RESUMEN
INTRODUCTION: Lumbar disc herniation is most common degenerative alteration of the spine. Whenever surgical therapy proves to be necessary, recurrent disc herniation is most frequent concern. Here, primary aim was to determine the percentage of patients eligible for insertion of an annular closure device (ACD). Secondary aim to evaluate 12-month incidence of recurrent disc herniation at the operated level. Our hypothesis was that ACD might help in preventing recurrent disc herniation. METHODS: Patients in a single Swiss neurosurgical center underwent limited discectomy alone (n=41, group 1) versus limited discectomy plus ACD (n=12, group 2). Mean postoperative follow-up period was 12months. RESULTS: Twelve out of 53 patients (22.6%) were eligible for ACD implantation. Patients of group 2 were significantly taller (mean 176cm, P=0.007) as compared with group 1 (mean 170). The only statistically significant difference of intraoperative parameters between group 1 and 2 was amount of nucleus materiel removed (P=0.01), being greater in group 2 (mean 0.9) as compared with group 1 (mean 0.3). In group 1 six patients (6/41, 14.6%) presented with symptomatic reherniation at same level of surgery, while in group 2 only one patient experienced recurrence (1/12, 8.3%). No adverse events were reported. DISCUSSION: In the current study one out of five patients with lumbar disc herniation was considered suitable for ACD placement. In vast majority of these patients reherniation was precluded on the short-term basis. Patients with ACD were taller and had intraoperatively a higher volume of the nucleus pulposus materiel removed.
Asunto(s)
Anillo Fibroso , Desplazamiento del Disco Intervertebral , Anillo Fibroso/cirugía , Discectomía , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Central neurocytoma are rare primary brain tumors of the young and middle-aged adult, typically located in the lateral ventricles. Diagnosis has historically been difficult due to histomorphologic similarities to oligodendroglioma and ependymal tumors and remains a challenge even today. We present two cases of intraventricular central neurocytoma in which careful consideration of the clinical and radiological findings led to reevaluation of the preliminary histological interpretation, highlighting the importance of a meticulous differential diagnosis.
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Neoplasias Encefálicas , Neurocitoma , Oligodendroglioma , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Diagnóstico Diferencial , Humanos , Ventrículos Laterales , Persona de Mediana Edad , Neurocitoma/diagnóstico por imagen , Neurocitoma/cirugía , Oligodendroglioma/diagnósticoRESUMEN
Spinal infections with Eikenella corrodens are rare. We report a unique case of infection caused by E. corrodens diagnosed more than two years after cervical surgery. All other published cases of spinal infections caused by E. corrodens were searched. Characteristics of this bacterium, its challenging diagnosis and therapy are discussed.
Asunto(s)
Eikenella corrodens , Infecciones por Bacterias Gramnegativas/microbiología , Enfermedades de la Columna Vertebral/microbiología , Adulto , Antibacterianos/uso terapéutico , Descompresión Quirúrgica , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/etiología , Humanos , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Dolor de Cuello/cirugía , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiologíaRESUMEN
The classic cervicobrachialgia results acutely from cervical nerve root compression by disc herniation or subacutely by radicular compression after progressive spondylotic changes of the cervical spine. The clinical presentation includes local and radiating pain syndromes that can be accompanied by sensorimotor deficits. Besides the medical history and a targeted clinical examination, supplementary radiographic means should be undertaken to confirm diagnosis. If no urgent surgical indication exists, conservative therapy should be initiated. However, with varying results of conservative and surgical therapy, chronic impairment can occur.
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Neuritis del Plexo Braquial/cirugía , Adulto , Factores de Edad , Anciano , Algoritmos , Neuritis del Plexo Braquial/diagnóstico , Neuritis del Plexo Braquial/epidemiología , Neuritis del Plexo Braquial/etiología , Terapia Combinada , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/epidemiología , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/rehabilitación , Fusión VertebralRESUMEN
Spinal tumors are classified according to their location in extradural, intradural-extramedullary, and intradural-intramedullary tumors. The most frequent extradural tumors are metastases. Primary spinal tumors are rare and predominantly benign. Independent of their origin, spinal tumors manifest themselves with progressive local or radicular pain and neurological deficits. A preferably early diagnosis and subsequent therapy is important to improve the prognosis. The treatment of choice for most of these tumors is the complete surgical resection. In particular with the occurrence of neurological deficits a fast surgical intervention is indicated, since the prognosis depends on duration and severity of the preoperative existing deficits. Below, clinical presentation and relevant treatment options of spinal extradural tumors are discussed.
Asunto(s)
Neoplasias Epidurales/diagnóstico , Terapia Combinada , Estudios Transversales , Diagnóstico Diferencial , Diagnóstico Precoz , Neoplasias Epidurales/epidemiología , Neoplasias Epidurales/secundario , Neoplasias Epidurales/terapia , Humanos , Imagen por Resonancia Magnética , Mielografía , Tomografía Computarizada por Rayos XRESUMEN
Intradural spinal tumors are classified in extra- and intramedullary tumors. The most frequent intradural-extramedullary tumors are meningiomas and neurinomas. Among the intradural-intramedullary tumors the most frequent ones are ependymomas and astrocytomas. Independent of their origin, spinal tumors usually manifest with progressive local or radicular pain and neurological deficits. The treatment of choice for most of these tumors is a complete surgical resection. In tumors with infiltrative growth into the intramedullary area, a marginal tumor tissue has to be left in situ in order to avoid additional neurological deficits. In particular if neurological deficits appear, a fast surgical intervention is indicated, since the prognosis depends on duration and severity of the preoperative existing deficits. Below, clinical presentation and relevant treatment options of spinal intradural tumors are discussed.
Asunto(s)
Neoplasias de la Médula Espinal/diagnóstico , Astrocitoma/diagnóstico , Astrocitoma/epidemiología , Astrocitoma/patología , Astrocitoma/cirugía , Cauda Equina/patología , Estudios Transversales , Diagnóstico Diferencial , Ependimoma/diagnóstico , Ependimoma/epidemiología , Ependimoma/patología , Ependimoma/cirugía , Hemangioblastoma/diagnóstico , Hemangioblastoma/epidemiología , Hemangioblastoma/patología , Hemangioblastoma/cirugía , Humanos , Imagen por Resonancia Magnética , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/epidemiología , Meningioma/patología , Meningioma/cirugía , Neurilemoma/diagnóstico , Neurilemoma/epidemiología , Neurilemoma/patología , Neurilemoma/cirugía , Neurofibroma/diagnóstico , Neurofibroma/epidemiología , Neurofibroma/patología , Neurofibroma/cirugía , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neoplasias del Sistema Nervioso Periférico/epidemiología , Neoplasias del Sistema Nervioso Periférico/patología , Neoplasias del Sistema Nervioso Periférico/cirugía , Pronóstico , Médula Espinal/patología , Neoplasias de la Médula Espinal/epidemiología , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/cirugíaRESUMEN
Meningiomas are common intracranial tumours that arise from arachnoidal cells. Clinically they often manifest by headache, focal or generalized seizures, or neurologic deficits as a result of brain compression. More than 90 percent of these mostly slow growing meningiomas are benign. In symptomatic patients a resection should be performed with the intention to cure or at least alleviate symptoms. In cases of subtotal resection an adjuvant radiotherapy should be deliberated. Stereotactic radiotherapy as initial treatment is an effective alternative for meningiomas, especially in patients not suitable for surgery due to various reasons. In patients that are refractory to treatment or with unresectable disease a hormonal- or chemotherapy can be considered.
Asunto(s)
Neoplasias Meníngeas/terapia , Algoritmos , Encéfalo/patología , Terapia Combinada , Irradiación Craneana , Craneotomía , Estudios Transversales , Humanos , Imagen por Resonancia Magnética , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/epidemiología , Pronóstico , Radiocirugia , Radioterapia Adyuvante , Tomografía Computarizada por Rayos XRESUMEN
The most characteristic symptom of an aneurysmal subarachnoid haemorrhage (aSAH) is a sudden onset of severe headache, which can be accompanied by meningism, impaired consciousness, and vegetative symptoms. A cerebral CT scan is the initial diagnostic tool of choice if aSAH is suspected. The localisation and morphology of the aneurysm is depicted in a CT-angiography and/or conventional panangiography. Until definitive exclusion of the aneurysm by either microsurgical clipping or endovascular coiling, rebleeding should be avoided implicitly. The postoperative phase, especially in patients with severe aSAH is embossed with the occurrence of disease-specific complications (cerebral vasospasm, intracranial hypertension, seizure disorder, hydrocephalus) and consecutively increased risk for secondary brain injury. Furthermore, many patients present systemic complications such as electrolyte disturbances and cardiac dysfunctions. Early identification and therapy of cerebral and systemic complications are very important in order improve functional outcome.
Asunto(s)
Angiografía Cerebral , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Aneurisma Intracraneal/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Embolización Terapéutica , Femenino , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraneal/patología , Aneurisma Intracraneal/terapia , Masculino , Microcirugia , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Pronóstico , Factores de Riesgo , Hemorragia Subaracnoidea/patología , Hemorragia Subaracnoidea/terapiaRESUMEN
Glioblastoma multiforme (GBM) is the most frequently encountered malignant cerebral tumor. Despite significant improvements in the treatment of GBM, this disease remains associated with a high morbidity and mortality, with more than half of all affected patients dying within the first year after diagnosis. Typical symptoms include focal neurological symptoms, seizures, personality changes and neurocognitive symptoms. GBM can be identified by means of cerebral imaging modalities and subsequently confirmed histopathologically through biopsy or resection. At present, surgical resection followed by radiotherapy with concomitant chemotherapy with temozolomide and subsequent adjuvant chemotherapy with temozolomide is considered the standard therapy for patients with GBM. Currently, many interdisciplinary studies with glioblastoma patients are accomplished with the aim to further improve the prognosis of the affected patients.
Asunto(s)
Glioblastoma/terapia , Algoritmos , Antineoplásicos Alquilantes/uso terapéutico , Quimioterapia Adyuvante , Dacarbazina/análogos & derivados , Dacarbazina/uso terapéutico , Glioblastoma/diagnóstico , Glioblastoma/tratamiento farmacológico , Glioblastoma/mortalidad , Glioblastoma/radioterapia , Glioblastoma/cirugía , Humanos , Pronóstico , Temozolomida , Factores de TiempoRESUMEN
The formation of catheter tip granulomas is an increasingly observed serious complication of intrathecally administered medication. This complication, which is frequently associated with neurological disturbances, has previously been attributed to high dosages and high concentrations of intrathecal morphine. Much less commonly, intrathecal hydromorphone and intrathecal baclofen have also been associated with intrathecal granuloma formation. In the current case, we report a patient who developed her fi rst catheter tip granuloma after 20 months of intrathecal morphine. After surgical granuloma removal and installation of a new catheter, the patient received intrathecal ziconitide for an interim period of six months. Because of a progressive inefficacy, ziconitide was replaced by hydromorphone. One month later, only nine months after the fi rst operative granuloma removal, a new catheter tip granuloma required a further surgical intervention. This case report highlights the potential of intrathecal morphine and hydromorphone to form consecutive inflammatory granulomas within the same patient. To the best of our knowledge, this is the fi rst report of a patient developing two consecutive catheter tip granulomas within nine months.
Asunto(s)
Cateterismo/efectos adversos , Granuloma/etiología , Granuloma/patología , Inyecciones Espinales/efectos adversos , Complicaciones Posoperatorias/patología , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/patología , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Femenino , Granuloma/cirugía , Humanos , Hidromorfona/administración & dosificación , Hidromorfona/uso terapéutico , Laminectomía , Dolor de la Región Lumbar/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Morfina/uso terapéutico , Procedimientos Ortopédicos , Complicaciones Posoperatorias/cirugía , Recurrencia , Enfermedades de la Columna Vertebral/cirugía , omega-Conotoxinas/administración & dosificación , omega-Conotoxinas/efectos adversos , omega-Conotoxinas/uso terapéuticoRESUMEN
The carpal tunnel syndrome is the most common entrapment neuropathy (about 3% of the adults are affected). It is characterized by pain and paresthesia along the distribution of the median nerve. Thenar muscle atrophy with corresponding muscle weakness is a late manifestation of advanced disease. Electrophysiological tests are helpful in suggesting the diagnosis. An imaging with a magnetic resonance tomography may be used in the diagnosis of atypical cases. Ergonomic manoeuvres, oral steroids and steroidal injections may alleviate symptoms in mild cases. Surgical decompression of the carpal tunnel is the classical treatment of severe cases as well as for those who do not respond to conservative treatment. After surgery patients usually show excellent results. The following article discusses clinical aspects, diagnosis and current therapeutic options.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Adulto , Algoritmos , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Diagnóstico Diferencial , Endoscopía , Humanos , Factores de RiesgoRESUMEN
The trigeminal neuralgia is characterised by paroxysmal appearing fulgurous stabbing pain. Its medical condition is caused through a local-circumscribed demyelinisation of the trigeminal nerve with consecutive conduction of salting impulses on afferent pain fibres. It is essential to differentiate the symptomatic from the idiopathic trigeminal neuralgia. As primary management, a pharmacological treatment with anticonvulsants is recommended in order to attenuate the ectopic-generated pain impulses. Different neurosurgical procedures are available in cases of resistance to therapy. Thereby, causal surgery in form of microvascular decompression is not only the operative treatment of choice, but because of the excellent results also a fundamental support of the theory of vascular compression. A comprehensive knowledge about diagnosis and management of trigeminal neuralgia is essential to treat patients efficiently and successfully. This synopsis summarises the current recommendations concerning diagnostics and therapeutic options.
Asunto(s)
Neuralgia del Trigémino/fisiopatología , Adulto , Factores de Edad , Anciano , Algoritmos , Analgésicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Descompresión Quirúrgica , Diagnóstico Diferencial , Electrocoagulación , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/terapia , Ganglio del Trigémino/patología , Ganglio del Trigémino/fisiopatología , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/diagnóstico , Neuralgia del Trigémino/terapiaRESUMEN
Dissection of extra- and intradural arteries is a common cause of cerebral insult in younger patients (<45 years). In patients with corresponding craniocervical injury and symptoms (carotidynie, ipsilateral headache, partial Horner syndrome, cranial nerve palsy) arterial dissection is always to be considered. Essential in diagnosing arterial dissection is the verification of the intramural hematoma and morphologic changes in the vessel (stenosis, pseudoaneurysm) by means of CT/CTA (acute phase) or MRI/MRA (subacute phase). These patients need to be monitored in an intensive care unit setting. The acute therapy includes anticoagulation or inhibition of thrombocyte aggregation. We present two cases with delayed cerebral infarction due to traumatic extra- and intradural arterial dissection after a motor vehicle accident. To perform primary diagnostic quickly and adequately may avoid permanent neurological deficit in these patients.
Asunto(s)
Accidentes de Tránsito , Disección Aórtica/diagnóstico , Traumatismos en Atletas/diagnóstico , Lesiones Encefálicas/diagnóstico , Disección de la Arteria Carótida Interna/diagnóstico , Infarto de la Arteria Cerebral Anterior/diagnóstico , Infarto de la Arteria Cerebral Media/diagnóstico , Aneurisma Intracraneal/diagnóstico , Patinación/lesiones , Algoritmos , Disección Aórtica/cirugía , Anticoagulantes/uso terapéutico , Lesiones Encefálicas/cirugía , Disección de la Arteria Carótida Interna/cirugía , Angiografía Cerebral , Terapia Combinada , Descompresión Quirúrgica , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Infarto de la Arteria Cerebral Anterior/cirugía , Infarto de la Arteria Cerebral Media/cirugía , Aneurisma Intracraneal/cirugía , Angiografía por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Normal pressure hydrocephalus (NPH) is characterized by the classic triad of symptoms including gait disturbance, urinary incontinence, and dementia. Gait impairment represents the cardinal symptom. NPH is associated with a radiological verifiable ventriculomegaly in the absence of elevated cerebrospinal fluid (CSF) pressure. Because many patients do not present with classical clinical and radiological findings, its diagnosis and management represents a challenge for the general practitioner, neurologist and neurosurgeon. Various supplemental preoperative tests, including lumbar CSF tap test or CSF outflow resistance determination, can improve the accuracy of predicting a response to surgical intervention. CSF shunt results in significant symptoms in the majority of appropriately evaluated patients. The following article discusses clinical aspects, diagnosis and current therapeutic options.
Asunto(s)
Hidrocéfalo Normotenso/diagnóstico , Algoritmos , Encéfalo/patología , Ventrículos Cerebrales/patología , Presión del Líquido Cefalorraquídeo/fisiología , Diagnóstico Diferencial , Humanos , Hidrocéfalo Normotenso/etiología , Hidrocéfalo Normotenso/cirugía , Imagen por Resonancia Magnética , Examen Neurológico , Complicaciones Posoperatorias/etiología , Punción Espinal , Tomografía Computarizada por Rayos X , Derivación VentriculoperitonealRESUMEN
Malignant gliomas, among others the glioblastoma multiforme, are the most frequent brain tumors. The glioblastoma itself represents the most unfavorable tumor. In Switzerland, about 450 humans contract a glioblastoma each year. The median survival time is under 12 months, thus the prognosis is dismal despite a combination of surgery, radiotherapy and chemotherapy. Surgical resection presents the major constituent in the management of patients with a glioblastoma. Postoperative radio- and chemotherapy have beneficial effects on the survival time and quality of life. Surgical removal of glioblastomas is challenging due to their infiltrative growth pattern. Therefore, the target extent of resection can only be achieved partially. For some time now, a new in Germany developed method is used in the Neurosurgical Clinic of the Cantonal Hospital in St. Gallen: The 5-ALA-guided microsurgical resection method allows a targeted and secure surgical resection of the tumor. A preoperative administered substance colors the tumor and makes it better visible for the neurosurgeon. Consequently, the healthy brain tissue can be better distinguished from the tumor. This permits not only a larger complete surgical resection of the tumor but also minimizes the resection of healthy tissue.
Asunto(s)
Ácido Aminolevulínico , Neoplasias Encefálicas/cirugía , Glioblastoma/cirugía , Microcirugia/métodos , Fármacos Fotosensibilizantes , Ácido Aminolevulínico/efectos adversos , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Fluorescencia , Glioblastoma/diagnóstico , Glioblastoma/patología , Humanos , Imagen por Resonancia Magnética , Fármacos Fotosensibilizantes/administración & dosificación , Complicaciones Posoperatorias/diagnóstico , PremedicaciónRESUMEN
A considerable part of the medical clinical daily routine incorporates the information of patients about medical diagnosis and especially about the scheduled operative intervention. The disease pattern, the course in the hospital before and after surgery and the operation itself will be discussed during these conversations. The patient has to be informed about all potential complications from a medico legal point of view. To optimise information delivery, auxiliary materials like charts, pictures, X-rays and models are used. Unfortunately, only a small percentage of the presented information is assimilated by the patient after strict verbal information. To inform patients better and earlier about medical details and internal processes before the operation, we developed a web-based audiovisual patient information system with a combination of pictures, text, tone and video about surgical interventions. The patient satisfaction could be markedly improved by the application of this patient information system in the informed consent process. Furthermore, the use of the web-based multimedia information portal may leads to an essential time saving for the medical staff.
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Recursos Audiovisuales , Internet , Educación del Paciente como Asunto , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Proyectos Piloto , Programas Informáticos , Encuestas y Cuestionarios , Suiza , Adulto JovenRESUMEN
Up to 10% of patients with low back pain develop chronic low back pain. By definition, this is a pain that has persisted for longer than three months. Patients with chronic low back pain suffer from a disease, which has serious effects on the psycho-social and physiological integrity of the persons concerned. Pain syndromes of the lumbar region are among the greatest health care system problems in industrialised countries with direct and indirect annual costs of 150 to 250 billion Swiss francs. Despite intensive treatment some patients remain symptomatic. Out of it results a complaint-driven functional under-utilisation, which leads to an alleviation of the performance and increased inactivity - the beginning of a vicious circle. A multimodal treatment concept including physio- and psychotherapy, supported by a targeted medicamentous therapy, normally improves physical functions and achieves a significant discomfort reduction. If resistance to therapy persists, it is suggestive to consider precociously minimal-invasive or invasive therapeutic options.
Asunto(s)
Dolor de la Región Lumbar , Psicoterapia , Enfermedad Crónica , Terapia Combinada , Humanos , Dolor de la Región Lumbar/terapiaRESUMEN
The lumbar spinal stenosis (LSS) is defined as a narrowing of the spinal canal together with neuronal and vascular structures via circumjacent bone and soft tissue. In patients aged over 65 years, the LSS is among the most frequent causes of lumbago, either with or without sciatica. The prevalence will continue to augment because of the increased life expectancy. The leading symptom is neurogenic claudicatio with lumbogluteal or sciatic pain, which occurs while walking and leads to a limitation of the walking distance. Its typical constellation of symptoms including subjective leg weakness is leading to the tentative diagnosis. Nowadays, the imaging technique of choice for the diagnosis is magnetic resonance imaging. A conservative treatment is initially sufficient in most cases. The indication for surgery is given, if the pain and limitation of walking distance are not tolerable any more. Additional fusion should be taken into account, when degenerative spondylolisthesis or other pathomorphological alterations result in an instability. Conservative and surgical therapeutic goals imply pain relief, amelioration of the physical functionality, mobility and general quality of life.