Treatment of syringomyelia with ventriculoperitoneal shunt: A case report

Komünikan sirengomiyeli saptanan olgularda, ventriküler sisteminde genişlemiş olduğu görülür ise ventrikiiloperitoneal şant sistemi ilk tedavi seçeneği olarak uygulanabilir. Bu çalışmada ventriküloperitoneal şant takılarak tedavi edilen komünikan sirengomiyelili bir olgu sunulmaktadır. Sağ elinde daha belirgin olmak üzere tüm ekstremitelerinde güçsüzlük ve ses kısıklığı yakınması ile başvuran 41 yaşındaki olgunun yapılan manyetik rezonans görüntüleme tetkikinde serebellum tonsillerinin 5mm. fıtıklanmasına ek olarak sirengomiyeli ve beyin venüiküllerinde genişleme saptandı. Tedavi için ventriküloperitoneal şant uygulandı. Ameliyat sonrası klinik ve radyolojik tüm bulgular düzeldi. İlk girişimden 7 yıl sonra yapılan kontrol muayenesinde iyilik halinin devam ettiği görüldü. Sirengomiyelinin doğru tedavisi, beyin omurilik sıvısı dinamiğinin anlaşılmasına ve buna yönelik uygun girişimin seçilmesine bağlıdır. Uygun olgularda ventriküloperitoneal şant tatkibi seçkin tedavi yöntemi olarak görülmektedir.SUMARY Treatment of syringomyelia with ventriculoperitoneal shunt: Case report. The ventriculoperitoneal shunting procedure may be first choice of treatment in patients harboring communicating syringomyelia associated with enlarged cerebral ventricles. In this report, a patient with communicating syringomyelia who was treated by inserting a ventriculoperitoneal shunt is presented. A 41-yeard-old man was admitted to our clinic with the complaints of hoarseness and weakness in all four extremities. Magnetic resonance imaging of the head and cervical spine revealed the presence of a type I Chiari malformation and syringomyelia associated with enlarged cerebral ventricles. Neurological symptoms improved dramatically after operation. Six months later, a control magnetic resonance imaging was performed to find out that the syrinx and the tonsillar hernation as well had disapperared completely. The patient was still in good neurological condition when he was lost to follow-up 7 years after operation. The accurate treatment of syringomyelia relies upon the understanding of dynamics of cérébro-spinal fluid and choosing the appropriate surgical procedures. Ventriculoperitoneal shunting should be considered as the initial treatment modality in the case of cervical syringomyelia associated with enlarged ventricles

Short-term X-ray Results of Posterior Vertebral Column Resection in Severe Congenital Kyphosis, Scoliosis, and Kyphoscoliosis

WOS: 000304364800017PubMed ID: 22024907Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection performed on a consecutive series of patients with severe congenital spinal deformity. Summary of Background Data. The treatment of severe congenital spinal deformities is a demanding and difficult surgical challenge. Conventional procedures, such as posterior and anterior instrumentation or combined anteroposterior instrumentation provide limited correction in rigid neglected or maltreated (fused) deformities. Methods. Forty-four patients with severe deformity and managed by posterior vertebral column resection between years 1997 and 2007 having more than 2 years of follow-up were included. Mean age was 8 (range, 2-28) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-in. standing anteroposterior and lateral radiographs obtained before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. Results. Preoperative coronal plane major curve of 106 degrees (range, 90 degrees-132 degrees) with flexibility of less than 30% was corrected to 41.4 degrees (range, 20 degrees-72 degrees), showing a 61% scoliosis correction at the final follow-up. Coronal imbalance was improved by 79% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 87 degrees (range, 67 degrees-103 degrees) in patients with kyphosis was corrected to 36 degrees range, 25 degrees-48 degrees) at the most recent follow-up evaluation. Lumbar lordosis of 27 degrees (range, 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 45 degrees. Complications included postoperative infection in 2 patients, dural laceration in 2 patients, and hemopneumothorax in 1 patient. Conclusion. Posterior vertebral column resection is an effective technique providing a successful correction of stiff complex congenital deformities. However, it is a technically demanding procedure, with possible risks for major complications

Posterior Vertebral Column Resection in Severe Spinal Deformities A Total of 102 Cases

WOS: 000287446300008PubMed ID: 21325930Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection (PVCR) performed to a consecutive series of patients with severe spinal deformity and managed by PVCR. Summary of Background Data. The treatment of severe spinal deformities is a demanding and difficult surgical challenge. Conventional procedures such as posterior and anterior instrumentation or combined anteroposterior instrumentation afford limited correction in rigid neglected or maltreated (fused) deformities. Methods. A total of 102 consecutive patients with severe deformity and managed by PVCR between years 1996 and 2007 having more than 2 years follow-up were included. Mean age was 37.6 (range = 2-84 years) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. Results. Preoperative coronal plane major curve of 102 degrees (range = 80 degrees-29 degrees) with flexibility of less than 30% was corrected to 38.3 degrees (range = 20 degrees-72 degrees) showing a 62% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 83 degrees (range = 65 degrees-104 degrees) in patients with kyphosis was corrected to 36 degrees (range = 25 degrees-48 degrees) at the most recent follow-up evaluation. Lumbar lordosis of 25 degrees (range = 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 42 degrees. Two patients had nerve root palsies not identified during the surgery and healed completely in 6 months after surgery. Conclusion. PVCR is an effective technique because it is a spinal column shortening procedure and it allows to do correction in same session. However, it is a technically demanding procedure with possible risks for major complications

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI inidiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. Aroutine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations.Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum

Transtentoryal herniasyondaki hastalarda dekompresif hemikranyektomi

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Objective: To present the results, technique and indications of decompressive hemicraniectomy in patients with unilateral transtentorial herniation. Methods: Ten consecutive patients with intracranial hypertension refractory to medical management and transtentorial herniation were treated with decompressive hemicraniectomy over a 3-year period with the following diagnoses: malignant infarction (3 patients), subarachnoid hemorrhage and vasospasm (2 patients), traumatic brain injury (3 patients), spontanous intracerebral hemorrhage, and venous thrombosis. Neurological status was assessed by the Glasgow Coma Scale (GCS) and by the modified Rankin Scale (mRS) on admission, and by the mRS on discharge, and on follow-up examinations. Computerized tomography (CT) scans performed preoperatively, and on the first, 7th postoperative days, and at one month were assessed for trastentorial herniation and midline shift. A decompressive hemicraniectomy, at least 14 by 11 cm was performed in all patients.Amaç: Unilateral transtentoryal herniasyonu olan hastalarda dekompresif hemikranyektominin sonuçlarını, tekniğini ve endikasyonlarını ortaya koymak. Yöntem: Üç yıl içinde, medikal tedaviye dirençli intrakranyal hipertansiyonlu ve transtentoryal herniasyonda, habis infarct (3 olgu), subaraknoid kanama ve vazospazm (2 olgu), travmatik beyin hasarı (3 olgu), spontan intraserebral kanama ve venöz tromboz tanıları olan 10 ardışık hastaya dekompresif hemikranyektomi yapıldı. Nörolojik durum girişte Glasgow Koma Skalası (GKS) ve modifiye Rankin Skalası (mRS) ile, çıkışta ve kontrollerde mRS ile değerlendirldi. Operasyon öncesinde, 1. ve 7. postoperatif günlerde ve 1.ayda yapılan bilgisayarlı tomografi (BT) incelemeleri değerlendirildi. Hastaların hepsinde en az 14x11 cm’lik dekompresif hemikranyektomi yapıldı

Epidural ampiyeme neden olan frontal sinüs aspergillomu

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Aspergillosis infection located primarily in the frontal sinus and invading into the dura is rare. A 74-year-old male patient was admitted with headache of 3-month duration that did not respond to analgesics. Cranial MRI showed an irregular hyperintense lesion in T2 FLAIR and T1 FLAIR, arising from the right frontal sinus and advancing to the intracranial space. A collection, hyperintense on T2 FLAIR and isointense on T1 FLAIR, adjacent to the left frontal sinus was observed, consistent with epidural empyema. The lesions were drained surgically, and subsequently treated with antifungal therapy using Amphotericin B. The headache resolved completely after surgical drainage. The patient has been followed-up for a year and is currently asymptomatic. Aspergillosis infections lodging primarily in the frontal sinus and spreading to the dura are very rare, therefore, we report this case in the present paper. (Primer olarak frontal sinüse yerleşerek duraya yayılım gösteren aspergillosis infeksiyonu oldukça nadirdir. Yetmiş dört yaşında erkek hasta 3 aydır olan analjezik tedaviye cevap vermeyen baş ağrısı yakınmasıyla başvurdu. Kranyal MR’ında; sağ frontal sinüsten intrakranyal alana doğru uzanan T2 FLAIR ve T1 FLAIR‘de hiperintens irregüler lezyon olduğu, intraserebral alana doğru ilerlediği görüldü. Sol frontal bölgede ise T2 FLAIR’de hiperintens, T1 FLAIR’de ve GRE (ECHO) incelemesinde izointens görünen epidural ampiyem ile uyumlu kolleksiyon saptandı. Cerrahi olarak lezyonlar drene edildi, amfoterisin B tedavisi başlandı. Cerrahi drenaj sonrası bir yıllık takibi boyunca benzer başağrısı tekrarlamadı. Primer olarak frontal sinüse yerleşerek duraya doğru yayılım gösteren ve epidural ampiyeme neden olan aspergillosis infeksiyonlarının çok nadir olması nedeniyle bu olgu sunulmaktadır

Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

WOS: 000586632300001Study Design: Retrospective study. Objective: the aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: the mean age was 49 years (range 22-83 years). the mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. the mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). the mean LKA improved from 34.7 degrees to 4.9 degrees (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis

The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI in idiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum