Ventral Thoracic Spinal Cord Herniation (original) (raw)
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Full Endoscopic Infratentorial Supracerebellar Approach to Lesion of Pineal Region-Case Report
2019
Introduction: The supracerebellar infratentorial approach was originally described by Sir Victor Horsley, and was later adapted by Stein who applied the microsurgical technique improving the results of surgeries of the pineal region. Objectives: To highlight and systematize the indications, technical-anatomical details in the supracerebellar infratentorial approach based on our surgical experience and the review of the microsurgical anatomy of the Pineal region. Material and Methods: A retrospective descriptive study was carried out analyzing the clinical histories of six patients surgically intervened by the author in the aforementioned hospitals, through a full endoscopic supracerebellar infratentorial approach, between January 2013 and June 2019. Results: During the 2013-2019 periods, 6 patients underwent surgery. All of them underwent a full endoscopic supracerebellar infratentorial approach. 3 tumors of the pineal region, 1 Pilocytic Astrocytoma and 2 Arachnoid Cyst were treate...
An overview of the current surgical options for pineal region tumors
Surgical Neurology International, 2014
Background: The list of pineal region tumors comprises an extensive array of pathological entities originating within one of the most complex areas of the intracranial cavity. With the exception of germ cell tumors, microsurgical excision is still nowadays the mainstay of management for most pineal region tumors. Methods: A search of the medical literature was conducted for publications addressing surgical options for management of pineal region tumors. Results: The infratentorial supracerebellar and the occipital transtentorial approaches are currently the most frequently used approaches for pineal region tumors. Endoscopic tumor biopsy with simultaneous endoscopic third ventriculostomy has emerged as a minimally invasive and highly effective strategy for initial management since it addresses the issue of tissue diagnosis and offers a solution for the associated hydrocephalus frequently encountered in these patients. Endoscope-assisted microsurgery and purely endoscopic excision have been reported in few reports and are likely to be more utilized in the future. Conclusion: Preoperative planning is very crucial and should most importantly be individualized according to the anatomical features of the lesion and structures encountered during the procedure.
Management of Arachnoid Cysts: A Comprehensive Review
Cureus
Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled spaces lined with arachnoid membranes. Large arachnoid cysts are often symptomatic because they compress surrounding structures; therefore, they must be treated surgically. As several surgical management options exist, we explore the best approach according to each major type of arachnoid cyst: middle cranial fossa cyst, suprasellar cyst, intrahemispheric cyst, and quadrigeminal cyst.
Pediatric brainstem gliomas: An institutional experience
Asian Journal of Neurosurgery
Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3-15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.
Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord
Neurosurgical Focus, 2010
Idiopathic ventral spinal cord herniation is a rare condition that has been increasingly reported in the last decade. The natural history and optimal management have yet to be defined. Therefore, debate exists regarding the pathogenesis and surgical management of this condition. The purpose of this review article is to further educate neurosurgeons about the surgical techniques and outcomes associated with treating this rare and often misdiagnosed condition.
Neurosurgical Focus
OBJECTIVEIndocyanine green videoangiography (ICG-VA) is an intraoperative technique used to highlight vessels in neurovascular surgery. Its application in the study of the vascular pathophysiology in CNS tumors and its role in their surgical management are still rather limited. A recent innovation of ICG-VA (i.e., the FLOW 800 algorithm integrated in the surgical microscope) allows a semiquantitative evaluation of cerebral blood flow. The aim of this study was to evaluate for the first time the systematic application of ICG-VA and FLOW 800 analysis during surgical removal of CNS tumors.METHODSBetween May 2011 and December 2017, all cases in which ICG-VA and FLOW 800 analysis were used at least one time before, during, or after the tumor resection, and in which surgical videos were available, were retrospectively reviewed. Results of the histological analysis were analyzed together with the intraoperative ICG-VA with FLOW 800 in order to investigate the tumor-related videoangiographi...
Asian spine journal, 2012
Idiopathic spinal cord herniation is a rare but potentially treatable cause of thoracic myelopathy. The rarity and variable clinical presentation often results in missed diagnosis and delay in treatment. Posterior midline approach with laminectomy has been the most common approach performed for spinal cord herniation in cases described in the literature. A posterior approach is limited by the danger of retracting the spinal cord and difficulty visualizing the dural defect. Considering the anterior location of the dural defect, a posterolateral allows for a more ventral view without spinal cord manipulation. We report a rare case of idiopathic spinal cord herniation which was managed by unilateral paramedian transpedicular approach with an excellent clinical outcome.
Spinal Cord Herniation: Why Anterior Thoracic?
Journal of Neurology and Neuroscience, 2015
Background: Spinal cord herniation and thoracic anterior adhesion syndrome make up the two extremes of a rare condition; characterized by anterior dural adhesion or protrusion of the spinal cord through the arachnoideal and dural membrane into the extradural space, respectively. Summary: We present the main features of the condition by our case series and forward a hypothesis for the consistent anterior, mid-thoracic localization. We surmise the role of an anterior pulling force by the Hofmann (meningo-vertebral) ligaments; acting when the physiologic thoracic kyphosis suddenly increases. The traction may tear the anterior dura; resulting in a dural defect; it allows the nipping/ protrusion of the spinal cord. Key messages: Because the spinal cord compression syndrome caused by adhesion or herniation of the spinal cord may be surgically treatable; the recognition of the condition is essential. The pathogenetic traction effect of the Hofmann ligament in the affected level may have surgical an prognostic implications.
A Review of Microsurgery Versus Endoscopy: Controversies for Treatment of Colloid Cysts
International Clinical Neuroscience Journal
Background: There is controversy about the value of endoscopic methods compared to microsurgical methods in the treatment of challenging colloidal cysts. This study aimed to review the findings of literature which studied microsurgery or neuroendoscopy in the colloid cyst. Methods: An advanced search in PubMed, Science Direct, and Google Scholar databases performed using keywords such as: "microsurgery," "endoscopy," "microsurgery versus endoscopy," and "colloid cysts." Results: Reviewing the findings of related studies showed some differences in sections of surgical management, microsurgery, endoscopy, complete cyst resection, recurrence rate, length of stay, and complications between the two surgical methods in the treatment of colloid cyst. Conclusion: Despite some disadvantages of endoscopy, it seems this method has more privileges than the other methods.