Surgical Treatment of Spinal Meningiomas

Spinal meningiomas are common spinal tumors; in most cases they are benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring to a less favorable prognosis. We reviewed a series of 173 consecutive patients with spinal meningiomas treated from 1976 to 2011 in our institution, and data were stratified according to sex, age, symptoms, axial location, Simpson resection grade, and functional pre-/postoperative status. Particular attention was paid to description of those factors leading to a poor outcome. Functional improvement at follow-up was observed in 86.7% of cases, 6.4% of patients resulted stable, and 6.9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grade I and II) was conducted in 98.8% and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. According to data from our series, negative prognostic factors seem to be: anterior or anterolateral axial implant, long-lasting symptoms before diagnosis, WHO grade > I, Simpson grade II and III resection, sphincter involvement, and worse functional grade at onset

Minimally Invasive Surgery for Treatment of Patients with Advanced Cancer and Thoraco-lumbar Spine Metastases

Spinal metastases are common in patients with cancer. Spinal cord compression is the initial symptom of 5–10% of patients with diffuse cancer, and about 70% of lesions are found in the thoracic vertebrae. Patients with advanced cancer are generally excluded from major spine surgery, to reduce postoperative morbidity and mortality. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, especially in advanced cancer patients, seeking to decrease the morbidity of more traditional open spine surgery; furthermore, reducing the recovery time, MISS permits the post-operative chemotherapy and radiotherapy to begin sooner

Pneumoventricle of Unknown Origin. A Personal Experience and Literature Review of a Clinical Enigma

Pneumocephalus (PC) is an uncommon and life-threatening neurological condition. Air within the ventricular system of the brain is also known as Pneumoventricle (PV). It requires emergency treatments to prevent catastrophic neurological outcomes. Head injury is the most common cause of PV, but there are other well-recognized etiologies in case there is no clear radiological evidence of skull discontinuity. Although this clinical entity has been well described in Literature, our report presents the unique feature of describing a purely ventricular PC without evidence of skull base or cranial vault fracture. Therefore, this case presentation explores mysterious causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault. The aim of the present paper is to report a case of post-traumatic PV without radiological signs of skull base or convexity fracture in a 72-years-old man, underlining the diagnostic and clinical features, and review the relevant Literature

Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review

AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one. METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident preoperative segmental instability. RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring. CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Preoperative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms "ganglion cyst" to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists

Non-Posterior Subtraction Osteotomy Surgery to Restore Lumbar Lordosis in the Hidden Sagittal Imbalance of the Adult Degenerative Spine

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Aggressive Vertebral Hemangioma Causing Acute Spinal Cord Compression

A 46-year-old woman presented to our emergency department with sudden onset of lower extremity weakness after physical activity. She referred only dorsal back pain before these symptoms. Neurologic examination revealed weakness 2/5 of lower limbs, hyperreflexia of deep tendon reflex of lower limbs, hypoesthesia under D7 level, and no sphincteric dysfunction. A computed tomography scan showed an accentuation of trabecular markings within the vertebral body and areas of lysis ([Figs. 1A] [F]). Contrast-enhanced magnetic resonance images show diffuse abnormal marrow signal throughout the T6 vertebral body with epidural components with spinal cord compression ([Fig. 1B] [H]

Percutaneous instrumentation with cement augmentation for traumatic hyperextension thoracic and lumbar fractures in ankylosing spondylitis: a single-institution experience

The typical traumatic thoracolumbar (TL) fracture in patients with ankylosing spondylitis (AS) is a hyperextension injury involving all three spinal columns, which is associated with unfavorable outcomes. Although a consensus on the management of these highly unstable injuries is missing, minimally invasive surgery (MIS) has been progressively accepted as a treatment option, since it is related to lower morbidity and mortality rates. This study aimed to evaluate clinical and radiological outcomes after percutaneous instrumentation with cement augmentation for hyperextension TL fractures in patients with AS at a single institution

Facial impaled trauma involving anterior cranial fossa: case report

An extraordinary case of trans-orbital penetrating injury is presented. A 42-year-old male was surprised while he was stealing into an apartment. While he was trying to escape through the window, he fell on a rod of the fence with not severe ocular and cerebral complications. We describe a unique presentation of a trans-orbital penetration injury that had a good outcome and not severe ocular and cerebral complications. After being transported at the S.M. Goretti Hospital in Latina, the rod was removed outside the operating room and the CT scan was performed. Patient underwent urgent surgery after stabilization of vital parameters

Adult Spinal Deformity in the Elderly. Preliminary Clinical and Radiological Results in 22 Patients Treated by a Two Times Minimally Invasive Spine Surgery

IntroductionThe adult spinal deformity (ASD) seems, in the last years, in a progressive increment. It should be in relation to the aging of the population. This trend leads to a progression of the ..

Dermoid cysts of the asterion. an unusual location for unusual dermoids, radiological findings and neurosurgical implications

Asterion is an uncommon site for lesions, especially dermoid cysts. We report a case series of three asterional intracranial dermoid cysts, which, to the best of our knowledge, have never been described before. Patients presented with non-specific symptoms and underwent surgical excision of the lesions. It is crucial to correctly diagnose intracranial masses and to identify their relationships with surrounding anatomical structures, especially if the location is unusual as the asterion, to plan surgery. The challenge of this tumor location is to preserve the venous drainage system during surgical procedures, because of the contiguity between the asterion and the transverse–sigmoid junction. Rupturing or damaging of the venous drainage system have been proven to be catastrophic because they lengthen surgical time and present dire consequences for patients. In conclusion, it is crucial to familiarize with atypical dermoid presentation to ensure proper diagnoses and to perform adequate imaging for optimal surgical plannin