1/6. Metastatic meningioma in the sacrum: a case report.STUDY DESIGN: This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma. OBJECTIVES: To describe an unusual presentation of a metastatic meningioma in the sacrum. SUMMARY OF BACKGROUND DATA: Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma. methods: A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space. RESULTS: Surgical removal of the sacral tumor via an anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention. CONCLUSIONS: In this case of metastatic meningioma in the sacrum, which is the first such report to the authors' best knowledge, total excision of the tumor was successful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. Swelling of the leg, deep venous thrombosis and the piriformis syndrome.BACKGROUND: The piriformis syndrome, which was first described 60 years ago, is a well recognized cause of sciatica, leg pain and low back pain, due to the entrapment of the sciatic nerve in the piriformis and other rotator muscles. Very few complications relating to this syndrome have been described. AIMS: To discuss how the piriformis syndrome may cause venous engorgement in the lower limb, and how the piriformis syndrome should be included as a possible cause of acute deep venous thrombosis in a not initially swollen leg. Both complications can occur independently. methods: Two cases of swelling of the leg and acute deep venous thrombosis independently associated with the piriformis syndrome are presented. CONCLUSIONS: Swelling of the leg and deep venous thrombosis are possible complications of the piriformis syndrome that occur due to entrapment of nerves and vessels within the leg, secondary to a severe spasm and hypertrophy of the piriformis and other rotator muscles.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/6. Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma.Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von hippel-lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/6. Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases.BACKGROUND: To define the etiologic, clinical, histological, and surgical features of lumbar hemorrhagic synovial cysts (LHSCs). Three personal cases are reported together with a review of the pertinent literature. methods: We identified 3 cases of LHSC treated in our departments and 20 cases culled from the literature. RESULTS: A total of 23 cases of LHSC were selected. All the patients underwent surgical treatment because of untreatable radicular pain and/or neurological deficits. The amount of bleeding, either massive or minor but repeated, influenced the timing of surgery. In our cases, the histological examinations showed an inflammatory reaction within the cyst and the consequent formation of neoangiogenic vessels. CONCLUSIONS: Hemorrhagic synovial cyst of the spine is rare and its most common localization is lumbar. Bleeding within the cyst leads to an increase of its volume, accompanied by neurological deficits and/or painful symptoms that are violent and generally intractable. In this event, surgical excision is the treatment of choice and, in some cases, emergency surgery is necessary. Hemorrhages are probably caused by the rupture of fragile neoangiogenic vessels.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/6. Injuries to the large abdominal vessels during lumbar nucleotomy.The rare complication of iatrogenic damage to the large abdominal blood vessels during lumbar intervertebral disc operations is demonstrated by three case reports. A sudden decrease in blood pressure and tachycardia are major signs of such vessel lacerations. Due to a valve mechanism which prevents a dorsal blood leakage through the intervertebral space, early detection of this problem by the surgeon or anesthesiologist may prove to be difficult. myocardial infarction, pulmonary embolism, abnormal volume distribution after positioning, dysfunction of circulatory regulation due to anesthesia or faulty positioning, obstruction of the subclavian artery due to false placement of chest padding, all occur more frequently and therefore must be considered and excluded. A wrong interpretation of this acute occurrence carries a mortality of 70%. Even immediate intervention by vascular surgery shows a mortality rate of 50% for this uncommon emergency. In order to prevent the disastrous sequelae to this complication, blood vessel injury should be suspected for every unexplained intraoperative decrease in blood pressure during lumbar nucleotomy. Only a rapid termination of the operation and appropriate preparation for vascular surgery can lower the mortality of this rare occurrence.- - - - - - - - - - ranking = 7keywords = vessel (Clic here for more details about this article) |
6/6. Dumb-bell shaped tuberculous abscess across the greater sciatic notch compressing both sciatic nerves.We report an instructive case of a 65-year-old man who presented with a dumb-bell shaped tuberculous abscess across the greater sciatic notch bilaterally compressing both sciatic nerves. Clinical symptoms progressed slowly and mimicked lumbar radiculopathy, thus delaying an accurate diagnosis. Anterolateral retroperitoneal and posterolateral gluteal approaches of the greater sciatic notch as well as the acetabulum on both sides were followed in order to provide safe viewing and resection of the abscess. The abscess wall was adherent to the sciatic nerve and surrounding blood vessels. The symptoms completely disappeared after resection of the abscess.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |