Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review.

Introduction: Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice.

Improved seizure control and regaining cognitive milestones after vagus nerve stimulation revision surgery in Lennox-Gastaut syndrome.

We report a child with Lennox-Gastaut syndrome with an increase in seizure frequency and loss of psychomotor skills due to a disintegrated cervical VNS lead, not detected during standard device monitoring. The lead was completely removed and replaced by a new 303 lead on the same nerve segment. After reinitiating VNS, side effects forced us to switch it off, resulting in immediate seizure recurrence.

Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview.

Background: With the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique.

Methods: We retrospectively reviewed our patient registry for all VNS surgeries performed between January 2007 (the year of our first complete removal) and May 2014.

Crippling upper back pain after whiplash and other motor vehicle collisions caused by thoracic disc herniations: report of 10 cases.

Study Design: Retrospective analysis of a prospectively collected database of thoracoscopic microdiscectomies performed at the Maastricht University Medical Center.

Objective: Many victims of a motor vehicle collision (MVC) report crippling upper back pain resistant to conservative treatment. Although this pain is often regarded as nonspecific or related to a whiplash type of cervical spine injury, this study demonstrates it may be caused by a thoracic disc herniation.

Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from The Netherlands.

Objective: Based on the assumption that children with spinal dysraphism are exposed to a large amount of ionising radiation for diagnostic purposes, our objective was to estimate this exposure, expressed in cumulative effective dose.

Design: Retrospective cohort study.

Settings: The Netherlands.

Behavioural and cognitive effects during vagus nerve stimulation in children with intractable epilepsy - a randomized controlled trial.

Background/aims: In addition to effects on seizure frequency in intractable epilepsy, multiple studies report benefits of vagus nerve stimulation (VNS) on behavioural outcomes and quality of life. The present study aims to investigate the effects of VNS on cognition, mood in general, depression, epilepsy-related restrictions and psychosocial adjustment in children with intractable epilepsy, as well as the relation between these effects and seizure reduction.

Methods: We conducted a randomized, active-controlled, double-blinded, add-on study in 41 children (age 4-18) with medically refractory epilepsy.

Vagus nerve stimulation in children with intractable epilepsy: a randomized controlled trial.

Aim: The aim of this study was to evaluate the effects of vagus nerve stimulation (VNS) in children with intractable epilepsy on seizure frequency and severity and in terms of tolerability and safety.

Method: In this study, the first randomized active controlled trial of its kind in children, 41 children (23 males; 18 females; mean age at implantation 11y 2mo, SD 4y 2mo, range 3y 10mo-17y 8mo) were included. Thirty-five participants had localization-related epilepsy (25 symptomatic; 10 cryptogenic), while six participants had generalized epilepsy (four symptomatic; two idiopathic).

Clinical characteristics and surgical outcome in 25 cases of childhood tight filum syndrome.

Objective: Tight filum syndrome (TFS) is caused by a thick (abnormal T1 MRI), shortened (low-lying conus), or non-elastic filum (strictly normal MRI). We carefully analyzed children treated for suspect TFS with or without radiological abnormalities.

Methods: Twenty-five children, operated between 2002 and 2009, were retrospectively identified.

Thoracic disc herniation and acute myelopathy: clinical presentation, neuroimaging findings, surgical considerations, and outcome.

Object: Thoracic disc herniations (TDHs) may occasionally present with an acute myelopathy, defined as a variable degree of motor, sensory, and sphincter disturbances developing in less than 24 hours, and resulting in a Frankel Grade C or worse. Confronted with such a patient, the surgeon has to decide whether to perform an emergency operation and whether to use an anterior or posterior approach. The authors analyze their own experience and the pertinent literature, focusing on clinical presentation, imaging findings, surgical timing, technique, and outcome.

The lumbosacral angle does not reflect progressive tethered cord syndrome in children with spinal dysraphism.

Purpose: Our goal was to validate the hypothesis that the lumbosacral angle (LSA) increases in children with spinal dysraphism who present with progressive symptoms and signs of tethered cord syndrome (TCS), and if so, to determine for which different types and/or levels the LSA would be a valid indicator of progressive TCS. Moreover, we studied the influence of surgical untethering and eventual retethering on the LSA.

Methods: We retrospectively analyzed the data of 33 children with spinal dysraphism and 33 controls with medulloblastoma.

The clinical spectrum of Blake's pouch cyst: report of six illustrative cases.

Introduction: Although Blake's pouch cyst (BPC) is frequently mentioned in the spectrum of posterior fossa cysts and cystlike malformations since its first description in 1996, its natural history, clinical presentation, specific imaging characteristics, optimal treatment, and outcome are relatively unknown. Consequently, BPC may still be underdiagnosed. We therefore report six cases ranging from a fatal hydrocephalus in a young boy, over an increasing head circumference with or without impaired neurological development in two infants, to a decompensating hydrocephalus at an advanced age.

Solitary juvenile xanthogranuloma of the temporal muscle and bone penetrating the dura mater in a 2-month-old boy.

Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder primarily observed during the first 2 years of life. Most patients present with a solitary cutaneous lesion; however, others present with extracutaneous manifestations or even with systemic involvement. The authors describe a 2-month-old boy in whom was diagnosed a unifocal extracutaneous JXG involving the temporal bone.

Intramedullary cavernoma presenting with hematomyelia: report of two girls.

Introduction: Less than 20 children with intramedullary cavernoma (ImC) have been reported in the English literature; however, cases with an unfavorable outcome may be underreported. Whereas these are predominantly boys, we report two girls who presented with hematomyelia (one cervical, one thoracic) and an acute, severe neurological deficit.

Case Material: A 10-year-old girl complaining about lower thoracic pain for several days suddenly developed lower body dysesthesias and paraparesis.

Two brothers with a symptomatic thoracic disc herniation at T11-T12: clinical report.

Background: In contrast to what is commonly believed, thoracic disc herniations are not rare lesions. Their etiopathogenesis is largely unknown, but may be linked to trauma, Scheuermann's disease or a degenerative back.

Objective: We report two brothers with a symptomatic thoracic disc herniation at T11-T12 and address the possibility of a genetic factor as well as other factors in the etiopathogenesis of (symptomatic) thoracic disc herniations.

The position of the aorta relative to the spine: is it mobile or not?

Study Design: This study analyzes the mobility of the aorta relative to the spine in patients with a herniated thoracic disc requiring surgical intervention.

Objectives: To determine the mobility of the aorta relative to the spine with the patient in prone and supine position.

Summary Of Background Data: In anterior scoliosis surgery, safe screw placement is important and knowledge of the position of the aorta relative to the spine is crucial.

Fatal cerebral and cerebellar hemorrhagic infarction after thoracoscopic microdiscectomy. Case report.

The authors present a rare case of fatal cerebral and cerebellar hemorrhagic infarction following an uneventful thoracoscopic microdiscectomy. They hypothesize that this complication was associated with cortical venous thrombosis secondary to intracranial hypotension, which was caused by an unnoticed leak of cerebrospinal fluid (CSF) into the thoracic cavity. Cortical venous thrombosis and intrathoracic CSF were confirmed at autopsy.

Spinal cord feeding arteries at MR angiography for thoracoscopic spinal surgery: feasibility study and implications for surgical approach.

Purpose: To prospectively investigate the feasibility of contrast material-enhanced magnetic resonance (MR) angiography for visualization of the spinal vasculature in patients referred for video-assisted thoracoscopic surgical treatment of a thoracic herniated disk and to prospectively assess the influence of preoperative imaging of the spinal vasculature on the choice of surgical approach.

Materials And Methods: Eight patients (three men and five women; mean age, 58 years; range, 42-83 years) with a thoracic herniated disk underwent contrast-enhanced MR angiography of the thoracoabdominal aorta and posterior branches. Imaging was performed with three-dimensional first-pass contrast-enhanced MR angiographic technique and a triple dose of gadolinium-based contrast agent.

In vitro high-field magnetic resonance imaging-documented anatomy of a fetal myelomeningocele at 20 weeks' gestation. A contribution to the rationale of intrauterine surgical repair of spina bifida.

Object: It remains uncertain if closure of a myelomeningocele at midgestation changes the neurological condition at birth in an infant born with spina bifida. The authors conducted a study to provide a detailed analysis of the morphology of the spinal cord with the myelomeningocele at the time fetal surgery usually is performed.

Methods: The myelomeningocele of a 20-week-gestation-age fetus was examined, and data were compared with those obtained in a neurologically intact specimen of the same age.

Acute distortion of the anatomy of the third ventricle during third ventriculostomy. Report of four cases.

The authors report on four third ventriculostomy procedures in which upward ballooning of the third ventricular floor occurred immediately after perforation of the floor and withdrawal of a Fogarty catheter. The floor herniated into the third ventricle, hindering the endoscopic view. Preoperative magnetic resonance imaging demonstrated a similar anatomy in all four cases, consisting of hydrocephalus, extreme dilation of the third ventricle, and disappearance of the interpeduncular cistern due to a very thin, membranous floor of the third ventricle, which herniated downward, draping over the basilar artery.