1/17. Arteriovenous and lymphatic malformations, linear verrucous epidermal nevus and mild overgrowth: another hamartoneoplastic syndrome?We report a 22 year old female presenting with slowly progressive paraparesis, who appeared to have many (mainly subcutaneous) hamartomas. The neurological symptoms were caused by intraspinal masses and arteriovenous malformations. In addition, she had mild overgrowth of one leg and lymph vessel malformations. This combination of symptoms resembles proteus syndrome, but is different in symptomatology and progression and may be yet another hamartoneoplastic syndrome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/17. Minimal access surgery in managing anterior lumbar disorders.Traditional anterior lumbar surgery usually requires a long and sometimes painful skin incision. The current study evaluated the feasibility and safety of minimal access surgery for anterior lumbar disorders, emphasizing indications, operative technique, and the minimum 2-year followup results. From May 1996 to December 1997, the authors used this technique on 25 patients whose indications for surgery included syndromes of failed back surgery, selected cases of lumbar disc herniations, tuberculous or pyogenic spondylitis, selected spondylolisthesis, and vertebral tumors. In 23 of 25 patients, the site of interest was approached through a left flank incision, regardless of the laterality of the lesion. The mean length of the main incision was 5 cm. There were no injuries to great vessels or any neurologic deterioration after the procedures. Solid interbody fusion could be identified radiographically between 3 and 6 months after surgery. At a mean followup of 39.6 months, nine patients had excellent clinical outcomes, 11 patients had good outcomes, two patients had fair outcomes, and one patient had a poor outcome. The authors think such minimal access surgery is simple, effective, and safe for anterior lumbar disorders. The merits of the current technique include no need for endoscopic, microscopic, or complex surgical instruments, a lower amount of radiation exposure during surgery, and a shortened learning curve because the approach is similar to the anterior open lumbar technique, although the skin incision is only 5 cm in length.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/17. Vascular complications in anterior thoracolumbar spinal reconstruction.OBJECT: Anterior approaches in thoracic and lumbar spinal surgery have potentially serious vascular injury-related complications. In this study the authors evaluate the incidence of vascular complications in anterior approaches to the thoracic and lumbar spine in cases requiring reconstructive surgery. methods: The authors retrospectively reviewed the medical records of 207 patients who underwent anterior thoracic and lumbar spinal reconstructive surgery during the period from 1992 through 1999 to determine the incidence, causes, and management of vascular complications. overall, the incidence of vascular complications following reconstructive spinal surgery was 5.8% (12 patients) and the mortality rate was 1% (two patient deaths). In seven patients (3.4%), direct vascular injuries developed as a result of surgical techniques or error; one patient died as a result. Five patients (2.4%) developed deep venous thromboses, and one patient in this subgroup died of pulmonary embolism. CONCLUSIONS: Vascular injury to the great vessels is a known and potentially serious complication associated with anterior spinal reconstructive procedures. The authors found, however, that the incidence is relatively low in cases in which venous injuries occurred acutely and arterial injuries presented in a delayed fashion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/17. Sacral origin of a spinal dural arteriovenous fistula: case report and review.STUDY DESIGN: A case of spinal dural arteriovenous fistula arising from a branch of the internal iliac artery is reported. OBJECTIVE: To report a rare case of spinal dural arteriovenous fistula supplied by a lateral sacral artery and treated with endovascular therapy. SUMMARY OF BACKGROUND DATA: Spinal dural arteriovenous fistulas usually occur in the thoracic and lumbosacral regions and arise from the intercostal and lumbar arteries. Rarely, they may occur in the sacral region, as in the reported case. methods: A 60-year-old man presented with progressive lower extremity paresis and decreased sensation below the waist of 6 months duration, which had progressed to paraparesis. diagnostic imaging included magnetic resonance imaging and spinal angiography. RESULTS: A sacral spinal dural arteriovenous fistula was diagnosed with spinal angiography, which showed the spinal dural arteriovenous fistula arising from the right lateral sacral artery branches at S2, and magnetic resonance imaging, which showed enlarged pial vessels along the surface of the spinal cord and central cord hyperintensity, with peripheral hypointensity on T2-weighted images. The patient was definitively treated with endovascular therapy using polyvinyl alcohol particles and Tornado coils. His symptoms almost completely resolved within 6 months of therapy. CONCLUSIONS: Although surgical ligation is the treatment of choice, endovascular therapy may be an effective treatment for patients with sacral region spinal dural arteriovenous fistula in cases of high surgical risk. Spinal angiography remains the definitive diagnostic examination for pinpointing the site of the dural arteriovenous fistula.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/17. Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis.STUDY DESIGN: A rare case of retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis is presented. OBJECTIVE: To discuss the pathomechanism of retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: Reports describing craniovertebral manifestations of diffuse idiopathic skeletal hyperostosis are quite rare. Only two cases of an atlantoaxial subluxation and one case of an odontoid fracture have been reported. Myelopathy resulting from retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis has not been reported previously. methods: A 74-year-old man presented with spastic tetraparesis caused by a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. Transoral removal of the extradural mass combined with a dorsal atlantoaxial fusion was performed using a titanium frame with sublaminar cable wiring. RESULTS: Yellowish amorphous material extruded from between the odontoid process and the arch of C1 when the anterior capsule had been incised. The retro-odontoid mass was very firmly attached to the hypertrophied ligaments. The mass therefore had to be sharply dissected away to expose the dura. The histologic appearance of the mass consisted of poorly cell-degenerated ligament, fibrocartilage, and fibrin. There was a focal proliferation of small vessels, but no significant inflammatory component and no evidence of neoplasia. The ligaments appeared fibrillated, disintegrated, and fragmented. After surgery, the patient's neurologic function improved. CONCLUSIONS: This is the first reported case of a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. The secondary transfer of mechanical stress to the atlantoaxial segment was presented as a pathomechanism underlying the formation of this retro-odontoid pseudotumor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/17. Symptomatic hematoma of lumbar facet joint: joint apoplexy of the spine?STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a rare case of epidural hematoma that was considered to be formed as a result of idiopathic bleeding occurring at the facet joint (joint apoplexy). SUMMARY OF THE BACKGROUND DATA: Spontaneous spinal epidural hematoma is a relatively rare condition. According to a review article of 199 spontaneous spinal epidural hematomas in the last 2 decades, the majority of these conditions are thought to result from a rupture of the epidural vascular network. Recently, a hemorrhagic lumbar synovial cyst and a hematoma occurring from the ligamentum flavum were reported as rare types of epidural hematoma. methods: The authors describe the treatment and the clinical, radiologic, surgical, and pathologic findings in one patient with a rare epidural hematoma. RESULTS: magnetic resonance imaging revealed that the extradural mass lesion was continuous with the right L4-5 facet joint; this was confirmed by surgery when the extradural hematoma was directly visualized. The joint cavity was also filled with the hematoma. There was no evidence of preceding cyst formation macroscopically or microscopically. The excised capsule of the left L4-5 facet joint revealed moderate hyperplasia of the synovium with an increased number of capillary vessels. CONCLUSIONS: This is the first reported case of radiculopathy considered to be a result of facet joint apoplexy in the absence of any preceding synovial cyst formation. The pathomechanism of the hemorrhage at the lumbar facet joint is unclear, but it is speculated that there could be an association with degenerative change of the facet joint. Surgical excision of this mass was considered to be the definitive treatment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/17. The use of ultrasonic bone curettes in spinal surgery.OBJECT: The author describes a clinical applications, procedure, and efficacy of ultrasonic bone curette (UBC) (bone-removal bar) in spinal surgery. methods: From July 2003 to March 2005, we operated on 98 consecutive spinal disorders by using UBC, Sonopet UST-2001; Chiari type-1 malformation (6 cases), cervical disorders (64 cases), thoracic disorders (5 cases), and lumbar disorders (23 cases). The instrument was devoid of any spinning parts, and the risk of grabbing cotton pledgets and damaging normal tissue was thereby avoided. Support from assistants for irrigation and suction was not required. FINDINGS: In this series, there were no iatrogenically induced injuries for example, direct or heat damage to surrounding soft tissues, including nerves, vessels, spinal cord, and dura matter. Considering potential complications of mechanical injuries by ultrasonic technique, intermittent usage and cotton protection during use under an operating microscope are recommended. We found that the ultrasonic device is easy to handle; however, it is time consuming for removing a large amount of bone and ossified lesions. Therefore, we recommend the combined use of this method with standard drilling. CONCLUSIONS: This system appears to be versatile, safe, and efficient in spinal surgery and could be improved by the development of a better handpiece.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/17. Atypical vertebral artery in a patient with an intra-and extraspinal cervical neurenteric cyst.A 15 year old girl experienced Horner's syndrome on the right side, paraesthesia of the right arm and meningitis. CT and MRI showed a cystic lesion on the right side of the cervical spine at C3/C4 which descended with an extraspinal portion down to C6. histology revealed a complex neurenteric cyst. The ipsilateral vertebral artery showed an atypical course. This abnormal artery besides a partial fusion of the vertebrae C2/C3/C4 suggest a complex malformation at the site of the cyst. Disturbed developmental relationships in this case indicate that pathological blood vessels may represent a risk factor in the surgical treatment of neurenteric cysts.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/17. Pulmonary plasma cell granuloma (inflammatory pseudotumor) with invasion of thoracic vertebra.Plasma cell granulomas (inflammatory pseudotumors) frequently appear as localized benign tumors of the lung in patients under 30 years of age. We describe the case of a 54-year-old woman with a plasma cell granuloma originating in the left lower lobe of lung and extending into the posterior mediastinum with destruction of the T8 vertebral body and pedicle. Distinctive histologic features included granulomatous aggregation of mature plasma cells around small blood vessels and direct invasion of the posterior mediastinum with subsequent dense fibrosis and bony destruction. Immunohistochemical studies revealed polyclonal kappa- and lambda-light chains in the proliferation of plasma cells.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/17. Mycotic thoracic aortic aneurysm producing vertebral body destruction and paraplegia: case report.In the surgical treatment of an aortic aneurysm, disruption of the blood supply to the spinal cord, resulting in paraplegia and anaesthesia below the level of involvement, is a dreaded complication. Occasionally, when an aortic aneurysm compresses a major vessel that supplies the anterior spinal artery, spinal cord ischaemia and paraplegia can occur before surgery. In the case presented here, however, preoperative paraplegia appears to have resulted from direct spinal destruction by an infected aortic aneurysm that was originally diagnosed as a spinal abscess. The patient underwent operative repair, but her aorta was so friable that the sutures would not hold. Despite repeat surgery, her condition rapidly proved fatal. This case shows that, in patients with a suspected spinal abscess, computer tomographic scanning and angiography should be performed to confirm the diagnosis and to rule out other pathological conditions. An accurate pre-operative diagnosis will permit adequate operative planning and prevent catastrophic results.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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