Visual improvement and pain resolution in traumatic optic nerve sheath meningocele treated by optic nerve sheath fenestration.

PURPOSE: There is no consensus as to the optimum treatment for traumatic optic neuropathy (TON). The decision to intervene medically or surgically, or simply observe was recommended to be on an individual basis. The purpose of this study is to test whether optic nerve sheath fenestration (ONSF) could improve vision in patients with traumatic optic nerve sheath meningocele, although it was reported to be effective in patients with traumatic optic nerve sheath hematoma. METHODS: ONSF was performed on two traumatic patients with dilated optic nerve sheath from MRI. RESULTS: Both patients initially suspected as traumatic optic nerve sheath hematoma were diagnosed as traumatic optic nerve sheath meningocele by intraoperative findings of the enlarged optic nerve sheath and clear fluid drained without evidence of blood in the subdural space. Moreover, significant orbit/head pain resolution and visual improvement within a week after ONSF was found. CONCLUSIONS: When TON presents with an enlarged optic nerve/sheath on CT or MRI with visual loss, an optic nerve sheath meningocele should be considered with the consideration that ONSF may benefit both visual acuity and post-traumatic pain, if present.

Effective analysis on cool-tipped catheter ablation of epicardial accessory pathway / 重庆医学

Objective To investigate the efficacy and safety of cool-tipped saline-irrigated catheter ablation of epicardial accesso-ry pathway in the patients after failure of conventional radiofrequency ablation .Methods 30 patients with epicardial accessory path-way after failuer of conventional radiofrequency ablation were included in this study ,among them ,25 cases of the left accessory pathway and 5 cases of the right accessory prathway used the cool-tipped catheter for conducting ablation through the endocardium (ventricular side or atrial side) or coronary sinus .Results All patients achieved success ,no intraoperative and postoperative related complications occurred .Conclusion The cool-tipped saline-irrigated catheter ablation of epicardial accessory pathway is effective and safe in the patients after failure of conventional radiofrequency ablation ,which may improve the success rate of epicardial acces-sory pathway ablation .

A pyogenic discitis at c3-c4 with associated ventral epidural abscess involving c1-c4 after intradiscal oxygen-ozone chemonucleolysis: a case report.

STUDY DESIGN: A case report and clinical discussion. OBJECTIVE: To describe an unique case of purulent discitis at C3-C4 and an anterior C1-C4 epidural abscess secondary to oxygen-ozone therapy for the herniated cervical discs. SUMMARY OF BACKGROUND DATA: Previously reported complications secondary to ozone therapy are rarely documented. No cases of pyogenic discitis with associated epidural abscess after oxygen-ozone therapy have been reported to date. To our knowledge, this is the first such case reported in literature. METHODS: A 57-year-old female patient with nuchal stiffness was previously treated with ozone therapy at the discs of C3-C4, C4-C5, and C6-C7. Five days later, she presented with an attack of neck pain and fever followed by progressive quadriplegia with sudden onset of dyspnea and was referred to our hospital. On admission, physical examination revealed a temperature of 38.8 degrees C, evident neck tenderness, marked global weakness (grade 1-2/5 MRC) in bilateral upper-limb, and a modest global weakness in bilateral lower-limb (grade 4/5 MRC). Laboratory findings showed a significantly elevated WCC, ESR, and CRP. Blood culture was negative. Enhanced-MR imaging demonstrated a purulent discitis at C3-C4 and a ventral C1-C4 epidural abscess with homogenous enhancement indicative of a solid phlegmonous granulation tissue. RESULTS: We formulated a 3-stage treatment involving C1-C4 multilevel decompressive laminectomies, subtotal unilateral C3-C4 facetectomies, and tissue sampling for culture with application of a corset after surgery, followed by a delayed secondary posterior thorough drainage of epidural liquid pus using a suction-irrigation drainage, after the abscess had turned to a necrotic liquid abscess, on the basis of findings of enhanced-MR imaging, by 10-day duration of intravenously antibiotic therapy tailored to Streptococcus bovis isolated from infected tissue. Over the next few weeks, the patient made an excellent neurologic recovery. However, she did not consent to undergo further occipitocervical fusion until the follow-up MR imaging at 8 months demonstrated postlaminectomy kyphosis. After surgery, the patient remained clinically satisfactory in neurology without evidence of a recurrence of spinal infection. A slight improvement in the cervical spine curve was demonstrated in the follow-up radiograph at nearly 4-month postoccipitocervical fusion. CONCLUSION: This case report illustrates a rare but life-threatening complication of oxygen-ozone therapy for the cervical disc herniation. Infection is a common risk for any invasive spinal techniques involving puncture, so attention should be paid to the sterility during the procedures. A high index of suspicion along with reliance on enhanced-MRI is essential to diagnose the condition and institute appropriate treatment on an individual basis.

Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study.

OBJECT: The purpose of this study was to elucidate the efficacy of endoscopic third ventriculostomy (ETV), the procedure's indications, and prognosis after treatment in patients with communicating hydrocephalus. METHODS: Between August 2002 and January 2007, 32 ETVs were performed in 32 patients with communicating hydrocephalus (24 men and 8 women) at the authors' institution. The patients ranged in age from 25 to 82 years old (mean 61.4 years), and had a follow-up of 2-53 months (mean 14 months). The patients were divided into 2 groups according to the results of preoperative tests. The first group included 17 patients with idiopathic normal-pressure hydrocephalus, and the second group included 15 patients with secondary communicating hydrocephalus who experienced meningitis, spontaneous subarachnoid hemorrhage, or hypertensive intracranial hemorrhage. Both univariate and multivariate statistical analyses were performed to assess the prognostic relevance of the cause of communicating hydrocephalus, the preoperative Kiefer scale score, and hydrodynamic findings in predicting the results after ETV. RESULTS: Excellent results were achieved in 25% of patients, good results in 40.6%, satisfactory in 12.5%, and poor in 21.9% of patients. The authors found that the preoperative Kiefer score and the patient's age had a high correlation with overall ETV outcome. Nineteen patients (59.3%) with comparatively mild symptoms (Kiefer Score 0-10) had a favorable course after ETV. Three patients in this group showed a satisfactory course, and 1 had a poor course. Among patients with Kiefer scores of 11-21 points, 6 (46%) had a favorable course, 1 (8%) a satisfactory one, and 6 (46%) had no relief from symptoms at all. Fourteen (88%) of 16 patients < 65 years of age had a favorable course after ETV. However, only 7 of 16 patients (44%) > 65 years showed definite improvement after ETV. Among the Kiefer score indicators, the preoperative mental state played an important role in predicting ETV outcome. The results of this test imply that the relative risk of ETV failure in a patient with a concentration disorder is about 2 times that in a patient without. Of the 7 patients with secondary communicating hydrocephalus who had elevated intracranial pressure (range 205-265 mm H2O), 5 patients had a favorable result from ETV. Meanwhile, in the same group, 5 (63%) of 8 patients with normal intracranial pressure had an excellent or good result. In comparing the findings on cine MR imaging before and after surgery, there was evidence of a decrease in the velocity and quantity of cerebrospinal fluid flow in the aqueduct after ETV. CONCLUSIONS: The new hydrodynamic concept of hydrocephalus opens the possibility that ETV may be an effective treatment for communicating hydrocephalus. It thus constitutes an interchangeable alternative to shunting. Patient age, analysis of the causes of hydrocephalus, and mental state evaluation play important roles in outcome prediction in patients with communicating hydrocephalus who undergo ETV. Randomized clinical studies are needed to explore further the role of this treatment in communicating hydrocephalus therapy.

Three-dimensional CT angiography and surgical correlation in the evaluation of intracranial aneurysms / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms.</p><p><b>METHODS</b>Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA).</p><p><b>RESULTS</b>A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P < 0.001), revealing that 3D-CT angiograms correlated well with surgical findings. Compared with images obtained by routine catheter four-vessel angiography, MRA and DSA, 3D-CTA images depicted the relationship of aneurysms to parent vessels and other branches more clearly.</p><p><b>CONCLUSION</b>3D-CTA enables surgeons to understand the 3D structure of intracranial aneurysms and is very useful in planning the surgical treatment of cerebral aneurysms.</p>

Effect of intracranial pressure and cerebral perfusion pressure on outcome prediction of severe traumatic brain injury / 中华创伤杂志(英文版)

OBJECTIVE: To investigate the influence of intra cranial pressure (ICP) and cerebral perfusion pressure (CPP) on neurological det erioration and outcome of severe traumatic brain injury (STBI). METHODS: A total of 245 patients with severe traumatic brain in jury were studied retrospectively with univariate and multivariate studies to ev aluate the contribution of ICP/CPP to neurological deterioration and outcome. RESULTS: The mortality rates rose from 16.2% in 142 patient s whose course of disease was smooth to 66.7% in 103 patients who suffered f rom neurological deterioration. Correspondingly, the favorable outcome fall from 54.2% in the patients without neurological deterioration to 18.3% in th ose with neurological deterioration. In the patients with clinical evidence of n eurological deterioration, the relative influence of the ICP and the CPP on outc ome was assessed. The most powerful predictors of neurological deterioration was the presence of intracranial hypertension (ICP>30 mm Hg, 1 mm Hg=0.133 kPa). The CPP also had a prognostic power on neurological deterioration when its level less than 60 mm Hg. CONCLUSIONS: It suggests that it's very important to lower the intracranial hypertension and keep the CPP not less than 60 mm Hg during the t reatment of STBI.