Post-op lumbar subdural hygroma: a case report.

Lumbar spinal decompression surgery is commonly performed to relieve radicular symptoms to good effect. The formation of post-operative spinal subdural hygroma, or spinal subdural extra-arachnoid hygromas (SSEH) following incidental intra-operative durotomies, have been described in previous literatures. We report a case of a 63 years old lady who had initially underwent an uneventful posterior lumbar decompression for lower limb radiculopathy, without intraoperative durotomy, with development of concurrent SSEH and spinal subarachnoid hygroma (SSSH) during the early post-operative period with cauda equina compression. Urgent surgical intervention was performed with limited durotomy to decompress the cyst through wide fenestration of the arachnoid layers and decompress the cauda equina nerve roots, with immediate recovery of her symptoms. To our knowledge, this is the first case reporting a concurrent post-operative SSEH and SSSH, without intra-operative durotomy. Both of which causing cauda equina nerve root compression which required surgical intervention. When a patient develops early post-operative recurrence of lower limb or cauda equina neurological symptoms after spinal decompression surgery, the rare entities of SSEH and/or SSSH should be considered as one of the differentials even without intraoperative durotomy as in our case. If diagnosis is suspected, surgical exploration should be performed to decompress the hygroma, as the signs and symptoms are readily reversible with prompt and early surgical treatment.

Review of Current Spinal Robotic Orthoses.

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report.

BACKGROUND: Juxtafacet cysts, synovial and ganglion cysts, emanate from the facet joints. Patients with these cysts are typically asymptomatic but may rarely present with radiculopathy and/or myelopathy. CASE DESCRIPTION: A 72-year-old female presented with a 1-month history of progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. Notably, she also had a C7 sensory level to pin appreciation of 1-month duration. The magnetic resonance imaging showed an extradural C7 cystic lesion whose capsule enhanced with gadolinium, causing severe cord compression. The patient underwent a left C7 hemilaminectomy for complete excision of the cyst; postoperatively in 2-weeks duration, she regained full neurological function. The final histopathology was consistent with a ganglion cyst. CONCLUSION: Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.

Recovery of Oculomotor Nerve Palsy after Endovascular and Surgical Treatment of Posterior Communicating Artery Aneurysms: A Single Institutional Experience.

INTRODUCTION: Surgical oculomotor nerve palsy(ONP), defined by ptosis, ophthalmoplegia, diplopia and pupillary dilatation, is associated with intracranial aneurysms, especially posterior communicating artery (PcomA) aneurysms. Treatment of PcomA aneurysms include endovascular coiling and surgical clipping. This study retrospectively compared the recovery of ONP in patients who underwent endovascular coiling or surgical clipping. METHODS: A retrospective review of patients with PcomA aneurysms who presented with ONP between 1998 and 2012 in the National Neuroscience Institute, Singapore, was performed. Inclusion criteria included adult patients of age above 21 who have radiologically confirmed PcomA aneurysms with presentation of ipsilateral ONP. The aneurysms may be unruptured or ruptured with WFNS grade 2 subarachnoid hemorrhage (SAH) or better. Only patients with completely surgically or endovascularly obliterated PcomA aneurysms with regular follow-up are included. RESULTS: A total of 22 patients were recruited. They were treated by either endovascular coiling or surgical clipping. The two groups of patients were demographically comparable, with 11 patients in each arm. 13 (59%) patients had unruptured aneurysms and 9 (41%) had WFNS grade 2 or better SAH. 13 (59%) patients presented with complete ONP and 9 (41%) had partial ONP. 64% of patients who underwent surgical clipping had resolution of ONP completely, compared to 18% of endovascularly coiling (P = 0.03) at 1-month follow-up. CONCLUSION: Compared to endovascular coiling, surgically clipped PcomA aneurysms are associated with a faster rate of full recovery of ONP.

A single institution experience of the incidence of extracranial metastasis in glioma.

Glioblastoma multiforme (GBM) is the most common and aggressive subtype of all gliomas. The prognosis is poor but despite the aggressiveness of the tumour, extracranial metastasis of glioma is rare. Most documented cases of extracranial metastases of GBM involve leptomeningeal spread to the spine. In this clinical study we aim to review the incidence and location of extracranial metastasis of glioma from the Brain Tumor Database of the National Neuroscience Institute of Singapore, between September 2004 to October 2009. Four of 148 patients (2.7%) were identified, one of whom had pleomorphic xanthoastrocytoma (PXA) with scalp and spinal metastasis, suggestive of haematogenous rather than cerebrospinal fluid spread that has been described elsewhere. To our knowledge, there has been no published report of PXA with scalp metastasis or vertebral metastasis.