Anatomical damages in the spinal nerve roots and the spinal cord after brachial plexus injury: descriptive study from a cohort of consecutive patients who underwent DREZ-lesioning for pain-practical implications.

Background: Systematic descriptions of anatomical damage after brachial plexus injury (BPI) at the intradural level have been scarcely reported in detail. However, considering these damages, not only in the spinal nerve roots but also in the spinal cord itself, is crucial in determining the appropriate surgical approach to restore upper limb function and address refractory pain. Therefore, the authors present a descriptive study focusing on intradural findings observed during microsurgical DREZ-lesioning.

Excitability of the radiculo-medullary circuitry in spastic cerebral palsy: An intraoperative neurophysiological study in children undergoing selective dorsal rhizotomy.

Aim: To explore - through intraoperative neurophysiology mapping and recordings - the comparative distribution of the reflexive excitability of the L2 to S2 radiculo-metameric segments of the spinal cord in a series of children with bilateral spastic cerebral palsy (CP) who underwent selective dorsal rhizotomy (SDR).

Method: Our series included 46 consecutive children (36 males, 10 females; aged 5-16 years, mean 8 years) who underwent SDR, using keyhole interlaminar dorsal rhizotomy. The procedure allowed access to all L2 to S2 roots independently, while preserving the posterior architecture of the lumbar spine.

How I do it: Selective dorsal rhizotomy, using interlaminar approaches, for spastic diplegia/quadriplegia in children with cerebral palsy.

Background: Dorsal rhizotomy is considered the gold standard for treating spastic diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of spasticity.

Method: The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut.

Usefulness of external anal sphincter EMG recording for intraoperative neuromonitoring of the sacral roots-a prospective study in dorsal rhizotomy.

Background: In conus medullaris and cauda equina surgery, identification of the sacral nerve roots may be uncertain in spite of their anatomical/radiological landmarks. Mapping the sacral roots by recording the muscular responses to their stimulation may benefit from EMG recording of the External Anal sphincter (EAS) in addition to the main muscular groups of the lower limbs.

Method: In a consecutive series of 27 lumbosacral dorsal rhizotomy (DRh), authors carried out a prospective study on the reliability of the EMG recording of the EAS for identification of the S1 and S2 sacral roots.

Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia: Insights to myotome innervation.

Objective: Most of knowledge on muscle radicular innervation was from explorations in root/spinal cord pathologies. Direct and individual access to each of the lumbar-sacral -ventral and dorsal- nerve roots during dorsal rhizotomy for spastic diplegia allows precise study of the corresponding muscle innervation. Authors report the lumbo-sacral segmental myotomal organization obtained from recordings of muscle responses to root stimulation in a 20-children prospective series.

Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin: usefulness of intraoperative monitoring.

OBJECTIVE The utility of intraoperative neuromonitoring (ION), namely the study of muscle responses to radicular stimulation, remains controversial. The authors performed a prospective study combining ventral root (VR) stimulation for mapping anatomical levels and dorsal root (DR) stimulation as physiological testing of metameric excitability. The purpose was to evaluate to what extent the intraoperative data led to modifications in the initial decisions for surgical sectioning established by the pediatric multidisciplinary team (i.

Primary Ewing sarcoma of the axis-C2: A case report and the review of the literature.

Introduction: Neck pain and torticollis are common symptoms in the pediatric population that rarely requires further investigation. However, in case symptoms persist, then a more meticulously approach should be considered. Underlying conditions such as infections, neck injury, autoimmune disorders or even cervical spine cancer should be excluded from diagnosis.

Focal Dystonia in Hemiplegic Upper Limb: Favorable Effect of Cervical Microsurgical DREZotomy Involving the Ventral Horn - A Report of 3 Patients.

Background: Focal dystonia in hemiplegic upper limbs is poorly responsive to medications or classical neurosurgical treatments. Only repeated botulinum toxin injections show efficacy, but in most severe cases effects are transient.

Objectives: Cervical DREZ lesioning, which has proven efficacious in hyperspasticity when done deeply (3-5 mm) in the dorsal horn, may have favorable effects on the dystonic component when performed down to, and including, the base of the ventral horn (5-6 mm in depth).

Intraoperative Monitoring of Diaphragm Neural Pathways During Cervical Surgery by Electrical Stimulation and Recordings of Ventilator Waveforms: Physiological Bases and Pilot Study.

Background: Surgery on the cervical spine entails the risk of damaging the neural structures responsible for diaphragmatic innervation, namely (C3)-C4-(C5) roots. In some "difficult" cases, anatomic identification of these structures may be hard to achieve. Therefore, monitoring of the diaphragm through the ventilation waveforms displayed on the anesthesia machine can be of practical help.

Ventilator waveforms on anesthesia machine: a simple tool for intraoperative mapping of phrenic nerve and mid-cervical roots.

Background: A crucial aspect of surgery on the supraclavicular region, lateral neck, and mid-cervical vertebral region is the identification and sparing of the phrenic nerve and cervical (C4) root that are responsible for diaphragmatic innervation. Therefore intraoperative mapping of these nerve structures can be useful for difficult cases. Electrical stimulation with simultaneous observation of the ventilator waveforms of the anesthesia machine provides an effective method for the precise intraoperative mapping of these structures.

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy.

Background: The efficiency and safety of dorsal rhizotomies for cerebral palsy lie in the accuracy of radicular identification together with selectivity of root sectioning. Two different exposures are currently in use. The first is extended laminotomy/laminectomy from the upper lumbar level to the sacrum, which allows accurate identification of all L2-S2 roots/rootlets.

Achondroplasia with synostosis of multiple sutures.

We report for the second time on a case of achondroplasia with synostosis of multiple sutures. The most common mutation for achondroplasia (FGFR3 Gly380Arg, resulting in 1138G>A) was identified. Imaging studies disclosed complex craniosynostosis and neurosurgical intervention was carried out, particularly for posterior plagiocephaly.

Cerebral abnormalities in infants with myelomeningocele.

Background And Purpose: We evaluated brain abnormalities associated with myelomeningocele in infants.

Material And Methods: Between June 1995 and June 2008, 42 patients with myelomeningocele were treated in our hospital. Only 24 patients (13 males, 11 females, mean age 1.

Anaplastic oligodendrogliomas after treatment of acute lymphoblastic leukemia in children: report of 2 cases.

Radiation-induced brain tumors are suggested to be the late complication of acute lymphoblastic leukemia (ALL) treatment. High-grade gliomas, meningiomas, and sarcomas are the most frequent neoplasms. Secondary anaplastic oligodendrogliomas are exceedingly rare.

Extragastrointestinal stromal tumors of the omentum: review apropos of a case with a novel gain-of-function KIT mutation.

Introduction: We describe a case of extragastrointestinal stromal tumor (EGIST) of the omentum harboring a novel KIT mutation and review the literature on omental EGISTs, emphasizing on molecular genetic data.

Case Presentation: A large EGIST arising from the lesser omentum was incidentally diagnosed in a 68-year-old man during emergency laparotomy for intra-abdominal hemorrhage following a car accident. The tumor was composed of CD117+/CD34+ spindle-shaped cells with low mitotic activity.