Efficacy of Titanium Mesh Cages for Anterior Column Reconstruction after Thoracolumbar Corpectomy

STUDY DESIGN: This retrospective study was conducted to determine the safety and efficacy of titanium cage reconstruction and anterior plating after thoracolumbar corpectomy. PURPOSE: To study the clinical and radiological outcome of anterior column reconstruction after thoracolumbar corpectomy. OVERVIEW OF LITERATURE: Anterior column reconstruction aims to optimize neural decompression with adequate stabilization. METHODS: A series of 16 patients underwent reconstruction after thoracolumbar corpectomy to treat injury due to trauma (n=10), tuberculosis (n=3), and tumor (n=3). The average duration of follow-up was 18 months (range, 8-58 months). The degree of kyphosis, construct height, and the subsidence of the cage in relation to the vertebral endplates were measured. The approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases. RESULTS: Four patients were neurologically intact with Frankel grade E on admission, and all remained intact postoperatively. Of the 6 patients with Frankel grade D, all fully recovered full motor and sensory functions. Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades. The mean height of the vertebra before surgery was 41 mm and the mean construct height immediately after surgery and at follow-up was 47 mm and 44 mm, respectively. Solid fusion was observed in all patients. The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle. CONCLUSIONS: Anterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

Surgery for cervical spondylotic myelopathy: anterior versus posterior approaches

Surgical treatment of cervical spondylotic myelopathy [CSM] remains controversial. Several approaches have been advocated to treat cervical spondylotic myelopathy including anterior, posterior and combined approaches. The aim of this study was to review the clinical and imaging varieties of cervical spondylotic myelopathy and their influence on choosing the appropriate surgical approach. Fifty five cases with cervical spondylotic myelopathy operated upon at the neurosurgery department, Alexandria University were reviewed. The different clinical and imaging features were analyzed, and parameters for choice of surgical approach were addressed. Among all patients with CSM, neck pain was present in 49%, brachialgia in 67%, mild myelopathy in 44% and moderate myelopathy in 56%. Following cervical laminectomy, neck pain improved in 50% and remained stationary in 50%; brachialgia recovered in 33%, improved in 50% and remained stationary in 17%; mild myelopathy showed good outcome in 80% and fair outcome in 20%; whereas moderate myelopathy showed good outcome in 20%, fair outcome in 60% and poor outcome in 20%. Following anterior discectomy with fusion, neck pain recovered in 28.5%, improved in 38% and remained stationary in 28.5%; brachialgia recovered in 58.5%, improved in 31% and remained stationary in 10.5%; mild myelopathy showed excellent outcome in 17%, good outcome in 58% and fair outcome in 25%; whereas moderate myelopathy showed good outcome in 35%, fair outcome in 30% and poor outcome in 35%. Following cervical laminoplasty, neck pain improved in 100%; brachialgia remained stationary in 100%; mild myelopathy showed good outcome in 100%; whereas moderate myelopathy showed fair outcome in 50% and poor outcome in 50%. Early surgical intervention for CSM is associated with higher recovery rate. Selection of surgical approach depends on age, cord morphology, and spine geometry mostly spinal curve and canal diameter. The presense of cervical spine instability necessitates complementation of spine decompression with spine fixation

Endoscopic removal of third ventricular colloid cysts in non dilated ventricles

Colloid cysts are benign conditions forming not more than 1% of all intracranial neoplasm. The natural history of colloid cysts is not fully understood and the presenting manifestations are usually non specific. Many treatment options have been established for treating colloid cysts, the most recent of them is the endoscopic removal Although small or non dilated ventricles add difficulty to the procedure, yet it is not an obstacle against safe and complete resection. Between 2004 and 2007 we have operated on 10 cases of colloid cysts with non dilated ventricles [average or small sized]. Eight cases were females and two were males. The age ranged between 18 and 43 years. Headache was the outstanding symptom and occurred in all patients. Two patients suffered short term memory deficit. We used the Gaab endoscopic system with an outer sheath diameter of 6.5mm. We used neither neuronavigation nor stereotactic guidance. Follow up period ranged from 35 to 2 monthes. we were able to achieve total cyst removal in all cases. Mild transient short term memory deficit occurred in I patient. There was no mortality. Taping and working inside dilated ventricles are easier than that in smaller ones, however average or even small ventricles are not a contraindication against endoscopic colloid cyst removal even in the absence of neuronavigation and stereotaxy. Still the endoscope in small ventricles can be used safely, effectively with shorter operative period and shorter hospital stay when compared to the traditional operative techniques

Conservative versus surgical management of hypertensive putaminal hemorrhage

Hypertensive putaminal hemorrhage is the most common type of intraparenchymal cerebral hemorrhage, yet the therapeutic policy is still controversial. The aim of this work was to analyze clinical and imaging data of patients with hypertensive putaminal hemorrhage and identify selection criteria for appropriate treatment. Thirty cases with hypertensive putaminal hemorrhage admitted to the neurosurgical emergency unit, Alexandria University were included in the study. All patients were evaluated clinically and using imaging studies. Analysis of data was conducted and parameters suggestive of therapeutic modality were identified. Patients with hypertensive putaminal hemorrhage had acute onset in 86.7% and subacute onset in 13.3%. The clinical course was progressive in 33.3%, regressive in 20%, and stationary in 46.7%. Putaminal hematomas were focal in 6.7%, insular in 13.3%, ruptured in 26.7%, dissecting in 26.7%, and massive in 26.7%. The ipsilateral lateral ventricle was patent in 6.7%, effaced in 40%, obliterated in 26.7%, obstructed in 6.7%, and occluded in 20%. Midline structures were central in 33.3%, mild shift in 33.3%, moderate shift in 13.3%, and severe shift in 20%. Associated brain stem hemorrhage was present in 13.3%. Hypertensive putaminal hematomas have different clinical and imaging presentations. Indications for surgical evacuation include; progressive clinical course, moderate [5-10 mm] and severe [>10 mm] midline shift, as well as dissecting and massive hematomas. Predictors for bad outcome include; old age, major brain attack, massive hematoma, occluded ipsilateral lateral venticle, severe midline shift [>10 mm] and associated brain stem hemorrhage