RESUMO
La Discectomía Percutánea Endoscópica Lumbar es una técnica mínimamente invasiva para el tratamiento de las hernias discales lumbares con resultados comparables a la microdiscectomía lumbar. La principal complicación, los fragmentos discales remanentes, son en gran parte producidos por la limitación de movimiento del endoscopio una vez realizada la punción. Presentamos una nota técnica y aplicación en un caso ejemplo de lo que hemos llamado "libre flotación foraminal": un acceso al espacio epidural por vía transforaminal que mantiene la libertad de movimiento y permite una exploración endoscópica en busca de fragmentos remanentes.
Percutaneous endoscopic lumbar discectomy is a minimally-invasive surgical approach for the treatment of lumbar disc herniation, with outcomes similar to open micro-discectomy. The main complication residual disc fragments is largely caused by a rigid endoscopic trajectory once the puncture has been made. We present a technical note of a surgery performed in a patient who underwent what we have called a "free foraminal flotation technique": accessing the epidural space through a transforaminal approach that maintains freedom of movement and allows for endoscopic exploration to locate residual disc fragments.
Assuntos
Humanos , Hérnia , Discotomia Percutânea , Discotomia , Região LombossacralRESUMO
BACKGROUND: Craniocervical junction pathology is infrequent in daily neurosurgical practice. In general, most of these lesions are of traumatic or rheumatic origin. Atlantoaxial instability of inflammatory origin (Grisel syndrome) is a rare entity of which only 16 adult cases have been reported in the literature. This pathology is characterized by the development of an osteolytic lesion at the level of the atlantoaxial joint after an infectious event, usually of the upper airways. CASE DESCRIPTION: We present the case of a 76-year-old patient who attended our office for clinical symptoms of spinal instability secondary to an osteolytic lesion, with involvement of C1 and C2. The symptomatology began after an infectious respiratory process. A posterior cervical occiput fixation and an endoscopic transnasal odontoidectomy with anterior decompression were performed. The patient evolved with complete resolution of symptoms. The cultures were negative, and the pathological anatomy study concluded nonspecific inflammatory changes. CONCLUSION: Until a few years ago, the only option to address this pathology was the transoral pathway with microsurgical technique. Nowadays, endoscopy offers many technical advantages. This is an option to be considered when planning approaches to craniocervical junction.
RESUMO
Objective: To evaluate the usefulness of intraoperative monitoring with transcranial Doppler during the carotid endarterectomy. Description: In the last two years we performed 15 carotid endarterectomies with transcranial doppler intraoperative monitoring. In all case we didnt use a shunt during the procedure based on the monitoring results. Results: All patients recovered without any neurological deficit. Conclusions: Intraoperative monitoring with transcranial Doppler seems to be a good method to determinate the use or not of a shunt during the procedure.