World Neurosurg
-
Case Reports
Sustainable effects of 8-year intermittent spinal cord stimulation in a patient with thalamic post-stroke pain.
Central post-stroke pain (CPSP) is a central neuropathic pain syndrome secondary to a cerebrovascular accident. CPSP treatment usually begins with medication; however, this is associated with inadequate pain relief and adverse effects. Neurostimulation therapies, including spinal cord stimulation (SCS), have been developed for improved pain relief. We report a patient with thalamic pain who underwent 8-year cervical SCS in an intermittent mode. ⋯ Our findings indicate that SCS is safe and efficacious for CPSP, including thalamic stroke pain. Long-term intermittent stimulation can preserve implantable pulse generator battery life and achieve sustained improvement of a patient's pain, movement, and affective mood status.
-
Although surgeries for intracerebral hemorrhage remain controversial, endoscopic surgery is considered a promising surgical treatment. The most fatal type of thalamic hemorrhage is the medial type, which is always combined with expansion of the hematoma into the third ventricle. The current endoscopic approach to this lesion involves injury to the mediodorsal nucleus of the thalamus (MDT). ⋯ The endoscopic-assisted translateral ventricular transchoroidal fissure approach is a safe and effective approach for evacuation of a medial thalamic hemorrhage with third intraventricular involvement. This approach allows parenchymal hematoma evacuation through the rupture of the third ventricle without incising the MDT in the lateral ventricle.
-
Chordomas are rare, locally malignant tumors derived from remnants of the notochord that can manifest anywhere in the spine or base of the skull. Surgical treatment for chordomas of the lumbar spine often fails to achieve successful en bloc resection, which is critical to minimizing recurrence risk. ⋯ This approach offers a promising technological adjunct for the treatment of complex spine tumors requiring precise resection and reconstruction.
-
Case Reports
"Gas Embolism after Hydrogen Peroxide Use during Spine Surgery: A Case Report and Literature Review".
As an irrigant, an antiseptic, and a hemostatic agent, hydrogen peroxide (H2O2) is widely used in surgical treatment, but it has been surrounded by persistent controversy. Fatal or near-fatal embolic events caused by H2O2 have been reported sporadically in spine surgery. ⋯ Spine surgeons should reconsider the pending results of using H2O2 during surgery. Prolonged prone positioning and semiclosed cavities may increase the risk of gas embolism. An early diagnosis and timely intervention may be the key measures to prevent the occurrence of fatal consequences caused by gas embolism.
-
According to previous reports, pseudoaneurysms that are concomitant with a dural arteriovenous fistula (dAVF) are associated with penetrating trauma, blunt trauma, and skull fractures. Moreover, dAVFs between the inferolateral trunk of the internal carotid artery and middle cerebral vein are a rare disease manifestation. Pseudoaneurysms concomitant with dural arteriovenous fistulas (dAVF) are rare and traumatic pseudoaneurysms with dAVF typically developed slowly with less rebleeding than isolated traumatic aneurysms. ⋯ The traumatic pseudoaneurysm was completely obliterated by surgical clipping, followed by decompressive craniectomy and postoperative coma therapy with propofol. Resulting from these surgical and postoperative treatments, 56 days after the operation the patient recovered fully and did not present any neurologic deficits.