Ulnar nerve entrapment neuropathy at the elbow: decisional algorithm and surgical considerations.

INTRODUCTION: We propose our surgical experience and the decisional algorithm we use to select the surgical procedure for the ulnar nerve entrapment at the elbow according to defined parameters. MATERIALS AND METHODS: Between 2005 and 2007, 44 patients were operated according to our algorithm that is based both on clinical parameters, classified through the McGowan scale, and on biological ones (the nervous morphology and the amount of scar around the medial epicondyle). Patients were treated through "modified" in situ simple decompression, subcutaneous and sub muscular transpositions. RESULTS: After an average follow-up of 13.4 months, function improved by one grade in 70% of patients, two grades in 16% and there was no change in 14%. Moreover 84.8% of patients operated through the modified in situ decompression technique reported an excellent outcome. CONCLUSION: We suggest an algorithm for uniformly treat the patients with cubital tunnel syndrome through a clinical and biological point of view. The modified in situ decompression is a safe and effective treatment for the majority of these patients reducing the risk of redo surgery.

Ulnar nerve entrapment neuropathy at the elbow: decisional algorithm and surgicalconsiderations

Introduction. We propose our surgical experienceand the decisional algorithm we use to select the surgicalprocedure for the ulnar nerve entrapment at theelbow according to defined parameters.Materials and methods. Between 2005 and 2007, 44patients were operated according to our algorithm thatis based both on clinical parameters, classified throughthe McGowan scale, and on biological ones (the nervousmorphology and the amount of scar around the medialepicondyle). Patients were treated through "modified"in situ simple decompression, subcutaneous and submuscular transpositions.Results. After an average follow-up of 13.4 months,function improved by one grade in 70% of patients,two grades in 16% and there was no change in 14%.Moreover 84,8% of patients operated through themodified in situ decompression technique reported anexcellent outcome.Conclusion. We suggest an algorithm for uniformlytreat the patients with cubital tunnel syndrome througha clinical and biological point of view. The modified insitu decompression is a safe and effective treatment forthe majority of these patients reducing the risk of redosurgery (AU)

Introducción. Proponemos nuestra experiencia quirúrgicay el método decisivo que utilizamos para elegirla técnica quirúrgica en el atrapamiento del nervioulnar en el codo según parámetros concretos.Materiales y técnicas. Entre el 2005 y el 2007, 44pacientes han sido sometidos a cirugía según nuestroalgoritmo basado en unos parámetros clínicos, clasificadosa través de la escala de McGrowan, y otros biológicos( morfología del nervio y cantidad de cicatriz entorno al epicóndilo medial). Los pacientes fueron tratadosmediante la decompresión simple "modificada" insitu, la transposición subcutánea y submuscular.Resultados. Después de un control durante 13.4meses, el 70% recuperó la función en un grado, el 16%en dos grados y no hubo cambios en el 14%.Además, el 84,8% de los pacientes operadosmediante la técnica de decompresión modificada in situpresentó excelentes resultados.Conclusión. Proponemos un algoritmo para trataruniformemente pacientes con síndrome del túnelcubital a través de puntos de vista clínicos y biológicos.La decompresión modificada in situ es un tratamientoseguro y eficaz en la mayor parte de pacientes reduciendoel riesgo de reintervención (AU)

[Cervical vertebral and spinal cord injury in intensive therapy]. / Il trauma vertebro-midollare cervicale in terapia intensiva.

24 of 184 patients with vertebro-medullary trauma admitted to the Neurosurgery Clinic of Milan University in the years 1976-1988 have been examined. A common feature of these was a myelic lesion (transverse, complete or incomplete) at cervical level in which respiratory problems had made a period of intensive care indispensable. The purpose of the research was to assess the reliability of certain parameters in establishing patient prognosis. The following parameters were compared: clinical, objective and instrumental examination for a strictly neurological evaluation and for an evaluation of general condition, quantification of the same clinical examination through two scales, the Sunnybrook Cord Injury Scale (SCIS) for the neurological factor and the APACHE II for general condition, the type of treatment, with the same basic medical-resuscitation treatment. The result of the surgery or non-surgery was considered a posteriori. It is concluded that, in the case of the patients considered (high myelic lesion) the prognosis must be split into two different moments that the patient goes through in succession: the acute phase and the stabilisation phase. In the first phase, in which the vital functions are involved, the SCIS and APACHE II scales (with their sum) have great prognostic value; in the second phase, certain values, already considered on the APACHE II scale, are comparable in all patients and the prognostic problem is based on the other scale (SCIS) and on the adjuvant neurophysiological techniques. The very distinction between the two different phases that the patient traverses appears important also for the purposes of surgical indication.2

Acute bilateral epidural hematomas. Report of two cases and review of the literature.

Two cases of acute postraumatic bilateral epidural hematomas with different clinical pictures are presented. In the review of the literature, acute, subacute and delayed bilateral epidural hematomas must be found. Clinical findings, results of CT scan and pathophysiology are discussed.

Non tumoral aqueduct stenosis. Multiple microscopic subependymal glial protuberances demonstrated at hystological examination.

A case of hydrocephalus associated to aqueduct stenosis is described. The microscopic examination showed aqueduct gliosis which was not possible to distinguish congenital or acquired.