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ABSTRACT: Neuroendoscopy is applied to various intracranial pathologic conditions. But this technique needs informations for the anatomy, critically. Neuronavigation makes the operation more safe, exact and lesser invasive procedures. But classical neuronavigation systems with rigid pinning fixations were difficult to apply to pediatric populations because of their thin and immature skull. Electromagnetic neuronavigation has used in the very young patients because it does not need rigid pinning fixations. The usefulness of electromagnetic neuronavigation is described through our experiences of neuroendoscopy for pediatric groups and reviews for several literatures.
Between January 2007 and July 2011, nine pediatric patients were managed with endoscopic surgery using electromagnetic neuronavigation (AxiEM, Medtronics, USA). The patients were 4.0 years of mean age (4 months-12 years) and consisted of 8 boys and 1 girl. Totally, 11 endoscopic procedures were performed. The cases involving surgical outcomes were reviewed.
The goal of surgery was achieved successfully at the time of surgery, as confirmed by postoperative imaging. In 2 patients, each patient underwent re-operations due to the aggravation of the previous lesion. And one had transient mild third nerve palsy due to intraoperative manipulation and the others had no surgery related complication.
By using electromagnetic neuronavigation, neuroendoscopy was found to be a safe and effective technique. In conclusion, electromagnetic neuronavigation is a useful adjunct to neuroendoscopy in very young pediatric patients and an alternative to classical optical neuronavigation.
Journal of Korean Neurosurgical Society 03/2013; 53(3):161-6. · 0.60 Impact Factor
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ABSTRACT: BACKGROUND: The accumulation of toxic free radicals plays a pivotal role in the early molecular cascades of blood-brain barrier (BBB) disruption mediated by matrix metalloproteinases (MMPs) activation in ischemic stroke. Theoretically, it is expected that early blockade of activation of MMPs may provide protective effects from secondary neural tissue damage. The present study was designed to determine the ability of melatonin to influence MMP-9 activity and BBB disruption, in a focal ischemia rat model induced by photothrombosis. METHODS: Adult, male, 8-week Sprague-Dawley rats weighing 230-300g received focal cerebral ischemia by photothrombosis using Rose Bengal (RB). The injured animals were divided into two groups. One group received 50mg/kg of melatonin intraperitoneally, starting 1h after injury and at 12h intervals for 3days. The control group received weight-adjusted doses of saline vehicle. In each group, MMP-9 expression and activity were assessed by Western blot and gelatin zymography, respectively, at various times. The effects of melatonin on BBB disruption and brain edema were also determined. RESULTS: MMP-9 activity and expression were significantly elevated at 24h in the ischemic cortex, which remained up-regulated at least until 72h after injury. Melatonin treatment significantly attenuated MMP-9 activity and expression at 24, 48, and 72h after ischemic injury. Relative to control group, BBB permeability was significantly reduced in the melatonin-treated group. The water content was decreased by melatonin treatment, although there was no statistically significant difference. CONCLUSIONS: Melatonin treatment starting 1h after injury attenuated BBB disruption during focal ischemia, which is at least partly due to inhibition of MMP-9 activity. Melatonin might have a potential role in clinical trials aimed to improve the outcome of patients suffering cerebral ischemia.
Journal of the neurological sciences 10/2012; · 2.32 Impact Factor
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ABSTRACT: PurposeYasagil temporary clips have been widely used in extracranial-intracranial (EC-IC) arterial bypass surgery. However, the extremely
delicate vessels involved often require the application of finer clips. We report on the use of the Kopitnik arteriovenous
malformation (AVM) microclip system for superficial temporal artery-middle cerebral artery (STA-MCA) bypass.
MethodsKopitnik AVM microclips are new mechanical devices that are used during AVM surgery. They exert a pre-defined closing force
of 50–70 g, and also feature a special, pyramid-shaped structure stamped on inner surfaces of the blades. These characteristics
avoid vascular intimal injury and provide a secure grip. We prospectively studied their use in 15 patients requiring STA-MCA
anastomosis.
ResultsClinical results were excellent and there were no new ischemic events during 6-months’ follow-up.
ConclusionsKopitnik AVM microclips have several advantages; they have small and variously sized clip blades (2, 3, 4 and 5mm), and the
small clip head allows the operator an excellent view of the pathology and clip status. The Kopitnik AVM microclip appears
to be clinically effective and safe for EC-IC bypass surgery, especially when smaller vessels are involved.
KeywordsMicrovascular anastomosis-Microclip-STA-MCA bypass
Acta Neurochirurgica 04/2012; 152(3):547-551. · 1.52 Impact Factor
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ABSTRACT: Matrix metalloproteinases (MMPs), especially MMP-2 and MMP-9 have been known to play an important role in secondary inflammatory reaction after spinal cord injury (SCI). The aim of this study was to investigate the expression and activity of MMP-2 and MMP-9 and to determine their relationship with disruption of endothelial blood-barrier after photochemically induced SCI in rats.
Female Sprague-Dawley rats, weighing between 250 and 300 g (aged 8 weeks) received focal spinal cord ischemia by photothrombosis using Rose Bengal. Expressions and activities of MMP-2 and MMP-9 were assessed by Western blot and gelatin zymography at various times from 6 h to 7 days. Endothelial blood-barrier integrity was assessed indirectly using spinal cord water content.
Zymography and Western blot analysis demonstrated rapid up-regulation of MMP-9 protein levels in spinal cord after ischemic onset. Expressions and activities of MMP-9 showed a significant increased at 6 h after the photothrombotic ischemic event, and reached a maximum level at 24 h after the insult. By contrast, activated MMP-2 was not detected at any time point in either the experimental or the control groups. When compared with the control group, a significant increase in spinal cord water content was detected in rats at 24 h after photothrombotic SCI.
Early up-regulation of MMP-9 might be correlated with increased water content in the spinal cord at 24 h after SCI in rats. Results of this study suggest that MMP-9 is the key factor involved in disruption of the endothelial blood-barrier of the spinal cord and subsequent secondary damage after photothrombotic SCI in rats.
Journal of Korean Neurosurgical Society 10/2011; 50(4):288-92. · 0.60 Impact Factor
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ABSTRACT: Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine.
The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views.
Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one.
Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.
Journal of Korean Neurosurgical Society 10/2011; 50(4):332-40. · 0.60 Impact Factor
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ABSTRACT: Although the vertebral artery injuries (VAI) associated with cervical spine trauma are usually clinically occult, they may cause fatal ischemic damage to the brain stem and cerebellum.
We performed a prospective study using computed tomographic angiography (CTA) to determine the frequency of VAI associated with cervical spine injuries and investigate the clinical and radiological characteristics. Between January 2005 and August 2007, 99 consecutive patients with cervical spine fractures and/or dislocations were prospectively evaluated for patency of the VA, using the CTA, at the time of injury.
Complete disruption of blood flow through the VA was demonstrated in seven patients with unilateral occlusion (7.1%). There were four men and three women with a mean age of 43 (range, 33-55 years). Unilateral occlusion of the right vertebral artery occurred in four patients and of the left in three. Regarding the cervical injury type, two cases were cervical burst fractures (C6 and C7), two had C4-5 fracture/dislocations, two had a unilateral transverse foraminal fracture, and one had dens type III fracture. All patients presented with good patency of the contralateral VA. None of the patients developed secondary neurological deterioration due to vertebrobasilar ischemia during the follow-up period with a mean duration of 23 months.
VAI should be suspected in patients with cervical trauma that have cervical spine fractures and/or dislocations or transverse foramen fractures. CTA was useful as a rapid diagnostic method for ruling out VAI after cervical spine trauma.
Surgical neurology international. 01/2011; 2:39.
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ABSTRACT: Symptomatic postoperative spinal epidural hematoma (PSEH) is a rare but potentially devastating postoperative complication, accounting for 0.1% to 0.2% of cases.
To describe a patient with a PSEH that completely resolved, clinically and radiographically, without surgical treatment.
Case report and review of the literature.
A 47-year-old man with no history of a bleeding disorder underwent anterior cervical interbody fusion for C5-C6 disc herniation. The dura was exposed through removal of the posterior longitudinal ligament, and extensive decompression of posterior osteophytes of C5 and C6 vertebral bodies was performed. The patient developed tetraparesis and respiratory distress rapidly in the postanesthesia care unit and was reintubated for assisted ventilation. The computed tomography (CT) scan revealed a very large ventral epidural hematoma compressing the dural sac from C1 to C6.
The patient was prepared for hematoma evacuation. However, the neurological symptoms and respiration problems began to resolve spontaneously before the surgery was started. The hematoma was markedly improved on the follow-up CT scan, and the patient was discharged 2 weeks after surgery without neurological deficit.
This case illustrates that an unpredictable extensive hematoma can occur after uneventful surgery of the cervical spine in low-risk patients. In case of the dural exposure with a creation of hidden and large epidural space, the spine surgeon must pay particular attention to the possibility of a PSEH during the early postoperative period.
The spine journal: official journal of the North American Spine Society 12/2010; 10(12):e1-5. · 2.90 Impact Factor
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ABSTRACT: Blood-brain barrier (BBB) disruption mediated by matrix metalloproteinase (MMPs) activation is a critical event during cerebral ischemia. The inhibition of MMP might be a potential approach to protect against secondary injury. The present study was designed to determine the effects of quercetin on BBB disruption and MMP activity, in a focal ischemia model induced by photothrombosis, in rats.
Adult male Sprague-Dawley rats received focal ischemia by photothrombosis. The injured animals were divided into two groups: one group received 25 μmol/kg of quercetin intraperitoneally, starting 1 h after injury with continued treatment at 12-h intervals for 3 days, while animals in the control group received weight-adjusted doses of a saline vehicle. The effects of quercetin on BBB disruption, brain edema, MMP activities, and neurological deficits were determined.
Quercetin treatment markedly reduced ischemia-induced up-regulation of MMP-9 at 24 and 48 h after ischemic injury. No significant change in MMP-2 activity was observed throughout the experimental period. Post-ischemic increase in BBB permeability and brain edema were significantly reduced in the quercetin-treated group compared to the vehicle-treated ischemia control. Quercetin treatment significantly improved the functional outcomes assessed by the accelerating rotarod test.
The results of this study demonstrated that quercetin attenuated BBB disruption during focal ischemia through inhibitory effects on MMP-9 activity. These results suggest that quercetin might have a potential role in the protection against neuronal injury in patients with focal ischemic stroke.
Acta Neurochirurgica 12/2010; 153(6):1321-9; discussion 1329. · 1.52 Impact Factor
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ABSTRACT: A posterior fossa epidural haematoma (EDH) is uncommon and the diagnosis is difficult because the clinical symptoms are non-specific. Therefore, a computed tomography scan is important for the early diagnosis and management. Thirty-four patients with a posterior fossa EDH were admitted between 2001 and 2008. A retrospective analysis of the clinical and radiographic findings with regard to outcome and prognostic factors was carried out. The Glasgow Coma Scale (GCS) score on admission was recorded to be: one in 3-5, five in 6-8, six in 9-12 and 22 patients in 13-15. The admission GCS score was the most valuable prognostic factor. Among the 28 patients with a GCS score of more than 9, 27 patients survived with good results; for the six patients with a GCS score of less than eight, two patients had good recovery and four patients had unfavourable outcome. The 15 patients that were conservatively treated and 14 out of the 19 patients surgically treated had a good recovery. Among the other surgically treated patients, two were moderately disabled, two remained in a vegetative state and one died (overall mortality 2.9%). An occipital fracture was present in 28 cases. Six patients with a diastatic fracture of the lambdoid suture had a more complicated venous sinus injury requiring early surgery compared to those with a simple linear fracture. The patients admitted with associated intracranial injuries, such as a contrecoup injury including subdural haemorrhage or traumatic subarachnoid haemorrhage had a poor outcome. The initial GCS score on admission and the presence of associated intracranial injuries were important factors associated with the patient prognosis. A diastatic fracture of the lambdoid suture was associated with complicated venous sinus injuries making surgery more difficult.
British Journal of Neurosurgery 10/2010; 25(1):55-61. · 0.88 Impact Factor
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ABSTRACT: Disc herniations at the L1-L2 and L2-L3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome. Spinal canals are narrower than those of lower levels, which may compromise multiple spinal nerve roots or conus medullaris. The aim of this study was to evaluate the clinical features and surgical outcomes of upper lumbar disc herniations.
We retrospectively reviewed the clinical features of 41 patients who had undergone surgery for single disc herniations at the L1-L2 and L2-3 levels from 1998 to 2007. The affected levels were L1-L2 in 14 patients and L2-L3 in 27 patients. Presenting symptoms and signs, patient characteristics, radiologic findings, operative methods, and surgical outcomes were investigated.
The mean age of patients with upper lumbar disc was 55.5 years (ranged 31 to 78). The mean follow-up period was 16.6 months. Most patients complained of back and buttock pain (38 patients, 92%), and radiating pain in areas such as the anterior or anterolateral aspect of the thigh (32 patients, 78%). Weakness of lower extremities was observed in 16 patients (39%) and sensory disturbance was presented in 19 patients (46%). Only 6 patients (14%) had undergone previous lumbar disc surgery. Discectomy was performed using three methods : unilateral laminectomy in 27 cases, bilateral laminectomy in 3 cases, and the transdural approach in 11 cases, which were performed through total laminectomy in 10 cases and unilateral laminectomy in 1 case. With regard to surgical outcomes, preoperative symptoms improved significantly in 33 patients (80.5%), partially in 7 patients (17%), and were aggravated in 1 patient (2.5%).
Clinical features of disc herniations at the L1-L2 and L2-L3 levels were variable, and localized sensory change or pain was rarely demonstrated. In most cases, the discectomy was performed successfully by conventional posterior laminectomy. On the other hand, in large central broad based disc herniation, when the neural elements are severely compromised, the posterior transdural approach could be an alternative.
Journal of Korean Neurosurgical Society 08/2010; 48(2):119-24. · 0.60 Impact Factor
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ABSTRACT: Case description.
To describe a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture and review the pertinent medical literature.
Intradural lumbar disc rupture is an uncommon and serious complication, particularly if it develops as an acute traumatic lesion. It can result in serious neurologic deficit if it is not treated in a timely and appropriate manner.
A 51-year-old man presented with motor paraparesis (grade 2/5) and hypeesthesia at left L1 and L2 sensory dermatome after a traffic collision. Computed tomography scan revealed a compression fracture of the L1 body. Lumbar magnetic resonance imaging demonstrated an intradural mass-like lesion behind the L2 body and deviation of the cauda equina by this lesion. An emergency L2 laminectomy was performed for removal of intradural space occupying lesion and decompression of cauda equina. The mass lesion was removed in 1 piece, and other space occupying lesions were not found in the spinal canal.
Pathologic examination for intradural mass lesion demonstrated fibrocartilage such as disc material. After the operation, the patient's neurologic symptoms showed gradual improvement, and by postoperative day 18, he had made a full recovery. At his 1-year follow-up examination, the patient was completely independent and free from any neurologic deficits.
We report a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention resulted in a good functional outcome. Lumbar disc rupture into the dural sac should be added to the differential diagnosis of acute traumatic spinal lesion causing spinal cord or cauda equina compression.
Spine 07/2010; 35(15):E726-9. · 2.08 Impact Factor
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ABSTRACT: Case description.
To clinically and radiographically describe a traumatic spinal epidural hematoma (TSEH) without adjacent spinal column fracture or soft tissue injury that completely resolved, without surgical intervention.
Symptomatic TSEH is an infrequent condition after spinal trauma, accounting for 0.5% to 1.7% of cases. It can result in permanent neurologic deficits if not treated in a timely and appropriate manner.
A 50-year-old man presented with progressive lower motor weakness and sensory change at 2 days after blunt trauma to the upper back area. Neurologic examination revealed paraplegia and hypesthesia below the T4 sensory dermatome. Magnetic resonance imaging for cervicothoracic spine showed a space-occupying lesion in the dorsal spinal epidural space from C7 to T5. The lesion was consistent with acute stage hematoma of the spinal epidural space.
The patient was prepared for decompression surgery. However, the patient's neurologic symptoms began to improve (grade 4/5) at 2 hours after onset of paraplegia. Surgical intervention was delayed, and the patient was treated conservatively with close neurologic monitoring. Three days after onset of symptoms, the patient's neurologic symptoms recovered completely. The follow-up magnetic resonance imaging at 12 days after the event showed complete resolution of the epidural hematoma.
An unpredictable extensive epidural hematoma can occur after blunt trauma of the cervicothoracic spine in patients at low risk for hemorrhage. This case illustrates that immediate surgical intervention may not always be necessary in certain patients with TSEH. Conservative management with careful observation may play a role as a management option for patients initially presenting with severe neurologic dysfunction if neurologic recovery is early and sustained.
Spine 05/2010; 35(12):E564-7. · 2.08 Impact Factor
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ABSTRACT: We recently experienced a case of synovial sarcoma in the posterior neck, which involved adjacent bony structures. Synovial sarcoma is rare, malignant soft tissue tumor that occur predominantly in the lower extremities. Wide surgical excision with involved tissue is the treatment of first choice, because most synovial sarcomas reveal aggressive features. We removed the tumor with involved bony structures and patient was given postoperative radiation therapy. Despite these treatment options, the patient died 1 year after surgery. We report this case with a review of the literature.
Journal of Korean Neurosurgical Society 04/2010; 47(4):306-9. · 0.60 Impact Factor
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ABSTRACT: Case description.
To describe a patient with a recurrent primary spinal subarachnoid neurocysticercosis (NCC) that was successfully treated with surgical decompression and medical therapy at our center.
Spinal subarachnoid NCC is thought to be the secondary result from larval migration through the ventricular system into the spinal subarachnoid space. However, this entity can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if it is not treated in an appropriate manner.
A 50-year-old woman with treatment history of spinal NCC presented with back pain and radicular pain. The lumbar magnetic resonance imaging showed a cystic lesion with septation and slight rim enhancement after gadolinium administration at the L4-S1 area. We performed surgical removal of this lesion and postoperative medical therapy for complete eradication of the parasite.
The histopathology was diagnostic for a cysticercal cyst. Adjuvant medical therapy with albendazole was administered for 30 days after surgery. The patient remained symptom-free for 1 year after surgery without any evidence of recurrence.
We report a rare case of recurrent primary spinal subarachnoid NCC at L4-S1 area. In cases of primary spinal subarachnoid NCC can be treated by adequate combined approach with surgery and medical therapy. Spinal subarachnoid NCC should be added to the differential diagnosis of primary spinal intradural cysts, because this lesion can occur primarily.
Spine 03/2010; 35(5):E172-5. · 2.08 Impact Factor
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ABSTRACT: Small bowel injury resulting from unforeseen penetration of the anterior annulus fibrosus and longitudinal ligament is a rare complication of lumbar microdiscectomy. The patient complained of abdominal tenderness and distention immediately after microdiscectomy for L4-5 and L5-S1 disc herniation. Using abdominal computed tomography, we found several foci of air overlying the anterior aspect of the vertebral body at the L5-S1 level. Segmental resection of the small bowel including small tears and primary anastomosis of the jejunum were performed. Here, we present a case of intestinal perforation after lumbar microdiscectomy and discuss technical methods to prevent this complication with a review of literature.
Journal of Korean Neurosurgical Society 03/2010; 47(3):224-7. · 0.60 Impact Factor
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ABSTRACT: Surgery for thoracic disc herniations is still challenging, and the disc excision via a posterior laminectomy is considered risky. A variety of dorsolateral and ventral approaches have been developed. However, the lateral extracavitary and transthoracic approach require extensive surgical exposure. Therefore, we adopted a posterior transdural approach for direct visualization without entry into the thoracic cavity. Three cases that illustrate this procedure are reported here with the preoperative findings, radiological findings and surgical techniques used. After the laminectomy, at the involved level, the dorsal dura was opened with a longitudinal paramedian incision. The cerebrospinal fluid was drained to gain more operating space. After sectioning of the dentate ligaments, gentle retraction was applied to the spinal cord. Between the rootlets above and below, the ventral dural bulging was clearly observed. A small paramedian dural incision was made over the disc space and the protruded disc fragment was removed. Neurological symptoms were improved, and no surgery-related complication was encountered. The posterior transdural approach may offer an alternative surgical option for selected patients with thoracic paracentral soft discs, while limiting the morbidity associated with the exposure.
European Spine Journal 02/2010; 19(7):1206-11. · 1.97 Impact Factor
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ABSTRACT: A mouse model of spinal cord injury (SCI) could further increase our basic understanding of the mechanisms involved in injury and repair of the nervous system. The purpose of this study was to investigate whether methods used to produce and evaluate photochemical graded ischemic SCI in rats, could be successfully adapted to mice, in a reliable and reproducible manner.
Thirty female imprinting control region mice (weighting 25-30 g, 8 weeks of age) were used in this study. Following intraperitoneal injection of Rose bengal, the translucent dorsal surface of the T8-T9 vertebral laminae of the mice were illuminated with a fiber optic bundle of a cold light source. The mice were divided into three groups; Group 1 (20 mg/kg Rose bengal, 5 minutes illumination), Group 2 (20 mg/kg Rose bengal, 10 minutes illumination), and Group 3 (40 mg/kg Rose bengal, 10 minutes illumination). The locomotor function, according to the Basso-Beattie-Bresnahan scale, was assessed at three days after the injury and then once per week for four weeks. The animals were sacrificed at 28 days after the injury, and the histopathology of the lesions was assessed.
The mice in group 1 had no hindlimb movement until seven days after the injury. Most mice had later recovery with movement in more than two joints at 28 days after injury. There was limited recovery of one joint, with only slight movement, for the mice in groups 2 and 3. The histopathology showed that the mice in group 1 had a cystic cavity involving the dorsal and partial involvement of the dorsolateral funiculi. A larger cavity, involving the dorsal, dorsolateral funiculi and the gray matter of the dorsal and ventral horns was found in group 2. In group 3, most of the spinal cord was destroyed and only a thin rim of tissue remained.
The results of this study show that the photochemical graded ischemic SCI model, described in rats, can be successfully adapted to mice, in a reliable and reproducible manner. The functional deficits are correlated an increase in the irradiation time and, therefore, to the severity of the injury. The photothrombotic model of SCI, in mice with 20 mg/kg Rose bengal for 5 minutes illumination, provides an effective model that could be used in future research. This photochemical model can be used for investigating secondary responses associated with traumatic SCI.
Journal of Korean Neurosurgical Society 11/2009; 46(5):479-83. · 0.60 Impact Factor
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ABSTRACT: Prospective study of 31 patients who underwent anterior cervical fusion.
To investigate the efficacy of polyetheretherketone (PEEK) cages and demineralized bone matrix (DBM) for anterior cervical discectomy and fusion (ACDF).
Although high fusion rates can be achieved with autogenous bone grafts, donor-site morbidity affects the patient's satisfaction with the surgical outcome.
Thirty-one consecutive patients treated with ACDF using the PEEK cage with DBM (Grafton, Osteotech, Inc., Shrewsbury, NJ) at 42 levels were prospectively evaluated with a minimum of 12-month follow-up (mean: 16 months). Twenty-one patients underwent a single-level ACDF, 9 patients underwent a 2-level ACDF, and 1 patient had a 3-level ACDF. The affected level was C3-C4 in 7 patients; C4-C5 in 9, C5-C6 in 16, and C6-C7 in 10. The neurologic outcomes were evaluated using the VAS score for neck and arm pain and the Japanese Orthopedic Association scoring system for myelopathy at 3, 6, and 12 months. The cervical lordosis and fusion status were assessed on radiographs including flexion/extension radiographs.
At 12 months, the radiographs demonstrated grades I, II, and III new bone formation at 1, 13, and 28 levels, respectively. There was a significant improvement in both the neck and arm pain and a significant improvement in the Japanese Orthopedic Association scores at the last follow-up. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of Grafton.
ACDF using the Solis cage packed with Grafton demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of the traditional ACDF using tricortical iliac crest grafts. Therefore, the results of this study suggest that the ongoing use of the PEEK cage packed with DBM and autologous bone chips in ACDF is a safe and effective alternative to the gold standard of autologous iliac bone grafts.
Spine 09/2009; 34(17):E591-5. · 2.08 Impact Factor
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ABSTRACT: Ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The aim of this study was to identify factors associated with the surgical outcome on the basis of preoperative clinical and radiological findings.
Data obtained in 26 patients whot underwent posterior decompression for thoracic myelopathy, caused by thoracic OLF, were analyzed retrospectively. Patient age, duration of symptoms, OLF type, preoperative and postoperative neurological status using the Japanese Orthopedic Association (JOA) scoring system, surgical outcome, and other factors were reviewed. We compared the various factors and postoperative prognosis. All patients had undergone decompressive laminectomy and excision of the OLF.
Using the JOA score, the functional improvement was excellent in 8 patients, good in 14, fair in 2, and unchanged in 2. A mean preoperative JOA score of 6.65 improved to 8.17 after an average of 27.3 months. According to our analysis, age, gender, duration of symptoms, the involved spinal level, coexisting spinal disorders, associated trauma, intramedullary signal change, and dural adhesions were not related to the surgical outcome. However, the preoperative JOA score and type of OLF were the most important predictors of the surgical outcome.
Early diagnosis and sufficient surgical decompression could improve the functional prognosis for thoracic OLF. The postoperative results were found to be significantly associated with the preoperative severity of myelopathy and type of OLF.
Journal of Korean Neurosurgical Society 09/2009; 46(3):189-94. · 0.60 Impact Factor
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ABSTRACT: To describe surgical strategies using cerebral revascularization for complex middle cerebral artery aneurysms unsuitable to microsurgical clipping.
In this study, the clinical features, case management, and results in 9 consecutive patients who underwent 10 cerebral revascularization procedures between January 1999 and April 2008 were retrospectively analyzed. The patient population consisted of 6 men and 3 women whose ages ranged from 15 to 71 years (mean, 42.4 years). The size of the aneurysms ranged from 12 to 35 mm (mean, 24.3 mm). Treated aneurysms were located in the M1 segment in 2 patients, the middle cerebral artery (MCA) bifurcation in 3 patients, the distal M3 segment in 3 patients, and the anterior temporal artery (ATA; the early cortical branch of the M1 segment) in 1 patient. A total of 10 revascularizations were performed. Three aneurysms were saccular and six aneurysms were fusiform. For the fusiform aneurysms of the M1 segment in 2 patients, superficial temporal artery (STA) trunk-saphenous vein (SV)-MCA bypasses followed by trapping were performed. For the large saccular MCA bifurcation aneurysms in 3 patients, STA-MCA bypasses followed by complete neck clipping, including the revascularized branch with the preservation of the flow of the other branch, were performed in 2 cases, and a STA trunk-SV-MCA bypass secondary to direct neck clipping with the preservation of both M2 branches was performed in 1 case. For the fusiform distal MCA aneurysms, STA-MCA bypasses in 2 patients and in situ MCA-MCA bypasses in 2 patients were performed. In one case involving distal MCA fusiform aneurysm, STA-MCA bypass and MCA-MCA bypass were performed simultaneously. In a case involving fusiform ATA aneurysm, primary reanastomosis after aneurysm excision was performed in 1 patient.
The post-operative 3-month Glasgow outcome scales were good recovery in 6 patients, severe disability in 1 patient, a vegetative state in 1 patient, and death in 1 patient. A follow-up angiography was performed in 6 patients and revealed a patent bypass in 5 patients. In one case treated by direct neck clipping secondary to cerebral revascularization, the angiography obtained 2 weeks later showed graft occlusion, but there were no neurologic symptoms. Among the unfavorable outcomes of 3 patients who did not undergo follow-up angiography, surgery-related morbidity secondary to cerebral infarction was due to the size discrepancy between the donor and recipient vessels in 1 patient with severe disability. In the other 2 patients, the preoperative conditions were Hunt and Hess grade V.
Cerebral revascularization is a safe and effective technique of treatment for selective cases of complex large or giant aneurysms and unclippable fusiform aneurysms in the MCA.
Clinical neurology and neurosurgery 08/2009; 111(8):670-5. · 1.30 Impact Factor
