Fusion Revision Surgery With Reamer-Irrigator-Aspirator to Harvest Autograft After Spinal Pseudarthrosis.

Background and purpose Spinal pseudarthrosis (SPA) is a common complication after attempted cervical or lumbosacral spinal fusion surgery. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site.

A computed tomography-based morphometric study of thoracic pedicle anatomy in a random United States trauma population.

Object: The objective of this study was to establish normative data for thoracic pedicle anatomy in the US adult population. To this end, CT scans chosen at random from an adult database were evaluated to determine the ideal pedicle screw (PS) length, diameter, trajectory, and starting point in the thoracic spine. The role of patient sex and side of screw placement were also assessed.

Surgical management of two- versus three-column injuries of the cervicothoracic junction: biomechanical comparison of translaminar screw and pedicle screw fixation using a cadaveric model.

Study Design: An in vitro cadaveric biomechanical study.

Objective: To determine the stability of translaminar screws compared to pedicle screws at T1-T2 for constructs bridging the cervicothoracic junction.

Summary Of Background Data: Instrumented fixation of the cervicothoracic junction is challenging both biomechanically, due to the transition from the mobile cervical to the rigid thoracic spine, and technically, due to the anatomic constraints of the T1-T2 pedicles.

Pretruncal nonaneurysmal subarachnoid hemorrhage causing basilar artery vasospasm.

Background: Pretruncal nonaneurysmal subarachnoid hemorrhage (PNSAH), more commonly known as perimesencephalic nonaneurysmal subarachnoid hemorrhage, is characterized by the presence of subarachnoid hemorrhage anterior to the midbrain with no evidence of an intracranial aneurysm on four vessel craniocervical angiogram. Although vasospasm is a common occurrence after aneurysmal subarachnoid hemorrhage and can lead to significant morbidity and mortality, vasospasm in the setting of PNSAH is rare.

Methods: The purpose of this report is to describe the case of a patient with PNSAH who developed significant radiographic vasospasm of the basilar artery that altered clinical management.

A computed tomography-based feasibility study of translaminar screw fixation in the upper thoracic spine.

Object: Translaminar screws (TLSs) offer an alternative to pedicle screw (PS) fixation in the upper thoracic spine. Although cadaveric studies have described the anatomy of the laminae and pedicles at T1-2, CT imaging is the modality of choice for presurgical planning. In this study, the goal was to determine the diameter, maximal screw length, and optimal screw trajectory for TLS placement at T1-2, and to compare this information to PS placement in the upper thoracic spine as determined by CT evaluation.

Dysphagia and neuropathic facial pain treated with motor cortex stimulation: case report.

Objective: We report on a patient with a neuropathic facial pain syndrome, including elements of trigeminal neuralgia, glossopharyngeal neuralgia, and dysphagia. After failing medical and surgical decompressive treatments, the patient underwent implantation of a motor cortex stimulation (MCS) system.

Clinical Presentation: A 54-year-old woman presented with a 14-year history of left-sided facial pain, throat pain, and associated nausea and vomiting.

Laminar screw fixation of the axis.

Object: Laminar fixation of the axis with crossing bilateral screws has been shown to provide rigid fixation with a theoretically decreased risk of vertebral artery damage compared with C1-2 transarticular screw fixation and C-2 pedicle screw fixation. Some studies, however, have shown restricted rigidity of such screws compared with C-2 pedicle screws, and others note that anatomical variability exists within the posterior elements of the axis that may have an impact on successful placement. To elucidate the clinical impact of such screws, the authors report their experience in placing C-2 laminar screws in adult patients over a 2-year period, with emphasis on clinical outcome and technical placement.

Thoracic kyphotic deformity reduction with a distractible titanium cage via an entirely posterior approach.

Objective: Surgical correction of thoracic kyphotic deformity is often associated with significant surgical and neurological morbidity and unsatisfactory reduction of kyphosis, especially in patients who cannot tolerate anterior thoracic procedures because of associated comorbidity. We describe a technique in which kyphotic deformity of the thoracic and thoracolumbar spine is corrected, decompressed, and stabilized with a circumferential fixation construct from a lone posterior approach.

Methods: We reviewed the radiographic and clinical outcomes of seven patients undergoing vertebrectomy via a bilateral modified costotransversectomy approach followed by posterior placement of a distractible cage, reduction of the deformity via cage distraction, and supplemental dorsal instrumentation.

Translaminar screw fixation in the upper thoracic spine.

Object: The use of pedicle screws (PSs) for instrument-assisted fusion in the cervical and thoracic spine has increased in recent years, allowing smaller constructs with improved biomechanical stability and repositioning possibilities. In the smaller pedicles of the upper thoracic spine, the placement of PSs can be challenging and may increase the risk of damage to neural structures. As an alternative to PSs, translaminar screws can provide spinal stability, and they may be used when pedicular anatomy precludes successful placement of PSs.

Intracranial aneurysm following radiation therapy during childhood for a brain tumor. Case report and review of the literature.

Ionizing radiation therapy is associated with pathological vascular changes in intracranial vessels, most commonly in the form of vessel thrombosis and occlusion. The development of an intracranial aneurysm following such therapy, however, is far less common. In this report the authors describe a 24-year-old man in whom a distal middle cerebral artery aneurysm developed 15 years after radiotherapy, which was given as adjuvant treatment following resection of a medulloblastoma.

Preoperative imaging of cervical spine hemangioblastomas using three-dimensional fusion digital subtraction angiography. Report of two cases.

Angiography is often performed to identify the vascular supply of hemangioblastomas prior to resection. Conventional two-dimensional (2D) digital subtraction (DS) angiography and three-dimensional (3D) DS angiography provides high-resolution images of the vascular structures associated with these lesions. However, such 3D DS angiography often does not provide reliable anatomical information about nearby osseous structures, or when it does, resolution of vascular anatomy in the immediate vicinity of bone is sacrificed.

Concomitant conus medullaris ependymoma and filum terminale lipoma: case report.

Objective: Ependymomas of the conus medullaris-cauda equina-filum terminale region are typically solitary lesions. In this report, we describe the clinical presentation, radiographic findings, operative details, and pathological features of a patient with a conus medullaris ependymoma and a filum terminale lipoma.

Clinical Presentation: A 40-year-old woman presented with increasing low back pain and bowel and bladder dysfunction.

Frameless stereotaxy in a transmandibular, circumglossal, retropharyngeal cervical decompression in a Klippel-Feil patient: technical note.

Frameless stereotaxy, while most commonly applied to intracranial surgery, has seen an increasing number of applications in spinal surgery. Its use in the spine has been described to a greater degree in posterior rather than anterior surgical approaches, presumably due to the relative paucity of anatomical landmarks appropriate for frameless stereotactic registration in the anterior spine. This technical note illustrates the previously undescribed, successful use of frameless stereotaxy to the transmandibular, circumglossal, retropharyngeal surgical approach in a patient with Klippel-Feil syndrome.

A novel intravertebral tumor model in rabbits.

Objective: Although the majority of human epidural spinal metastases originate in the vertebral body, current animal models of spinal epidural tumors are limited to extraosseous tumor placement. We investigated the onset of paraparesis, radiographic changes (magnetic resonance imaging [MRI] and computed tomographic [CT] scans), and histopathological findings after intraosseous injection of VX2 carcinoma cells into the lower thoracic vertebrae of rabbits.

Methods: New Zealand white rabbits (n = 23) were injected with a 15-mul suspension containing 300,000 VX2 carcinoma cells in the lowest thoracic vertebral body.

Ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain.

Background: Ventriculoperitoneal (VP) shunts are widely used for treating hydrocephalus. These devices are prone to malfunction with up to 70% requiring revision. Shunt infection and obstruction comprise the majority of malfunctions and usually present dramatically.

Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers.

Objective: Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals.

Methods: Outcomes and charges were analyzed for all adult patients undergoing craniotomy for tumor in 33 nonfederal acute care hospitals in Maryland using the Maryland Health Service Cost Review Commission database for the years 1990 to 1996.

Decompressive craniectomy for intractable cerebral edema: experience of a single center.

Several case reports and small clinical series have reported benefits of decompressive hemicraniectomy in patients with intractable cerebral edema and early clinical herniation. Specific indications and timing for this intervention remain unclear. We present our experience with this procedure in a subset of 18 patients with massive cerebral edema refractory to medical management, treated with decompressive craniectomy over a 3-year period (1997 to 2000).

Intraoperative microelectrode and semi-microelectrode recording during the physiological localization of the thalamic nucleus ventral intermediate.

We review the techniques of physiological localization of the site for ventralis intermedius (Vim) thalamotomy or implantation of Vim-deep brain stimulation (DBS) for treatment of parkinsonian, essential, and intention tremor. Both microelectrode and semi-microelectrode techniques are reviewed. We believe the use of microelectrode and semi-microelectrode recordings in combination with Radiological landmarks provide the most accurate localization of the target.

Ectopic recurrence of craniopharyngioma after an interhemispheric transcallosal approach: case report.

Objective And Importance: Ectopic recurrence of a craniopharyngioma is a rare postoperative complication. We present a case of a craniopharyngioma that ectopically recurred along the tract of a previous surgical route.

Clinical Presentation: A 73-year-old female patient presented 8 years earlier with a suprasellar craniopharyngioma.