Journal of neurosurgery
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Journal of neurosurgery · Apr 2004
Case ReportsIntramedullary and extramedullary solitary fibrous tumor of the cervical spine. Case report and review of the literature.
Solitary fibrous tumor is a spindle cell tumor deriving from mesenchymal cells that arises most commonly in the pleura. Only very recently has this tumor been reported in the spine. ⋯ The authors report an unusual intra- and extramedullary location for a solitary fibrous tumor of the cervical spine. Findings in this case and a comprehensive review of the literature indicate that solitary fibrous tumors can originate from various spinal anatomical substrates and mimic both intra- and extramedullary tumor types.
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Journal of neurosurgery · Apr 2004
Clinical TrialThoracic pedicle screws: postoperative computerized tomography scanning assessment.
The authors evaluated the accuracy of placement of thoracic pedicle screws by performing postoperative computerized tomography (CT) scanning. A grading system is presented by which screw placement is classified in relation to neurological, bone, and intrathoracic landmarks. ⋯ The authors' grading system has advantages over those previously described; however, further study to determine its reliability, reproducibility, and predictive value of clinical sequelae is warranted. Postoperative CT scanning should be considered the gold standard for evaluating thoracic pedicle screw placement.
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Journal of neurosurgery · Apr 2004
Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis.
The purpose of this paper is to elucidate the safety and efficacy of, and indications and outcome prognosis for endoscopic third ventriculostomy (ETV) in 58 patients with obstructive hydrocephalus. ⋯ The results indicate that ETV is a most effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. For patients with infections or intraventricular bleeding, ETV has considerable effects in selected cases with confirmed CSF dynamic studies. Early clinical and cine phase-contrast MR imaging findings after the operation play an important role in predicting patient outcomes after ETV. The predictive value of an alteration in ventricle size, especially during the early stage following ETV, is unsatisfactory. Seventy-five percent of ETV failures occur within 6 months after surgery. A repeated ventriculostomy should be considered to be a sufficient treatment option in cases in which stoma dysfunction is suspected.
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Journal of neurosurgery · Apr 2004
Case ReportsTotal spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine. Case report.
Lung cancers invading the chest wall and spinal column are often considered unresectable, and consequently there are few reports describing resection of invasive vertebral lesions. The authors developed a new anterior approach procedure for the en bloc resection of primary lung adenocarcinoma invading the thoracic spine and chest wall, in which the primary tumor does not need to be separated from the vertebrae. The authors describe a total spondylectomy for the en bloc resection of lung cancer invading the spine. ⋯ At 46 months after surgery, there is no evidence of local recurrence or distant metastasis, and the patient continues to improve. This new procedure allows for the en bloc resection of primary lung tumors and adherent vertebral invasion without separation of the lesion from the vertebra. Thus, surgical management by complete excision of Pancoast tumors can achieve longer-term survival rates without sequelae.
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Journal of neurosurgery · Apr 2004
Case ReportsIntracerebral pneumocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma. Case report.
A halo orthosis is often used to immobilize the cervical spine after severe injury in patients who cannot tolerate surgery. Although complications such as pin loosening or brain abscess have been reported, there are no reported cases of hemiparesis following pneumocephalus associated with halo use. The authors report the case of a 77-year-old man with multiple myeloma who, after undergoing halo vest therapy and chemotherapy, suddenly developed hemiparesis and speech disturbance. ⋯ When a halo device is used, attention to detail in pin application, maintenance, and proper pin-site care must be undertaken to minimize complications. The tightening of the pin in cases in which late-onset loosening has occurred should not be performed. Additionally, because late loosening of the pin and pin-site infection increase the risks of complications, a halo vest should be used only as a short-term treatment, and the clinician should be aware of the possible increased risk of serious complications such as pneumocephalus or subdural abscess formation.