Lumbar spinal osteoblastoma mimicking a dumbbell radicular schwannoma.

Spinal dumbbell tumors originate from nerve roots, usually growing within the spinal canal, the neural foramen and the extraforaminal compartment in the paraspinal region. We report a case of a 20-year-old man who presented with back pain radiating to his left lower limb mostly when in a supine position. Magnetic resonance imaging of the lumbar spine showed a dumbbell lesion at the L5-S1 neural foramen, with enlargement of the foramen and extension into the left paraspinal compartment. Although MR imaging studies were strongly suggestive of a dumbbell radicular schwannoma, the histological diagnosis was an osteoblastoma of the lumbar spine originating from the left L5 pedicle with intracanalicular, intraforaminal and extracanalicular extension. The presentation, imaging studies, intervention, pathology and differential diagnosis are described.

Balloon-assisted endoscopic retroperitoneal gasless approach (BERG) for lumbar interbody fusion: is it a valid alternative to the laparoscopic approach?

OBJECTIVE: In the last years the use of interbody fusion devices with an anterior spinal lumbar approach has become a common procedure for the treatment of degenerative disc disease and spinal instability. We analysed our series of a simplified endoscopic approach to the anterior spine and made a review of the retroperitoneal endoscopically assisted approach to the anterior lumbar spine in the international literature. METHODS AND RESULTS: From 1999 through 2002, twenty consecutive "balloon-assisted endoscopic retroperitoneal gasless (BERG)" lumbar fusions were performed at San Filippo Neri Hospital in Rome, Italy. The surgical indications included patients with grade I or II spondylolisthesis and symptomatic degenerative disc disease with foraminal stenosis. Fourteen patients underwent a single level fusion (4 cases at L4-L5; 10 cases at L5-S1) and six patients underwent a double level fusion (L4-L5 and L5-S1). Mean operating time was 135 minutes (single level fusion), 175 minutes (double level fusion) and the mean intraoperative blood loss was 177 mL. No perioperative complications were observed and no procedure was converted to open surgical fusion. Patients were allowed to ambulate on the second postoperative day. Fusion was achieved in nineteen patients (fusion rate of 95%) 12 months after surgery. CONCLUSIONS: The BERG technique is a safe, effective, simplified, less technically demanding alternative approach when performing ALIF procedures, without the morbidity associated with laparoscopic or traditional approaches.

Clinical results of epidural spinal cord electrical stimulation in patients affected with limb-threatening chronic arterial obstructive disease.

Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4 +/- 10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. The overall limb salvage rate was 42%. Pain control was obtained in 80% of patients at the one-year and 75% at the two-year follow-up, with infrequent use of pain relievers. Despite the poor clinical results observed, the limb salvage rate testifies to the effectiveness of ESES in limb-threatening ischemia. Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods. In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.

Spinal cord stimulation (SCS) in peripheral ischemic pain.

Between 1982 and 1987, 45 patients suffering from painful symptomatology caused by peripheral vascular disease, not curable by medical or surgical therapy, were implanted with epidural neurological stimulators. Measurements used in evaluating the effectiveness of the method were pain control, walking distance, and development of trophic problems. With most patients, we noted a satisfactory and long-lasting degree of pain control. Walking distance increased to a surprising degree. Trophic lesions smaller than 3 sq cm healed, while lesions of greater size required amputation of the limb. Transcutaneous oxygen tension (TcpO2) was used to study the effects of SCS on peripheral circulation in implanted patients. In addition, TcpO2 was calculated in 15 patients before and during the percutaneous test to predict the effectiveness of SCS. Regression of painful symptomatology was achieved only in patients whose TcpO2 improved during the course of the testing. Therefore, this method provides an objective measure for the implantation of neurostimulator.

[New simplified technic for cranioplasty. Technical note]. / Una nuova tecnica semplificata di cranioplastica. Nota tecnica.

The authors report a new simplified technique of cranioplasty in order to repair wide losses of bony substance, particularly useful after wide craniectomies or decompressive craniectomies. They also underline the aesthetic result of such technique which is analogous to the same repair carried out with the patient's bony strip.

Modifications of transcutaneous oxygen tension in lower limb peripheral arterial occlusive disease patients treated with spinal cord stimulation.

The current noninvasive techniques for investigating the response to epidural spinal cord stimulation in peripheral arterial occlusive disease patients are far from optimal. Transcutaneous oxygen tension measurements in these patients treated with spinal cord stimulation demonstrated a statistically significant increase during the stimulation and 30 min after the pacemaker has been switched off, suggesting the effectiveness of the spinal cord stimulation on cutaneous oxygenation. The transcutaneous oxygen tension measurements would represent in the future a reliable parameter to predict the effect and to modulate the pacemaker setting in peripheral arterial occlusive disease patients.

Association of two saccular aneurysms of the posterior inferior cerebellar artery with a cerebellar arteriovenous malformation fed by the same artery. Case report.

Coexistence of posterior fossa aneurysms and AVMs on the same feeding artery is very rare; the case of an association of two saccular aneurysms of the posterior inferior cerebellar artery with a cerebellar arteriovenous malformation of the same artery is reported. Theories concerning etiology are reported as well.

[Subarachnoid hemorrhage as the 1st clinical manifestation of neurinoma of the acoustic nerve]. / Emorragia sub-aracnoidea, prima manifestazione clinica di un neurinoma dell'acustico.

The association of sub-arachnoidal hemorrhage and benignant tumors of the pontocerebellar angle represent a rare event. The authors describe a case of neurinoma of the acoustic nerve which revealed itself with a sub-arachnoidal hemorrhage. After recalling the other only observation reported in literature, the authors discuss both its clinic and etiopathogenesis.