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Objective:To investigate the clinicopathologic features of intraspinal ganglioneuroma.Meth-ods:We collected 1 2 cases of diagnosed ganlioneuroma arising from the spine and one case of ganlioneuro-ma arising from mediastinum as the control.Clinical and radiographic features were reviewed.The pathologi-cal parameters of these cases were analyzed with routine and immunohistochemical stainings of neural fiber (NF),S-100 protein(S-100),myelin based protein(MBP),peripheral myelin protein 22(PMP22),smooth mus-cle actin(SMA),glial fibrilary acidic protein(GFAP)and Ki-67.Results:The disease was likely to occur in pa-tients aged 30-40 years old and more common in female.These cases were all intral cervical spinal tumors and presented with radicular neuralgia and mass effects of cervical spinal cord compression.Ganglioneuro-mas which occasionally contained normal spindle shaped cells were composed of mature or degenarative ganglion cells and neoplastic Schwannian stroma.Ganglion cells appeared positive for NF.Schwannian stro-ma as well as satellite cells around ganglion showed immunoreactivity for S-100.more intense than neurofi-bro-stroma.Mature spindle shaped cells showed immumoreactivity for MBP.Ki-67 labeling indices were usual-ly 0-1%while in Schwannian stroma areas were 3%.No blood vessel endothelium proliferation was ob-served.Conclusion:Intraspinal ganglioneuromas are rare benign tumors(WHO grand I),causing radicular neuralgia.It is jmportant to distinguish ganglioneuroma with spinal root encircled from Schwannoma or neuro-fibroma in the same anatomic location.The optimal treatment is surgical total resection.
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Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied.All the patients received a CT scanning,and 8 patients were given an MRI examination(two of them underwent a magnetic resonance spectroscopy).An administration of ceftriaxone in combination with metronidazole was given for 1~9 weeks(mean,3.7 weeks).Surgery was conducted in 8 patients under the guidance of CT scanning or B-ultrasonography,including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement,16 patients were cured without after-effects,and 3 patients were improved but the hemiplegia was left behind.No surgery-related deaths were encountered in the 8 surgical cases.Among 8 patients who complicated with diabetes mellitus,tuberculosis,HIV infection,or kidney transplantation,4 patients were cured;all the remaining 12 patients without co-morbidities were cured.Among 9 patients with lesions closely near the ventricle,5 were cured,while the rest of 11 patients with superficial abscesses were all cured.All the 5 patients with multiple abscesses were cured,and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration.The magnetic resonance is an important means for early diagnosis,and the stereotactic operation is a favorable surgical treatment.
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Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.
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Objective The purpose of this study was to evaluate the outcome of surgical treatment for spinal cord tumors. Methods We retrospectively analyzed a series of 660 patients with 676 intra-spinal tumors who were treated surgically from February 1993 to December 2007. The tumors located at the cervical level in 231 patients,thoracic in 202,lumbar in 159,sacral in 9,cervico-thoracic in 16,thoracico-lumbar in 42,and lumbar-sacral in 17. Totally 699 operations were performed,including posterior bilateral laminectomy approach in 599,unilateral laminotomy in 71 and laminoplasty in 6 cases.Besides,23 additional operations via lateral or ventral-lateral were performed for resection of extra-spinal component of dumbbell shaped tumors. Results In this series,Schwannomas and meningiomas were the most common extramedullary tumors accounting for 76.5% of the cases [517/676,rate of total resection: 92.3% (477/517)]. The intra-medullary tumors accounted for 23.5% (159/676),in which astrocytomas and ependymomas were the most often observed [rate of total resection: 67.3% (107/159)]. The peri-operative mortality was 1.7% (11/660). The motor and sensory functions were found to be improved after operation in 77.8% (357/459) and 79.2% (397/501) respectively. The sphincter function was improved in 72.4% (215/297). The rate of pain relief was 93.3% (361/387). The follow-up periods ranged from 0.5 to 15.1 years in 582 patients with an average of 5.9 years;during the period,87.8% (499/568) of the patients had an ASIA impairment scale E neurological function. Conclusions Intra-spinal tumors locate mostly in the subdural-extramedullary space,with a majority are Schwannomas and meningiomas. The widespread application and availability of MRI investigation provide the physician with accurate localization of the lesion thereafter ensure a minimally invasive surgical treatment strategy keeping the stability of the spine while removing the tumors with an satisfactory outcome.
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Objective To investigate the diagnosis and treatment of multiple spinal intradural extramedullary tumors.Methods Totally 15 patients(11 men and 4 women) with multiple spinal intradural extramedullary tumors were enrolled in this study.The patients aged from 16 to 81 years with a mean of(51.0?21.2) years.The mean course of the disease was(11.0?7.6) months(range:2-27 months).In the patients,no skin neurofibroma or coffee spots were detected;brain MR showed no abnormalities.Enhanced MR revealed totally 46 spinal intradural extramedullary tumors,35 of which ≥0.5 cm in diameter,involving the cervical segment in 1 case,the thoracic segment in 5,and lumbar and sacrum segments in 12.All the patients received tumorectomy via the posterior midline approach.If the tumor was less than 1 cm,hemilaminectomy was performed under a microscope;the tumor was removed completely,while crucial nerves supplying the tumor were conserved as much as possible.When it is difficult to separate the nerves,we freed the roots of the nerves at our best ability,so that to carry out anastomosis of the roots after removing the tumor.Antibiotics and hormone therapy were administered after the operation,and the patients were required to wear neck/waist support brace for 2 months,and practice the back and waist muscles at the meantime.Results Among the 15 cases,total resection of the spinal tumors was performed on 12 patients(33 tumors were removed),of which one patient received anastomosis of the nerve roots.In the other three patients,two were diagnosed as having scattered multiple small neurofibroma or Schwannoma(
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Objective To evaluate the effect of surgical treatment of hypertensive intracerebral hemorrhage (HICH) through a straight incision and keyhole minimally invasive craniotomy. Methods According to the location of the hematoma revealed by preoperative CT scans, a straight skin incision was made 4～5 cm in length, and then a keyhole craniotomy 2 cm in diameter was performed. The underlying cortex was incised the hematoma was exposed and removed under microscope. Results The hematomas were thoroughly cleared in 17 cases. The clearance rate was 90% in 18 cases and 80% in 4 cases. Re-hemorrhage occurred in 2 cases after operation. A total of 35 cases was followed for 0.5～3 years (mean, 2.1 years). The quality of life was assessed by activity of daily living (ADL) classification, which revealed 9 cases of grade 1, 12 cases of grade 2, 9 cases of grade 3, 4 cases of grade 4, and 1 case of grade 5 at the 6th postoperative month. The mortality of this series was 10.3% (4/39). Conclusions Straight incision keyhole minimally invasive craniotomy is a rapid, effective, and safe technique for the removal of hypertensive cerebral hemorrhage. The method herein provides an effective decompression of hematoma, with low recurrence rate and good prognosis compared with conventional surgery.