Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

OBJECTIVE: The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. METHODS: Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. RESULTS: Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. CONCLUSION: Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

En Plaque Meningioma in Thoracic Spine: Case Report

Spinal en plaque meningioma is rarely found in the spinal canal, although lateral sphenoid wing meningioma displays a propensity for growth en plaque. We encountered a case of completely circumferential spinal en plaque meningioma, which is an even rarer condition. Herein, we report the CT & MRI findings along with a review of the related literature.

Post-Traumatic Syringomyelia Treated with Expansile Duraplasty and Syringosubarachnoid Shunt : Case Report

No abstract available.

Endovascular Treatment of Basilar Bifurcation Aneurysm with Open Access of Vertebral Artery

Microsurgical clipping is considered the treatment of choice for ruptured intracranial aneurysms. However, ruptured posterior circulation aneurysms remain technically difficult to expose or clip and outcomes in these cases are poorer than those seen in cases of anterior circulation aneurysms. Therefore, endovascular treatment becomes another treatment option in cases of ruptured posterior circulation aneurysms. But, the vertebral artery may not be selected due to luminal narrowing, which are atherosclerotic stenosis clinically, congenital anomalies, or acquired kinking, and structural problem of angle between aorta, subclavian artery and vertebral artery. In these cases, other approaches can be used through, for example, subclavian, axillary, or brachial artery approach. But sometimes such prcedures may be also inappropriate. One other approach is direct percutaneous vertebral artery approach. Though this one also doesn't overcome many clinical and anatomical problems. The authors present two cases of ruptured basilar tip aneurysms which was treated with endovascular Guglielmi detachable coil embolization with open surgery and catheterization, because the one had anatomical problem, and the other had structural problem.

Anterior Ceervical Interbody Fusion: Comparison Study between Simple Fusion, Locked and Non-locked Plating Systems

The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.

Management of Perimedullary Giant Arteriovenous Fistula(Type IV c)by Embolization Operative Ligation

Intradural perimedullary arteriovenous fistulas(type IV spinal cord arteriovenous malformations) that occur at cervical level are rarely reported in the literature. A twelve year-old male patient was presented with suddenly developed progressing quadriparesis. MR imaging and angiography demonstrated focal intramedullary hemorrage at C5 vertebral level and intradural perimedullary arteriovenous fistula at C4 vertebral level and ectatic endocranial venous drainage, fed by anterior spinal artery, radicular branch of right vertebral artery, right thyrocervical trunk. The large draining vein ascends toward and into the posterior fossa along route which was anterior to the lower brain stem. The initial treatment consisted of selective embolization of arterial feeders arising from the right thyrocervical trunk and anterior spinal artery. The embolization procedures were performed using GDC coil. Eight days after embolization, corpectomy was performed at the C4-5 level and fistula ligation was done. Following these procedures, the patient has progressively improved in motor and sensory function and post operative angiogram revealed disappearance of fistula and abnormal endocranial venous drainage.

Neurilemmomas of the Cervicla Vagus Nerve: A Case Report

A case of the recurrent neurilemmoma of vagus nerve in the neck is presented. It was located in the upper third of the right lateral neck. The patient was presented with hoarseness and monoparesis of the right arm. The tumor was composed of large cystic portion and solid nodule in the right carotid fossa. Since total surgical removal of the tumor could cause functional deterioration of the involved vagus nerve, it was removed by means of intracapsular enucleation. Postoperatively, the monoparesis of the right arm was disappeared with preservation of vagus nerve function. It would appear that an intracapsular enucleation may be advisible in some cases of neurilemmomas of the cervical vagus nerve to maintain the function of the involved vagus nerve.

Intraoperative Facial EMG Monitoring during Decompression Operation for Hemifacial Spasm

Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.

Intradural Dissecting Aneurysms Treated by Extreme Lateral Transcondylar Approach(2 cases)

We expierenced two cases of intradural verteral artery dissecting aneurysms. The presenting symptom was subarachnoid hemorrhage in one case and ischemic symptom in the other. The preoperative angiographic finding typically showed fusiform dilatation and proximal and/or distal narrowing of the affected artery. In one case, the vertebral artery was clipped distal to the PICA and in the other case trapping was performed through the extreme lateral transcondylar approaches. This approach permits a control of the aneurysm through the direct view of whole length of the vertebral artery, lower cranial nerves and ventral brain stem. In order to obtain ample view and to save the lower cranial nerves and perforating vessels, jugular tubercle should be sufficiently drilled out. Postoperitive neurological outcomes were favorable except mild hoarseness for some period in trapping case.