Anterior cervical discectomy and fusion with ROI-C peek cage: cervical alignment and patient outcomes

OBJECTIVE: The intersomatic cage ROI-C one is a new promising system in anterior cervical discectomy with subsequent fusion. METHODS: Patients were studied prospectively. ROI-C cages were used in consecutive 32 patients. Intraoperative parameters, clinical features and dysphagia scores were recorded. Radiographs evaluated the height of intervertebral space, the cervical Cobb angle and implant positioning. Data were collected on the last day of hospital stay, at 6 weeks, at 3, 6, 12 and 24 months. RESULTS: A total of 32 cages were implanted. One patient had transient dysphagia. The intervertebral height and the cervical Cobb angle were significantly improved at 24 months follow-up (P < 0.05). Compared to pre-operatively, visual analog scale pain score and neck pain and disability scale were reduced at 1-month follow-up without change during subsequent follow-up. CONCLUSIONS: This is the first prospective study on ROI-C cages. Although this is a preliminary assessment, the ROI-C cage may represent an excellent alternative to other devices or simple bone graft

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

Background: Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients. Case Report: A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura. Conclusions: Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence

Hemostasis in brain tumor surgery using the Aaquamantys system

Background: Adequate hemostasis in cranial and spinal tumor surgery is of paramount importance in neurosurgical practice. Generalized ooze bleeding from the surgical walls cavity, coming from neoplastic vessels or nervous tissue, may be problematic. Recent technical advances have dramatically reduced intraoperative complications related to blood loss. Several techniques are usually employed to control hemostasis in tumor surgery, including preoperative embolization, intraoperative hypotension, electrical coagulation, and local application of fibrin sealants or hemostatic matrix, which influence coagulation. Material/Methods: Our aim in this study was to evaluate the efficacy and the safety of the Aquamantys system (Medtronic Advanced Energy, Portsmouth, NH, USA), a novel bipolar coagulation device that incorporates a new bipolar coagulation technique. This device has been used in 10 consecutive patients affected by cerebral tumor along with the standard microsurgical technique and well-known intraoperative tools. The technique is associated with simultaneous delivery of bipolar radio frequency energy and conductive fluid through its electrode tip. The volume of saline passing by the electrode tip prevents charring and maintains a clean tip. This cools the tissue as it raises the temperature sufficiently to shrink the collagen of veins and arteries. Results: Effective hemostasis was achieved in all the cases. No complications or unwanted reactions associated with the device have been observed. Conclusions: Our findings suggest that the Aquamantys system may be a highly effective adjuvant tool in minimizing blood loss in a patient with brain tumor, as well as reducing time of surgery. © Med Sci Monit, 2014

Clinical analysis following lumbar interspinous devices implant: Where we are and where we go

Objectives:We present our experience with patients treated with interspinous devices who are affected by neurogenic intermittent claudication (NIC) or lumbar disc herniation (LDH) where the interspinous system has been inserted following microdiscectomy.Study design:Retrospective study.Methods:This study included patients (n=100) with NIC secondary to lumbar spinal stenosis (group 1), and patients (n=100) with LDH (group 2) in whom the interspinous device has been implanted following radicular decompression in a period spanning 6 years. The latter have been compared with a homogenous group of patients (n=100) where no interspinous system has been implanted following microdiscectomy (group 3). Clinical findings have been observed preoperatively and 3, 6, 12 months and every year post-operatively using dedicated questionnaires (Zurich Claudication Questionnaire, Visual Analog Scale and Oswestry Disability Index).Results:Six years following surgical treatment, 85% of the patients of group 1 presented good improvement of symptoms and 90% of the patients referred satisfaction for surgery. Only few cases needed reoperation. In one case, the device was removed and in two cases, we changed the surgical strategy. Overall, patients of group 2 presented significantly less lumbar disc recurrences compared with group 3 (P&lt;0.05) and better clinical outcome when compared with the same group (P&lt;0.01).Conclusion:According to our features, interspinous systems showed significant and clinically meaningful improvements in pain and disability for up to 6 years. Furthermore, interspinous devices have shown better clinical outcome and less lumbar disc recurrences when associated with standard microdiscectomy. These data, however, need further studies and a longer period of follow-up

Typical trigeminal neuralgia by an atypical compression: case report and review of the literature.

Trigeminal neuralgia is a disabling form of facial pain that causes a considerable discomfort and a marked reduction in the quality of life. Although neurovascular compression is often associated with trigeminal neuralgia, other intracranial pathologies can result in compression along the nerve. CASE DESCRIPTION: The authors report a case of a patient suffering from a typical left trigeminal neuralgia affecting both the second and the third branches. Neuroradiological examinations showed the presence of an arachnoid cyst located in the left temporal lobe, contiguous with the Meckel's cave, eroding the greater wing of the sphenoid bone. Following a meticulous decision-making process the patient underwent conservative treatment with success. A properly modulation of the drug dosage allowed pain relief to be achieved. CONCLUSION: This is a rare case reporting a typical trigeminal neuralgia by an arachnoid cyst of the Meckel's cave mimicking a neurovascular compression syndrome. Our findings, behind the review of the current literature, point out the importance of such a pathological condition when dealing with patients affected by cranial nerve dysfunction syndrome

Aneurysm clipping following endovascular coil embolization: a report of two cases.

Abstract BACKGROUND: Treatment of intracranial aneurysms by Guglielmi detachable coil (GDC) embolization is a useful therapeutic alternative to surgery. This procedure is attractive as a minimally invasive approach to treat cerebral aneurysms; however, is not devoid of complications or failure and retreatment, with either a surgical or endovascular technique, may often be required. CASE REPORTS: Two cases are presented in which surgery was required after coil embolization. In one case, surgical treatment was performed one month later because of regrowth and subsequent bleeding of the aneurysm. In the second case, surgical treatment was carried out six months later because of recanalization of the vascular malformation. Surgical treatment excluded both aneurysms from the cerebral circulation. CONCLUSIONS: In this paper the authors illustrate their experience and underline the difficulty of aneurysm surgery with coils in place.Treatment of intracranial aneurysms by Guglielmi detachable coil (GDC) embolization is a useful therapeutic alternative to surgery. This procedure is attractive as a minimally invasive approach to treat cerebral aneurysms; however, is not devoid of complications or failure and retreatment, with either a surgical or endovascular technique, may often be required. CASE REPORTS: Two cases are presented in which surgery was required after coil embolization. In one case, surgical treatment was performed one month later because of regrowth and subsequent bleeding of the aneurysm. In the second case, surgical treatment was carried out six months later because of recanalization of the vascular malformation. Surgical treatment excluded both aneurysms from the cerebral circulation. CONCLUSIONS: In this paper the authors illustrate their experience and underline the difficulty of aneurysm surgery with coils in place