Neurosurgery

Pang, Dachling; Zovickian, John; Oviedo, Angelica

Neurosurgery. 66(2):253-273, February 2010.

doi: 10.1227/01.NEU.0000363598.81101.7B

Partial resection of complex spinal cord lipomas results in a high rate of symptomatic recurrence. Since 1991, we have performed total resection of spinal cord lipomas with radical reconstruction of the neural placode. Part 1 was a detailed description of total lipoma resection in 238 patients with complex lipomas, showing that total and near-total removal of fat was successful in over 90% of patients. The state of reconstruction of the neural placode was excellent in 70% of cases, and very good in another 25%. The neurological-urological and wound complication rates were approximately 5%, comparing favorably with the literature. Part 2 of this study shows that the long-term prognosis of symptomatic control for total lipoma resection over a 16-year follow-up period is far better than partial resection using traditional methods, by a factor of approximately 2.5. Total resection is also far superior when compared to non-surgical treatment of asymptomatic lipomas, according to results from a prospective French series. The most significant fact in total resection that directly affects outcome is “cord-sac ration,” which measures the relative diameters of the reconstructed cord and the newly exposed (by grafting) dural sac.

Abstract:

Samdani, Amer F.; Ranade, Ashish; Saldanha, Vilas; Yondorf, Menacham Z.

Neurosurgery. 66(2):290-295, February 2010.

doi: 10.1227/01.NEU.0000363853.62897.94

Placement of thoracic pedicle screws, particularly in the deformed spine, poses unique challenges with a significant learning curve. A retrospective analysis of 30 patients with adolescent idiopathic scoliosis (mean age 14, mean thoracic Cobb angle: 62.6 degrees) after posterior spinal fusion with a pedicle screw construct were analyzed using post-operative CT, by two surgeons. A statistically significant (p<.05) decline in post-operative breach rate was demonstrated. The overall accuracy of placement of thoracic pedicle screws in the deformed spine was 88.4% with no neurological or visceral complications.

Abstract:

Levine, Joshua; Kofke, Andrew; Cen, Liyi; Chen, Zhen; Faerber, Jennifer; Elliott, J. Paul; Winn, H. Richard; Le Roux, Peter

Neurosurgery. 66(2):312-318, February 2010.

doi: 10.1227/01.NEU.0000363747.47587.6C

Blood transfusions may result in medical complications in general medical and surgical patients. This study examines medical complications in patients with a ruptured cerebral aneurysm.

Abstract:

de Oliveira, Jean G.; Lekovic, Gregory P.; Safavi-Abbasi, Sam; Reis, Cassius V.; Hanel, Ricardo A.; Porter, Randall W.; Preul, Mark C.; Spetzler, Robert F.

Neurosurgery. 66(2):389-399, February 2010.

doi: 10.1227/01.NEU.0000363702.67016.5D

Cavernous malformations of the brainstem located on the posterolateral surface of the upper pons and midbrain can be reached through the supracerebellar infratentorial approach, at the midline (median variant) and the posterolateral surface of the upper pons and midbrain (paramedian and extreme lateral variants). The choice depends on the best trajectory between the most superficial point of the lesion and the surface of the skull. We analyzed our clinical experience with these three variants for the treatment of cavernous malformations of the brainstem. Use of these variants avoids other complex and time-consuming approaches to the same region. Refined microsurgical techniques associated with neuronavigational assistance should be used to ensure the safe surgical resection of cavernous malformations of the brainstem.

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