Neurosurgery
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Basal ganglia and thalamic arteriovenous malformations (AVMs) show a poor natural history and have proven difficult to treat. We report the safety and efficacy of presurgical and preradiosurgical embolization of these deep central lesions and describe the contribution of embolization to multimodality treatment. ⋯ Endovascular embolization plays an important role in multimodality treatment of AVMs involving the basal ganglia and/or thalamus. Embolization can result in obliteration of a significant volume of the AVM and may allow complete obliteration of the AVM when combined with microsurgical resection and/or stereotactic radiosurgery.
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The source of fluid and the mechanism of cyst enlargement in syringomyelia are unknown. It has been demonstrated that cerebrospinal fluid (CSF) normally flows from the subarachnoid space through perivascular spaces and into the spinal cord central canal. The aim of this study was to investigate whether this flow continues during cyst formation in an animal model of syringomyelia and to determine the role of subarachnoid CSF flow in this model. ⋯ In this animal model, noncommunicating syringes continue to enlarge even when there is evidence that they are under high pressure. There may be an increase in pulse pressure rostral to the block of subarachnoid CSF flow, causing an increase in perivascular flow and contributing to syrinx formation. The source of fluid in noncommunicating syringomyelia may be arterial pulsation-dependent CSF flow from perivascular spaces into the central canal.
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To illustrate how an understanding of the basic biological responses of peripheral nerves to injury is important in formulating a rational treatment plan. ⋯ The diagnosis and treatment of peripheral nerve injuries follow logically from an understanding of the biological responses of peripheral nerves after injury and during recovery.
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In the posterolateral extraforaminal and anterolateral retroperitoneal approaches to lumbar spinal lesions, the neural structures in the lumbar extraforaminal region are unfamiliar to many spinal surgeons. The purpose of this study was to determine the normal anatomic morphometric parameters for all lumbar nerve roots around their exits, from the intervertebral foramen to the surrounding bony structure. ⋯ The lumbar nerve component, including both the lumbar trunk and each exiting nerve root in the extraforaminal region (the so-called "danger zone"), was located anteriorly at a distance more than 5 mm from the TP, more than 19 mm from the superior articular process, and up to 25 mm from the intervertebral disc space. Based on our results, the danger zone occupied up to 25 mm forward from the intervertebral foramen at the lower lumbar segments. Therefore, during operations such as percutaneous posterolateral procedures and open posterolateral or anterolateral approaches, great care should be taken within 25 mm of the extraforaminal region, especially for the lower lumbar spine.
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Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. ⋯ Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.