Neurosurgery
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Case Reports
Treatment of delayed-onset neurological deficit after aortic surgery with lumbar cerebrospinal fluid drainage.
The phenomenon of delayed neurological deficit after thoracoabdominal aortic aneurysm repair was first reported in the late 1980s. The mechanism may be reduced collateral circulation during periods of hypotension, cord edema, or reperfusion injury. Few patients with delayed-onset neurological deficit have recovered from this devastating complication. The experience with six patients treated with lumbar cerebrospinal fluid (CSF) drainage is reported. ⋯ The efficacy of CSF drainage may relate to reducing CSF pressure, which may increase spinal cord perfusion. Rapid initiation of CSF drainage with aggressive support of blood pressure may result in neurological improvement in some patients.
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We investigated the effectiveness of a new material, polyetheretherketone (PEEK), in a spinal cage used in performing cervical spinal fusion for the correction of cervical kyphosis. ⋯ The PEEK cage provides solid fusion, increased cervical lordosis, and increased height and cross sectional area of the foramina. There are few complications associated with the use of this cage, and the functional and neurological outcomes are satisfactory. It also facilitates postoperative x-ray and magnetic resonance imaging evaluation. The PEEK cage is therefore a good substitute for AICG fusion in patients with cervical disc disease.
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Case Reports
Spinal cord mapping as an adjunct for resection of intramedullary tumors: surgical technique with case illustrations.
Resection of intramedullary spinal cord tumors may result in transient or permanent neurological deficits. Intraoperative somatosensory evoked potentials (SSEPs) and motor evoked potentials are commonly used to limit complications. We used both antidromically elicited SSEPs for planning the myelotomy site and direct mapping of spinal cord tracts during tumor resection to reduce the risk of neurological deficits and increase the extent of tumor resection. ⋯ Antidromically elicited SSEPs were important in determining the midline of a distorted cord for placement of the myelotomy incision. Mapping spinal cord motor tracts with direct spinal cord stimulation and electromyographic recording facilitated the extent of surgical resection.