A Rare Case Report of Thoracic Epidural Angiolipoma During Pregnancy: Differential Diagnosis and Treatment

Introduction. Spinal angiolipomas are benign tumors composed of adipocytes and vascular elements. There is a limited number of cases involving pregnant patients in the literature. Mostly located in the thoracic region, these tumors are usually expected to be seen in the fifth decade. To the best of our knowledge, we present the youngest reported case of a pregnant patient with angiolipoma. Case Report. We present a case of a 24-year-old pregnant woman who was referred to our clinic with complaints of gait disturbance and numbness in her legs. Paraplegia, hyperactive deep tendon reflexes, and hypoesthesia up to the umbilicus level were the first findings. Electromyographic tests, including F-waves, were normal. Spinal magnetic resonance imaging (MRI) revealed a thoracic spinal extradural tumor compressing the spinal cord posteriorly. Total tumor resection and histologic examination confirmed the diagnosis of angiolipoma. Postoperatively, the patient experienced rapid improvements in neurological deficits, with complete recovery in the following days. Conclusions. Spinal angiolipomas are very rare in pregnancy. At the time of initial admission, the symptoms and findings may mimic acute polyneuropathies and myelitis. Spinal MRI is essential to localize the lesion. Early angiolipoma removal may result in complete recovery and the procedure is safe and applicable even in the early postpartum period

Neurourological complications in patients with myelodisplasia

Spina bifida is a frequently seen congenital anomaly which is compatible with life. During the embryological period the defects in the closure of neural tube leads to open or closed spinal dysraphism. At the present day with the improving neurochirurgical techniques, the patients multidisciplinary follow-ups became important as a matter of the health quality. To prevent and to determine the urological complications some approaches became standardized. In the long term period all accompanying pathologies have to be beared in the mind in addition to neurosurgical prognosis and the patients must have to be guided indeed. The aim of this review is to look over the urological problems and the last studies about these problems in spina bifida patients

Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI). The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery

Wyniki leczenia uszkodzenia nerwu strzałkowego na wysokości kolana: doświadczenie oddziału szpitala wo¡skowego

Background and purpose We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. Material and methods Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). Results Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. Conclusions Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short ‘lazy S-shaped incision’ around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.Wstęp i cel pracy Autorzy ocenili wyniki chirurgicznego odbarczenia nerwu strzałkowego wspólnego na wysokości kolana, wykonywanego w latach 2005–2009. Materiał i metody Przedoperacyjnej i pooperacyjnej ocenie klinicznej (w skali Medical Research Council) oraz elektrofizjologicznej poddano 30 kolejnych pacjentów z uszkodzeniem nerwu strzałkowego na wysokości kolana, u których wykonano odbarczenie chirurgiczne z zewnętrzną neurolizą. Wyniki Wśród leczonych było 28 mężczyzn (średnia wieku: 31,1 roku) i dwie kobiety (średnia wieku: 57,5 roku). U zdecydowanej większości pacjentów (n = 28, 93%) przyczyną uszkodzenia nerwu była aktywność fizyczna w czasie szkolenia wojskowego (nadmierne rozciągnięcie/stłuczenie). Średnia czasu od rozpoznania do operacji wyniosła 5 miesięcy. Obserwacja po zabiegu trwała od 3 do 48 miesięcy (średnia: 14 miesięcy). U 29 na 30 chorych (97%) uzyskano pełny lub prawie pełny powrót zgięcia grzbietowego stopy/palców. Wnioski Wczesne chirurgiczne odbarczenie i neuroliza nerwu strzałkowego wspólnego na wysokości kolana w leczeniu urazu powstałego wskutek nadmiernej aktywności fizycznej daje możliwość znakomitej poprawy czynnościowej. Ponadto w przypadku uszkodzeń nerwu strzałkowego wspólnego na wysokości kolana w celu zminimalizowania blizny pooperacyjnej, nasilenia bólu i opóźnienia w gojeniu się rany pooperacyjnej autorzy usilnie zalecają krótkie cięcie w kształcie wydłużonej litery „S” wokół głowy strzałki u chorego w pozycji leżącej na plecach zamiast klasycznego otwarcia aż do górnej granicy dołu podkolanowego w pozycji leżącej na brzuchu

Minör kafa travmalı çocuklarda gözlemin önemi : olgu sunumu

Bu yazıda belirgin bası etkisi oluşturan ve acil cerrahi gerektiren geç epidural hematom olgusunun analizi sunulmaktadır. Böyle bir durumun oluşturacağı zararlardan korunmada klinik şüphe ile daha sık ve kolay bilgisayarlı tomografi incelemesinin anahtar rol oynadığını düşünüyoruz. Geç epidural hematomlar da klinik gerilemenin yakın takibi ile tekrar bilgisayarlı tomografi çekilmesi olguların erken saptanmasında en önemli faktördür.Here we present an analysis of the case of delayed epidural hematoma which had a significant mass effect and required surgical evacuation. We consider that maintaining a high clinical suspicion, coupled with a low threshold for computed tomography scanning, is the key to morbidity prevention in this situation. Close observation for signs of clinical deterioration and repeat CT scan are the most important factors for early detection of the delayed epidural hematoma

Çocuklarda minimal invazif bir yöntem ile gergin kord serbestleştirilmesi : teknik not

Gergi omurilik serbestleştirilmesi pediatrik nöroşirurjide yaygın olarak yapılmaktadır. Günümüzde minimal invazif yöntemler gittikçe artan bir ilgi görmektedir. Cerrahi uygularken giriş yollarına en az hasar verilmesi ve normal dokunun azami korunması amaç olmuştur. Bizde günümüzde gergin omurilik sendromunun cerrahi tedavisinde uygulanan pek çok yöntemlerden farklı olarak olgudan hiçbir doku çıkartılmadan kordun serbestleştirilmesini sağlayan bir yöntemi tanıtmayı amaçladık. Bu yaklaşımın temel avantajı işlemin 2 cm kesi ile yapılması, ligamentum flavum ve lamina gibi kemik yapıların korunması ve buna bağlı gelişebilen skar dokusunun azalmasıdır.Teknik not: Olgu sitting-prone pozisyonda operasyon masasına alındı ve skopi ile L5-S1 mesafesi belirlendi. Orta hattın 0.5 cm lateralinden 2 cm vertikal kesi sonrasında cilt ve cilt altı dokular geçildi. L5 laminası rehberliğinde L5-S1 mesafesi ve mesafeyi örten ligamentum flavum ortaya kondu. Mikroskop çekildi ve Williams Ekartörü mesafeye yerleştirildi. Buraya kadarki işlemler disk cerrahisiyle aynıydı. Mikroskop altında flavum'a vertikal kesi yapılarak her iki dudağı sırtlarındaki dokuya basit sütür ile asılarak duranın rahat görünümü sağlandı. 0.5 cm'lik vertikal kesi ile tekal sak açıldı. Sinir oku yardımıyla filum bulunarak serbestleştirildi. Dura primer olarak mikro cerrahi enstrümanları ile dikildi ve üzerine flavum tekrar serildi.Tethered cord release is commonly performed in pediatric neurosurgery. Nowadays, minimally invasive procedures are created growing interest due to its highly tolerable nature for surgery. It has been main purpose a minimal damaging on access route and maximum protection of normal structures in surgery. We present a surgical treatment of tethered cord syndrome, by which is provided the cord releasing unlike the many methods being applied with tissue removal. The main advantage of performing this surgery through 2 cm hole is to avoid removing ligamentum flavum and bony structure like lamina in addition to reduce the length of the incision and the related scar tissue. J Clin Exp Invest 2014; 5 (1): 115-117Technical note: the patient was taken on the operating table in the sitting-prone position, and L5-S1 distance was determined by fluoroscopy. The skin and subcutaneous tissues was passed via a 2 cm vertical incision settled in 0.5 cm laterally from midline. L5-S1 distance and its covering ligamentum flavum are displayed by the guidance of L5 lamina. Williams's retractor was placed in the distance after fetching microscope. The foregoing procedures are the same with microdiscectomic surgery. By a vertical incision made on the flavum, its both layer was lifted up and hanged with simple suture on the back tissue for a comfortable exposure of the Dura. Thecal sac was opened by 0.5 cm long vertical incision on the Dura after obtaining secure CSF drainage with the help of yellowtipped syringe needle. With finding by a nerve hook, the phylum was burned and released securely. Then the Dura was sutured primarily for the closure by means of microsurgery instruments, and flavum was laid on it again

NEURONAVIGATION: A REVOLUTIONARY STEP OF NEUROSURGERY AND ITS EDUCATION

Abtract Neuronavigation provides intraoperative orientation to the surgeon and helps in planning a precise surgical approach to the targetted lesion and defines the surrounding neurovascular structures. Incorporation of the functional data provided by computed tomography and magnetic resonance imaging or ultrasound with neuronavigation renders neurosergeons to avoid the eloquent areas of the brain during surgery. An intraoperative images enable radical resection of the lesions, the possibility of immediate control for tumor remnants and updates of neuronavigation with these data to compensate for brain shift. This study reviews the pointer and microscope based navigational systems and also highlights the role and to show its indispensibility for a clean surgery with minimal morbidit

CURRENT MINIMALLY INVASIVE SURGICAL TECHNIQUES IN NARROWED SPINAL CANAL

Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and mainly problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with many advantages such as less bleeding, smaller incisions, little muscle distraction and quicker patient recovery. This paper will review the techniques of performing ipsilateral or bilateral decompressions using some microsurgical instruments (microscope, endoscope) and Kit (mild

Travmanın eşlik etmediği akut monopleji nedeni olan intradural servikal disk hernisi

Dura içi disk herniasyonu nadir olarak bildirilmiştir ve intervertebral disk herniasyonlarının özel bir tipidir. En çok lomber bölgede görülür ve servikal ve torakal bölgede nadirdir. Travma olmaksızın servikal dura içi disk herniasyonu oldukça nadir görülüp, İngilizce literatürde 17 olgu bildirilmiştir ve Brown-Sequard sendromu, transvers myelopati ve radikülopati şeklinde kendini gösterebilir. Biz alt ekstremitede sadece monoplejiye neden olan nadir bir servikal intradural disk hernisi olgusunu sunduk. Bilgimize göre bu literatürde tanımlanan ilk olgudur. Olguya anterior yaklaşımla mikrodisektomi sonrası servikal kafes uygulaması yapıldı.Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage

Travmanın eşlik etmediği akut monopleji nedeni olan intradural servikal disk hernisi

Dura içi disk herniasyonu nadir olarak bildirilmiştir ve intervertebral disk herniasyonlarının özel bir tipidir. En çok lomber bölgede görülür ve servikal ve torakal bölgede nadirdir. Travma olmaksızın servikal dura içi disk herniasyonu oldukça nadir görülüp, İngilizce literatürde 17 olgu bildirilmiştir ve Brown-Sequard sendromu, transvers myelopati ve radikülopati şeklinde kendini gösterebilir. Biz alt ekstremitede sadece monoplejiye neden olan nadir bir servikal intradural disk hernisi olgusunu sunduk. Bilgimize göre bu literatürde tanımlanan ilk olgudur. Olguya anterior yaklaşımla mikrodisektomi sonrası servikal kafes uygulaması yapıldı.Ahahtar kelimeler: Servikal disk hernisi, intradural, monopleji.Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage