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1.
BMJ Case Rep ; 20132013 Jan 11.
Article in English | MEDLINE | ID: mdl-23314873

ABSTRACT

A 24-year-old man with a history of Klippel-Trenaunay-Weber syndrome presented with severe headache and neck pain. Work-up revealed subarachnoid hemorrhage and evidence of multiple intracranial aneurysms. The patient was treated with open surgical clipping of his ruptured aneurysm and is currently doing well.


Subject(s)
Aneurysm, Ruptured/surgery , Intracranial Aneurysm/surgery , Klippel-Trenaunay-Weber Syndrome/complications , Subarachnoid Hemorrhage/surgery , Aneurysm, Ruptured/etiology , Cerebral Angiography , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/etiology , Male , Subarachnoid Hemorrhage/etiology , Young Adult
2.
Int J Spine Surg ; 7: e39-41, 2013.
Article in English | MEDLINE | ID: mdl-25694902

ABSTRACT

PURPOSE: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF. METHODS: The 2 cases presented in this technical note illustrate resolution of s-EMG firing during LTIF, following distraction across the disk space. Removal of the distracting device produced the return of s-EMG firing. Both of these cases were operated at the L2-3 level. RESULTS: In the first case, s-EMG firing was noted in the bilateral tibialis anterior leads. Resolution of EMG firing may suggest indirect decompression of the canal via ligamentotaxis as the L5 root traverses the L2-3 disk space. In the second case, s-EMG firing was noted in the left abductor hallucis and resolved with distraction of the L2-3 disk space. Again, this may be explained by canal decompression via ligamentotaxis as the S1 root traverses the L2-3 disk space. CONCLUSION: In both cases, distraction across the disk space resulted in resolution of s-EMG discharges-this correlated with an improvement in symptoms. These findings may suggest a role for s-EMG as a marker for adequacy of decompression in a select subset of patients undergoing LTIF. Further study is needed to determine if resolution of s-EMG is a useful measure of indirect decompression during LTIF.

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