Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis.

Ventral epidural abscess with osteomyelitis at the craniocervical junction is a rare occurrence that typically mandates spinal cord decompression via a transoral approach. However, given the potential for morbidity with transoral surgery, especially in the setting of immunosuppression, together with the advent of extended endonasal techniques, the transnasal approach could be attractive for selected patients. We present two cases of ventral epidural abscess and osteomyelitis at the craniocervical junction involving C1/C2 that were successfully treated via the endoscopic transnasal approach.

Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation.

Object: Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously implanted instrumentation. A minimally invasive lateral approach allows the surgeon to potentially reduce the risk of these hazards.

Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid.

Object: In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1-2 surgery for basilar invagination at Stanford Hospital and Clinics from 2010 to 2013.

Methods: Of these 5 patients undergoing C1-2 surgery for basilar invagination, 4 underwent a 2-tiered anterior C1-2 resection with posterior occipitocervical fusion during a first stage surgery, followed by endoscopic endonasal odontoidectomy in a separate setting. Intraoperative stereotactic navigation was performed using a surgical navigation system in all cases.

A novel computer algorithm allows for volumetric and cross-sectional area analysis of indirect decompression following transpsoas lumbar arthrodesis despite variations in MRI technique.

Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry angle. While these images may be sufficient in conjunction with a physical exam to make surgical evaluations, we have found they are often incapable of being used for objective post-operative volumetric comparisons.

Spontaneous intracranial hypotension secondary to anterior thoracic osteophyte: Resolution after primary dural repair via posterior approach.

Introduction: Spontaneous intracranial hypotension (SIH) is an uncommon syndrome widely attributed to CSF hypovolemia, typically secondary to spontaneous CSF leak. Although commonly associated with postural headache and variable neurological symptoms, one of the most severe consequences of SIH is bilateral subdural hematomas with resultant neurological deterioration.

Presentation Of Case: We present the case of a patient diagnosed with SIH secondary to an anteriorly positioned thoracic osteophyte with resultant dural disruption, who after multiple attempts at nonsurgical management developed bilateral subdural hematomas necessitating emergent surgical intervention.

Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy.

Study Design: An in vitro biomechanical study.

Objective: To biomechanically test and evaluate 4 different methods of spinopelvic reconstruction techniques and determine the most biomechanically stable construct for stabilization of the spinopelvic junction after total sacrectomy.

Summary Of Background Data: Total sacrectomy is necessary to treat a sacral tumor when it involves the S1 vertebra.

Intracranial hypotension producing reversible coma: a systematic review, including three new cases.

Intracranial hypotension is a disorder of CSF hypovolemia due to iatrogenic or spontaneous spinal CSF leakage. Rarely, positional headaches may progress to coma, with frequent misdiagnosis. The authors review reported cases of verified intracranial hypotension-associated coma, including 3 previously unpublished cases, totaling 29.

Morbidity and mortality of C2 fractures in the elderly: surgery and conservative treatment.

Background: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients.

Objective: To compare outcomes for elderly patients with closed C2 fractures by treatment modality.

Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy.

Objective: To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports.

Biomechanical evaluations of various c1-c2 posterior fixation techniques.

Study Design: A biomechanical in vitro study using human cadaveric spine.

Objective: To compare the biomechanical stability of pedicle screws versus various established posterior atlantoaxial fixations used to manage atlantoaxial instability.

Summary Of Background Data: Rigid screw fixation of the atlantoaxial complex provides immediate stability and excellent fusion success though has a high risk of neurovascular complications.

Charlson score is a robust predictor of 30-day complications following spinal metastasis surgery.

Study Design: Retrospective chart review.

Objective: To identify predictors of 30-day complications after the surgical treatment of spinal metastasis.

Summary Of Background Data: Surgical treatment of spinal metastasis is considered palliative with the aim of reducing or delaying neurologic deficit.

Predictors of survival after surgical treatment of spinal metastasis.

Background: Surgery for spinal metastasis is a palliative treatment aimed at improving patient quality of life by alleviating pain and reversing or delaying neurologic dysfunction, but with a mean survival time of less than 1 year and significant complication rates, appropriate patient selection is crucial.

Objective: To identify the most significant prognostic variables of survival after surgery for spinal metastasis.

Methods: Chart review was performed on 200 surgically treated spinal metastasis patients at Stanford Hospital between 1999 and 2009.

Recombinant human bone morphogenetic protein-2-induced radiculitis in elective minimally invasive transforaminal lumbar interbody fusions: a series review.

Study Design: Retrospective single center analysis.

Objective: The purpose of our study is to quantify the development of a postoperative radiculitis in our minimally invasive transforaminal lumbar interbody fusion patient population.

Summary Of Background Data: The application of recombinant human Bone Morphogenetic Protein-2 (BMP) in spinal surgery has allowed for greater success in spinal fusions.

Endovascular embolization of a recurrent cervical giant cell neoplasm using N-butyl 2-cyanoacrylate.

Pre-operative endovascular embolization of spinal giant cell tumors (GCTs) has been an effective strategy to reduce blood loss during surgical resection. Traditionally, spinal GCTs have been embolized with polyvinyl acetate (PVA) particles. We present the pre-operative embolization of a recurrent cervical GCT with N-butyl 2-cyanoacrylate (NBCA) rather than PVA.

The management of cranial injuries in antiquity and beyond.

Cranial injuries were among the earliest neurosurgical problems faced by ancient physicians and surgeons. In this review, the authors trace the development of neurosurgical theory and practice for the treatment of cranial injuries beginning from the earliest ancient evidence available to the collapse of the Greco-Roman civilizations. The earliest neurosurgical procedure was trephination, which modern scientists believe was used to treat skull fractures in some civilizations.

Diagnostic approach to Cushing disease.

In Cushing disease, a pituitary corticotroph neoplasm causes secondary adrenal hypercortisolism. This condition has known morbidity and mortality, underscoring the need for an efficient and accurate diagnostic approach. An 11 p.

Medical management of Cushing disease.

Although transsphenoidal excision of the adrenocorticotropic hormone (ACTH)-producing neoplasm is often the treatment of choice in patients with Cushing disease, medical management is itself a useful preoperative temporizing measure, an option for long-term management in nonsurgical candidates, and an option for patients in whom surgery and/or radiotherapy have failed. Three pathophysiologically based approaches exist in the research literature--neuro-modulation to limit ACTH levels, adrenal enzyme inhibition, and glucocorticoid receptor antagonism. Unfortunately, the neuromodulatory approach involving agents such as bromocriptine, cyproheptadine, octreotide, and valproate has yielded only suboptimal results.

Granular cell tumor involving the axillary nerve: an unusual occurrence. Case report.

Granular cell tumors (GCTs) are benign lesions that, paradoxically, despite originating from the Schwann cell, are most commonly seen in nonneuronal tissue including the skin, subcutaneous tissue, and tongue. Their presence in the brachial plexus is quite rare, but their involvement of peripheral nerves is exceptional. The authors report on a case of GCT involving the axillary nerve in a 54-year-old woman who underwent complete resection of the lesion.

Unruptured arteriovenous malformation in a patient presenting with obstructive hydrocephalus. Case report and review of the literature.

The authors report on a patient harboring an unruptured cortical arteriovenous malformation (AVM), who had presented with obstructive hydrocephalus due to compression of the cerebral aqueduct by a large venous varix. Although patients with ruptured AVMs are known to either present with or later suffer from obstructive hydrocephalus, those with unruptured AVMs who present in this manner are quite rare. Moreover, hydrocephalus caused by a venous varix draining an AVM, to our knowledge, has never been previously reported in the literature.

Endovascular treatment strategies for cerebral vasospasm.

Cerebral vasospasm is a significant cause of morbidity and mortality in patients who have sustained a subarachnoid hemorrhage from aneurysm rupture. Symptomatic cerebral vasospasm is also a strong predictor of poor clinical outcome and has thus drawn a great deal of interest from cerebrovascular surgeons. Although medical management is the cornerstone of treatment for this condition, endovascular intervention may be warranted for those in whom this treatment fails and in whom symptomatic vasospasm subsequently develops.

Cerebral cavernous malformations: clinical insights from genetic studies.

Familial disease is responsible for one third to one half of cerebral cavernous malformation (CCM) cases presenting to clinical attention. Much has been learned in the past decade about the genetics of these cases, which are all inherited in an autosomal dominant pattern, at three known chromosome loci. Unique features of inherited CCMs in Hispanic-Americans of Mexican descent have been described.

Indications and rationale for use of vascularized fibula bone flaps in cervical spine arthrodeses.

Background: Anterior cervical spine arthrodesis for large defects using autograft or allograft fibula for anterior structural support is a widely accepted procedure. In unique demand situations, a vascularized fibular flap is regarded as an "improvement" to the standard procedure. While a vascularized flap does deliver living tissue to the region, it does so with added potential morbidity and increased technical demand.