Surgical management of Juxtafacet cysts in the lumbar spine.

INTRODUCTION: Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic juxta facet cysts in the Neurosurgical Department of our hospital and review of the literature. METHODS: Data from seven patients (age range 58-68 years, mean age 63 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concominant local pathology, treatment and results of treatment were recorded. After surgery there was no case of a recurrent cyst during the follow-up period. The mean follow-up period of patients at the time of this study was 4 years. RESULTS: All patients had back pain, while five also experienced unilateral radicular leg pain and two had bilateral leg pain. Four patients had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. CONCLUSION: Surgery is a safe and effective treatment for lumbar juxtafacet cysts.

Co-existence of L5-S1 disc herniation and conus medullaris ependymoma.

INTRODUCTION: The lumbar disc herniations are seen very common than spinal ependymomas in the neurosurgery polyclinic routine. PRESENTATION OF CASE: In our case, both pathologies were seen at the most frequently located levels compatible with the literature. Aim of this case report is, to remind once more that, different pathologies can be found at the same time in a single patient; differential diagnosis must be done very carefully. DISCUSSION: The routine Computed Tomography (CT) imaging for low back pain can not show the conus medullaris pathology. Spinal tumors or other similar pathologies should be kept in mind for differential diagnosis. A good medical history and a good physical examination must be completed before the final diagnosis. CONCLUSION: Viewing of spinal canal with Magnetic Resonance Imaging (MRI) will be useful for the patients who we intend to do disc surgery.

Primary rhabdoid tumor of the brain in an adult.

Rhabdoid tumor (RT) is an uncommon childhood neoplasm that typically arises within the kidney. It is characterized by an aggressive clinical course. Since its description in 1978, several cases of primary extrarenal RT, including a CNS localization, have been reported. The first case in the CNS was reported in 1985 and was defined as "rhabdoid tumor" initially, and was classified as grade IV in the most recent classification of the World Health Organization under the term of "atypical teratoid/rhabdoid tumor". Nearly 200 cases of atypical teratoid/rhabdoid tumor of the CNS have been reported to date, most of them occurring in childhood. We report a case of primary RT of the brain located in the right frontal lobe with the clinical, radiographic and pathological features presenting at an unusual age. This tumor, which was composed purely of rhabdoid cells with no additional primitive neuroectodermal, epithelial and mesenchymal components, was in a 27-year-old male patient. In conclusion, RT should be considered also in the differential diagnosis of intracerebral neoplasms of adult patients.

Intraoperative fetal heart rate monitoring during emergency neurosurgery in a parturient.

Malignant brain tumors during pregnancy are rare, and these patients seldom require immediate surgical intervention. A 27-year-old pregnant woman underwent emergency craniotomy. Anesthesia was induced with intravenous thiopental-fentanyl; it was maintained with isoflurane in oxygen and continuous intravenous remifentanil infusion. We used full stomach precautions but omitted succinylcholine for fear of increasing the intracranial pressure during induction of anesthesia. To detect fetal hypoxia and the effects of anesthesia on fetal hemodynamics, the fetal heart rate (FHR) was monitored using a fetal Doppler ultrasonography unit fixed to the mother's abdominal wall. Intraoperative and recovery periods were uneventful. Use of an isoflurane and remifentanil combination provided stable hemodynamics with adequate arterial blood pressure to avoid uterine hypoperfusion and fetal hypoxia. In this case, using FHR monitoring we found that craniotomy can be performed safely under isoflurane/remifentanil based-general anesthesia during the second trimester of pregnancy.