Localizing value of pain distribution patterns in cervical spondylosis.

STUDY DESIGN: Prospective observational study. PURPOSE: To investigate the value of pain distribution in localizing appropriate surgical levels in patients with cervical spondylosis. OVERVIEW OF LITERATURE: Previous studies have investigated the value of pain drawings in its correlation with various features in degenerative spine diseases including surgical outcome, magnetic resonance imaging findings, discographic study, and psychogenic issues. However, there is no previous study on the value of pain drawings in identifying symptomatic levels for the surgery in cervical spondylosis. METHODS: The study collected data from patients with cervical spondylosis who underwent surgical treatment between August 2009 and July 2012. Pain diagrams drawn separately by each patient and physician were collected. Pain distribution patterns among various levels of surgery were analyzed by the chi-square test. Agreement between different pairs of data, including pain diagrams drawn by each patient and physician, intra-examiner agreement on interpretation of pain diagrams, inter-examiner agreement on interpretation of pain diagrams, interpretation of pain diagram by examiners and actual surgery, was analyzed by Kappa statistics. RESULTS: The study group consisted of 19 men and 28 women with an average age of 55.2 years. Average duration of symptoms was 16.8 months. There was no difference in the pain distribution pattern at any level of surgery. The agreement between pain diagram drawn by each patient and physician was moderate. Intra-examiner agreement was moderate. There was slight agreement of inter-examiners, examiners versus actual surgery. CONCLUSIONS: Pain distribution pattern by itself has limited value in identifying surgical levels in patients with cervical spondylosis.

A levering technique for open reduction of traumatic unilateral locked facets of cervical spine: technical note.

Reduction of traumatic unilateral locked facets of the cervical spine can be accomplished by closed or open means. If closed reduction is unsuccessful, then open reduction is indicated. The previously described techniques of open reduction of a unilateral locked facets of the cervical spine in the literature included drilling facet, forceful manipulation or using special equipment. We describe a reduction technique that uses a basic spinal curette, in a forceless manner, and it does not need facet drilling. We have successfully used this technique in 5 consecutive patients with unilateral locked facets. There have been no complications related to this technique.

Duration of symptoms in brain tumors: influencing factors and its value in predicting malignant tumors.

BACKGROUND: Although brain tumor is a common neurosurgical condition, diagnosis is generally made after long duration of symptoms. This may have negative impact on treatment outcome. OBJECTIVE: Study the duration of symptoms of brain tumor, how it is influenced by various factors, and find their value in predicting malignant tumors. MATERIAL AND METHOD: The authors retrospectively reviewed 185 patients with pathologically proven brain tumors. Pertinent data including age, types of tumors, locations of tumors, symptoms, and duration of symptoms were analyzed by univariate and multivariate analysis. RESULTS: There were 70 males and 115 females. The mean age at diagnosis was 47.3 years. The average duration of symptoms was 471 days with median of 120 days. On univariate analysis, hormone symptoms (p = 0.001), age more than 45 years old (p = 0.005), malignant tumor (p < 0.001), auditory symptoms (p = 0.004), and motor symptoms (p < 0.001) had significant influence on duration of symptom. In multivariate analyses, malignant types of tumor, age, and hormonal symptoms were significant. In addition, there was higher risk of malignant brain tumor in patients with duration of symptoms 1 month or less (p < 0.001). CONCLUSION: Certain factors were associated with longer duration of symptoms in brain tumors. This information may lead to early diagnosis of brain tumors. Furthermore, duration ofsymptoms of 1 month or less was suggestive of malignant brain tumors.

The outcome of surgical treatment for tumors of the craniocervical junction.

OBJECTIVE: The authors report the clinical, radiological, and surgicalfindings ofpatients with craniocervical junction tumors surgically treated in the institution over the last 8 years. MATERIAL AND METHOD: A retrospective study was performed. Clinical, radiological, and operative data were evaluated, and follow-up information was obtained from outpatient examinations, and telephone interviews. RESULTS: There were 25 patients consisting of nine chordomas, eight meningiomas, three cysts, two schwannomas, one each of aneurysmal bone cyst, plasmacytoma, and metastasis. Twenty-nine operative procedures were performed, classified as 12 anterior nine posterior-lateral, and eight posterior approaches. Gross total removal was achieved in 17 cases, subtotal removal in six cases, and partial removal in two cases. Re-operation was performed in six cases. Median follow-up time was 31 months. The authors found significant improvement in Karnofsky Performance Scale scores. CONCLUSION: Appropriate surgical approaches provide successful tumor removal with less surgical morbidities, nevertheless recurrent tumors occasionally occur and so, long-term follow-up is mandatory.

Successful resection of Hypothalamic Hamartoma with intractable gelastic seizures--by transcallosal subchoroidal approach.

A 19-year old female with intractable gelastic seizures was found to have 0.7 x 1.8 x 1.8 cm elliptical mass on the floor of the third ventricle. The signal intensity on the Magnetic Resonance Imaging (MRI) was consistent with the Hypothalamic Hamartoma (HH). Ictal EEG demonstrated rhythmic 7 Hz waves over Fp2, F4, and C4 with spreading to the right temporal region and then bilaterally. Ictal Single Photon Emission Computerized Tomography (SPECT) showed hyperperfusion at hypothalamic and medial frontopolar regions. The patient underwent surgical resection using Trans Callosal Subchoroidal Approach (TCSA) to the third ventricle. Pathological finding confirmed the diagnosis of hypothalamic hamartoma. Following the operation, she has been seizure free up to 12 months. Thereafter, provoked seizures seldom occurred and there has been improvement in her memory, emotional control and independence. This appears to be the first report of this surgical approach for HH, which is less likely to disturb memory function compared to previously described interfoniceal approach.

Three-dimensional frameless stereotactic-guided pedicle screw fixation of the spine: early experiences in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To study the accuracy and safety of pedicle screw insertion by three-dimensional frameless stereo-tactic-guided technique. MATERIAL AND METHOD: Twelve patients underwent spinal surgery using three- dimensional frameless stereo-tactic-guided technique at King Chulalongkorn Memorial Hospital (KCMH) during June - December 2004. In all patients, post-operative CT scan of the operated spinal segments were obtained and evaluated for the position of each screw placed. Medical records were reviewed and all patients were interviewed by telephone to assess clinical outcomes and complications RESULTS: 5I pedicle screws were inserted in 12 patients. Postoperative CT scan of the instrumented spine revealed that 50 screws were considered grade I screw while one screw was considered grade II. No patient suffered direct vascular or neurological injury. CONCLUSION: Three-dimensional frameless stereotactic-guided technique provides additional safety to spinal instrumentation

Currarino syndrome: report of two cases and review of the literature.

In the present paper the authors examine two cases of Currarino syndrome and review the existing literature on the disease. Both cases presented with chronic constipation. The first concerns a two year old male born with anorectal stenosis and diagnosed with Currarino syndrome when scimitar sacrum and anterior meningocele were finally detected. The second concerns a 25 year old female who suffered from chronic constipation but was not diagnosed until thorough examination revealed ectopic anus with Hirschsprung disease, scimitar sacrum and anterior meningocele. Because these patients were not diagnosed with Currarino syndrome when first seen, the authors reviewed its prevalence, embryogenesis, clinical manifestations, diagnosis and treatment. The authors' research supports the significance of prompt diagnosis in effective treatment and reduction of morbidity.

Supratentorial lobar anaplastic ependymoma resembling cerebral metastasis: a case report.

A 45-year-old man presented with progressive deterioration of vision. Visual acuity test revealed no light perception in both eyes. The fundoscopic examination demonstrated pale optic discs, consistent with secondary optic atrophy. Preoperative neuroimaging studies revealed a well-defined contrast-enhancing mass, 3 cm in diameter, at the left parietal region. Its radiologic appearances simulated those of cerebral metastases. A totally removed lesion was verified pathologically as an anaplastic clear cell ependymoma, which is rare in this location. A brief review of clinical features and neuroimaging of supratentorial lobar ependymoma is also included.