Ancient schwannoma of the cauda equina. / A cauda equina "ancient" típusú schwannomája.

Összefoglaló. A cauda equina daganatai a leggyakrabban lumbagós panaszokkal jelentkeznek. Általában késoi stádiumban ismerik fel oket, mivel lassan növekednek, az anatómiai környezet tágas, a megjeleno tünetek nem specifikusak, valamint az érintett betegek többsége fiatal és egyébként egészséges. Jelen közleményünkben egy ritka variáns, a cauda equinát érinto "ancient" típusú schwannoma esetének kórtörténetét és kezelését mutatjuk be. Mutéti ellátás során a daganat totális eltávolítása történt, ezt követoen a beteg panaszai megszuntek. Ezen daganat klinikai kimutatását preoperatív T1-, T2-súlyozott MRI tette lehetové, a pontos diagnózist azonban az eltávolított daganat patológiai szövettani feldolgozása biztosította. Irodalmi áttekintésünk alapján a cauda equinában ez a szövettani altípusú schwannoma kifejezetten ritka: nemzetközi szinten 3 ilyen publikált eset jelent meg, magyar nyelvu közlést a témában azonban nem találtunk. Orv Hetil. 2022; 163(5): 195-200. Summary. Tumors of the cauda equina generally present with lower back pain. They are usually recognized at a late stage as they grow slowly, the surrounding anatomical environment is spacious, the symptoms that appear are not specific, and the majority of the affected patients are young and otherwise healthy. In this paper, we present the diagnosis and treatment of a young male patient who has undergone the surgical removal of an ancient schwannoma of the cauda equina. During the operation, the tumor was completely resected, and following that the patient's complaints disappeared. The key point to an accurate diagnosis of this kind of tumor before the operation was the appropriate radiological study, i.e., T1-, T2-weighted MRI, and postoperatively the histological processing of the removed neoplasm. Reviewing the literature, this pathological type of schwannoma appeared to be extremely rare in the cauda equina: so far, only three cases have been published internationally, however, we could not find a single paper in the Hungarian medical literature on this topic. Orv Hetil. 2022; 163(5): 195-200.

Vertebral artery thrombosis in a 7-year-old child / Arteria vertebralis thrombosis egy 7 éves gyermekben.

Összefoglaló. Az agyi érrendszer elzáródásos panaszai elsosorban felnottkorban jelentkeznek, nem ritkák azonban gyermekek esetében sem. A gyermekkori stroke gyakorisága 2,5/1 000 000 fo; ilyenkor általában az arteria carotis interna vagy az arteria cerebri media érintett. Az ischaemiás stroke-ok 25%-a a hátsó keringési rendszer területén keletkezik. Az arteria vertebralis extracranialis szakaszának stenosisa 18%-ban a jobb oldalon, 22,3%-ban a bal oldalon észlelheto. Esetünkben egy 7 éves kisfiú kórtörténetét mutatjuk be, aki facialis paresis, súlyosbodó ataxia és somnolentia tüneteivel került egy megyei kórház gyermek intenzív osztályára. A készült kontrasztos koponya angiográfiás MR-vizsgálaton akut ischaemiás elváltozások voltak láthatók, valamint sejteni lehetett, hogy a bal oldali arteria vertebralis gracilisabb; a hypoplasia azonban csak a beteg egyetemi centrumba kerülése után, az ott elvégzett, a nyaki erekre is kiterjedo TOF - (time of flight) angiográfia és nyaki ultrahang készítését követoen bizonyosodott be. A beállított gyógyszeres kezelések hatására az ischaemiát okozó artériás thrombus feloldódott, majd megkezdodött a rehabilitáció folyamata, melynek során a beteg állapota nagymértékben javult. A gyermek kórházba kerülése elott hónapokkal észlelt, magatartás- és figyelembeli zavarainak romlása felveti a már korábban bekövetkezo átmeneti ischaemiás periódusok lehetoségét is. A hátsó keringési rendszert érinto stroke-ok etiológiája változó, többször kerültek már leírásra különbözo háttérrel. Esetünkben a fejlodési rendellenesség - 'bow hunter' szindróma tunik a legvalószínubbnek. A készült dinamikus nyaki ultrahangvizsgálat is erre utaló eredményt adott. Idointervallumon belül szóba jöhet az arteria vertebralis thrombosis kezelése endovascularis módszerek segítségével is. Ennek kivitelezhetosége érdekében azonban fontos a mielobbi pontos diagnózis felállítása a megfelelo képalkotó vizsgálatok segítségével és a betegnek a kezelésére felkészült centrumba juttatása. Orv Hetil. 2021; 162(47): 1902-1907. Summary. Cerebrovascular obstruction primarily affects adults, but it is not uncommon in children either. The incidence of childhood stroke is 2.5/1 000 000 population, usually affecting the internal carotid artery or the middle cerebral artery. The posterior circulatory system is involved in 25% of ischemic strokes. Stenosis of the extracranial section of the vertebral artery is demonstrated in 18% on the right side and 22.3% on the left side. We present the case history of a 7-year-old boy who was admitted to the pediatric intensive care unit of a county hospital with symptoms of facial palsy, progrediating ataxia and somnolence. Contrast-enhanced angiographic MR images of the skull revealed acute ischemic lesions and suggested stenosis of the left vertebral artery, then it was confirmed by TOF (time of flight) angiography of vessels of the neck and cervical ultrasound examination. The arterial thrombus causing ischaemia was eliminated by drug treatment and the rehabilitation process could be started. The patient's condition improved considerably following that. Deterioration in behavioral and attentional problems of the patient, which had been realised months prior to hospitalisation, raises the possibility of earlier ischemic periods. The etiology of strokes affecting the posterior circulatory system has been described with different backgrounds. In the presented case, a developmental disorder - bow hunter's syndrome seems to be the most likely one. The result of dynamic cervical ultrasound examination also supported this theory. Treatment of vertebral artery thrombosis with endovascular methods may also be considered within a time interval. However, to make it feasible, it is important to establish an accurate diagnosis as soon as possible by appropriate imaging studies, and to transfer the patient to a specialised center. Orv Hetil. 2021; 162(47): 1902-1907.

[Our experiences with anterior cervical cages and spacer]. / Ventralis nyaki cage-ekkel es spacerrel szerzett tapasztalataink.

OBJECTIVES: Between 2001 and 2005 86 patients were treated for cervical disc herniations and spondylosis at our department. Stabilization was performed with different cervical cages or spacer after discectomy and decompression. The aim of the study was to examine the changes of the patients' pain, quality of life and work ability, fusion rate, the intervertebral disc height, changes of under and upper segments and finally curvature of cervical spine. PATIENTS AND METHODS: Patients were followed by the authors, clinical examination, lateral and antero-posterior radiographic examinations were performed. They were asked to fill in a questionnaire, concerning their pre- and postoperative pain, quality of life and work ability. The patients' pain was graded using a 10-point analog scale (VAS) and with a simplified, McGill-Melzak analog scale. The quality of life was measured with a 10-graduated analog scale as well. RESULTS: More than 77% of our patients appeared at follow up examination. The fusion rate was 89.3%, operated spaces were held in 61%. In the upper segment of operated space 7%, and in the under-segment 14% were found increasingly degenerated. The curvature of cervical spine of the patients' were 64.51% lordotic, 27.42% straight and 8.07% kyphotic. On average the patients' pain changed on VAS from 8.179 to 5.015; on McGill-Melzak scale from 3.89 to 2.80; quality of life changed from 8.045 to 5.463. CONCLUSION: By the advantage of using cages, the operative approach has become smaller than before, consequently the operative pain has become less too. In addition operation time and hospital stay were significantly shorter (p < 0.005) than using traditional operation approach. The majority of the patients, pain was decreased, quality of life got better. Despite this fact only 3 patients continue their original work and 5 patients do easier work. The majority of our patients were disabled before the operation, but from that time many of them became disabled, in some cases the grade of disability increased. There can be some reasons for it: the majority of the patients have other diseases for example: lumbar spondylosis and disc herniation, hypertension, diabetes, asthma and depression. There is just a few possibility of work for the disabled people. To conclude, with some of the patients, their disability means "the way out" from unemployment. These facts do not decrease the importance and usefulness of this method. Our results with this type of operation are very similar to the international statistics. This method seems to be applicable and useful.

[Effectiveness of autologous free fat graft and of Spongostan in preventing scar formation after microdiscectomy]. / Az autológ szabad zsírlebeny és a Spongostan hegesedést gátló hatásának összehasonlítása microdiscectomiát követóen.

INTRODUCTION: Postoperative scar formation has been implicated as one of the possible cause of persistent or recurrent pain after spine surgery. The efficacy of the autologous free fat graft and the Spongostan gel foam for the prevention of extradural adhesion after lumbar discectomy was investigated by the evaluation of postoperative neurological symptoms and visual analogue scale. PATIENTS AND METHODS: In the study 174 patients were involved, average 14.5 months after the intervention. Autologous free fat graft (group I) and Spongostan gel foam (group II) was used randomly by the operations. Patients were operated by the same surgeon, and they were investigated by another independent surgeon. RESULT: No significant difference was found between the two groups.