Vertebroplasty and Kyphoplasty Under Local Anesthesia: Review of 91 Patients

WOS: 000284087100008PubMed ID: 20963695AIM: Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive methods for the treatment of vertebral compression fractures (VCF). In this study, we aimed to present our experience with VP and KP performed under local anesthesia and percutaneously. MATERIAL and METHODS: Between 2002 and 2008, 91 patients (total 112 vertebrae) with VCF due to osteoporosis, tumor and trauma underwent VP or KP. After radiological and routine evaluations, all patients were operated under local anesthesia. Mean operation time was 20 minutes per vertebrae. We never stopped the operation because of intolerance of any patient and all of them were discharged on the day of operation or the next day except one. RESULTS: All patients had severe back pain. Mean preoperative Visual Analogue Scale (VAS) score for pain was 8.3 and the mean postoperative value was 2.7. Mean anterior wall and mid-vertebral body heights increased by 32% and 43%, respectively. The mean kyphotic angle decreased from 15.4 to 11.2. Cement leakage was observed in 4 patients and one of them underwent an open operation (decompression and stabilization) because of cement leakage to the epidural space. There was no other complication. CONCLUSION: Vertebroplasty and kyphoplasty are safe, effective and minimally invasive procedures. Elderly patients can thefore avoid the potential complications of general surgery and be mobilized and discharged early

Cervical Screw Missing Secondary to Delayed Esophageal Fistula: Case Report

WOS: 000271572900021PubMed ID: 19847769Although anterior surgical approaches to the cervical spine have become popular and safe in recent years, they also have some complications. We present a case of loss of an anterior cervical plate screw by the natural tracts. The patient was a 47-year-old woman who was operated on for cervical spondylotic myelopathy at another institution. Surgical interference included two levels of anterior discectomy, iliac graft placement and fixation using plate and screws. Two years later, plate dislocation and partial migration of the upper screws were observed. After 7 years the patient complained of dysphagia and she accepted removal of the osteosynthesis. Radiographical examination showed that one of the upper screws was missing and two lower screws were broken. Esophageal perforation was found during the surgery and repaired. Further progress was favourable. Complications associated with esophageal perforation may range from massive infection and death to spontaneous recovery. Erosion of the esophageal wall due to extruded bulky constructs may lead to a persistent fistula, abscess or septic diffusion. Spontaneous perforation of the esophagus and screw loss via the gastrointestinal tract make this case interesting.

Compressive hyperextension injury of C2-C3 managed with anterior plate fixation: Case report

WOS: 000256792700010PubMed ID: 17935029We report a C2 tear-drop fracture of a 69-year-old patient which occurred after a fall. Although tear drop fractures of the subaxial cervical spine mostly develop due to a flexion type injury, the mechanism is often compressive hyperextension injury at the C2 vertebra. Rigid external stabilization and internal fixation are the treatment alternatives. Internal fixation may be performed using the posterior or anterior approach. This paper describes a C2 tear drop fracture which was treated with an anterior plate fixation

Neuronavigation-guided Endoscopic Endonasal Excision of Schwannoma-like Chordoma of Meckel's Cave: A Case Report

###EgeUn###Chordomas are locally aggressive malignant tumors due to their recurrence potential and originate from embryonic notochord remnants. Chordomas can originate anywhere on the axial skeleton. They are extradural and spread by bone destruction. Chordomas are locally aggressive tumors that invade the dura mater, and may also present with secondary intradural growth. The Meckel's cave location of chordomas has been very rarely reported in the literature. Chordomas located in Meckel's cave can be radiologically confused with trigeminal schwannomas. Herein, we report a case of Meckel's cave chordoma that was successfully excised through neuronavigation-guided endoscopic endonasal excision, a technique commonly used in skull base surgeries

Primary tumors of the cervical spine: a retrospective review of 35 surgically managed cases

7th International Congress on Spine -- APR, 2005 -- Antalya, TURKEYWOS: 000251488300005PubMed ID: 17321965BACKGROUND CONTEXT: Primary tumors of the cervical spine are rare, and many issues regarding their surgical management remain unanswered yet. PURPOSE: To demonstrate results of surgery for primary tumors of the cervical spine and to elucidate which factors influence outcome. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Sixty-six surgeries were performed on 35 patients, ranging in age from 7 to 70 years. OUTCOME MEASURES: Preoperative and postoperative degree of pain and neurological status were quantified. Radiological investigations were used to detect recurrence and evaluate the stability and fusion. METHODS: Data were collected on patient characteristics, therapy, and results. Follow-up ranged from 6 months to 15 years (mean 59.9 months). RESULTS: Posterior (26), anterolateral (24), retropharyngeal (9), combined (4), lateral (2), and transmandibular approaches (1) were used. Chordomas (n = 8) and 17 different types of tumors were encountered. One patient died 3 weeks postoperatively and 5 died of their disease at follow-up. Twenty patients had no evidence of disease, and 7 patients had recurrent tumors. According to the Weinstein-Boriani-Biagini classification, tumor extension into both anterior and posterior columns of a vertebra was correlated with a poor outcome. Incomplete resections resulted in tumor recurrence which warranted subsequent surgeries (up to 9), especially in chordoma cases. CONCLUSIONS: Complete tumor resection is the oncologically best surgical strategy and should be attempted whenever possible. However, this may not be feasible in every case because of the complexity of the cervical spine. In these cases, acceptable mortality-morbidity rates and symptom-free years could be achieved by subtotal resections, even for malignant tumors. (c) 2007 Elsevier Inc. All rights reserved

Three-dimensional-printed marker-based augmented reality neuronavigation: a new neuronavigation technique

OBJECTIVE The aim of this study was to assess the precision and feasibility of 3D-printed marker-based augmented reality (AR) neurosurgical navigation and its use intraoperatively compared with optical tracking neuronavigation systems (OTNSs). METHODS Three-dimensional-printed markers for CT and MRI and intraoperative use were applied with mobile devices using an AR light detection and ranging (LI DAR) camera. The 3D segmentations of intracranial tumors were created with CT and MR images, and preoperative registration of the marker and pathology was performed. A patientspecific, surgeon-facilitated mobile application was developed, and a mobile device camera was used for neuronavigation with high accuracy, ease, and cost-effectiveness. After accuracy values were preliminarily assessed, this technique was used intraoperatively in 8 patients. RESULTS The mobile device LIDAR camera was found to successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The targeting error that was measured ranged from 0.5 to 3.5 mm (mean 1.70 +/- 1.02 mm, median 1.58 mm). The mean preoperative preparation time was 35.7 +/- 5.56 minutes, which is longer than that for routine OTNSs, but the amount of time required for preoperative registration and the placement of the intraoperative marker was very brief compared with other neurosurgical navigation systems (mean 1.02 +/- 0.3 minutes). CONCLUSIONS The 3D-printed marker-based AR neuronavigation system was a clinically feasible, highly precise, low-cost, and easy-to-use navigation technique. Three-dimensional segmentation of intracranial tumors was targeted on the brain and was clearly visualized from the skin incision to the end of surgery

Tongue abscesses: MR imaging findings

BACKGROUND AND PURPOSE: A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses

Prognostic Significance of The Ki-67 Labeling Index and P53 Protein Expression For Patient With Craniopharyngioma

WOS: 000270682900004Craniopharyngiomas are histological benign tumors. Craniopharyngiomas are slowly growing locally invasive intracranial tumors that can generate considerable morbidity and recurrences that are often difficult to manage. Reliable morphologic criteria for predicting clinical outcome of these tumors are lacking. The aim of the study was to investigate the prognostic value of Ki-67 labeling indices and p53 protein expression for recurrence in craniopharyngiomas. A series of 47 patients with craniopharyngiomas (29 male and 18 female; age range: 4-74 years, mean years: 31.4 +/- 17.8) were reviewed. Nine cases were papillary squamous and 38 cases were adamantinomatous variant. Tumors recurred in 10 (%21.2) patients (range 2-120, mean 23.2 months). Ki-67 labeling indices varied from 0% to 12% (mean 1.68 +/- 2.7%). The ratio of p53 staining was 1-25% in 24 cases, in most majority (17 cases) it was under 10%. Ki-67 labeling index and p53 immunopositivity showed no statistically significant correlation with tumor recurrences and histological subtypes. Low Ki-67 labeling indices and p53 immunopositivity are common findings in the majority of craniopharyngiomas. Ki-67 labeling indices and p53 expression of primary tumors did not have prognostic value to predict tumor recurrence.Pamukkale University Research FoundationPamukkale UniversityThis study was supported by agrant from Pamukkale University Research Foundatio