Objectives: Miyazaki syndrome is a cervical myelopathy or radiculopathy caused by cervical epidural venous congestion, due to cerebrospinal fluid over-drainage by an implanted ventricular shunt. The complex pathophysiology includes CSF pressure-changes consistent with the Monro-Kellie doctrine and a non-functional Starling resistor, leading to spinal epidural venous plexus enlargement and dilation. This venous congestion may be significant enough to exert compression on the spinal cord or nerve roots.
View Article and Find Full Text PDFJ Neuropsychiatry Clin Neurosci
December 2016
Minimally invasive procedures in spine surgery have undergone significant development in recent times. These procedures have the common aim of avoiding biomechanical complications associated with some traditional destructive methods and improving efficacy. These new techniques prevent damage to crucial posterior stabilizers and preserve the structural integrity and stability of the spine.
View Article and Find Full Text PDFObjective: The author main objective was to improve the previously developed technique of split laminotomy and moderate enlargement of the spinal canal with preservation of the majority of posterior structures, and to avoid the complications of the classic autologous bone grafting procedure.
Methods: A multilevel spinous process splitting and distracting laminotomy technique with complementary spacer insertion between the laminar parts was developed. We used Poly-Ether-Ether-Ketone (PEEK) cages.
Multilevel laminectomy to open the spinal canal carries the risk of spinal deformities and instability. With the aim of preserving and reconstructing the posterior structures the authors developed a novel, minimally invasive, multilevel spinous process splitting and distracting laminotomy approach with or without complementary corticocancellous iliac crest or PEEK cage "archbone" grafting. The technique allows exploration of the spinal canal and the removal of intramedullary pathologies.
View Article and Find Full Text PDFJ Neurol Surg A Cent Eur Neurosurg
July 2014
Objective: Conventional posterior approaches, which may involve multilevel laminectomies and facetectomies, may lead to spinal deformities, instability, and subluxation. We developed the multilevel spinous process splitting and distraction laminotomy technique, which is an option for approaching midline intramedullary spinal pathologies with preservation of mechanically relevant bone and muscle structures. In some cases, midline splitting is not feasible or convenient because of anatomical differences of spinous processes and laminas.
View Article and Find Full Text PDFJ Neurol Surg A Cent Eur Neurosurg
January 2014
Background: The conventional posterior approaches, which may involve multilevel laminectomies and facetectomies, may lead to spinal deformities, instability, or subluxation. Our objective was to develop a minimally invasive approach suitable for exploring neuromas with an intraforaminal component in the cervical spine, with the aim of preserving mechanically relevant bone structures and the facet joints as much as possible.
Methods: The authors used the hemi-semi-laminectomy combined with partial lateral facetectomy "open-tunnel" technique in nine adult patients with neuromas of the cervical spine extending into the foramen.
The last decade has brought significant development in spine surgery. As in all field of surgery, introduction of the minimal invasive, atraumatic procedures characterized our activities. The number of short and long-time complications were significantly reduced and the effectiveness of operations were markedly improved by the new technical conditions, for example by the use of neuronavigation, surgical microscope, intraoperative fluoroscopy, high speed drill and the widespread of keyhole concept.
View Article and Find Full Text PDFA very rare case of gliosarcoma of the pineal region with cerebellar metastasis is presented. A few cases of glioblastoma and fibrosarcoma have already been published however there was no reported case with gliosarcoma at the pineal region even with cerebellar metastases.
View Article and Find Full Text PDFThe endocannabinoid system plays a central role in retrograde synaptic communication, and controls both glutamatergic and gamma-aminobutyric acid (GABA)ergic transmission via type 1 cannabinoid (CB1) receptor. Both in sclerotic human hippocampi and in the chronic phase of pilocarpine-induced epilepsy in mice with sclerosis, CB1-receptor-positive interneuron somata were preserved both in the dentate gyrus and in the CA1 area, and the density of CB1-immunostained fibers increased considerably in the dentate molecular layer. This suggests that, although CB1 receptors are known to be reduced in density on glutamatergic axons, the CB1-receptor-expressing GABAergic axons sprout, or there is an increase of CB1-receptor levels on these fibers.
View Article and Find Full Text PDFCalretinin is expressed mainly in interneurons that specialize to innervate either principal cell dendrites or other interneurons in the human hippocampus. Calretinin-containing cells were shown to be vulnerable in animal models of ischaemia and epilepsy. In the human hippocampus, controversial data were published regarding their sensitivity in epilepsy.
View Article and Find Full Text PDFObjective: To develop a novel minimally invasive approach suitable for exploring different pathologies located in the spinal canal, allowing moderate enlargement of the canal with preservation of the majority of posterior structures so muscle attachments remain intact and postoperative complications are reduced.
Methods: The authors developed a multilevel spinous process splitting and distracting laminotomy technique with or without complementary corticocancellous iliac crest "archbone" autografting. Technical details are discussed.
Objective: The conventional dorsal surgical approaches used in removal of intraspinal space-occupying lesions by unroofing the spinal canal, often result the destruction of dorsal bony structures, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles causing a pathologic biomechanical milieu may lead to spinal deformities, instability. Various less invasive techniques exist to save the integrity and to prevent the instability of the spinal column and allow removal of intraspinally located space-occupying lesions at the same time. The authors discuss the experiences with unilateral partial laminectomy approach in removal of intraspinally, mainly lateral, intra- or extradurally located pathologic lesions.
View Article and Find Full Text PDFEndocannabinoid signaling is a key regulator of synaptic neurotransmission throughout the brain. Compelling evidence shows that its perturbation leads to development of epileptic seizures, thus indicating that endocannabinoids play an intrinsic protective role in suppressing pathologic neuronal excitability. To elucidate whether long-term reorganization of endocannabinoid signaling occurs in epileptic patients, we performed comparative expression profiling along with quantitative electron microscopic analysis in control (postmortem samples from subjects with no signs of neurological disorders) and epileptic (surgically removed from patients with intractable temporal lobe epilepsy) hippocampal tissue.
View Article and Find Full Text PDFA large proportion of hippocampal afferents and efferents are relayed through the subiculum. It is also thought to be a key structure in the generation and maintenance of epileptic activity; rhythmic interictal-like discharges were recorded in previous studies of subicular slices excised from temporal lobe epilepsy patients. In order to investigate if and how the subiculum is involved in the generation of epileptic discharges in vivo, subicular and lateral temporal lobe electrical activity were recorded under anesthesia in 11 drug-resistant epilepsy patients undergoing temporal lobectomy.
View Article and Find Full Text PDFBackground: The low-pressure water dissection technique of Toth, first reported in 1987, is a method to cautiously open neurosurgical cleavage planes such as the sylvian fissure or the interhemispheric space, and the interfaces between extraparenchymal masses and the adjacent brain. The aim of this technical report is to present our long-term experience with this simple and elegant asset of microneurosurgery and to promote its widespread use.
Method: Water is injected under microscopic control by a hand-held syringe with a blunt needle or by an irrigating balloon applying repeated injections of physiological saline into the cleavage plane to open it.
We analyzed possible predictors of late worsening of seizure control in 94 adult patients who had anterior temporal lobectomy (ATL) from the Epilepsy Center of the National Institute of Psychiatry and Neurology, Budapest between 1985 and 2001. We evaluated data regarding epilepsy, presurgical evaluation, pre- and postoperative EEG, structural imaging, histology and operative complications. The mean follow-up was 6.
View Article and Find Full Text PDFIn this article the possibilities, indications, methods and results of surgery in epilepsy are summarized in general with the Hungarian experience emphasized. Surgery may provide effective treatment in about 5-10% of the epileptic population. Surgical solution nowadays became an essential treatment in medial temporal epilepsy, if hippocampal sclerosis or other lesion is present, in therapy resistant lesional extratemporal epilepsies and in catastrophic childhood epilepsies if the epileptic disorder is restricted to one hemisphere (Rasmussen syndrome, hemimegalencephaly, Sturge-Weber disease and posttraumatic or postencephalitic hemispherial epilepsies).
View Article and Find Full Text PDFLaminar multiple microelectrodes have been developed to sample cortical and hippocampal activity in animals. If these measurements are adequately co-registered with the anatomy of the region, they can yield important information about its function and structure. In vivo laminar electrophysiological recordings from the human epileptic hippocampus are rare.
View Article and Find Full Text PDF1-1.5% of the Hungarian child population has epilepsy, and around 20% of them produces seizures in spite of modern antiepileptic drugs. A part of the pharmaco-resistant children may benefit from surgical removal of the epileptogenic focus.
View Article and Find Full Text PDFTechnique: A novel technique of multilevel opening of the spinal canal is introduced into pediatric neurosurgery. Split laminotomy helps to preserve the spinal column integrity in cases of posterior exposure of the spinal canal. The spinal processes are cut in the midline and the laminae are separated and retracted while the lesion in the spinal canal is explored.
View Article and Find Full Text PDFIntroduction: The surgical removal of the cervical intradural pathologies located ventrally carries a high risk. According to the anatomical situation and the increasing experience with anterior cervical approach and corpectomy revealed the reality to remove the ventral midline pathologies this way. The anterior approach which require corpectomy preferable to cervical intradural lesions located ventrally at the midline.
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