High-speed drill craniostomy as a minimally invasive method of chronic subdural hematoma management. Preliminary results of a pilot study

Cilj: Cilj je ovoga istraživanja procjena učinkovitosti i sigurnosti trepanacije visokoobrtajnom brusilicom u liječenju kroničnih subduralnih hematoma. Nacrt studije: Presječna studija s povijesnim podacima. Ispitanici i metode: Bolesnici s kompresijskim kroničnim subduralnim hematomima operacijski su liječeni minimalno invazivnom metodom trepanacije visokoobrtajnom brusilicom u lokalnoj anesteziji ili sedaciji. Primijenjena je minimalna incizija kože i trepanacija visokoobrtajnom brusilicom u čeonoj ili tjemenoj regiji, u području maksimalne debljine hematoma. Nakon aspiracije hematoma, silikonski kateter promjera 1,9 mm postavljen je u subduralni prostor i spojen na gravitacijsku drenažu. Bolesnici su mobilizirani neposredno po operaciji. Zabilježeni su i analizirani podaci o tijeku i uspješnosti liječenja. Rezultati: U istraživanje je uključeno 23 bolesnika (pet ženskoga spola, 21,7%). Medijan životne dobi bolesnika iznosio je 77,5 godina (interkvartilni raspon 67 – 83). Šest (26,1%) bolesnika imalo je obostrane subduralne hematome. Septirani i multilokularni hematomi opaženi su u šest (26,1%) bolesnika. Heterodenzne lezije koje odgovaraju recentnijim hematomima zabilježene su u 16 (69,5%) bolesnika. Medijan trajanja hospitalizacije iznosio je 9,5 dana (interkvartilni raspon 6 – 16). U jednoga je bolesnika zabilježen letalni ishod kao posljedica nozokomijalne infekcije i sepse. U jednoga je bolesnika zabilježena infekcija rane s razvojem subduralnoga empijema, što je zahtijevalo kraniotomiju. Jedan je bolesnik razvio duboku vensku trombozu i plućnu emboliju. U svih je bolesnika poslijeoperacijskim CT oslikavanjem zabilježena znatna redukcija volumena hematoma i pomaka središnjih mozgovnih struktura. U ovoj skupini bolesnika nisu zabilježeni epileptički napadaji nakon operacije. Zaključak: Trepanacija visokoobrtajnom brusilicom sigurna je, jednostavna i učinkovita metoda liječenja kroničnih subduralnih hematoma, uključujući multilokularne i heterodenzne lezije. Posebice je prikladna u bolesnika starije životne dobi, zbog izbjegavanja opće anestezije i dugoga trajanja operacije te kratke duljine hospitalizacijeObjectives: The objective of this study was to assess the safety and efficiency of minimally invasive high-speed drill craniostomy in the treatment of chronic subdural hematomas. Study design: The study was designed as a retrospective case series study. Patients and Methods: The patients with compressivechronic subdural hematomas were treated by minimally invasive high-speed craniostomy performed under local anesthesia or conscious sedation. A minimal skin incision was followed by a single high-speed drill hole placement in the frontal or parietal region, over the area of maximal hematoma thickness. After hematoma aspiration, a 1.9 mm silicone catheter was placed in subdural space and connected to gravity-assisted drainage. Patients were ambulatory immediately after surgery. Data on clinical course and outcome were recorded and analyzed. Results: There were 23 patients (5 female, 21.7%) included in the study. The median patient age was 77.5 years (interquartile range 67 – 83). Six (26.1%) of the patients had bilateral subdural hematomas. Septated/multiloculated hematomas were observed in 6 (26.1%) patients. Heterodense hematomas denoting more recent bleeding were recorded in 16 (69.5%) patients. The median duration of subdural drainage was 4 days (interquartile range 3 to 5). The median length of hospital stay was 9.5 days (interquartile range 6 – 16). One patient died of sepsis following a nosocomial respiratory infection. One patient developed a wound infection with subdural empyema, requiring subsequent craniotomy. One patient had deep venous thrombosis and pulmonary embolism. In all patients, postoperative CT scans showed a significant reduction of hematoma volume and midline shifting. No postoperative seizures were observed. Conclusion: High-speed drill craniostomy is a safe, simple, straightforward, and effective treatment for the management of chronic subdural hematomas, including multiloculated and heterodense lesions. Elderly patients could most benefit from such a procedure, avoiding general anesthesia, prolonged intracranial procedures, and lengthy hospital stays

Aneurysmal Bone Cyst of the Cervical Spine – Case Report

Aneurysmal bone cyst (ABC) is a non-neoplastic locally destructive primary bone lesion mostly occurring within the first two decades of life with female predominance. Cervical spine ABCs are a very rare clinical entity with particularly demanding surgical resection limited by the involvement of nearby neurovascular structures and a risk for cervical spine instability. We present a case of a 17-year-old patient with a symptomatic ABC of the cervical spine who underwent surgical removal of the osseous lesion with good postoperative outcome. There are different therapeutic strategies for ABC management, but complete surgical removal of the cyst remains one of the most important predictors of favorable outcome, although it can be often limited, especially in the cervical region. Previously described lesions have a very high recurrence rate and therefore different additional methods, such as radiotherapy, embolization and sclerosation have been used in addition to surgical resection. Further studies are necessary for development of evidence-based treatment regimens for cervical spine ABCs in pediatric population

The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease

Objectives: To compare patients with lumbar spine degenerative disease treated by minimally invasive surgery using tubular retractor system and conventional surgical method. Study Design: Cross-sectional study with historical data. Patients and Methods: The single-institution series included 48 adult patients treated with one of the two surgical methods during a one-year period. The patients were divided between a case group consisting of minimally invasively treated patients and a control group of those operated on by conventional surgery. The research data were the following: age, gender, duration of symptoms, type of spinal pathology, type of surgical method, number of surgical levels treated, neurological status, pain intensity assessed by Visual Analogue Scale, duration of surgery and length of hospital stay. Modified Odom’s criteria were used as a primary outcome measure. All data were documented from electronic medical records, statistically analyzed, and correlated between The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease the groups. The level of statistical significance was set at p<0.001. Results: A significant improvement of neurological status after surgery was recorded in all patients (case group, Fisher’s exact test, p=0.002, control group, Fisher’s exact test p=0.012). The pain intensity was significantly reduced after surgery in both groups (case group, Wilcoxon test, p<0.001, control group, Wilcoxon test, p<0.001). A statistically significant difference was observed between the case and the control group in the length of hospital stay (Mann-Whitney U test, p<0.001) and in time elapsed from surgery to patient mobilization (Mann-Whitney U test, p<0.001). In all other data examined, no statistically significant difference was noted between the case and control groups. Conclusion: Surgical treatment of lumbar spine degenerative disease results in significant improvement of neurological status and in reduced pain intensity. Minimally invasive surgery using tubular retractors results in shorter length of stay and earlier patient mobilization

Austria – Vienna – St. Michael – Hochaltar im Weihnachtsschmuck

https://digital.sandiego.edu/austrianpc/1138/thumbnail.jp

Management and Prognosis of Primary Cerebral Melanocytic Tumors. A Case Report and Systematic Review

Primary melanocytic cerebral tumors form a spectrum of different lesions that range from benign to extremely malignant, such as an intracranial melanoma. This article points out some characteristics of primary melanocytic cerebral tumors and discusses their management and prognosis, based on a systematic literature review and a case of primary cerebral malignant melanoma. Because the biological characteristics of primary melanocytic cerebral tumors remain unclear, it appears that total surgical resection of the tumor followed by oncologic treatment is the mainstay of the management. The prognosis still depends on the degree of malignancy

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

Background: Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor

Mineralna gustoća i razine vitamina D u bolesnika s psorijatičnim artritisom

The objective of this study was to explore the possible differences in bone mass density (BMD) and markers of bone metabolism between patients with psoriasis with concomitant psoriatic arthritis (PsA) and patients with psoriasis only (PV). A comparable sample of both types of patients were included in analysis. In all patients, vitamin D serum levels along with inflammatory markers and parathyroid hormone (PTH) were measured. BMD was assessed with dual-energy x-ray absorptiometry scan in axial and appendicular skeleton. Patients with PsA tended to have decreased BMD in axial skeleton, while BMD in appendicular skeleton was comparable between the groups. No statistically significant correlation was found of inflammatory markers, vitamin D and PTH levels with BMD in either patient group. A negative correlation was recorded between vitamin D serum concentration and PTH levels.Cilj ovoga istraživanja bio je ispitati moguće različitosti u mineralnoj koštanoj masi između bolesnika s psorijatičnim artritisom (PsA) i psorijazom. U analizu je bio uključen usporediv uzorak obiju skupina bolesnika. U svih ispitanika određena je serumska koncentracija vitamina D, upalni parametri i paratireoidni hormon (PTH). Denzitometrijom je utvrđena mineralna koštana masa aksijalnoga skeleta i apendikularnoga skeleta. Bolesnici s PsA imali su sniženu mineralnu koštanu masu aksijalnoga skeleta, dok je mineralna koštana masa apendikularnoga skeleta bila usporediva između ovih skupina. Nije pronađena statistički značajna korelacija upalnih parametara, serumske koncentracije vitamina D i PTH s mineralnom koštanom gustoćom ni u jednoj skupini bolesnika. Zabilježena je negativna korelacija između serumske koncentracije vitamina D i PTH

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

Background: Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor

Primary Central Nervous System Anaplastic Large T-cell Lymphoma

INTRODUCTION: Primary central nervous system lymphoma (PCNSL) of T-cell origin is an exceptionally rare, highly malignant intracranial neoplasm. Although such a tumor typically presents with a focal mass lesion. CASE REPORT: Past medical history of a 26-year-old male patient with a PCNS lymphoma of T-cell origin was not suggestive of intracranial pathology or any disorder of other organs and organic systems. To achieve a gross total tumor resection, surgery was performed via osteoplastic craniotomy using the left frontal transcortical transventricular approach. Histological and immunohistochemical analyses of the tissue removed described tumor as anaplastic large cell lymphoma of T-cells (T-ALCL). Postoperative and neurological recovery was complete, while control imaging of the brain showed no signs of residual tumor at a six-month follow-up. The patient, who did not appear immunocompromized, was referred to a hematologist and an oncologist where corticosteroids, the particular chemotherapeutic protocol and irradiation therapy were applied. CONCLUSION: Since PCNS lymphoma is a potentially curable brain tumor, we believe that proper selection of the management options, including early radical tumor resection for solitary PCNS lymphoma, may be proposed as a major treatment of such a tumor in selected patients, resulting in a satisfactory outcome

Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different age Groups

OBJECTIVE: To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence. METHODS: We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel’s criteria), pain intensity, and neurologic status were analyzed. RESULTS: The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n [ 22; moderate, n [ 9; severe, n [ 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis. CONCLUSIONS: Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery