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Terrapon APR, Stienen MN, Veeravagu A, Fehlings M, Bozinov O, Hejrati N. Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor. BRAIN & SPINE 2024; 4:102843. [PMID: 38947985 PMCID: PMC11214289 DOI: 10.1016/j.bas.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
Introduction Cystic schwannomas have only been reported in a few case reports/series. As a result, they may be misdiagnosed and a standardized management approach remains challenging to establish. Research question The aim of this study was to compile all reported cases of cystic schwannomas and analyze the perioperative course based on a systematic review of the literature with an additional two cases from the authors' experience. Material and methods We conducted a search of MEDLINE and CENTRAL databases for spinal intradural extramedullary cystic schwannomas, in accordance to the PRISMA statement. All title/abstracts were screened, and a full-text review of the remaining articles was conducted. The results were compiled in tables and summarized using means and standard deviation (SD), median and interquartile range, and percentage and 95% confidence intervals. Results We identified 263 articles, of which 35, which reported 54 cases, were included. Including our case-reports (n = 56), patients had a mean age of 47.7 years (SD ± 13.0 years) at presentation, 57% were males, and most lesions were lumbar (43%). The most common symptoms were pain (82%) and muscle weakness (68%) with 84% of patients showing neurological findings. 70% of patients showed a complete relief of symptoms after surgery and 96% reported improvement. Only four complications were reported. Discussion and conclusion Schwannomas should be considered in the differential diagnosis of intradural extramedullary cystic lesions. Patients typically present with subacute to chronic pain and/or neurologic changes. Surgical resection is the primary therapeutic modality and usually has a good to excellent outcome.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
- Department of Neurosurgery, Bern University Hospital, Rosenbühlgasse 25, 3010 Bern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Oliver Bozinov
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Nader Hejrati
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
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Said W, Maragno E, Leibrandt L, Spille D, Schipmann S, Stummer W, Gallus M, Schwake M. A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01069. [PMID: 38376184 DOI: 10.1227/ons.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The primary treatment modality for spinal meningiomas (SM) is surgical resection. In recent years, minimal invasive spine surgery has gained considerable popularity, attributing its growth to advancements in surgical technologies and improved training of surgeons. Nonetheless, the suitability and effectiveness of minimal invasive spine surgery for intradural spinal tumor resection remain a subject of debate. In this cohort study, we aimed to compare the extent of resection of the unilateral hemilaminectomy approach, a less invasive technique, with the more traditional and invasive bilateral laminectomy. METHODS We performed a retrospective cohort study including patients with SM who underwent surgery at our department between 1996 and 2020. Cohorts included patients who underwent tumor resection through bilateral laminectomy and patients who underwent a unilateral hemilaminectomy. The primary end point was extent of resection according to the Simpson classification. RESULTS Of 131 with SM, 36 had a bilateral laminectomy and 95 were operated through a unilateral hemilaminectomy. In both groups, gross total resection, Simpson grades 1 and 2, was achieved in 94.44% and 94.74%, respectively (P = .999). The neurological outcome was also comparable in both cohorts (P = .356). Both length of hospital stay and estimated blood loss were significantly lower in the unilateral cohort (P < .05). CONCLUSION The results of this study indicate that the unilateral hemilaminectomy yields comparable results in both oncological and neurological outcome when compared with the bilateral laminectomy. Thus, unilateral hemilaminectomy may serve as a viable and safe alternative for the surgical removal of SM.
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Affiliation(s)
- Wesam Said
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Emanuele Maragno
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Lara Leibrandt
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Dorothee Spille
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Bergen, Bergen, Norway
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Marco Gallus
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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Schwake M, Krahwinkel S, Gallus M, Schipmann S, Maragno E, Neuschmelting V, Perrech M, Müther M, Lenschow M. Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?-A Dual-Center Comparative Effectiveness Research. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:171. [PMID: 38256431 PMCID: PMC10821288 DOI: 10.3390/medicina60010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Prolonged bed rest after the resection of spinal intradural tumors is postulated to mitigate the development of cerebrospinal fluid leaks (CSFLs), which is one of the feared postoperative complications. Nonetheless, the empirical evidence supporting this conjecture remains limited and requires further investigation. The goal of the study was to investigate whether prolonged bed rest lowers the risk of CSFL after the resection of spinal intradural tumors. The primary outcome was the rate of CSFL in each cohort. Materials and Methods: To validate this hypothesis, we conducted a comparative effectiveness research (CER) study at two distinct academic neurosurgical centers, wherein diverse postoperative treatment protocols were employed. Specifically, one center adopted a prolonged bed rest regimen lasting for three days, while the other implemented early postoperative mobilization. For statistical analysis, case-control matching was performed. Results: Out of an overall 451 cases, we matched 101 patients from each center. We analyzed clinical records and images from each case. In the bed rest center, two patients developed a CSFL (n = 2, 1.98%) compared to four patients (n = 4, 3.96%) in the early mobilization center (p = 0.683). Accordingly, CSFL development was not associated with early mobilization (OR 2.041, 95% CI 0.365-11.403; p = 0.416). Univariate and multivariate analysis identified expansion duraplasty as an independent risk factor for CSFL (OR 60.33, 95% CI: 0.015-0.447; p < 0.001). Conclusions: In this CER, we demonstrate that early mobilization following the resection of spinal intradural tumors does not confer an increased risk of the development of CSFL.
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Affiliation(s)
- Michael Schwake
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
| | - Sophia Krahwinkel
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
| | - Marco Gallus
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
- Department of Neurosurgery, University Hospital Bergen, 5009 Bergen, Norway
| | - Emanuele Maragno
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
| | - Volker Neuschmelting
- Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (V.N.); (M.P.); (M.L.)
| | - Moritz Perrech
- Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (V.N.); (M.P.); (M.L.)
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany; (S.K.); (M.G.); (S.S.); (E.M.); (M.M.)
| | - Moritz Lenschow
- Department of Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany; (V.N.); (M.P.); (M.L.)
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Byvaltsev VA, Polkin RA, Kalinin AA, Belykh E, Riew KD. Laminectomy with Laminar Reconstruction for Resection of Intradural Tumors at the Thoracolumbar Junction: A Technical Note. World Neurosurg 2023; 179:104-108. [PMID: 37611800 DOI: 10.1016/j.wneu.2023.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To introduce a new laminar reconstruction technique to treat primary spinal cord tumors. METHODS Laminectomy and laminoplasty techniques have been used to treat intradural spinal tumors. The advantage of laminectomy is its superior exposure of the spinal cord, whereas the advantage of laminoplasty is the reconstruction of the dorsal roof of the spine. In this technical note, we present a technique that combines a full laminectomy to maximize exposure, with a reconstructive technique to repair the lamina. This technique restores the posterior ligamentous complex to preserve spinal biomechanics. RESULTS In this illustrative case, a 55-year-old woman with severe back pain radiating to the right lower extremity was found to have an intradural tumor at the T12-L1 spinal level. Given the transitional level of the spine and potentially high biomechanical stresses on the posterior support structures, we used a T12 laminectomy to resect the tumor, followed by reconstruction using miniplates. The patient tolerated the surgery well, without any complications. She was discharged home and was doing well during the 3 months follow-up visit. Appropriate patient consent was obtained. CONCLUSIONS Laminectomy and laminar reconstruction allow maximum visualization and manipulation of the tumor, followed by restoration of the dorsal roof of the spinal ring, and is an effective technique for treating spinal cord tumors.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia; Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
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Krahwinkel S, Schipmann S, Spille D, Maragno E, Al Barim B, Warneke N, Stummer W, Gallus M, Schwake M. The Role of Prolonged Bed Rest in Postoperative Cerebrospinal Fluid Leakage After Surgery of Intradural Pathology-A Retrospective Cohort Study. Neurosurgery 2023; 93:563-575. [PMID: 36883822 DOI: 10.1227/neu.0000000000002448] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Postoperative cerebrospinal fluid leakage (CSFL) is a feared complication after surgery on intradural pathologies and may cause postoperative complications and subsequently higher treatment costs. OBJECTIVE To assess whether prolonged bed rest may lower the risk of CSFL. METHODS We performed a retrospective cohort study including patients with intradural pathologies who underwent surgery at our department between 2013 and 2021. Cohorts included patients who completed 3 days of postoperative bed rest and patients who were mobilized earlier. The primary end point was the occurrence of clinically proven CSFL. RESULTS Four hundred and thirty-three patients were included (female [51.7%], male [48.3%]) with a mean age of 48 years (SD ±20). Bed rest was ordered in 315 cases (72.7%). In 7 cases (N = 7/433, 1.6%), we identified a postoperative CSFL. Four of them (N = 4/118) did not preserve bed rest, showing no significant difference to the bed rest cohort (N = 3/315; P = .091). In univariate analysis, laminectomy (N = 4/61; odds ratio [OR] 8.632, 95% CI 1.883-39.573), expansion duraplasty (N = 6/70; OR 33.938, 95% CI 4.019-286.615), and recurrent surgery (N = 5/66; OR 14.959, 95% CI 2.838-78.838) were significant risk factors for developing CSFL. In multivariate analysis, expansion duraplasty was confirmed as independent risk factor (OR 33.937, 95% CI 4.018-286.615, P = .001). In addition, patients with CSFL had significant higher risk for meningitis (N = 3/7; 42.8%, P = .001). CONCLUSION Prolonged bed rest did not protect patients from developing CSFL after surgery on intradural pathologies. Avoiding laminectomy, large voids, and minimal invasive approaches may play a role in preventing CSFL. Furthermore, special caution is indicated if expansion duraplasty was done.
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Affiliation(s)
- Sophia Krahwinkel
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
- Department of Neurosurgery, University Hospital Bergen, Bergen, Norway
| | - Dorothee Spille
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Emanuele Maragno
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Bilal Al Barim
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Nils Warneke
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Marco Gallus
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
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Quiceno E, Hussein A, Pico A, Abdulla E, Bauer IL, Nosova K, Moniakis A, Khan MA, Farhadi DS, Prim M, Baaj A. Indications for Fusion With Intradural Spine Tumor Resection in Adults: A Systematic Review and Meta-analysis. World Neurosurg 2023; 176:21-30. [PMID: 37080455 DOI: 10.1016/j.wneu.2023.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The evidence for instrumented fusion in the setting of degenerative, traumatic, or congenital deformity is well established. Data on fusion indications in intradural spinal tumors (IDST) are scarce and reduced to retrospective studies. The objective of this work is to systematically review the published literature since 2015 and analyze the change of practice patterns for stabilization and fusion after intradural tumor resection in adults. METHODS A systematic literature review was performed via PubMed with the terms: "intradural spinal tumors", "intramedullary spinal tumors", and "intraspinal tumors". The analysis was limited to adult patients with IDST and studies with more than 10 patients. Data on the proportion of patients who underwent instrumentation and had postoperative deformity was pooled in a meta-analysis. RESULTS A total of 1073 articles were identified and 47 papers were selected. All the studies were retrospective series and a total of 2473 patients were included. The follow-up ranged from 1 to 96 months, the pooled spinal fixation rate was 6% (95% CI 4.5%-7.6%), the pooled laminoplasty rate was 14.4% (95% CI 5.9%-23%), the pooled rate of postoperative deformity or malalignment in patients with a follow up of at least 6 months was 2.1% (95% CI 1.2%-3%) and just 7 patients were reoperated due to progressive deformity. CONCLUSIONS Based on existing evidence, the rate of fusion during resection of intradural spinal tumors is low. Prophylactic fixation is often unnecessary and only indicated in unique cases that require extensive bony resection.
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Affiliation(s)
- Esteban Quiceno
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA.
| | - Amna Hussein
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Annie Pico
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Ebtesam Abdulla
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Isabel L Bauer
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Alexandros Moniakis
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Monis Ahmed Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Dara S Farhadi
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Michael Prim
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA
| | - Ali Baaj
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
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Lee S, Min S, Han J, Kim ES, Lee SH. Long-term Follow-up Results of Reconstructive Laminoplasty With L-shaped Leibinger Mini-plate for Posterior Approach in the Treatment of Intraspinal Tumor Surgery. World Neurosurg 2023; 171:e382-e390. [PMID: 36521755 DOI: 10.1016/j.wneu.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Laminoplasty using mini-plates is one of the most common surgical techniques in surgery for intraspinal pathologies. However, limited are present in the literature. The aim of this study was to determine its long-term clinical and radiologic outcome, specifically using an L-shaped mini-plate. METHODS Patients who underwent surgery for spinal intradural pathology from January 2008 to December 2019 were retrospectively reviewed. Those who received laminoplasty using the Leibinger mini-plate and were followed for more than 2 years were included. Patient demographics and clinical and radiographic data were reviewed and analyzed. A total of 117 patients (male:female = 47:70; mean age 50.9 years, range 16-92 years) were included, and mean follow-up period was 50.3 months (range 24-151 months). RESULTS The most common pathology was schwannoma (n = 66, 56.4%) followed by meningioma (n = 30, 25.6%). Gross total resection was achieved in 82.9% (n = 97). Clinical outcomes at last follow-up were mostly good and excellent (n = 95, 81.2%). Computed tomography at the postoperative 1-year follow-up were available in 32 patients (27.4%) and the overall fusion rate was 89.3% (50 of 56 laminae). The fusion rate was significantly lower in the cervical spine compared to other locations (50% vs. thoracic [100%], lumbar [85.7%], P < 0.002). No displacement of laminae or postoperative spinal deformity were observed throughout the follow-up. CONCLUSIONS Laminoplasty using L-shape Leibinger mini-plates had an 89.3% fusion rate, and no displacement of the re-attached laminae was observed. We think it is a safe and feasible option in surgeries for intraspinal pathologies.
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Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sunghoon Min
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurosurgery, Wiltse Memorial Hospital, Suwon, South Korea
| | - Junghoon Han
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment : A Three Center Retrospective Study. Clin Neuroradiol 2023; 33:99-105. [PMID: 35768696 DOI: 10.1007/s00062-022-01187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting. METHODS We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up. RESULTS We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases. CONCLUSION The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.
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Jiang L, Luo J, Gong H, Zhang F, Zhang L, Cheng L, Gao X, Zhang D, Liu T, Xiao J. Clinical and Biomechanical Study of Laminoplasty for Thoracic and Lumbar Intradural Tumors. J Clin Med 2023; 12:jcm12010355. [PMID: 36615155 PMCID: PMC9821651 DOI: 10.3390/jcm12010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.
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Affiliation(s)
- Lijun Jiang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jie Luo
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Haiyi Gong
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Fei Zhang
- Department of Orthopedics, Ningbo Beilun Orthopedic Hospital, Ningbo 315899, China
| | - Linxiang Zhang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Linfei Cheng
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xin Gao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Dan Zhang
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Tielong Liu
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Jianru Xiao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
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Spinal canal stenosis in children with achondroplasia: the role of augmentation laminoplasty-a 15-year single institution experience. Childs Nerv Syst 2023; 39:229-237. [PMID: 35654849 DOI: 10.1007/s00381-022-05566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Achondroplasia typically results in compressive spinal canal stenosis in one-third of children, but rare under the age of 15 years. Laminectomy is the mainstay of treatment but this leads to instability and progressive deformity requiring complex fixation. In order to reduce that risk, we developed a novel modified augmented laminoplasty that increases spinal canal diameter while preserving the posterior column stability. METHODS All laminoplasty cases for spinal compressive achondroplasia from 2006 to 2020 were included. Ten augmentation laminoplasty procedures were performed in 7 children with regular clinical and radiological post-operative follow-up. Kyphotic deformity and clinical outcomes (neurological and urological) were evaluated. RESULTS At presentation, clinical features included radiculopathy, neurogenic claudication or acute cauda equina compression with sphincter dysfunction. The average age at initial surgery was 11.2 (range 5-16) with a mean follow-up of 5 (range 2-8) years. All patients demonstrated improvement in neurogenic claudication symptoms after surgery; however, bladder dysfunction persisted in some children. In one child, cervical and lumbar augmentation laminoplasties were performed for concomitant disease. Augmentation laminoplasty effectively prevented deformity progression over time in all cases except one where a further revision laminoplasty with extension was required for screw loosening. Despite this, progressive symptomatic kyphotic deformity led to a 360° fixation. Minor complications included one dural breach (repaired intraoperatively) and one superficial wound infection. CONCLUSION Augmentation laminoplasty is a viable surgical option following laminectomy in achondroplasia patients as an alternative to surgical fixation. Fixation can be reserved for cases where there is progressive deformity and kyphosis.
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Aoyama R, Anazawa U, Hotta H, Watanabe I, Takahashi Y, Matsumoto S. A Novel Technique of Mixed Reality Systems in the Treatment of Spinal Cord Tumors. Cureus 2022; 14:e23096. [PMID: 35296052 PMCID: PMC8917809 DOI: 10.7759/cureus.23096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/29/2022] Open
Abstract
Several reports have compared spinal cord tumor removal techniques but none have clearly described the appropriate site and level of indication for laminectomy or laminoplasty. The approach method for tumor removal depends on the type and localization of the tumor and the surgeon's skill. Therefore, a system that can suggest various surgical techniques is useful for spinal cord tumor surgery. The mixed reality system introduced in this paper is an excellent system that can suggest various surgical procedures. Using this system for spinal cord tumor removal, we made the surgery less invasive; therefore, we introduced this system and demonstrated its usefulness. Stereoscopic data of the patients with spinal cord tumors were obtained from preoperative myelogram-CT data. Stereoscopic laminectomy models including tumors were created using Blender, a free three-dimensional (3D) image editing software. We observed these data as 3D object images using a head-mounted display (HMD). This HMD is commercially available and relatively inexpensive. The surgical procedure is determined by considering those 3D images, radiological diagnosis, and the skill of surgeons. Intraoperative confirmation of the laminectomy site could be performed using the HMD. The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases. Stereoscopic images using HMDs allow us a more intuitive understanding of the positional relationship between the tumor and spinal structure. These 3D object images can bring us more accurate preoperative planning and proper determination of surgical methods.
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Graham P. Spinal Cord Tumor: Ependymoma. Orthop Nurs 2022; 41:37-39. [PMID: 35045541 DOI: 10.1097/nor.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Patrick Graham
- Patrick Graham, MSN, RN, APRN/ANP-BC, Banner University Medical Center Tuscon, Tuscon, AZ
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Zhao H, Ren R, Ma W, Xu S, Peng L, Zhong Z, Zheng Y. Comparison of Laminoplasty vs. Laminectomy for Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:790593. [PMID: 35111804 PMCID: PMC8801503 DOI: 10.3389/fsurg.2021.790593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Laminoplasty (LP) and laminectomy (LC) with or without fusion are recommended as treatment procedures for cervical spondylotic myelopathy (CSM). The purpose of this study is to conduct a meta-analysis to analyze the results of CSM patients undergoing LP or LC surgery. METHODS We systematically and comprehensively searched Web of Science, Cochrane Library, PubMed, EMBASE, OVID, VIP database, Google Scholar, Chinese Bio-medicine Literature database, and China Scientific Journal Full-text database to July 2021 for randomized controlled trials (RCTs) and observational case series that compared LP and LC in patients with CSM. The main endpoints were the surgical process, radiographic outcomes, clinical outcomes, and surgical complications. RESULTS A total of 19 were included the inclusion criteria in this meta-analysis (n = 4,348 patients). There was no significant difference in range of motion (ROM), sagittal vertical axis (SVA), Japanese Orthopedic Association (JOA), Cobb angle, visual analog scale (VAS), cervical curvature index (CCI), Nurick score, Neck Dysfunction Index (NDI), and complications. LP was found to be superior than LC in terms of complications of C5 radiculopathy and surperficial infection. CONCLUSION Our results indicate that LP can achieve better results in C5 radiculopathy and superficial infection in surgical treatment of CSM compared with LC. Further high-quality research is warranted to further verify our findings. SYSTEMATIC REVIEW REGISTRATION PRISMA: CRD42018107070.
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Affiliation(s)
- Huaguo Zhao
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Rong Ren
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Weihu Ma
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Song Xu
- Department of Hepatobiliary Surgery, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Linrui Peng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Zhaoping Zhong
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Yan Zheng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
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Lee S, Cho DC, Kim KT, Lee YS, Rhim SC, Park JH. Reliability of Early Ambulation after Intradural Spine Surgery : Risk Factors and a Preventive Method for Cerebrospinal Fluid Leak Related Complications. J Korean Neurosurg Soc 2021; 64:799-807. [PMID: 34425635 PMCID: PMC8435651 DOI: 10.3340/jkns.2020.0350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/18/2022] Open
Abstract
Objective Cerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC.
Methods For this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6–0 was used as the dura suture material, while black silk 5–0 was used as the dura suture material in the late group.
Results The overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p<0.05). Logistic regression analysis revealed that CLC was associated with practices specific to the late group (p=0.011) and the revision surgery (p=0.022).
Conclusion Using Prolene 6–0 as a dura suture material for intradural spinal surgery resulted in lower CLC rates compared to black silk 5–0 sutures despite a shorter bed rest period. Our findings revealed that suture - needle ratio related to dura defect was the most critical factor for CLC. One-day ambulation after primary dura closure using Prolene 6–0 sutures appears to be a cost-effective and safe strategy for intradural spinal surgery.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young-Seok Lee
- Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Chul Rhim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim S, Hwang SH, Cho BK, Yoon SH, Yoon J. Posterior Approach in C2-3 Disc Herniation: C1 Laminectomy, C2-3 Laminoplasty and Posterior Fixation in C2-3 Disc Herniation. Korean J Neurotrauma 2021; 17:81-87. [PMID: 33981649 PMCID: PMC8093021 DOI: 10.13004/kjnt.2021.17.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
C2–3 disc herniation is rare and a definitive treatment of choice has not been established. The purpose of this case report is to suggest posterior approach as one of the best options. A 49-year-old man visited our clinic with a 7-year history of neck pain and occipital headache and a 2-month history of right arm pain. C2–3 intervertebral disc herniation of the central type was diagnosed on magnetic resonance imaging (MRI), and surgery was performed, including C1 laminectomy, C2–3 laminoplasty, and C2–3 posterior fixation. The posterior approach was used because the patient's neck was difficult to operate anteriorly. After 3 months postoperatively, MRI showed widened cerebrospinal fluid space at the C2–3 level. The visual analogue scale score for pain improved in the occipital area and right arm. However, the untouched protruded central disc, subjective weakness in right hand grasping, and numbness persisted. In conclusion, this case highlights posterior decompression and fixation as a good treatment of choice for decompression at the C2–3 level disc herniation, from where it is difficult to remove compressive lesions directly via the anterior corridor.
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Affiliation(s)
- Sunho Kim
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sung Hwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Joonho Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Surgical and Radiologic Prognostic Factors in Intramedullary Spinal Cord Lesions. World Neurosurg 2021; 150:e550-e560. [PMID: 33746103 DOI: 10.1016/j.wneu.2021.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The present study aimed to perform a comprehensive data analysis of 47 consecutive patients treated in 8 years and to observe how clinical, radiologic, and surgical factors affect early and long-term outcomes, recurrence rate, and survival. METHODS Clinical, radiologic, and surgical data were collected retrospectively from the review of a prospectively collected database. The neurologic disability was evaluated according to the modified Rankin Scale (mRS). Radiologic data were obtained by direct measurement performed on magnetic resonance imaging (MRI). Univariate and multivariate statistical analysis was performed. RESULTS From 2008 to 2016, 47 consecutive patients underwent microsurgical resection of intramedullary lesions (28 males and 19 females; mean age, 41.2 years). Ependymoma (53.2%), astrocytoma (14.9%), hemangioblastoma (14.9%), and cavernous angioma (6.4%) were the most frequent tumor histology. The mean follow-up duration was 69.3 months. Gross total tumor resection was performed in 80.8% of cases. Forty-two patients (89.4%) were alive at last follow-up. Five-year overall survival and recurrence-free survival were 92% and 82%, respectively. CONCLUSIONS Among the examined variables, age seemed to strongly correlate with outcomes; better chances of recovery and a good postoperative outcome were observed in younger patients. Surfacing lesions had a better early functional outcome than did intramedullary located lesions. Patients' preoperative neurologic and functional status (mRS score ≤2) had a significant impact on late neurologic outcome. Progression-free survival correlated with the extent of tumor resection. Surgery should probably be performed before patients' neurologic decline, aiming to achieve maximal resection without compromising patients' quality of life.
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Comparative Five-Year Surgical Outcomes of Open-Door versus French-Door Laminoplasty in Multilevel Cervical Spondylotic Myelopathy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8853733. [PMID: 33376747 PMCID: PMC7746444 DOI: 10.1155/2020/8853733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/18/2020] [Indexed: 12/31/2022]
Abstract
Objective To compare the five-year surgical outcomes between Open-Door laminoplasty (ODL) and French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM). Methods Sixty patients with MCSM, who were operated by ODL or FDL, were included in this study and followed up for at least 5 years. The average follow-up period was 69.2 ± 3.2 months. The modified Japanese Orthopaedic Association (mJOA) score and radiological assessments including the Cobb angle and cervical range of motion (ROM) were evaluated and compared before surgery and at the final follow-up. The incidence of postoperative complications and medical costs were also compared. Results Both ODL and FDL groups achieved significant improvements of the mJOA score in postoperative 5 years; the average recovery rate (RR) of the mJOA score in the ODL and FDL groups was 72.14 ± 6.97% and 69.53 ± 7.51%, respectively. No statistically significant differences regarding the pre- and postoperative mJOA score, the RR of the mJOA score, the loss and the loss rate of the Cobb angle, and the incidence of postoperative complications existed between ODL and FDL. The mean loss and the loss rate of cervical ROM in the FDL group (18.70 ± 8.91°, 41.08 ± 11.17%) were significantly higher than those of the ODL group (13.81 ± 8.62°, 31.47 ± 12.43%) (P < 0.05). FDL reduced medical costs more greatly than ODL (33014.37 ± 3424.12 China Yuan versus 82096.62 ± 7093.07 China Yuan, P < 0.001). Conclusions Both ODL and FDL are effective for MCSM. The 5-year neurological results are similar between the two groups. ODL trends to be superior to FDL in postoperative preservation of cervical ROM while FDL reduced medical costs more greatly.
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18
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Chen Y, Li Z, Chen X, Yin Y, Qiao G. Surgical Treatment Outcomes of Patients with Conus Medullaris Teratoma: A Single-Center Experience of 39 Patients. World Neurosurg 2020; 143:e374-e383. [PMID: 32730968 DOI: 10.1016/j.wneu.2020.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conus medullaris teratomas are extremely rare, and the treatment experience has been limited. The purpose of the present study was to evaluate the clinical characteristics, radiological features, surgical outcomes, and prognosis of patients with conus medullaris teratoma. METHODS We retrospectively reviewed the data from 39 patients who had undergone surgical resection for conus medullaris teratomas from January 2008 to December 2018. All the operations were performed by 1 senior doctor. The clinical features, pre- and postoperative magnetic resonance imaging findings, pathological features, treatment strategies, and outcomes were analyzed. The neurological status was evaluated using the modified Japanese Orthopaedic Association scale score. RESULTS Of the 39 patients, the mean age was 30.9 years. Of the 39 patients, 20 were male and 19 were female. The symptom duration ranged from 0.3 to 252 months (mean, 61.6 months). Bladder and bowel dysfunction was the most common symptom (76.9%). Total resection was achieved in 25 patients (64.1%), subtotal resection in 11 (28.2%), and partial resection in 3 (7.7%). A mature teratoma was confirmed in all 39 patients. The neurological outcomes were improved 16 patients (45.7%), stable in 14 (40.0%), and aggravated in 5 (14.3%) at a mean follow-up of 62.7 months. Recurrence developed in 1 patient who had undergone subtotal resection. A second surgery with total resection was performed, and the patient's neurological symptoms were stable during follow-up. CONCLUSIONS Total surgical resection is the optimal treatment strategy for patients with conus medullaris teratoma. Safe maximum tumor removal and residual tumor inactivation using electrocoagulation are recommended when total resection cannot be achieved. Surgery can provide a low recurrence rate and an acceptable low complication rate.
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Affiliation(s)
- Yakun Chen
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ze Li
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Chen
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiheng Yin
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guangyu Qiao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Ten-Year Surgical Outcomes and Prognostic Factors for French-Door Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3627071. [PMID: 32461980 PMCID: PMC7229559 DOI: 10.1155/2020/3627071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Objective To analyze the ten-year surgical outcomes and postoperative complications of French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM) and analyze the prognostic factors for FDL in treating MCSM. Methods 64 patients with MCSM, who were operated by FDL, were included in this study and followed up for at least 10 years. Clinical assessments including modified Japanese Orthopaedic Association (mJOA) score, age at surgery, preoperative symptom duration, operative time, blood loss and postoperative complications, radiological assessments including Cobb angle, cervical range of motion (ROM), intramedullary signal intensity on T2W MRI, canal narrowing ratio (CNR), and maximum spinal cord compression (MSCC). mJOA score, Cobb angle, cervical ROM, intramedullary signal intensity on T2W MRI, and CNR were assessed before surgery and at the final follow-up. Results The average mJOA score was significantly improved from preoperative 10.32 ± 1.63 points to 15.10 ± 0.62 points at the final follow-up (p < 0.05). The average RR of the mJOA score at the final follow-up was 69.10 ± 7.32%. The cervical Cobb angle and ROM decreased significantly at the final follow-up. Patients with high intramedullary signal intensity of T2W MRI or CNR more than 50% showed a lower RR of the mJOA score. Correlation analysis revealed that preoperative symptom duration and intramedullary signal intensity of T2W MRI, CNR, MSCC, and blood loss were significantly correlated with the RR of the mJOA score. Gender, operative method, and age at surgery were significantly correlated with the preservation rate of ROM. Operative time was significantly correlated with the incidence of axial symptoms. Conclusions The ten-year clinical outcomes of FDL were satisfactory. Higher intramedullary signal intensity of T2W MRI and a greater CNR predicted poorer prognoses.
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Chen YN, Yang SH, Chou SC, Kuo MF. The role of sacral laminoplasty in the management of spina bifida and sacral cystic lesions: case series. Neurosurg Focus 2019; 47:E20. [PMID: 31574475 DOI: 10.3171/2019.7.focus19414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although laminae are not viewed as essential structures for spinal integrity, in the sacrum the anatomical weakness and gravity makes it a vulnerable area for CSF accumulation and expansion. The congenital or postoperative defects of sacral laminae, such as in patients with spina bifida, make this area more susceptible to forming progressive dural ectasia, pseudomeningocele, or expansile arachnoid cyst (Tarlov cyst). In addition, adhesions between the dura and surrounding soft tissue after laminectomy can cause some local symptoms, which are difficult to relieve. The authors propose that sacral laminoplasty with titanium mesh can provide a rigid support and barrier to resolve these sacral lesions and local symptoms. METHODS From January 2016 to December 2017, patients with progressive CSF-containing lesions in the sacral area and defective sacral laminae were included in the study. After repair of the lesion, the authors performed sacral laminoplasty with titanium mesh in each patient. Subsequently, the soft tissue and skin were closed primarily. RESULTS A total of 6 patients were included. Four patients with repaired myelomeningocele had progressive dural ectasia. One patient with lipomyelomeningocele previously underwent detethering surgery and developed postoperative pseudomeningocele. One patient had a symptomatic Tarlov cyst. Four of these 6 cases presented with low-back pain and local tenderness. During follow-up, ranging from 13 to 37 months, all 6 patients experienced no recurrence of dural ectasia or pseudomeningocele and were free from local symptoms. CONCLUSIONS Sacral laminoplasty with titanium mesh is a safe and effective procedure for treating progressive sacral dural ectasia and refractory pseudomeningocele, preventing CSF leakage as well as relieving local symptoms that may occur years after previous surgery for spina bifida.
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Affiliation(s)
- Yu-Ning Chen
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
| | - Shih-Hung Yang
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
| | - Sheng-Che Chou
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.,2Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, National Taiwan University College of Medicine, Yunlin; and.,3Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Meng-Fai Kuo
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
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