Effect of CO2 laser on spinal epidural fibrosis

In this study the effect of CO2 laser on spinal epidural fibrosis was examined in 24 guinea pigs which were divided into two groups. The first group was the control group, the second one the CO2 laser group. All animals had laminectomies at 3 levels. Re-exploration was performed three months after the laminectomy. In the second group the same procedure was performed but at the end of the re-exploration, CO2 laser irradiation of the epidural fibrotic tissue was done. The wounds in both groups were closed again. Four months later all animals were sacrificed. For verification and quantification of scar formation (postoperative fibrosis) light microscopic examinations and determination of hydroxyproline were done, using Bergman's spectrophotometric method. The differences which were observed between the two groups were statistically significant (U : 134, P < 0.05). This study demonstrates the reducing effect of CO2 laser irradiation on epidural scar formation. The findings encourage its use as an alternative method of prevention of epidural fibrosis after spinal surgery.

Congenital cholesteatoma with spontaneous epidural abscess, sinus thrombosis and cutaneous fistula

A congenital cholesteatoma or epidermoid is a benign mass that causes devastating effects if left untreated. An unusual case with a congenital cholesteatoma located in the mastoid region complicated by epidural abscess, sinus thrombosis, and cutaneous fistula is presented. The patient had normal otologic findings and had no neurologic deficit. A review of the literature found no report of a similar case.

Transforaminal endoscopic microdiscectomy

Foraminal epidural endoscopic surgery (FEES) is a minimally invasive spine surgery technique that allows maximum exposure for visualization, identification, and exploration of anatomy, pathology, and structures at risk; therefore, it provides for dissection of neuropathologic anatomy and documentation of surgical correction. Minimal intervention with maximum surgical capability supports consideration of FEES as "microdiscectomy through a cannula."

Neurogenic claudication by epidural lipomatosis: a case report and review of literature

Epidural lipomatosis is most frequently seen in patients on chronic steroid treatment. Only twelve cases of idiopathic spinal epidural lipomatosis have been described. In this report we present an additional case of this condition in a middle-aged male presenting with neurogenic claudication.

[Spinal epidural abscess]

The aspecific spinal epidural abscess is an uncommon cause of the spinal cord compression. Forty eight patients presented with epidural abscess were operated on during the last 37-year-period in the National Institute of Neurosurgery Budapest. Experiences with the diagnostic methods and the results of the treatment of these patients are analysed. Based on the case history data, preoperative symptoms and operative findings 31 male and 17 female patients (their age ranged from 15-64 years) have been selected in acute, subacute and chronic groups. Localized backpain, acceleration of the blood sedimentation, leukocytosis and fever were significant findings which were followed by sings of radicular or medullary compression. This clinical picture developed rapidly in the acute group. Aspecific abscess most commonly appeared in thoracal or lumbal localisation and was rarely found in the ventral area. Staphylococcus aureus was the causative organism in nearly 100 percent of the cases. Surgery carried out before the onset of the neurological deficits according to proper CSF examination and myelography, proved to be favourable. Early diagnosis and emergency operation led to a significant improvement of the outcome.

Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine

STUDY DESIGN

This is a case report.

OBJECTIVES

To provide a better understanding of a rare entity, ligamentum flavum hematoma, based on a successfully treated patient.

SUMMARY OF BACKGROUND DATA

Lumbar root compression is frequently caused by disc herniation. Canal stenosis, epidural hematoma, or tumors are less common. Few cases of hematoma in the ligamentum flavum causing lumbar root compression have been described.

METHODS

A patient was treated for ligamentum flavum hematoma causing progressive lumbar root symptoms. Clinical and radiologic features, including magnetic resonance images, were recorded.

RESULTS

Symptoms consisted of progressive lumbar root deficit after mild physical exertion. On magnetic resonance images, a mass continuous with the ligamentum flavum, compressing the dural sac and roots, was found. Areas of high signal in T1 were present in it. In this patient, removal of the ligamentum flavum (degenerated tissue containing hematoma) resolved all of the symptoms. The diagnosis could have been suspected based on clinical history and magnetic resonance imaging.

CONCLUSIONS

Magnetic resonance imaging can provide a basis for diagnosing ligamentum flavum hematoma. Removal of ligamentum flavum is the treatment of choice.

Lumbar epidural lipomatosis causing neurogenic claudication in two obese patients

Two obese patients suffering from neurogenic claudication caused by lumbar epidural lipomatosis are described. Although lumbar epidural lipomatosis is most often related to prolonged use of steroid drugs, obesity has also been reported as a possible cause. Both CT and MRI can demonstrate excess epidural fat; because of the possibility of sagittal views MRI is to be preferred. In one of our patient with neurogenic claudication the excess epidural fat normalised completely after considerable weight reduction and symptoms resolved. Therefore weight reduction might be the initial therapy in an obese patient with symptomatic epidural lipomatosis. When weight reduction fails or when there are urgent clinical reasons, surgical removal of the excess amount of epidural fat should be considered.

[Angio-fibrolipoma in epidural space of the vertebral canal]

55-yera old patient with angio-fibro-lipoma of thoracic part of the vertebral canal was described. This rare, benign tumour was totally removed. Subsequently the neurological state of the patient improved.

[Internal occlusive hydrocephalus following cholesteatoma]

A 30-year-old Vietnamese patient is reported who was admitted with a resistant acute otitis externa, and who complained also of headache and fever. The symptoms were found to be caused by the intracranial complications (epidural abscess and bacterial meningitis) of an aural cholesteatoma. A secondary occlusive hydrocephalus developed in spite of successful otological surgery that preserved hearing and vestibular function.

Posterior epidural migration of extruded lumbar disk

Migration of herniated lumbar disks is discussed, and the case of a 61-year-old man with acute lower back pain is reviewed.

Recurring tetraparesis attributable to a heartworm in the epidural space of a dog

Recurring nonambulatory tetraparesis caused by a heartworm in the epidural space was diagnosed in a dog. On myelography and digital subtraction imaging, the parasite appeared as a large extradural mass. Surgical removal of a mature, female Dirofilaria immitis resulted in resolution of the neurologic signs.

The surgical procedures and evaluation of two modifications of endolymphatic sac surgery: the epidural shunt and vein graft drainage

A method of ELS surgery was originally described in 1926 by George Portmann. However, the risk of adhesive closure of an incision on the lateral wall of the ELS in his technique has been a matter of dispute ever since. A number of modifications have been advocated in order to improve the patency of the ELS, such as Yamakawa-Naito's subarachnoid shunt (1954), House's endolymphatic-subarachnoid shunt (1962), Shea's Teflon film drainage of the sac (1966), the T-tube shunt of Paparella & Hanson (1976), the valve implant by Arenberg (1979), the epidural drainage by an L-shaped incision in the lateral wall of the sac with insertion of gelatin film, developed by Kitahara & Futaki (1974), and vein graft drainage of the ELS by Futaki & Nomura (1988). During the period July 1980 to February 1986, 142 patients with endolymphatic hydrops were followed postoperatively according to the AAO-HNS (1985) guidelines. Of these 142 cases, 122 patients were operated on by Kitahara & Futaki's procedure and 20 by the vein graft drainage procedure. The incidence of vertigo was cured in over 90% of the cases and hearing impairment was improved in over 30%. In this paper, the surgical procedures are described in detail, using illustrations.

[Selection of the method of treatment of suppurative spinal epiduritis]

The author has analyzed 65 observations of patients with purulent spinal epiduritis resulting mostly from purulent diseases of the skin and subcutaneous fat. A period of pyo-resorptive fever was established which in most cases preceded the appearance of local symptoms of the disease. The purulent process is more frequently accompanied with fever, more rarely it turns into sepsis. The most rational method of treatment of the disease is early operation followed by irrigative drainage of the wound in complex with antibacterial and symptomatic therapy. A classification of purulent spinal epidurites is proposed.

The surgical management of epidural mucoceles

Mucoceles of the paranasal sinuses extending into the epidural space are both uncommon and difficult to surgically manage. To best overcome the problem of recurrent disease, we have adopted a combined otorhinolaryngologic-neurosurgical approach which emphasizes removal of as much as possible of the mucocele and marsupialization, or permanent drainage, of the disease site into the nasal cavity. Recently, we have modified this procedure in selected cases to include resection of involved dura and isolation of the epidural space from the nasal cavity. The indications and results of both forms of management are now reported in ten patients.

Sciatica and epidural gas

Epidural gas in the patient with sciatica can sometimes provide a clue that there is a surgically treatable lesion. Our patient had the sudden onset of sciatica at night, which was relieved by walking. An intraspinal synovial cyst was associated with epidural gas.

Thoracic spinal epidural cysts

Two cases of spinal cord compression by thoracic epidural cysts are reported. The first case, associated with a lipoma, is of a congenital type, while the second illustrates a rare mechanism of spinal cord compression caused by a post-traumatic cyst after stretching of the brachial plexus and tearing of the meningeal sheaths of nerve roots. Computed tomography of the spine is helpful in disclosing the cyst and associated malformation, particularly in congenital cases. The prognosis is good after removing the cyst and closing the fistula communicating with the subarachnoid space. Further surgical treatment may be required in complex congenital malformations.

Anterior decompression of the spine for metastatic epidural cord compression: a promising avenue of therapy?

Most metastatic epidural tumors arise in a vertebral body and invade the anterior epidural space. Therefore, it is logical to decompress the spine anteriorly and not by traditional laminectomy. Surgical decompression is indicated if relapse occurs after radiotherapy and further radiation cannot be administered, if there is neurological deterioration during radiotherapy, and when histological diagnosis of the primary tumor is lacking. This pilot study consists of eleven consecutive anterior decompressions of the spine performed in nine patients. In seven instances other treatment modalities had been exhausted, and in four patients a tissue diagnosis was lacking. Before operation eight of the patients were nonambulatory, four of them paraplegic. Following decompression all but one patient became ambulatory. At operation the main bulk of the compressing tumor was found anterior or anterolateral to the cord. Spine stabilization was done when stability was a problem. Wound infection in one patient was the only postoperative complication. The encouraging outcome of our management prompts us to suggest that anterior decompression of the spine should be considered more often in metastatic compression of the cord and cauda equina.

Spinal epidural abscess in children

This is a report of three children with spinal epidural abscess. The literature is reviewed and the features of this condition in children are noted. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed, resulting in a worse outcome, especially in children under 1 year of age. The extensive laminectomy advised for the treatment of spinal epidural abscesses in adults is undesirable in children because of the risk of spinal deformity and in most cases is probably not necessary.

Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy

Metastases to the spinal epidural space with compression of the spinal cord or cauda equina are commonly encountered by physicians in a variety of clinical field. In the recent past, decompressive laminectomy followed by radiotheray was thought to be the best available treatment. More recently, radiotherapy alone has been advocated as an alternative treatment mode with a similar rate of effectiveness. This study compares laminectomy followed by radiotherapy to radiotherapy alone in the treatment of spinal epidural metastases in a randomized, prospective clinical trial. No significant difference was found in the effectiveness of the two treatment methods in regard to pain relief, improved ambulation, or improved sphincter function. Patients with an incomplete myelographic block fared well regardless of treatment, and those with a complete block fared poorly. Because of the limited size of this study and because of certain unforeseen design defects, the results are suggestive but not conclusive. Suggestions are made for a future randomized, prospective multicenter study that would conclusively answer the perplexing question as to the most efficacious method for treating spinal epidural metastases.

[Epidural abscesses of the spinal cord treated surgically]

The authors discuss 5 cases of epidural empyemas of the vertebral canal in which a good surgical effect was obtained. On the basis of a literature survey and own material they discuss the aetiology of the disease, its rarity, and diagnostic difficulties caused frequently by absence of typical neurological changes, lack of systemic inflammatory reaction and primary purulent focus.