Percutaneous vertebroplasty at C2: case report of a patient with multiple myeloma and a literature review.

Percutaneous vertebroplasty (PVP) of the axis is a challenging procedure which may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. We report a case of unstable C2 fracture treated with the percutaneous approach. The fracture was the first manifestation of multiple myeloma in a previously healthy 47-year-old woman. After local radiotherapy and chemotherapy, the fracture was still unstable and the patient had been continuously wearing a stiff cervical collar for 9 months. Complication-free PVP resulted in pain relief and stabilization and use of the cervical collar could be discontinued. At 18 months follow-up the patient remained free from pain, the fracture was stable and she had returned to work. The purpose of this article is to present the technical facts and to highlight the benefits and potential complications of the procedure. The technical characteristics of the procedure, the indication and results of the present case are discussed together with previously reported cases of PVP treatment at C2.

[Venous malformations in the head and neck should be treated]. / Venösa kärlmissbildningar i huvud och hals bör behandlas.

Vascular lesions are tumours or malformations. Haemangioma is the most common tumour. It disappears at the age of seven. Malformations may be arterial, capillary, venous, arteriovenous, lymphatic or mixed. The vascular malformations do not disappear. There are several options for treating venous or lymphatic malformations. One of them is sclerosing therapy with Sotradecol by direct puncture. We have 15 years' experience of this method but present only the last 60 patients, treated between 1997 and 2001. Excellent or good results were seen in 59 patients. No permanent complications occurred. It is important to know the nomenclature and the different options for treatment as discussed in the International Society for the Study of Vascular Anomalies.

[Percutaneous vertebroplasty--a new method for alleviation of back pain]. / Perkutan vertebroplastik--ny metod för lindring av ryggsmärta.

Percutaneous vertebroplasty (PV) is an interventional radiological procedure for the treatment of pain in patients with vertebral compressions caused by osteoporosis, metastases or hemangioma. The method was introduced by Professors P Galibert and H Deramond at the University Hospital of Amiens, France in 1984. It consists of percutaneous injection of bone cement (polymethylmethacrylate) into the vertebral body under fluoroscopy guidance. PV has proved to be effective and safe. Permanent complete or partial pain relief is obtained within hours or days in more than 90% of cases. The complication rate is low, less than 3% for patients with osteoporosis and up to 10% in patients with metastases. We report on the first 17 patients (11 with osteoporosis, 3 with metastases and 3 with hemangiomas) treated in Sweden at the Department of Interventional Neuroradiology, Sahlgrenska Hospital, Göteborg University. We obtained complete pain relief in 71% and partial pain relief in 17% of cases. The majority of the patients improved in mobility and quality of life. We had no clinical complications.

Juvenile nasopharyngeal angiofibroma: long-term results in preoperative embolized and non-embolized patients.

A treatment and follow-up study of 32 patients with juvenile nasopharyngeal angiofibroma (JNA) was performed at our clinic between 1974 and 1998. The majority had undergone surgery either via an antral approach or with a lateral rhinotomy. In the 1970s, surgery was combined with ligature of the external carotid artery and, since 1981, it has been combined with preoperative embolization. Two patients received radiotherapy (45 Gy) as primary treatment and the 3 cases of multiple recurrence received radiotherapy (30-45 Gy) as secondary treatment. No recurrence was found in patients treated with radiotherapy. The overall recurrence rate was 25%; the recurrence rate in non-embolized patients was 8% and among embolized patients it was 41%. We found no statistically verified differences in recurrence rate between embolized and non-embolized patients. No statistically significant difference was found in either recurrence or peroperative bleeding when comparing preoperatively embolized patients with non-embolized patients. Regression analyses showed that the only factor affecting recurrence was age, i.e. the younger the patient was at diagnosis the greater the risk of developing recurrence. The development of imaging and embolization techniques will hopefully contribute in the future towards reducing the recurrence rate.