Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training / Acuerdo inter e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico

Introduction and objectives: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. Materials and methods: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. Results: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52–0.63) and 0.69 (0.55–0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46–0.60) for junior residents, 0.61 (0.54–0.67) for senior residents and 0.67 (0.59–0.74) for attendings. Intraobserver agreement was of 0.54 (0.48–0.60) for junior, 0.60 (0.55–0.66) for senior and 0.66 (0.60–0.72) for attendings. Conclusion: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.(AU)

Introducción y objetivos: La estenosis espinal lumbar es una condición frecuente relacionada con la edad que afecta la calidad de vida. Se han desarrollado múltiples clasificaciones para cuantificar la gravedad de la estenosis que afectan la comparación entre estudios y la comunicación homogénea entre cirujanos e investigadores. A pesar de que esta clasificación no ha mostrado una correlación directa con la clínica, la clasificación de Schizas parece ser un método simple para evaluar la estenosis. Nuestro objetivo fue evaluar el acuerdo independiente inter e intraobservador de la clasificación de Schizas en la severidad de la estenosis. Además, comparamos la concordancia entre tres niveles de formación en cirugía de columna. Materiales y métodos: Se llevó a cabo un acuerdo independiente inter e intraobservador entre los residentes ortopédicos principiantes, avanzados y los cirujanos de columna; 90 niveles lumbares de 30 pacientes fueron evaluados por 16 observadores. Se utilizó concordancia a través del kappa ponderado. Resultados: La concordancia global interobservador e intraobservador fue de 0,57 (IC 95%=0,52-0,63) y 0,69 (0,55-0,79), respectivamente. La concordancia interobservador según el nivel de formación arroja valores de 0,53 (0,46-0,60) para los residentes menores, 0,61 (0,54-0,67) para los residentes mayores y 0,67 (0,59-0,74) para los asistentes. La concordancia intraobservador fue de 0,54 (0,48-0,60) para principiantes, 0,60 (0,55-0,66) para avanzados y 0,66 (0,60-0,72) para cirujanos de columna. Conclusión: La clasificación de Schizas mostró concordancia interobservador moderada y concordancia intraobservador sustancial. Entre los cirujanos de columna, se observó un acuerdo sustancial inter e intraobservador. La clasificación permitió una comunicación aceptable entre los cirujanos de columna entrenados.(AU)

[Artículo traducido] Acuerdo inter-e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico / Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training

Introduction and objectives: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. Materials and methods: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. Results: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52–0.63) and 0.69 (0.55–0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46–0.60) for junior residents, 0.61 (0.54–0.67) for senior residents and 0.67 (0.59–0.74) for attendings. Intraobserver agreement was of 0.54 (0.48–0.60) for junior, 0.60 (0.55–0.66) for senior and 0.66 (0.60–0.72) for attendings. Conclusion: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.(AU)

Introducción y objetivos: La estenosis espinal lumbar es una condición frecuente relacionada con la edad que afecta la calidad de vida. Se han desarrollado múltiples clasificaciones para cuantificar la gravedad de la estenosis que afectan la comparación entre estudios y la comunicación homogénea entre cirujanos e investigadores. A pesar de que esta clasificación no ha mostrado una correlación directa con la clínica, la clasificación de Schizas parece ser un método simple para evaluar la estenosis. Nuestro objetivo fue evaluar el acuerdo independiente inter e intraobservador de la clasificación de Schizas en la severidad de la estenosis. Además, comparamos la concordancia entre tres niveles de formación en cirugía de columna. Materiales y métodos: Se llevó a cabo un acuerdo independiente inter e intraobservador entre los residentes ortopédicos principiantes, avanzados y los cirujanos de columna; 90 niveles lumbares de 30 pacientes fueron evaluados por 16 observadores. Se utilizó concordancia a través del kappa ponderado. Resultados: La concordancia global interobservador e intraobservador fue de 0,57 (IC 95%=0,52-0,63) y 0,69 (0,55-0,79), respectivamente. La concordancia interobservador según el nivel de formación arroja valores de 0,53 (0,46-0,60) para los residentes menores, 0,61 (0,54-0,67) para los residentes mayores y 0,67 (0,59-0,74) para los asistentes. La concordancia intraobservador fue de 0,54 (0,48-0,60) para principiantes, 0,60 (0,55-0,66) para avanzados y 0,66 (0,60-0,72) para cirujanos de columna. Conclusión: La clasificación de Schizas mostró concordancia interobservador moderada y concordancia intraobservador sustancial. Entre los cirujanos de columna, se observó un acuerdo sustancial inter e intraobservador. La clasificación permitió una comunicación aceptable entre los cirujanos de columna entrenados.(AU)

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training. / [Artículo traducido] Acuerdo inter- e intraobservador independiente de la clasificación de Schizas de estenosis lumbar degenerativa. Comparación entre tres niveles de entrenamiento quirúrgico.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Independent inter and intra-observer agreement of the Schizas's classification of degenerative lumbar stenosis: Comparison among three levels of surgical training.

INTRODUCTION AND OBJECTIVES: Lumbar spinal stenosis is a common age-related condition that affects the quality of life. Multiple classifications have been developed to quantify the severity of stenosis affecting comparison between studies and homogenous communication among surgeons and researchers. Even though this classification has not shown a direct clinical correlation, Schizas's classification appears to be a simple method to assess stenosis. Our objective was to evaluate the inter and intraobserver independent agreement of the Schizas's classification to assess stenosis severity. Additionally, we aimed to compare agreement among three levels of training in spine surgery. MATERIALS AND METHODS: An independent inter and intra observer agreement was conducted among junior, senior orthopedic residents and attending spine surgeons. Ninety lumbar levels from 30 patients were evaluated by 16 observers. Weighted kappa agreement was used. RESULTS: Overall interobserver and intraobserver agreement was of 0.57 (95% CI=0.52-0.63) and 0.69 (0.55-0.79), respectively. Interobserver agreement according to level of training yielded values of 0.53 (0.46-0.60) for junior residents, 0.61 (0.54-0.67) for senior residents and 0.67 (0.59-0.74) for attendings. Intraobserver agreement was of 0.54 (0.48-0.60) for junior, 0.60 (0.55-0.66) for senior and 0.66 (0.60-0.72) for attendings. CONCLUSION: The Schizas's classification showed moderate interobserver and substantial intraobserver agreement. Among attending surgeons, substantial inter and intraobserver agreement was observed. The classification allowed acceptable communication among trained spine surgeons.

Wound-related complications in the surgical treatment of vertebral metastatic disease – A case series analysis / Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

[Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos / Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis. / [Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC -surgical site infection, hematoma, and/or dehiscence- at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=.044). There was no difference between groups on 90 days survival rate (p=.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC - surgical site infection, hematoma, and/or dehiscence - at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía / Factors associated with lumbar disc hernia recurrence after microdiscectomy

Introducción. Las hernias de disco lumbares son una causa frecuente de cirugía lumbar. La recurrencia herniaria es una complicación prevalente. Objetivo. Analizar los factores de riesgo asociados a recurrencia herniaria en pacientes intervenidos por hernia discal lumbar en nuestra institución. Materiales y métodos. Se analizaron en forma retrospectiva una serie de 177 microdiscectomías lumbares entre 2010 y 2014; se excluyeron pacientes con cirugías previas, hernias foraminales y extraforaminales. Los pacientes con recurrencia herniaria constituyeron el grupo de casos y los que no presentaron recurrencia fueron el grupo control; se analizó: sexo, edad, índice de masa corporal, nivel, degeneración facetaria, altura discal y protrusión discal. Resultados. Hubo 177 pacientes con microdiscectomía lumbar, de los cuales 30 (16%) presentaron recurrencia herniaria; de ellos, 27 fueron reoperados. Entre los factores de riesgo asociados a recurrencia observamos mayor índice de altura discal, mayor porcentaje de canal ocupado por la hernia y mayor presencia de cambios degenerativos facetarios; no observamos diferencias en cuanto al sexo, índice de masa corporal y edad. Discusión. Estudios previos muestran el aumento de altura discal y pacientes jóvenes como posibles factores asociados a recidiva. Conclusión. En nuestra serie encontramos que el mayor índice de altura discal, el porcentaje de canal ocupado por la hernia y los cambios degenerativos facetarios se asociaron a recurrencia herniaria (AU)

Introduction. Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. Objective. To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Materials and methods. Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. Results. 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. Discussion. Previous studies show increased disc height and young patients as possible factors associated with recurrence. Conclusion. In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence (AU)

Factors associated with lumbar disc hernia recurrence after microdiscectomy. / Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía.

INTRODUCTION: Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. OBJECTIVE: To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. MATERIALS AND METHODS: Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. RESULTS: 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. DISCUSSION: Previous studies show increased disc height and young patients as possible factors associated with recurrence. CONCLUSION: In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence.

[The two familial occurrence of von Hippel-Lindau disease].

Five cases of von Hippel-Lindau disease in two families were reported. In one family there were 2 cases in a mother (55 years old) and her daughter (26 years old) which had multiple hemangioblastomas in the optic nerve, cerebellum and spinal cord in each case. Retinal angioma appeared in the case of daughter, but not in the mother. In the other family there were 3 cases in a father (28 years old), his son (11 years old) and daughter (14 years old). All of them had retinal angioma and cerebellar hemangioblastoma. Two cases out of 5 cases in the two families were associated with abdominal organ diseases which were renal cell carcinoma in a case and pancreas cyst in the other. The familial occurrence of von Hippel-Lindau disease in Japan was recognized in 21 families with 103 cases including our cases. On the study of reported cases hemangioblastoma frequently occurred in multiple region such as cerebellum, medulla oblongata and frequently presented with renal cell carcinoma, pheochromocytoma and cyst in pancreas, kidney and liver. The location of hemangioblastoma and combined disease was similar in cases in each family. The age of onset of von Hippel-Lindau disease in the second generation was younger than that of the first generation.

[Clinical study on the recurrence of meningiomas: correlating factors for the recurrence and therapeutic prognosis of meningiomas].

Authors have studied 128 cases of meningiomas which were operated on and examined histologically. 12 cases (11.3%) of 106 cases of the meningiomas followed up for more than 5 years after surgery had recurrence after the primary operation. The distribution of age and sex, the tumor location, the histological type, the extent of tumor evacuation and AgNORs counts and BrdU labeling index for the evaluation of tumor proliferation were studied comparatively in the two groups, the recurrent and nonrecurrent meningiomas. 8 cases (19.0%) of 42 cases of the meningiomas in the age-group lower than 50 years old were recurrent cases, whereas 4 cases (6.0%) of 67 cases in the age-group over 50 years old were non-recurrent. Concerning the sex distribution of the meningiomas in our cases recurrent rate was 20.5% among males and 6.0% among females. The tumor locations of the meningiomas did not correlate significantly with recurrence. The extent of tumor removal demonstrated Simpson grade I (47 cases), grade II (37 cases), grade III (17 cases), grade IV (5 cases) on primary operation. Recurrence was found in 11 cases (13.1%) of 84 cases operated on by total removal of Simpson grade I or grade II. 8 cases of 11 cases had recurrence within 5 years after the primary operation of Simpson grade I or II. Total removal of the tumor was important in order to bring about long survival after operation. But correlation between the extent of tumor removal and recurrence was not able to be recognized. Histologically, all of the malignant, atypical and papillary type of meningiomas treated in the primary operations had recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

[Turner's syndrome with pituitary hyperplasia: a case report].

Turner's syndrome, a sex-chromosome abnormality, is often accompanied by cardiovascular disorders, such as coarctation of the aorta. We encountered a case of Turner's syndrome with meningioma and pituitary hyperplasia which resulted in death from dissection of the aorta. The patient was 36-year-old female who was diagnosed as having Turner's syndrome of mosaic-type at the age of 15. She had accepted sex-hormone replacement with estrogen and progesterone over 20 years. She lost consciousness and was transferred to our institute on June 20th, 1992. She was in shock but her condition began to improve after intensive treatment. CT scan revealed a calcified mass lesion at the left frontal convexity and a markedly enhanced round mass lesion at the suprasellar region. Angiography showed tumor stain of the suprasellar region fed by the posterior ethmoidal artery. These tumors were diagnosed as multiple meningiomas. She developed dyspnea on June 24th and chest X-ray showed right pleural fluid collection and cardiomegaly. This condition was diagnosed as congestive heart failure. Her condition was getting worse and she suffered abrupt cardiac arrest on June 28th. Autopsy revealed dissection of the aorta as the cause of death. The tumor of the convexity was meningioma, and the suprasellar lesion was diagnosed as pituitary hyperplasia. It is well known that frequent excess dose injection of estrogen can induce pituitary adenoma or hyperplasia in rats. In this case, the presence of pituitary hyperplasia was thought to be the result of long-term injection of estrogen.(ABSTRACT TRUNCATED AT 250 WORDS)

Pituitary adenoma combined with Rathke's cleft cyst--case report.

A rare pituitary adenoma associated with Rathke's cleft cyst was discovered incidentally in a 44-year-old male admitted after head trauma. Neurological and physiological examination found no abnormalities, except for panhypopituitarism. Computed tomography and magnetic resonance imaging demonstrated a solid mass in the sellar cavity with suprasellar extension, associated with a cystic mass extending into the third ventricle. The tumor was removed subtotally by the transcranial approach. Light microscopy demonstrated that the cyst wall was composed of ciliated columnar cells, cuboidal cells, and goblet cells, and the solid part indicated chromophobe pituitary adenoma. Immunohistochemistry demonstrated that a few adenoma cells were positive for prolactin and the cyst wall cells were positive for cytokeratin and negative for S-100 protein.

[Central neurocytoma--report of a case].

The authors present a case of central neurocytoma in a 23-year-old male with increased intracranial pressure syndrome. Computed tomographic (CT) scans and magnetic resonance images showed a large tumor mass with no evidence of calcification in the right lateral ventricle extending towards the third ventricle. A right transcortical-transventricular approach was performed and the tumor was totally removed. The postoperative course was uneventful and no further treatment was administered. CT shows no evidence of tumor recurrence after the six months from his surgery. Light microscopic findings suggested a diagnosis of oligodendroglioma. However, ultrastructural examinations demonstrated many dense-core or clear vesicles, microtubules and synaptic like structures within the abundant cytoplasmic processes of the tumor cells which suggested neuronal differentiation. Immunohistochemical examinations showed the tumor cells to be positive for neuron-specific enolase, sporadically positive for synaptophysin, and negative for glial fibrillary acidic protein. The final histological diagnosis was central neurocytoma. Central neurocytoma was first described by Hassoun et al, in 1982. Since then, 96 cases have been reported in the literatures. Their clinicopathological features, neuroradiological findings and prognosis are discussed.