Objective: To review 41 patients with complete spontaneous PIN palsy with HLFC to clarify the necessity and choice of surgery.
Methods: Interfascicular neurolysis (NY), neurorrhaphy and autografting were carried out on 10, 8 and 6 patients, respectively. The thinning extent of a nerve fasciculus <=0.25, 0.25-0.75 and >=0.75 was defined as mild, moderate and severe constriction, respectively. Final British Medical Research Council muscle power grade >=4 was defined as good recovery.
Background and Importance: Angioleiomyoma (ALM) is a rare, benign smooth muscle tumor that can occur anywhere in the body. Diagnosis is usually delayed due to the unfamiliar location and presentation of the lesion. This tumor is not frequently discussed in neurosurgical publications as part of the differential diagnosis of painful subcutaneous lesions. To our knowledge, this is the first report of a neurosurgical presentation of ALM within an extremity.
Clinical Presentation: A 42-year-old woman presented with over 2 years of severe, right knee pain. The patient had undergone several treatments, including a knee arthroscopy, all without significant relief. MRI performed with a fiducial marker placed directly on the point of tenderness demonstrated an 8mm subcutaneous nodule. The patient underwent complete excision of the lesion, guided by the placement of the fiducial marker and its correlation with the preoperative MRI. Intraoperatively, the lesion was not found to be associated with a nerve; however, there was a small vessel adjacent to the lesion. Pathology demonstrated this lesion to be an angioleiomyoma. The patient’s symptoms had completely resolved without any new neurological parasthesias or deficits on follow-up.
Concussion Guidelines Step 1: Systematic Review of Prevalent Indicators, a special supplement of Neurosurgery, is available online with free full text access.
It is authored by Nancy Carney, PhD; Jamshid Ghajar, MD, PhD; Andy Jagoda, MD; Steven Bedrick, PhD; Cynthia Davis-O’Reilly, BSc; Hugo du Coudray, PhD; Dallas Hack, MD; Nora Helfand; Amy Huddleston, MPA; Tracie Nettleton, MS; and Silvana Riggio, MD.
Because of the lack of sufficient objective data from strong studies, concussion remains undefined. There was sufficient reliable information to compile the following:
The most prevalent indicators of concussion, observed in alert individuals (Glascow Coma Scale of 13 to 15) after a force to the head are:
- Observed and documented disorientation or confusion immediately after the event
- Impaired balance within 1 day after injury
- Slower reaction time within 2 days after injury
- Impaired verbal learning and memory within 2 days after injury
Key Findings – Among the studies included in the review:
- Loss of Consciousness (LOC) ranged from 1% to 14.3%
- Posttraumatic amnesia (PTA) ranged from 2% to 29.7%
- Retrograde amnesia ranged from 7.4% to 53.3%
- Disorientation/confusion ranged from 18% to 44.7%
- The prevalence of balance deficits ranged from 23.8% to 36.5% within 24 hours of injury and decreased to 19.2% to 24% by day 2.
- The prevalence of slowed reaction time ranged from 41.7% to 71.4% within 24 hours of injury.
- Findings indicated that in the majority of cases, cognitive deficits resolved within one week.
Click here for free access to the article and executive summary.
Background: Functioning pituitary adenomas (FPA) can be difficult to delineate on post-operative MRI, making them difficult targets for stereotactic radiosurgery (SRS). In such cases, radiation delivery to the entire sella has been utilized as a radiosurgical equivalent of a total hypophysectomy.
Objective: To evaluate the outcomes of a cohort of patients with FPA who underwent SRS to the whole-sellar region.
Methods: This is a retrospective review of patients who underwent whole-sellar SRS for FPA between 1989 and 2012. Sixty-four patients met the inclusion criteria: they were treated with whole-sellar SRS following surgical resection for persistently elevated hormone levels, and 1) no visible lesions on imaging studies, and/or 2) tumor infiltration of dura or adjacent venous sinuses observed at the time of a prior resection. The median radiosurgical volume covering sellar structures was 3.2 mL, with a median margin dose of 25 Gy.
Background: One challenge performing endoscopic endonasal approaches is the surgical conflict that occurs between the surgical instruments and endoscope in the crowded nasal corridor. This conflict decreases surgical freedom, increases surgeon frustration, and lengthens the learning curve for trainees.
Objective: To evaluate the impact a malleable endoscope has on surgical freedom for endoscopic approaches to the parasellar region.
Methods: Uninostril and binostril endoscopic transsphenoidal approaches to the pituitary gland and cavernous carotid arteries were performed on eight silicon-injected, formalin-fixed cadaveric heads using both rigid and flexible 3-D endoscopes. Surgical freedom to targets in the parasellar region was assessed using an established technique based on image guidance. Results are presented as three measurements: area of surgical freedom for a point target, area for the surgical field (cavernous carotids and sella), and angular surgical freedom (angle of attack).
Background: Pontine cavernous malformations (CM) located on a peripheral pontine surface or the fourth ventricular floor are resectable lesions, but those deep within the pons away from a pial surface are typically observed. However, the anterior bulge of the pons formed by the brachium pontis creates a unique entry point for access to deep pontine lesions from below, working upwards through the pontomedullary sulcus (PMS).
Objective: We developed a transpontomedullary sulcus (TPMS) approach to these lesions.
Methods: The TPMS approach used the far lateral craniotomy and upper vagoaccessory triangle to define the surgical corridor. The entry point was above the olive, lateral to the pyramidal tracts and cranial nerve (CN) 6, above the pre-olivary sulcus and CN 12, and medial to CN 7/8 and CN9/10/11.
Background: En bloc resection of chordomas is associated with increased patient survival. Achievement of en bloc resection, however, may present a great surgical challenge, particularly in the mobile spine. Novel multi-disciplinary techniques may enable en bloc resection of lesions presenting in anatomically challenging locations. A combined, simultaneous thoracoscopic and posterior approach in a patient with an upper thoracic chordoma is presented; en bloc resection was achieved.
Objective: To show the feasibility, safety, and utility of performing a thoracoscopic-assisted en bloc resection of a chordoma involving the upper thoracic spine.
Methods: A case study is presented of a patient with biopsy-proven chordoma of T2-T3 with predominantly paravertebral involvement, who underwent multilevel en bloc resection via a simultaneous combined anterolateral thoracoscopic and posterior approach. Thoracoscopic assistance achieved separation of the tumor and ventral spine from the adjacent mediastinal structures. En bloc resection proceeded without complication. The spine was stabilized with posterior instrumentation.