22 research outputs found
Goel′s Teflon sponge internal shunt for anterior spinal arachnoid cyst
We report a case of a 6-year-old boy who presented with progressive quadriparesis and bowel-bladder incontinence. Magnetic resonance imaging (MRI) of the spine showed anteriorly located arachnoid cyst in the cervicodorsal region. Following marsupialization of the cyst, an internal Teflon sponge shunt (Goel′s shunt) was done that extended from the cyst cavity to the subarchnoid space. The patient improved dramatically in his symptoms. The physical nature of the teflon sponge and its usefulness as an internal shunt are discussed
Atlantoaxial joint distraction as a treatment for basilar invagination: A report of an experience with 11 cases
Objective: A novel method of treatment of basilar invagination that
involves distraction of the atlantoaxial joint using specially designed
spiked spacers is described. Bone graft that is additionally placed
within the appropriately prepared atlantoaxial joint and posterior to
the arch of atlas and lamina of C2 provides bony fusion. Materials and
Methods: Between December 2002 and April 2007, 11 patients underwent
the discussed method of fixation at the Department of Neurosurgery,
King Edward Memorial Hospital in Mumbai, India. All 11 patients had
"congenital" basilar invagination and the symptoms were progressive in
nature. Results: The mean follow-up period was 21 months (range 8-40
months). Neurological improvement and successful distraction with
atlantoaxial stabilization and ultimate bone fusion was achieved in all
the patients and was documented with dynamic radiography. There were no
neurological, vascular, or infective complications. Conclusions: We
conclude that the described method of atlantoaxial joint distraction
and fixation provides an alternative treatment strategy for cases with
basilar invagination. "Joint distraction" as a stand-alone method could
provide reduction of basilar invagination and firm stabilization in
such cases
Basilar invagination associated with brainstem tumor opposite the odontoid process
An 8-year-old girl presented with the symptom of nasal regurgitation and hoarseness of voice. Investigations revealed severe basilar invagination and a large intra-axial pons-medulla brainstem tumor adjoining the tip of the odontoid process. The child underwent lateral mass plate and screw atlantoaxial fixation and attempted craniovertebral junction realignment. Biopsy of the brainstem tumor was done during the same surgical procedure. Histology of the brainstem tumor revealed it to be a pilocytic astrocytoma. Simultaneous presence of brainstem tumor and basilar invagination is a rare clinical association and a complex therapeutic challenge. The possible cause of genesis of brainstem tumor in an unusual location is speculated
Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach
Patients with ankylosing spondylitis (AS) are at an increased risk of spinal fractures due to the altered spinal biomechanics. Moreover, it is difficult to treat these fractures due to the combination of ankylosis and osteoporosis. We report successful management of a C6-C7 vertebral fracture in a patient with AS. The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months
Case Report - Teflon sponge shunt for recurrent arachnoid cyst
A 50-year-old female presented with complaints of progressive ataxia.
Investigations showed a large intradural arachnoid cyst located
anterior to the brainstem. Following marsupialization of the cyst she
improved remarkably in her symptoms. The symptoms recurred nine months
later and investigations revealed recurrence of the cyst. The cyst was
evacuated again and two Teflon sponge sheets were placed such that they
traversed the length of the cyst cavity and extended into the cisterna
magna. At follow-up after 25 months, there has been no recurrence of
symptoms or the cyst. The role and advantages of Teflon sponge in such
cases is evaluated
Unilateral facet fixation as a salvage procedure: Report of two cases with cervical primary bone tumors with extensive bone destruction
We describe cases of two patients with primary cervical bone tumors that resulted in extensive destruction of bones of the region. In the first patient, the tumor and its growth resulted in the destruction of C3–C5 vertebral bodies and the unilateral destruction of facets and pedicles. In the second case, there was focal destruction of the body and odontoid process and unilateral pedicle and facet of C2. Tumor resection and spinal stabilization were the aims of the surgery. In both cases, unilateral fixation of facets was done. In the first patient, multi-segmental transarticular fixation by Camille's technique was done, and in the second patient, unilateral lateral mass plate and screw fixation was done by the Goel technique. Solid bone fusion of spinal segments was observed at more than a 2-year follow-up in both cases. Based on this experience, it appears that unilateral facetal fixation can provide firm stability and can be used when other more frequently and popularly used techniques are either not available or possible