Adult Patients with Congenital Muscular Torticollis Treated with Bipolar Release: Report of 31 Cases

OBJECTIVE: We assessed the surgical results of bipolar release in 31 adult patients with uncorrected congenital muscular torticollis (CMT) and more than 12 months of follow-up. METHODS: Thirty-one patients underwent a bipolar release of the sternocleidomastoid muscle (SCM) and were retrospectively analyzed. The mean follow-up period was 14.9 months (range, 12–30). The mean age at time of surgery was 30.3 years (range, 20–54). Patients were evaluated with a modified Lee’s scoring system, cervicomandibular angle (CMA) measurement, and a global satisfaction rating scale using patient self-reporting. RESULTS: The modified Lee’s scoring system indicated excellent results in 4 (12.9%) patients, good in 18 (58.1%), and fair in 9 (29.0%) at the last follow-up after surgery. The improvements in neck movement and head tilt were statistically significant (p<0.05). The preoperative mean CMA was 15.4° (range, 5.4–29.0), which was reduced to a mean of CMA of 6.3° (range, 0–25) after surgery (p<0.05). The global satisfaction rating scale was 93.7% (range, 90–100). A transient sensory deficit on the ipsilateral lower ear lobe was noted in three cases. No significant permanent complications occurred. CONCLUSION: Bipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults.

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion.

Comparative Study of Clinical and Radiological Outcomes of a Zero-Profile Device Concerning Reduced Postoperative Dysphagia after Single Level Anterior Cervical Discectomy and Fusion

OBJECTIVE: This study analyzed clinical and radiological outcomes of a zero-profile anchored spacer (Zero-P) and conventional cage-plate (CCP) for single level anterior cervical discectomy and fusion (ACDF) to compare the incidence and difference of postoperative dysphagia with both devices. METHODS: We retrospectively reviewed our experiences of single level ACDF with the CCP and Zero-P. From January 2011 to December 2013, 48 patients who had single level herniated intervertebral disc were operated on using ACDF, with CCP in 27 patients and Zero-P in 21 patients. Patients who received more than double-level ACDF or combined circumferential fusion were excluded. Age, operation time, estimated blood loss (EBL), pre-operative modified Japanese Orthopaedic Association (mJOA) scores, post-operative mJOA scores, achieved mJOA scores and recovery rate of mJOA scores were assessed. Prevertebral soft tissue thickness and postoperative dysphagia were analyzed on the day of surgery, and 2 weeks and 6 months postoperatively. RESULTS: The Zero-P group showed same or favorable clinical and radiological outcomes compared with the CCP group. Postoperative dysphagia was significantly low in the Zero-P group. CONCLUSIONS: Application of Zero-P may achieve favorable outcomes and reduce postoperative dysphagia in single level ACDF.

A Groove Technique for Securing an Electrode Connector on the Cranial Bone: Case Analysis of Efficacy

OBJECTIVE: A groove technique for securing an electrode connector was described as an alternative surgical technique in deep brain stimulation (DBS) surgery to avoid electrode connector-related complications, such as skin erosion, infection, and migration. METHODS: We retrospectively reviewed 109 patients undergoing one of two techniques; the standard technique (52 patients using 104 electrodes) and the groove technique (57 patients using 109 electrodes) for securing the electrode connector in DBS surgery, regardless of patient disease. In the standard percutaneous tunneling technique, the connector was placed on the vertex of the cranial surface. The other technique, so called the groove technique, created a groove (about 4 cm long, 8 mm wide) in the cranial bone at the posterior parietal area. Wound erosion and migration related to the connectors were compared between the two techniques. RESULTS: The mean follow-up period was 73 months for the standard method and 46 months for the groove technique. Connector-related complications were observed in three patients with the groove technique and in seven patients with the standard technique. Wound erosion at the connector sites per electrode was one (0.9%) with the groove technique and six (5.8%) with the standard technique. This difference was statistically significant. The electrode connector was migrated in two patients with the groove technique and in one patient with the standard technique. CONCLUSIONS: The groove technique, which involves securing an electrode using a groove in the cranial bone at the posterior parietal area, offers an effective and safe method to avoid electrode connector-related complications during DBS surgery.

Hemangiopericytoma of the Posterior Fossa: A Case Report and Review of the Literature

Intracranial hemangiopericytoma is unusual, and those occurring in the posterior fossa is extremely rare; we report such a rare case of hemangiopericytoma of the posterior fossa. The radiologic findings and gross characteristics of hemangiopericytomas are sometimes quite similar to those of meningiomas. Although extremely rare, the operator should be aware of the existence of this disorder to dexterously manage the aggressive nature and high vascular tendency of hemangiopericytomas. The radiological features and histological findings in this case are discussed in this study.

Terson Syndrome Caused by Intraventricular Hemorrhage Associated with Moyamoya Disease

Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. A 41-year-old man presented with left visual disturbance. He had a history of intraventicular hemorrhage associated with moyamoya disease three months prior to admission. At that time he was in comatose mentality. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye, with right eye remaining normal. Vitrectomy with epiretinal membrane removal was performed. After operation his left visual acuity was recovered. Careful ophthalmologic examination is mandatory in patients with hemorrhagic moyamoya disease.

Fusiform Aneurysm Presenting with Cervical Radiculopathy in Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) type IV is characterized by its clinical manifestations, which are easy bruising, thin skin with visible veins, and rupture of arteries, uterus, or intestines. Arterial complications are the leading cause of death in vascular EDS because they are unpredictable and surgical repair is difficult due to tissue fragility. The authors report a case presented with cervical radiculopathy due to a segmental fusiform aneurysm of the cervical vertebral artery. Transfemoral cerebral angiography (TFCA) was done to verify the aneurysmal dilatation. However, during TFCA, bleeding at the puncture site was not controlled, skin and underlying muscle was disrupted and profound bleeding occurred during manual compression after femoral catheter removal. Accordingly, surgical repair of the injured femoral artery was performed. At this time it was possible to diagnose it as an EDS with fusiform aneurysm on cervical vertebral artery. Particularly, cervical fusiform aneurysm is rare condition, and therefore, connective tissue disorder must be considered in such cases. If connective tissue disorder is suspected, the authors suggest that a noninvasive imaging modality, such as, high quality computed tomography angiography, be used to evaluate the vascular lesion to avoid potential arterial complications.

Symptomatic Spinal Epidural Lipomatosis Induced by Repeated Epidural Steroid Injections

We present a very rare case of symptomatic spinal epidural lipomatosis(SEL) induced by repeated epidural steroid injections. A 59-year-old woman presented with severe neurogenic claudication and bilateral radiating leg pain aggravated for 1 year. She had undergone epidural triamcinolone injections 19 times for 3 years in a local clinic for chronic low back pain. At first, there had been no symptoms of lumbar stenosis such as leg pain or claudication. During the period of injections, radiating leg pain and claudication appeared newly and were gradually aggravated. Hormonal study and physical examination confirmed iatrogenic Cushing's syndrome. Magnetic resonance imaging(MRI) revealed extensive epidural fat deposition compressing cauda equnina from L3 to S1. Therefore, we concluded that multiple epidural steroid injections caused iatrogenic Cushing's syndrome and SEL. We performed debulking of epidural fat and bilateral neural decompression via left unilateral partial hemilaminectomy at L3-4-5-S1 in order to preserve stability considering preexisting multiple compression fractures. After operation, the patient's neurogenic claudication and radiating pain were completely disappeared.

Isolation of Phenolate Type Siderophore from Pseudomonas sp. PY002

Phenolate type siderophore was produced in Pseudomonas sp. PY002 (P. sp. PY002) which cultured in M9 minimal medium supplemented with 0 to 500 uM of dipyridyl. Pyochelin, a kind of siderophore, was detected as a single broad absorption band (280 nm) at pH 12.0, which is a characteristic of phenolate type siderophore. The 280 nm absorption spectrum of pyochelin was changed to 310 nm at pH 1.5. The pyochelin produced was a structurally unique phenolate siderophore, designated 2-[2-(o-hydroxyphenyl)-2-thiazolin-4-yl]-3-methyl-4-thiazolidine car- boxylic acid on the analysis of infrared radiation and 'H and ""C nuclear magnetic resonance spectroscopy. Additionally, purified pyochelin increased the cell growth rate, like as growth fac- tor. All these results suggest that phenolate type siderophore play an important role in cell growth of P. sp. PY002.