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Objective@#To explore the effects of surgical technique of single one-stage posterior C1-2 screw rod fixation of Chiari malformation (CM) associated with occipitalization and without atlantoaxial dislocation.@*Methods@#A total of 23 patients with CM treated between January 2014 and October 2015 in Department of Neurosurgery of Chinese People′s Liberation Army General Hospital were retrospective reviewed. All of them were diagnosis with CM associated with occipitalization and without atlantoaxial dislocation, including 8 males and 15 females, aging from 11 to 57 years (mean (35.5±10.52) years). Single one-stage posterior C1-2 screw rod fixation with bone grafting fusion was performed. Operation time and intraoperative blood loss were recorded. Japanese Orthopaedic Association (JOA) scores and Odom rating were used to evaluate the clinical effects at pre- and post-operative. Regression of the cerebellar tonsillar was measured by MRI. The results were analyzed by paired samples t test.@*Results@#Twenty-three patients were implanted screws successfully, the vertebral artery injury and cerebrospinal fluid leakage were not found. The mean operation time was (172.7±19.9) minutes, the intraoperative blood loss was (153.9±49.3) ml. Compared to preoperative, the JOA score increased (13.7±1.6 vs. 11.5±1.4) and the tonsillar herniation decreased ((0.8±0.6)cm vs. (1.9±0.6) cm) in the last follow-up, there were statistical difference (t=13.386, P<0.01; t=17.995, P<0.01). The results of the postoperative Odom grading were as follows: 6 cases were perfect (26.1%), 13 cases were good (56.5%), 4 cases were moderate (17.4%) and no case was poor.No signs of instrument loosen or screw broken was noticed. 100% bony fusion rate was achieved. The follow-up time was 6 to 23 months (mean (10.5±3.2) months). One case developed internal fixator related discomfort, the symptom was relieved by internal fixator removal surgery performed 4 months after the operation when osseous fusion had already been achieved. No new neurologic symptoms were observed in other 22 patients.@*Conclusions@#The results of the study substantiates the effectiveness of single one-stage posterior fixation strategy for CM, which is associated with occipitalization and without atlantoaxial dislocation. This technique could be an alternative choice for this type of CM.
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Objective To study the technique of lumbar cathetering in lumbosacral vertebral canal operation and its effect on prevention of postoperative cerebrospinal fluid leakage.Methods Retrospectively analyzed the clinical data of patients who underwent lumbosacral ver-tebral canal surgery and suffered from difficult dural repair during the operation in Department of Neurosurgery from August 2015 to October 2015.These patients were divided into the observation group (11 cases)and the control group (12 cases)according to whether lumbar cathe-ter were placed during the operation or not.Volume of drainage was strictly controlled after surgery.Remove the epidural drainage after primi-tive healing of the dura mater.The lumbar catheter was removed after 7 to 10 days.The indwelling time of each patient was collected and sta-tistical analyzed.Results The observation group got obvious shorter epidural drainage indwelling time than the control group(P <0.05). Short-term postoperative complications did occur in some cases in observation group,however,there was no obvious increase of infection rate in patients with lumbar continuous drainage indwelling.Conclusion Lumbar cathetering during the operation could be an effective method to solve difficult problem of placeing a lumbar drainage after lumbar puncture and to prevent cerebrospinal fluid leakage after operations of lum-bosacral vertebral canal.But it can not replace the delicate operation and tight dural suture.Drainage should be used only as a remedial measure of dural repair failure.
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Objective To improve the diagnosis and treatment of neurenteric cyst. Methods The clinical manifestations, MRI characteristics and surgical results of 11 cases of intraspinal neurenteric cysts were analyzed. Results Positive pathological signs and paresis appeared in all cases, and radicular pain in 9 cases. The symptoms were episodic in 2 cases whose courses were more than 3 years. MRI could clearly demonstrate the exact extension of the cyst and the surrounding structures. These cysts showed as slightly long T 1, long T 2 homogeneous signal on MRI. Their neurological functions improved steadily after complete resection in 8 cases, subtotal resection in 3 cases. Conclusion Neurenteric cysts are rare congenital lesions, often associated with vertebral anomalies and occurred at subdural cervical location, anterior to the cord. MRI is a more effective and convenient method for neurenteric cyst image investigation. Total or subtotal resection of neurenteric cysts with subsequent recovery in neurological function is usually possible.
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Objective To evaluate MRI or CT appearance and clinicopathologic features of dysembryoplastic neuroepithelial tumor (DNT). Methods MRI or CT appearance and clinicopathologic features in 12 cases of histopathology confirmed DNT were retrospectively studied. Results There were 6 men and 6 women, and the age ranged from 12 to 68 years with the average age of 36.7 years. Most patients had partial seizures, but the neurological deficits were absent. All lesions were located in the supratentorial region and involved the cerebral cortex on MRI scan. Localization of lesions was predominantly in the frontal (n=4) and temporal (n=3) lobes. The maximum lesion diameter ranged in size from 2 cm to 5 cm, and the lesion showed round, lobular- or irregular-shaped. The white matter was involved in 2 cases, and 7 were with cystic change (58.3%). All lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images as well as devoid of peritumoral edema or mass effect. MRI signal intensity of cystic lesions was homogeneous on T1-weighted images which was equal to or slightly higher than that of cerebrospinal fluid. CT scan of 6 cases disclosed moderately hypodense lesion, 2 of which were markedly hypodense cystic-lobular shaped, and foci of calcification was observed in 1 case. Contrast enhancement was absent in 4 cases and only 1 case showed slight enhancement unevenly. Histologically, the DNT were classified into three subtypes: simple form (n=4), complex form (n=6), and non-specific variant (n=2). All patients experienced lesion gross total or subtotal surgical removal, and had received no chemo- or radiotherapy postoperatively. Conclusion DNT is a benign lesion, and its characterization is better disclosed by MRI compared to CT scan.