Anterior Lumbar Interbody Fusion with Percutaneous Pedicle Screw Fixation for the Treatment of Postoperative Pyogenic Spondylodiscitis

Deep wound infection is a serious surgical complication. The majority of patients with pyogenic spondylodiscitis can be treated non-surgically with antibiotics and immobilization. However, although surgical management of pyogenic spondylodiscitis continues to evolve, no consensus has yet been reached regarding the best surgical approaches and techniques. Anterior lumbar interbody fusion (ALIF) followed by percutaneous pedicle screw fixation (PPF) is an effective surgical option for treating postoperative pyogenic spondylodiscitis (PPS). In this report, we describe a case of PPS in a 64-year-old man who underwent ALIF with PPF.

Microcystic Meningiomas: Its Immunohistochemical and Genetic Aspect

The authors report three microcystic meningiomas with its characteristic immunohistochemical findings and chromosomal pattern. Three patients with surgically treated microcystic meningioma were studied for its radiological, histopathological findings, and chromosomal analysis was done in the one patient. Tumors were convexity meningioma in the frontal area. The tumors were enhanced homogenously in the two, and enhanced inhomogenously with multiple small cysts in the other one on preoperative magnetic resonance image. Pathological examination showed marked nuclear pleomorphism, many small cysts, hyaline thickening in blood vessel wall, and mucinous background, compatable to microcystic type. EMA and vimentin were positive on the immunohistochemical stain. Chromosomal analysis showed tetrasomies of chromosome 5, 13, 17, and 20, and trisomies of chromosome 6, 7, 9, 11, 12, 16, 19, and 21, which are quite different from those of benign meningioma.

Surgically Treated Anterior Communicating Artery Aneurysm

OBJECTIVE: The purpose of this study is to assess the factors related to the outcome of 84 patients who underwent surgery for anterior communicating Artery(ACoA) aneurysms. METHODS: The authors review 84 patients who were undertaken from January 1998 to May 2004. In the management of ACoA aneurysms, the outcome was based on several factors: Clinical condition, Distribution of hemorrhage, Time between aneurysmal rupture and surgery, Direction and shape of the aneurysm. RESULTS: The incidence rate of the ACoA aneurysm was 35%. Seventy four patients were classified as those having a good recovery, but 5 patients suffered from some morbidity and 5 patients died. The rate of good outcome for the patients with Hunt and Hess grade was as follows 100% in grade I, 95% in grade II, 80% in grade III, IV and V. The rate of good outcome for the patients with Fisher grade was as follows 98% in grade I, II and 81% in grade III, IV. Nineteen of 22 patients who underwent early surgery were rated as good, while twenty six of 30 patients for whom surgery was delayed showed a favorable result. The unfavorable outcomes were also attributed by vasospasm or other medical problems. CONCLUSION: For further improvement of the overall surgical outcome: First, early surgical intervention is recommended for good grade patients. Second, active management of poor grade patients should be scrutinized with early surgery. Third, it is also important to step up the effort to minimize the risk of medical complications to enhance surgical results on top of the mainstay of prevention efforts for vasospasm and rebleeding.