. Each patient's neurological state was reviewed using the American Spinal Injury Association and modified McCormick scale scores, and spinal instability was assessed using the Spinal Instability Neoplastic Score (SINS). RESULTS: Initially, percutaneous biopsy was performed in 16 patients, and open biopsy was performed in 6 patients. Eight of the patients who underwent percutaneous biopsy were followed up with hematological examination alone, as they had no additional complaints. The SINS was used to evaluate the presence of spinal instability, and the type of surgery to be performed was decided accordingly. In the second surgery, decompression and stabilization were performed in 5 of the remaining 8 patients, and only decompression was performed in 3 of them. Neurological improvement was observed in 6 of 7 patients with acute neurological deficit. CONCLUSION: Percutaneous biopsy for tissue diagnosis is the first step in the management of spinal lymphomas. Patients without neurological deficit should be referred for hematological examination. Those with acute neurological deficit require emergency surgery, and those with chronic symptoms must undergo operation for decompression and/or stabilization. This study confirmed the safety of the SINS in the evaluation of spinal instability in spinal lymphoma cases.

Role of Spinal Instability Neoplastic Score in Management of Spinal Plasmacytoma.

OBJECTIVE: The decision to perform surgery in cases of spinal plasmacytoma (SP) is controversial. This study aimed to evaluate the reliability of the Spinal Instability Neoplastic Score (SINS) in evaluation of spinal instability in patients with SP. METHODS: Clinical and radiological characteristics of 10 patients with SP were retrospectively evaluated. Age, sex, preoperative symptoms, duration of symptoms, pain score, American Spinal Injury Association score, and SINS were analyzed. RESULTS: The 10 patients included 6 men and 4 women. Plasmacytoma was located in the sacrum in 1 patient, in the lumbar spine in 2 patients, in the thoracic spine in 6 patients, and in the cervical spine in 1 patient. Biopsy was performed in 2 patients, biopsy and vertebroplasty were performed in 2 patients, and biopsy and acute decompression and stabilization surgery were performed in 6 patients. SINS was <7 in 1 patient, 7-12 in 5 patients, and >12 in 4 patients. Two patients with a low SINS (<13) underwent only biopsy, and 2 patients underwent biopsy and vertebroplasty. Decompression and stabilization surgery was performed in 2 patients with SINS 7-12 and 4 patients with SINS >12. CONCLUSIONS: Decision making regarding augmentation, decompression, and stabilization in patients with SP is controversial. SINS may play a role during the decision-making process. Augmentation can be performed in patients with painful SPs with osteolytic changes with or without fracture (SINS <13). Decompression and stabilization surgery is the first-choice treatment in patients with SINS >12.

A brief case series of radiation associated myelopathy.

Radiation myelopathy (RM) is a rare but serious complication of radiotherapy. Small vessel ischemia and demyelination are some of the more remarkable indications of RM's pathophysiology. The RM is a diagnosis of exclusion. In the differential diagnosis, infectious causes, tumors, rheumatic diseases, and paraneoplastic syndromes are the main diseases that should be excluded. Contrast-enhanced magnetic resonance imaging (MRI) is a useful method for diagnosis. We present a report on 3 patients diagnosed with radiation myelitis. All the patients presented with late paraparasia and paresthesia. Despite high-dose steroids, hyperbaric oxygen, and physical therapy, there was no clinical improvement at the follow-up one year later.

Pediatric age, posterior fossa meningioma.

Meningiomas are benign, slow-growing tumors originating from arachnoid gap cells. They constitute 15%-20% of all intracranial tumors in adults and 04%-4% in the pediatric age group. Meningiomas in the posterior fossa in the pediatric period do not initially come to mind. In the case presented here, there was a cystic meningioma showing heterogenous contrast and obstructive hydrocephaly was observed associated with 4th ventricle pressure. the tumor was totally removed, then the ventriculo peritoneal shunt was applied.

Spinal Hemangioblastomas and Neuropathic Pain.

BACKGROUND: Spinal hemangioblastomas (SHs) are rare and benign tumors. Primary symptoms include pain, hypoesthesia, and neuropathic pain (NP). Clinical symptoms may be as a result of tumor mass effect, peritumoral effect, syrinx, or venous congestion. No studies have focused on NP in SHs. The objective of this study was to review the rate and causes of NP in patients with SHs. METHODS: The present study comprises a retrospective analysis of 13 patients with spinal hemangioblastomas. For the retrospective analysis of the patients, we analyzed the absence or presence of NP in the pre- and postoperative periods and its relationship with the level, location, and size of the tumor, as well as the size and location of the syrinx. RESULTS: Postoperative NP was detected in 6 out of 13 patients. All 6 patients' tumors were located at the dorsal aspect of the spinal cord. There was a predominance of rostral syrinx location in patients with NP. Tumor size and level and syrinx size and level were not found to affect the occurrence of NP. CONCLUSIONS: The present study shows that NP is observable in both pre- and postoperative periods. Proximity of the tumor to the dorsal root entry zone, and especially the presence of rostral syrinx, are the main factors affecting postoperative NP symptomatology. It is concluded that the combination of these factors and iatrogenic injury of anatomic pathways of NP within the spinal cord are responsible for postoperative NP.

Acute Neurologic Deterioration in Mobile Spinal Schwannoma.

BACKGROUND: Spinal schwannomas are commonly presented with minor symptoms, including radicular pain, sensory deficits, and minor neurologic deficit. Acute neurologic deterioration is uncommon. CASE DESCRIPTION: In this study, a case of cauda equina schwannoma presented with acute neurologic deficit after movement of spinal schwannoma is presented. CONCLUSIONS: It is noted that movement of spinal schwannoma and resultant acute neurologic deterioration should be considered during the follow-up.

The Application of an Enhanced Recovery After Surgery to Spine Instrumentation.

AIM: To evaluate the clinical and economic outcomes of the adoption of the enhanced recovery after spine surgery (ERSS) program in patients undergoing spine instrumentation. MATERIAL AND METHODS: This study described the introduction of the ERSS program, and we compared 86 consecutive patients who participated in ERSS with a retrospective cohort of 88 patients who underwent the same surgery before the implementation of this program. Groups were compared in terms of age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) physical scores, operative time, comorbidities, intraoperative blood loss, blood transfusion rate, first oral intake, time of first mobilization, length of hospital stay, preoperative and postoperative pain scores using a numeric pain rating scale, 30-day readmission and complication rates, and total cost. RESULTS: Groups were similar in terms of age, sex, BMI, ASA scores, and comorbidities. Intraoperative blood loss, blood transfusion rate, and length of hospital stay were lower in the ERSS group. First oral intake and first mobilization occurred earlier in the ERSS group. Postoperative pain scores were significantly lower in the ERSS group. Operative time, readmissions, or complications at 30 days did not statistically differ between the two groups. The ERSS group was found to be significantly cost effective. CONCLUSION: ERSS is feasible, comprehensive, and cost effective for spine instrumentation with better perioperative outcomes.