ABSTRACT
BACKGROUND: Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology. CASE SUMMARY: A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up. CONCLUSION: PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.
ABSTRACT
Trigeminal neuralgia affects approximately 182 in 100,000 Chinese, and the number keeps increasing these years. The role of surgery for patients with medically refractory trigeminal neuralgia is well established. Computed tomographic images provided by the First Affiliated Hospital of Jilin University were used to reconstruct the 3-dimensional skull models. We measured the positional relationship between oval foramen and trigeminal impression to analyze the relatively safe puncture angle for the internal carotid artery protection. Point O, A, and B are the projection of 3 points on plane C: the center of oval foramen, the medial edge of trigeminal impression, and the lateral edge of trigeminal impression, respectively. The length of OA was 11.02 mm (95% confidence interval [CI], 10.64-11.40 mm), and OB was 13.59 mm (95% CI, 13.20-13.98 mm). Angle study included the angle contained by the median sagittal plane and OA or OB, angle α or ß, and the angle contained by OA and OB, angle γ. Angle α was 50.74 degrees (95% CI, 48.60-52.88 degrees). Angle ß was 6.62 degrees (95% CI, 4.02-9.22 degrees). Angle γ was 44.12 degrees (95% CI, 41.95-46.29 degrees). So the ideal horizontal angle between the needle axis and the median sagittal plane ranges between angle α and ß, 6.62 to 50.74 degrees, and the best puncture angle should be 33.18 degrees. The depth of needling insertion after entering the oval foramen should be less than the minimum length of the 95% CI of OA and OB, 10.64 mm.
