In response to: Collet-Sicard Syndrome After Jefferson Fracture.

We read with great interest the recent article by Shahrvini et al. concerning Collect-Sicard syndrome after Jefferson fracture.1 The authors present a detailed report of the syndrome in an aged woman after an accidental forward fall with head injury. This case is unique, as we found no geriatric patients with associated Jefferson fracture in our previous review of Collect-Sicard syndrome

Intradural angiomatous meningioma arising from a thoracic nerve root

BACKGROUND: Spinal intradural meningiomas that arise purely from a nerve root without dural attachments are extremely rare. Spinal meningiomas arise from arachnoidal cap cells in the spinal canal, and growth of these tumors exerts pressure on the spinal cord and nerve roots. CASE DESCRIPTION: A patient presented with a lesion at the T3-T4 level that resembled a schwannoma on magnetic resonance imaging. During surgery, the tumor originated from a spinal nerve root. Pathologically, it was an angiomatous meningioma (AM). CONCLUSIONS: In a review of the literature, we discuss the pathogenesis and surgical strategy for diagnosing and treating these extremely rare AM lesions

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

Emergency decompressive craniectomy after removal of convexity meningiomas

BACKGROUND: Convexity meningiomas are benign brain tumors that are amenable to complete surgical resection and are associated with a low complication rate. The aim of this study was to identify factors that result in acute postoperative neurological worsening after the removal of convexity meningiomas. METHODS: Clinical evaluation and neuroradiological analysis of patients who underwent removal of a supratentorial convexity meningioma were reviewed. Patients were selected when their postoperative course was complicated by acute neurological deterioration requiring decompressive craniectomy. RESULTS: Six patients (mean age: 43.3 years) underwent surgical removal of a supratentorial convexity meningioma. Brain shift (mean: 9.9 mm) was evident on preoperative imaging due to lesions of varying size and perilesional edema. At various times postoperatively, patient consciousness worsened (up to decerebrate posture) with contralateral paresis and pupillary anisocoria. Computed tomography revealed no postoperative hematoma, however, did indicate increased brain edema and ventricular shift (mean: 12 mm). Emergency decompressive craniectomy and brief ventilator assistance were performed in all patients. Ischemia of the ipsilateral posterior cerebral artery occurred in 3 patients and hydrocephalus occurred in 2 patients. Outcome was good in 2, fair in 2, 1 patient had severe disability, and 1 patient died after 8 months. CONCLUSIONS: Brain shift on preoperative imaging is a substantial risk factor for postoperative neurological worsening in young adult patients after the removal of convexity meningiomas. Emergency decompressive craniectomy must be considered because it is effective in most cases. Other than consciousness impairment, there is no reliable clinical landmark to guide the decision to perform decompressive craniectomy; however, brain ischemia may have already occurred

Avenzoar (1092-1162 AD) and Averroes (1126-1198 AD) and Origin of the Cannula for Tracheotomy: Reply

[No abstract available

The origin of the cannula for ventriculostomy in pediatric hydrocephalus.

Medical and surgical texts from the 16th to the 18th centuries document the origin of the cannula for ventriculostomy in pediatric hydrocephalus. Fabrizio d'Acquapendente was the first physician to report external ventriculostomy through the insertion of a silver cannula with a stopper. More than 100 years later, extended use of the trocar by urologists allowed Claude-Nicolas Le Cat to perform an external ventriculostomy with a trocar and a bung

Transplantation of parts of autologous bone organs

The bone organs, or bones, are composed of cartilaginous, connective, hematopoietic, nervous, bone, vascular, and lipid tissues, each of which has specific functions. An autologous bone flap that has been cryopreserved, ethylene oxide sterilized or placed in an abdominal pouch and re-implanted after decompressive craniectomy meets Directive 2004/23/EC’s definition of a “part of organ” because it “maintains its structure and resumes the capacity to develop physiological functions with an important level of autonomy”

Fibrolipoma. Reply.

We are very grateful for the comments and constructive suggestions made by Mark A. Mahan et al. regarding our recent article1. The critical review provides better knowledge regarding lipomatous lesions of the nerves2. However, in our manuscript we do not discuss the broad but interrelated spectrum of lipomatous lesions of the nerves. We have reviewed our magnetic resonance images and found that the lesion appeared to have homogeneous low signal intensity on T1-weighted images and dishomogeneous hyperintensity on T2-weighted images. In the sagittal sequences, the T-6 nerve, which was very thin and stretched, was detectable in its intra-foraminal and extra-foraminal course and completely surrounded by pathological tissue, as a single strand. An abnormal area of high signal intensity in the vertebral body of T6 was evident on T2-weighted images. After the addition of contrast medium, the lesion exhibited dishomogeneous enhancement. In the surgical theater, the T6 nerve was found to be completely embedded inside the lesion. The distal portion of the nerve emerged from the lesion, and the proximal stump of the nerve emerged only after total resection of the tumor. The lesion did not invade the bone, which had a normal appearance without any sign of infiltration. We interpreted this finding as a reaction (edema) of the bone marrow to the fibrous-fatty tissue, which persisted, though to a lesser extent, in the postoperative MRI performed a few days ago, without any recurrence. The histological specimen showed a very poor vascular network, not allowing the utilization of the adjective “vascular”, and consequently angiofibrolipoma. In contrast, fibrous connective tissue was abundant and perineural fibrosis evident. We maintain our diagnosis of neural fibrolipoma of the T-6 nerve but think that additional cases in the spinal cord could enhance our knowledge of this rare entity, as well as lipomatous lesions of the nerves

Clinical effects of posterior longitudinal ligament removal and wide anterior cervical corpectomy for spondylosis

Background: Removing the posterior longitudinal ligament in cervical corpectomy is a controversial issue. It is unclear whether the risks are counterbalanced by clinical benefits. Another unexplored topic is whether the width of the corpectomy affects outcome. Methods: This cross-sectional retrospective study included consecutive patients who underwent cervical corpectomy for spondylosis by 6 different neurosurgeons. We compared 2 groups, where the posterior longitudinal ligament was either removed (N = 15 patients) or preserved (N = 21 patients). The posterior width of the corpectomy was assessed postoperatively with computed tomography and magnetic resonance imaging. Clinical results were evaluated with the visual analog scale (VAS), Modified Japanese Orthopedic Association scale (MJOAS), Cooper scale, and neck disability index (NDI), in the long-term follow-up. Results: Compared to preservation, removal of the posterior longitudinal ligament produced more favorable clinical results (but not statistically significant), based on the VAS (+41%, P = 0.48), MJOAS (+26.5%, P = 0.62), Cooper scale (+19%, P = 0.75), and NDI (+62%, P = 0.22). Magnetic resonance imagings showed that removing the posterior longitudinal ligament produced greater evagination of the dural sac into the space left by the corpectomy. Improvements in clinical outcome were associated with more posterior bone wall removal in the corpectomy (corpectomy width ≥15.6 mm; P < 0.05), based on the VAS, NDI, and MJOAS. Conclusions: Removing the posterior longitudinal ligament in cervical corpectomy may produce a better outcome, particularly when associated with more posterior bone wall removal in the corpectomy