The impact of vertebral osteomyelitis on spinal stability and principles of surgical stabilization: Medical literature review

Vertebral osteomyelitis (VO) is a disease that responds well to conservative treatment and antibiotherapy if diagnosed in an early stage. Due to the prolonged onset of this pathology, many cases are diagnosed in mid or late stages and require surgery. The surgical treatment is not yet standardized and may only mean decompression of the infectious outbreak without stabilization, or surgical decompression associated with stabilization. Using only bone grafts for surgery or stabilizing the spine through segmental posterior and/or anterior instrumentation is accompanied by many controversies. In this review, we focus on demonstrating that combining a well-conducted antibiotherapy with thorough debridement of the necrotic areas and using metal implants for spinal stabilization lowers the infection rates, provides an early pain-free mobilization of the patient and reduces hospitalization costs

Incidence of vertebral osteomyelitis and benefits of spinal stabilization in infection: Retrospective analysis of 94 cases in 5 years

In order to evaluate the etiology, characteristics and outcome of the surgical treatment of vertebral osteomyelitis cases in our hospital, patients with vertebral osteomyelitis between January 2014 and December 2018 were included in the study. Clinical and paraclinical data of the patients were collected from the medical records of the patients. Of the 164 patients diagnosed with vertebral osteomyelitis in our clinic 94 underwent surgery and only these last ones were included in the study. Of these 94 patients, 18 cases were diagnosed with tuberculous osteomyelitis and 76 with nontuberculous osteomyelitis. The age of the majority of patients ranged from 40 to 80 years with a peak of incidence between 61-70 years. All of the patients had back pain and regional tenderness of the affected area and many cases presented neurological deficits. The most common involved area affected in our cases was the thoracic spine. Magnetic resonance imaging is the examination that reveals the degree of involvement and excludes other pathologies from the differential diagnosis. The majority of patients had several comorbidities which we included in the study. From all the patients included 76 % underwent surgery with decompression and spinal stabilization using titanium instrumentation and 24 % underwent surgery with only spinal decompression. We also evaluated number hospitalization days of the operated cases. An early diagnosis seems crucial for a fast recovery, lowering the hospitalization costs of both the patient and the hospital and preventing sequelae development.&nbsp

Overview of patients with vascular pathology and cost analysis of medical care – research market for an entrepreneurial project

Introduction: Brain vascular pathology, aneurysms, arteriovenous malformations (AVMs), cavernomas, dural arteriovenous fistulas (DAVF), venous angiomas and capillary telangiectasia, represents a serious health problem worldwide. Aim: The aim of this article is to perform an analysis of patients with brain vascular pathology and to analyze costs of health services, a research market for an entrepreneurial project, in order to design guidelines for patients’ selection and treatment. Material and methods: We performed an observational, descriptive study of patients with vascular pathology, from 2018 to 2019. Results: A total of 153 patients with brain vascular pathology were admitted in our department. Mean age was 49.53 ± 13.997 years. Sex ratio was 0.86. Mean hospital stay was 11.33 ± 13.724 days. Seventy-four patients (48.37%) underwent surgery. Seventy-eight patients (50.98%) had cerebral aneurysms. Complications were seen in 24 patients (30.77%) and vasospasm in 32 cases (41.03%). Thirty-six patients underwent surgery. Outcome was favorable, according to mRS(p=0.001) and Karnofsky score(p=0.006).Thirty-three patients (21.57%) had brain AVMs. Twenty patients underwent surgery. Complications were seen in 4 cases (12.12%). The outcome was favourable, according to mRS(p=0.001) and Karnofsky score (p=0.002). Thirty-nine patients (25.49%) had cavernomas. Surgery was performed in 18 cases. The outcome was favourable, according to Engel Epilepsy Surgery Outcome Scale, mRS (p=0.000) and Karnofsky score (p =0.000). Costs of health services were correlated with longer hospitalization, higher mRS, lower Karnosfsky score, presence of complications and presence of vasospasm. Conclusions: Proper treatment of brain vascular pathology ensures a favourable outcome. Adequate patients’ selection and choosing the best treatment can reduce costs. Surgery is the treatment of choice in ruptured aneurysms, AVMs and cavernomas. Early surgery, with specific treatment of the vascular lesion and removal of intracranial blood ensures a better outcome, with lower medical costs. Prevention of complications, aggressive treatment of vasospasm reduces medical costs

Small and medium size intracranial aneurysms: A 5 years retrospective analysis trial and multimodal treatment

Clinical context. Subarachnoid hemorrhage (SAH) due to rupture of an aneurysm is one of the most common neurosurgical emergencies who account for one-third of stroke .In the SAH cases , aneurysms accounted for 70%. Aneurysms had a bleeding rate of 12 per 100,000 population per year, and in particular between 50 to 60 years of age with a high morbidity and mortality, especially in the first episode of bleeding at about 43% of cases (1, 4, 14). Surgery is indicated to prevent rebleeding. 2.5% of patients in the general population may have unbroken aneurysms with a prevalence of 0.65%, with a preponderance of aneurysms in a 2: 1 in women. ACI aneurysms are more common in women and Acom aneurysms are more common in men and in 15-30% of patients with presence of multiple aneurysms. Surgical timing, the assessment in each individual case for rebleeding usage of endovascular techniques (3, 12), neurological status, the presence or absence of intraparenchymal hematoma or intraventricular hemorrhage with or without vasospasm, have an influence on the result. Over a period of 5 years from January 2010 to November 2014, 317 cases of patients with intracranial aneurysms in four clinics of neurosurgery in Bagdasar -Arseni hospital have been studied. The follow up period range between 6 month and 4 years and 3 month

Step training in a rat model for complex aneurysmal vascular microsurgery

Introduction: Microsurgery training is a key step for the young neurosurgeons. Both in vascular and peripheral nerve pathology, microsurgical techniques are useful tools for the proper treatment. Many training models have been described, including ex vivo (chicken wings) and in vivo (rat, rabbit) ones. Complex microsurgery training include termino-terminal vessel anastomosis and nerve repair. The aim of this study was to describe a reproducible complex microsurgery training model in rats.Materials and methods: The experimental animals were Brown Norway male rats between 10-16 weeks (average 13) and weighing between 250-400g (average 320g). We performed n=10 rat hind limb replantations. The surgical steps and preoperative management are carefully described. We evaluated the vascular patency by clinical assessment-color, temperature, capillary refill. The rats were daily inspected for any signs of infections. The nerve regeneration was assessed by foot print method.Results: There were no case of vascular compromise or autophagia. All rats had long term survival (>90 days). The nerve regeneration was clinically completed at 6 months postoperative. The mean operative time was 183 minutes, and ischemia time was 25 minutes

Multimodal treatment for temporobasal arteriovenous malformation: Case report

Background: Arteriovenous malformations (AVMs) are congenital lesions requiring multimodal approach. Method: We report a case of a 25 years old woman, with ruptured temporobasal AVM, who required multimodal treatment, emphasizing on treatment options, advantages and disadvantages of each treatment chosen, encountered difficulties, technical considerations and outcome. Results: The patient, admitted for the first time in comatose state, underwent emergent surgery with evacuation of an intraparenchymatal hematoma and decompressive craniectomy. After neurological recovery, the patient was thoroughly investigated and positive diagnosis of left temporobasal AVM was established. The patient underwent surgery with subtotal resection of the AVM, followed by Gamma knife stereotactic radiosurgery of the residual nidus. The outcome was favorable. Conclusions: AVMs need complex treatment performed in a multidisciplinary team. Surgery is the treatment of choice in management of the AVMs. Gamma knife stereotactic surgery is required if a residual nidus is left in place following surgery. Definitive treatment in AVMs is mandatory because of the high risks of hemorrhage with high morbidity and mortality

Giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased: Case report and review of the literature

This 64-year-old man presented with symptoms of optic chiasm and nerve compression from a giant tuberculum sellae meningioma with unruptured anterior communicating artery aneurysm encased. Preoperative magnetic resonance imaging disclosed that the aneurysm was completely enclosed in the tumor, but angiographic studies did not reveal any important arterial narrowing. The embedded aneurysm caused neither SAH nor intratumoral hemorrhage. All of these factors pointed to little adhesion between the tumor and the encased arteries. Surgery was performed a week after admission and the intraoperative findings revealed that the tumor did not adhere too much to the enclosed vasculature except for a little part attached to the left ICA. The aneurysm was safely clipped after piecemeal removal of the tumor, which was finally extirpated without fear of aneurysm rupture, and with a good visual outcome. To treat both the tumor and aneurysm simultaneously, careful stepwise operative procedures were essential

Current perspectives concerning the multimodal therapy in Glioblastoma

GBM (Glioblastoma) is the most common, malignant type of primary brain tumor. It has a dismal prognosis, with an average life expectancy of less than 15 months. A better understanding of the tumor biology of GBM has been achieved in the past decade and set up new directions in the multimodal therapy by targeting the molecular paths involved in tumor initiation and progression. Invasion is a hallmark of GBM, and targeting the complex invasive mechanism of the tumor is mandatory in order to achieve a satisfactory result in GBM therapy. The goal of this review is to describe the tumor biology and key features of GBM and to provide an up-to-date overview of the current identified molecular alterations involved both in tumorigenesis and tumor progression

Total resection in a giant left frontal arteriovenous malformation, grade V Spetzler-Martin: Case report

Background: Giant arteriovenous malformations (AVMs) are congenital lesions, with nidus sizing more than 6 cm. According to Spetzler-Martin scale, grade V AVMs have a nidus larger than 6 cm in diameter, profound venous drainage and are located in eloquent areas. Method: We report a case of a 39 years old woman, with giant left frontal AVM, grade V Spetzler-Martin, who was admitted for generalized seizures, with onset 32 years ago, refractory to full dose antiepileptic polytherapy, which severely impaired the patient’s quality of life. Results: The patient underwent surgery and we performed total resection of the AVM. We emphasize on surgical technique, intraoperative difficulties and outcome. Conclusions: Surgery is the therapy of choice in AVMs, because it provides cure of the lesion, and is the only treatment capable of preventing hemorrhage and controlling seizures. Management in grade V AVMs is challenging, because of their large size, multiple dilated arterial feeders from anterior and posterior circulation and external carotid arteries, high blood flow, vascular steel from the surrounding brain, enlarged draining veins, profound venous drainage and location in eloquent area. Giant AVMs with high flow nidus, causing a great degree of vascular steel in the surrounding brain, with hypoperfusion of normal parenchyma may develop early normal perfusion pressure breakthrough. Total resection in grade V AVMs can be performed with minimal transient morbidity and favorable outcome. Total resection permits control of intractable seizures with reduced dose of antiepileptic therapy

Pituitary apoplexy with intraventricular hemorrhage: Clinical presentation, treatment and outcome, case report

Background: Pituitary tumor apoplexy is a clinical syndrome characterized by abrupt onset of a severe headache, nausea, vertigo, meningismus, and/or decreased level of consciousness.Case report: we report a case of a 56-year old man presented to medical attention with sudden severe headache, nausea, vomiting, dizziness, diplopia and blurring of vision. Computer tomography and contrast-enhanced magnetic resonance imaging of the head proved a large sellar tumor with extension to the sphenoid sinus, suprasellar region and both cavernous sinuses, predominantly on the right side with intratumoral hemorrhagic zones and the hemorrhagic accumulation in the posterior horns of the lateral ventricles.The treatment of choice was transsphenoidal approach and the patient was discharged in a good condition, completely oriented, without other neurological signs.Conclusions: Pituitary apoplexy remains a potentially life-threatening disease. Its presentation may vary from relatively benign symptoms to major neurological deficits and even death. Its early recognition and treatment are vital