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

Correction of the frontoethmoidal encephalomeningocele with minimal facial incision: modified Chula technique.

BACKGROUND: At present all surgical techniques to correct the frontoethmoidal encephalomeningocele require extensive incisions over the mass and perinasal area, thus adding scars to the already-disfigured faces. This study demonstrates a possibility of doing definitive surgery with minimal facial incision. METHODS: The technique follows the principles of the "Chula technique," which is the one-stage definitive technique without formal frontal craniotomy. However facial incision was kept to minimum, or even avoided, while amputation of the herniation, dural repair, skull defect closure, and repositioning of the medial canthal ligaments were performed mainly via the coronal incision. RESULTS: There were 20 patients operated on using this modified Chula technique. No perinasal incision was needed at all in three patients (15%) with F1 masses (small- and medium-sized masses according to the "FEEM classification"). Three patients with F1 masses had only small stab incisions just medial to the medial canthus for medial canthopexy. The rest (70%) consisting of two F2 (large-sized) masses and twelve F1 masses had limited nasal incisions just to help removing the facial masses and correcting facial deformity. With an average of 287 days of follow-up period (14-997 days), there had been no cerebrospinal fluid leakage or disease recurrence. CONCLUSIONS: Correction of the frontoethmoidal encephalomeningocele can be done safely via the coronal incision alone while facial incision can be omitted or, if necessary, kept to minimum.

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.