Radiological Analysis of the Triangular Working Zone during Transforaminal Endoscopic Lumbar Discectomy

STUDY DESIGN: Clinical study. PURPOSE: The dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area. OVERVIEW OF LITERATURE: Few studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed. METHODS: Images of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated. RESULTS: No significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared. CONCLUSIONS: We suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.

Intracranial cavernomas: analysis of 37 cases and literature review.

AIMS: Thirty-seven patients with intracranial cavernomas managed in our department are retrospectively analyzed. MATERIALS AND METHODS: The data of 37 patients with cavernoma who were admitted to our department between 1995 and 2003 were reviewed retrospectively. There were 30 male and 7 female patients with a median age of 26 years (range, 9-57 years). Four cases were treated surgically, 13 were treated by stereotactic radiosurgery (SRS) and the remainder were managed conservatively. RESULTS: New hemorrhage or additional neurological deficits were not observed in the surgically treated cases, 12 patients who underwent SRS and the other patients who were followed up. One of the 13 patients treated by SRS, underwent microsurgery due to increased seizure frequency. One of the patients treated surgically died on the 11th postoperative day. CONCLUSION: Clinical observation should be the choice of management for patients without new or progressive neurological deficits, without two or more hemorrhages and in patients where the seizures are controlled with drugs. Surgery is the first choice for the cavernomas located in the non-eloquent locations. Radiosurgery may be an alternative for patients having deep-seated and eloquent area located cavernomas and for patients not willing or suitable for surgery.