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1.
J Neurosurg Sci ; 50(2): 45-8, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16841027

ABSTRACT

This paper illustrates the repair of a complex and unusually placed iatrogenic injury of the brachial plexus. The authors present the case of a 36-year old woman, musician (piano solista), with a dumbbell tumour of the brachial plexus. A general surgeon performed a gross total removal of the tumour, cutting it flush with the exit of the neuroforamen and this resulted in a severe upper brachial plexus injury. Four months later, the brachial plexus was repaired with a nerve graft, using a double extraforaminal and preforaminal approach via the transarticular route. The surgical procedure proved to be effective and without significant consequences for the patient.


Subject(s)
Brachial Plexus/injuries , Brachial Plexus/surgery , Nerve Transfer/methods , Neurofibroma/surgery , Peripheral Nervous System Neoplasms/surgery , Adult , Brachial Plexus/pathology , Cervical Vertebrae/surgery , Female , Humans , Neurofibroma/diagnosis , Peripheral Nervous System Neoplasms/diagnosis , Peripheral Nervous System Neoplasms/pathology
2.
J Neurosurg Sci ; 48(3): 105-12; discussion 112, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15557879

ABSTRACT

AIM: Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries. METHODS: A 62-patient series controlled over a period of 15 years with a post-traumatic palsy of the CPN is reported. All the patients underwent surgery. In open wounds, when a nerve transection was suspected, surgery was performed at emergency (2 cases). In closed injuries, operative treatment was advised when no spontaneous regeneration occurred 3-4 months after the injury. From 1988 till 1991, 9 patients were elected for surgery : in 6 cases treatment consisted of neuroma resection and nerve repair by means of a graft. In 3 patients it was performed only a CPN decompression at the fibular neck. Since 1991, surgical treatment has always consisted of nerve repair associated with a tendon transfer during the same procedure. Fifty-three patients were elected for surgery. Nerve repair was achieved by direct suture in 1 case and by means of a graft in 46 patients. Decompression of the CPN at the fibular neck was performed in 6 patients where nerve continuity was demonstrated. RESULTS: In the first group of patients, nerve repair outcome was highly disapponting: no recovery in 5 cases, reinnervation occurred in 1 patient only (M1-2). CPN decompression was followed by complete recovery in 2 cases, no improvement was observed in 1 case. Nerve repair associated with tibialis tendon transfer dramatically improved the postoperative outcome: at 2 year follow-up, neural regeneration was demonstrated in 90% of the patients. Surgical outcome depends on the causative mechanisms of the lesion: sharp injuries and severe dislocations of the knee had an excellent recovery, while in crush injuries and gunshot wounds good recovery was less common. CONCLUSION: Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.


Subject(s)
Nerve Regeneration/physiology , Peroneal Nerve/injuries , Peroneal Nerve/surgery , Peroneal Neuropathies/surgery , Tendon Transfer/methods , Tendon Transfer/standards , Tissue Transplantation/methods , Adolescent , Adult , Anastomosis, Surgical/methods , Decompression, Surgical/methods , Female , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/prevention & control , Gait Disorders, Neurologic/surgery , Humans , Knee Dislocation/complications , Knee Dislocation/surgery , Male , Middle Aged , Muscle Contraction/physiology , Muscle, Skeletal/innervation , Muscle, Skeletal/physiology , Muscle, Skeletal/surgery , Neuroma/etiology , Neuroma/pathology , Neuroma/surgery , Patient Selection , Peroneal Nerve/physiopathology , Peroneal Neuropathies/etiology , Peroneal Neuropathies/physiopathology , Recovery of Function/physiology , Sural Nerve/anatomy & histology , Sural Nerve/surgery , Tendons/anatomy & histology , Tendons/physiology , Tendons/surgery , Time Factors , Treatment Outcome
3.
J Orthop Traumatol ; 2(3): 135-7, 2002 Jun.
Article in English | MEDLINE | ID: mdl-24604491

ABSTRACT

We report our experience in the treatment of common peroneal nerve (CPN) palsy following knee dislocations: a twelve-year surgical series of 26 patients presenting with a traumatic injury of the lateral sciatic nerve and no spontaneous recovery is reviewed. From 1988 to 1991, we performed nerve surgery alone on 3 patients. Their results were highly disappointing and in none did we observe muscle recovery. Since 1991 nerve surgery was associated with a palliative procedure for 23 patients. Although at surgical exploration, severe nerve damage was found in 87% of these patients (thereby indicating the need for graft repair), the overall outcome was good, with a score of M3 on the BMRC scale in about 75% of the cases. These results suggest that the one-stage association of microsurgical nerve repair and tibialis posterior tendon transfer changed the destiny of these injuries.

4.
Dis Colon Rectum ; 38(2): 121-4, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7851164

ABSTRACT

PURPOSE: Management of perianal Crohn's disease is still controversial, and reports on large series are very few in the literature. The aim of this multicenter study was to investigate the outcome of both medical and surgical treatment in 225 patients. METHODS: Patients cared for at different institutions were followed up for a median of six years. Most of them had either anal fistula or an abscess (86 percent and 43 percent, respectively), but fissures were also present in 26 percent of the cases. Diarrhea and anal pain were the most common symptoms. Anal lesions preceded the onset of intestinal symptoms in 19 percent of cases. RESULTS: Medical treatment was curative only in 21 of 123 patients. Overall, medical and surgical treatment either cured or improved 62 percent of the cases. Fifty percent had an intestinal resection. Abscess drainage and fistulotomy were the most common anal surgeries. Rectovaginal fistulas (n = 30) required intestinal surgery in 36 percent and anal surgery in 20 percent of the cases, 50 percent with good results. Of 166 patients who had anal surgery, 97 (58 percent) had a positive outcome. Recurrence of anal disease requiring further surgery occurred in 24.5 percent of the cases. CONCLUSIONS: Limited surgeries seem to achieve satisfactory results in more than one-half of the patients affected by perianal Crohn's lesions, whereas medical treatment alone is curative in a small portion of them.


Subject(s)
Anus Diseases/drug therapy , Anus Diseases/surgery , Crohn Disease/drug therapy , Crohn Disease/surgery , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Aminosalicylic Acids/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anus Diseases/classification , Child , Colostomy/methods , Crohn Disease/diagnosis , Female , Follow-Up Studies , Humans , Ileostomy/methods , Male , Mesalamine , Metronidazole/therapeutic use , Middle Aged , Reoperation , Sulfasalazine/therapeutic use , Treatment Outcome
5.
Minerva Gastroenterol Dietol ; 40(2): 95-8, 1994 Jun.
Article in Italian | MEDLINE | ID: mdl-8054394

ABSTRACT

The authors describe a case of antral Watermelon Stomach (WS) in a seventy-eight year old woman with severe iron-deficient chronic anemia, liver cirrhosis and diabetes mellitus. Endoscopy was diagnostic on the 3rd-4th examination because of the disease's rarity and the concomitance of systemic pathologies, such as portal hypertension, in which often a congestive gastropathy with similar aspects is associated. Whether out of clinical evolution, or capillary thrombosis, or vertical fibromuscular hyperplasia of the lamina propria were considered distinctive elements. By means of literature review it wasn't possible to establish the portal hypertension's prevalence out of the WS cases, but it could be a chance factor. In this way some polycentric prospective trials could be useful. The endoscopic practice is important not only for diagnosis but also for therapeutical means, even if in our case surgery was the chosen treatment.


Subject(s)
Stomach Diseases , Aged , Anemia, Hypochromic/complications , Endoscopy , Female , Humans , Liver Cirrhosis/complications , Stomach/pathology , Stomach Diseases/diagnosis , Stomach Diseases/pathology , Syndrome
6.
Neurochirurgie ; 33(1): 38-43, 1987.
Article in French | MEDLINE | ID: mdl-3561645

ABSTRACT

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.


Subject(s)
Cervical Vertebrae/surgery , Laminectomy/methods , Spinal Stenosis/surgery , Adult , Female , Humans , Male , Middle Aged , Radiography , Spinal Stenosis/congenital , Spinal Stenosis/diagnostic imaging
7.
Surg Neurol ; 26(5): 441-52, 1986 Nov.
Article in English | MEDLINE | ID: mdl-3764649

ABSTRACT

Eighteen unusual cases of intracranial meningioma associated with a cyst are considered. Three patients were operated upon before the introduction of computed tomography scanning, and the discovery of a peritumoral cyst was unexpected. Among 15 patients studied with computed tomography, 8 had a peritumoral cyst, 6 had an intratumoral cyst, and 1 had a totally cystic meningioma (hypodense on computed tomography). Computed tomography permitted a correct preoperative diagnosis only in four cases. In six additional cases diagnosis was reached by selective angiographic studies. In the remaining cases diagnosis was impossible or incorrect. Different pathogenetic mechanisms underlie different radiologic patterns. The authors comment on the complex processes that lead to cyst formation in meningiomas and stress the necessity of an accurate preoperative study to avoid misdiagnosis.


Subject(s)
Cysts/complications , Meningeal Neoplasms/complications , Meninges , Meningioma/complications , Adult , Aged , Brain Diseases/complications , Brain Diseases/diagnostic imaging , Cerebral Angiography , Cysts/diagnostic imaging , Female , Humans , Male , Meningioma/diagnostic imaging , Middle Aged , Tomography, X-Ray Computed
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