30 research outputs found
Miksopapilarni ependimom kralježniÄne moždine u odraslih: prikaz osobne serije i pregled literature
Myxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.Miksopapilarni ependimomi (MPE) kralježniÄne moždine sporo su rastuÄi, dobroÄudni tumori najÄeÅ”Äe zastupljeni u odraslih u dobi izmeÄu 30 i 50 godina života. Nastaju iz ependima filuma terminale, a pretežito su smjeÅ”teni u podruÄju medularnoga konusa i kaude. KirurÅ”ko uklanjanje tumora u cijelosti preporuÄena je metoda lijeÄenja, dok u bolesnika u kojih to nije moguÄe uÄiniti u obzir dolazi subtotalna resekcija nakon koje je potrebno zraÄenje. Potpuno uklanjanje tumora uz oÄuvanje cjelovitosti tumorske kapsule postiže se jednostavnom resekcijom filuma terminale iznad i ispod tumorske mase, Å”to može dovesti do izljeÄenja. UnatoÄ tomu, tumorska diseminacija uzduž neuralne osi može se javiti u oko 30% sluÄajeva. U ovom radu predlažemo originalnu klasifikaciju MPE koja prosuÄuje smjeÅ”taj tumora i obujam tumorske resekcije, a temeljena je na osobnoj seriji operiranih bolesnika. TakoÄer raspravljamo o kirurÅ”koj tehnici, o moguÄnostima recidiva i Å”irenja ovakvih tumora, kao i o oblicima pomoÄnog lijeÄenja, koristeÄi se pregledom literature. ZakljuÄujemo kako naÅ”i rezultati
zagovaraju kirurÅ”ko lijeÄenje temeljeno na predloženoj originalnoj tumorskoj klasifikaciji, koje može biti uspjeÅ”no u pažljivo odabranih bolesnika u kojih je tumor uklonjen u cijelosti. Naknadna istraživanja na znatno veÄem uzorku potrebna su za potvrdu naÅ”ih rezultata
Surgical anatomy of microsurgical 3-level anterior cervical discectomy and fusion C4āC7
Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, frequently used for the treatment of cervical spine degenerative diseases. It was first described in 1958. Interestingly, to our knowledge, 3-level ACDF has not been previously published as a peer-reviewed video case with a detailed description of intraoperative microsurgical anatomy. In this video, we present the case of a 33-year-old male who presented with a combination of myelopathy (hyperreflexia and long tract signs in the upper and lower extremities) and bilateral radiculopathy of the upper extremities. He had been previously treated conservatively with physical therapy and pain management for 6 months without success. We performed 3-level microsurgical ACDF from C4 to C7. All 3 levels were decompressed, and bone allografts were placed to achieve intervertebral body fusion. A titanium plate was utilized from C4 to C7 for internal fixation. The patient was discharged home on the first postoperative day. His pain, numbness and tingling resolved, as well as his myelopathy. No perioperative complications were encountered. Herein we present the surgical anatomy of our operative technique including ertain technical tips. Written consent was obtained directly from the patient.
VIDEO
https://vimeo.com/user128225853
VIDEO ANNOTATIONS
01:13 ā opening the surgery site
02:29 ā positioning of retractors
03:02 ā start of 3-level discectomy
06:04 ā allograft placement and fixation
08:20 ā drain placement and closur
Compound osteosynthesis in the thoracic spine for treatment of vertebral metastases: technical report
Limited additional lateral biopsies improve the diagnostic accuracy of transrectal ultrasound guided sextant prostate biopsy
We prospectively evaluated the need for routine use of additional lateral biopsies at the time of standard sextant prostatic biopsy to reduce the false negative rates. A total of 23 consecutive patients underwent 24 TRUS guided prostatic biopsies resulting in 246 biopsy cores. Prostate cancer was diagnosed in 8/24 (33.3%) biopsies. Although the age and prostate volume did not significantly differ between patients with or without cancer (p>O. 05), the pre-biopsy PSA and PSAD were significantly higher in pa-tients diagnosed with prostate cancer (p< 0.05). Of the 8 patients diagnosed with prostate cancer 2/8 (25%) had cancer in the biopsies lateral to but not in the standard sextant biopsy sites. The additional lateral biopsies im-proved the sensitivity and negative predictive value of TRUS guided biopsy by 33.3% and 13% respectively. In conclusion, in spite of the small sample size in this study, prostate cancer detection is increased by 25% because of additional lateral biopsies at time of standard sextant prostatic biopsy
Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes.
Compound osteosynthesis in the thoracic spine for treatment of vertebral metastases: technical report
Metastases to vertebrae often cause bone destruction leading to instability and neural compression. Anterior surgical approaches allow tumor resection and direct neural decompression. For patients with a short life expectancy, vertebral body replacement with methyl-methacrylate polymerized in situ can be used for load sharing in the axial plane. Screws hung from the rod into the corpectomy site are incorporated into the acrylic cement. The technique described in this article allows for immediate spinal stabilization and provides a protective environment for the neural elements. All the patients tolerated the procedure well and were able to ambulation without an orthoses