THE PREVENTION OF DEEP VENOUS THROMBOSIS IN NEUROSURGERY: AN UPDATE FROM OUR INSTITUTION

Prophylactic low weight molecular subcutaneous heparin combined with mechanical devices and elastic stockings has already been correlated to a low incidence of deep venous thrombosis. However, there is still concern with the use of heparin in the neurosurgical field due to the potential hemorrhagic risks. We would like to update this topic with new data coming from a larger cohort of patients operated on at our Department in the last 8 years both for cranial and spinal procedures. We collected information on 5347 patients: 1497 were cranial and 3850 were spinal cases. We recorded 35 clinically symptomatic DVTs (0.6%) and 18 cases (0.3%) of hemorrhagic complications and no cases of pulmonary embolus. It is our opinion that the protocol we have implemented in our Unit for the prevention of deep venous thrombosis and pulmonary embolus is safe and effective and does not seem to increase the incidence of hemorrhagic complications

Complex developmental abnormality of the atlas mimicking a Jefferson fracture: Diagnostic tips and tricks

Congenital atlas abnormalities are rare - often asymptomatic - findings, not requiring any specific treatment. They are frequently discovered, by chance, in trauma patients, in the course of the radiological work flow at the Emergency Department. In these cases they may represent a diagnostic challenge, since physicians are expected to differentiate them from complex C1 fractures (isolated Jefferson′s fractures or associated with Anderson and d′Alonzo′s fractures) requiring surgical treatment. Although difficult to identify, a correct diagnosis is mandatory in order to optimize the patient′s treatment. In this article we report a case of congenital atlas abnormality, and discuss the tips and tricks to make a correct differential diagnosis through the most appropriate clinical and radiological work flow

Cervical foraminotomy by full-endoscopic posterior cervical approach: A randomized study

Background: FEPCP for lateral disc herniation or osteophytes is becoming a valuable technique. In 2008, the first study describing full-endoscopy posterior cervical foraminotomy (FEPCF) to treat lateral disc herniations was published. The technique has gained popularity over the last decade, and the outcomes have been compared to open or minimally invasive techniques, proving to be similarly effective. Later in 2016, FEPCF was also applied for bony foraminal stenosis. We randomized a sample of patients with cervical radiculopathy to either FEPCF or open posterior cervical foraminotomy (OPCF) to compare postoperative outcomes and foraminal size parameters. Methods: we prospectively collected data from 37 patients with cervical radiculopathy consequent to foraminal stenosis due to lateral disc herniation or osteophytes formation, failed conservative treatment, and adequate imaging (pre and postoperative three-dimensional 1 mm thick slices computer tomography (CT)). Patients were randomly assigned to FEPCF (17) or OPCF (20). Data were collected on demographics, arm and neck pain, disability, complications, and follow-up time. Foraminal size analysis was performed manually using 3D-Slicer software. The clinical outcomes and foramen dimension data were subsequently compared between the two groups. Results: There were no statistical differences in intraoperative parameters and postoperative outcomes in terms of mean postoperative arm VAS (p-value: 0.709) and mean NDI values (p-value:0.925), but postoperative mean neck pain values were lower in FEPCF patients (3.6 vs. 6.1 for OPCF, p-value:<0.001). In the FEPCF group, foraminal height, width, and area were increased by a mean value of 17.2%, 22.5%, and 19%, respectively, with no differences between FEPCF and OPCF. Conclusions: FEPCF has overlapping results in postoperative findings and foraminal size enlargement than OPCF, either for lateral disc protrusion or foraminal osteophytes

A “home made” titanium telescopic mesh for an emergent multilevel cervical corpectomy: A case example of surgical preparedness

We present the case of a 49 years old man operated as emergency for cervical spinal cord compression for a Pott disease. We had planned a limited anterior cervical decompression with plating and a second stage posterior decompression and stabilization, a few days after the first operation in case of residual compression. Unfortunately, because of the extensive and consistency of dural compression we ended up in removing 4 vertebral bodies. We did not have, in house, a such long cage and plate for the reconstruction. We managed to achieve a good fixation making a “home made” titanium telescopic mesh as well as building a long plate too. The patient did extremely well with a prompt resolution of the neurological deficits. We describe how we manage to solve this problem stressing, in the same time, the importance of a careful plan, when possible, for such difficult cases. Keywords: Vertebrectomy, Pott disease, Mesh, Cag

Unruptured Aneurysms Italian Study (UAIS) background and method

Treatment of unruptured cerebral aneurysms still represents an unsettled question in neurosurgical and neuroradiological communities. Although nowadays the indication for treatment have become relatively clear, indeed uncertainity remains for what concerns the proper treatment modality (surgical or endovascular) in terms of both the risk and the mid and long-term efficacy of the two procedures. The "Unruptured Aneurysms Italian Study" is a cooperative prospective study which aims to delineate the "State of the Art" in a nation based population. It has been designed: 1) to depict the nationwide modality of treatment of Unruptured Aneurysms, 2) to assess in the most objective way the overall treatment-related mortality and morbidity as well as the surgical and endovascular risk in the respective patient populations (it is not a surgical versus endovascular study) and 3) to asses the efficacy of the different procedures in the mid and long term periods. The study started on June 2003 and to June 2006, 637 patients have been enrolled. The study will end when the 1000th patient is enrolled