World Neurosurg
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The treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts mainly when they are associated with degenerative spondylolisthesis. We report one consecutive series of 50 patients with lumbar synovial cysts operated on with microsurgery without arthrodesis. ⋯ The microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. Total surgical resection was obtained in all cases, with a late fusion rate of only 6% and no recurrence at the operated site. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.
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There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCI affect the thoracic spine. This cohort has not been extensively investigated - mainly due to less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for chronic paraplegic patients. Therefore, this study investigates the effect of early decompression (here defined as < 8 hours) versus delayed management on neurological and functional outcome. ⋯ Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multi-center studies.
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In the management of meningiomas, single-fraction stereotactic radiosurgery (SRS) is an established alternative treatment to surgical resection (1). However, its effects on tumorigenesis and malignant transformation are still uncertain (2). ⋯ The tumour recurred again 7 years later, with histological features of a grade-III rhabdoid-papillary lesion, with local brain invasion. To our knowledge, this was the first report to describe malignant transformation of a grade II to a grade III meningioma following SRS therapy to date.