Background
Dorsal pons cavernoma can be approached through telo-velar approach instead of transvermian approach, with lower risk of neurological deficits since it uses natural clefts to reach the ...floor of the fourth ventricle.
Materials and methods
We present our surgical technique for telo-velar approach to address pathologies of the dorsal pons, assisted by neuronavigation and neuromonitoring. This surgical technique is illustrated by a surgical video of a dorsal pons cavernoma.
Conclusion
Dorsal pons cavernomas can be reached through telo-velar approach after suboccipital midline craniotomy. The accurate patient positioning, cisternal dissection, and neuromonitoring use are mandatory to avoid neural injuries and identify the safe entry points into the brainstem.
Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory and immunoregulatory cytokine involved in the pathogenesis of several autoimmune disorders. Etanercept, a TNF-α antagonist (anti-TNF-α) ...acting as a soluble TNF-α receptor, has been associated with neurological demyelinating disorders. This paper aims to report an unusual case showing tumefactive central nervous system (CNS) inflammatory demyelination in a patient in the course of TNF -α antagonist therapy, requiring decompressive hemicraniectomy. This report is based on magnetic resonance imaging (MRI) findings and histology. A biopsy confirmed the inflammatory demyelinating nature of the lesions. The clinical presentation is unusual due to the severity of the disease process, requiring decompressive hemicraniotomy with a clinically favorable outcome.
Aims
: The main aim of this retrospective analysis was to examine the real impact of the systematic use of a cone beam computed tomography with navigation (O-arm) on screw positioning in spine ...arthrodesis procedures.
Our initial hypothesis was that using this technique in a standardized and systematic way, we could reduce damage to neurovascular structures, augment the precision of screw positioning, and reduce intraoperative time.
Methods
: The analysis includes 144 patients submitted to posterior spine arthrodesis with screws, from January 2013 to December 2013. All were operated with aid of Neuronavigation. 75% of the patients had degenerative lesion, while the remaining 25% had traumatic, neoplastic or infectious diseases. In the same period, other patients were submitted to same procedures without the use of O-arm, mainly because this was not available due to the simultaneous use of the machine by orthopedic surgeons.
Preoperative and intraoperative data were retrospectively collected and analyzed in all patients. All patients were postoperatively submitted to CT scans with sagittal and coronal reconstructions, within 24 hours after surgery to assess screw positioning. The position of the screws was analyzed on postoperative CT and the degree of perforation of the cortical bone of the pedicle was classified according to criteria published in other studies
1
in 4 grades: Grade 1 (0- 2mm), Grade 2 (2 -4mm), Grade 3 (4 -6mm), Grade 4 (over 6 mm).
Results
: Mean age was 66 years old. A total of 868 pedicle screws were placed, between C1 and S1.
11 procedures (7%) were at cervical levels, 21 (14%) at thoracic levels, and 112 (77%) at lumbar levels. No patient presented neurologic complications related to screw malpositioning. On postoperative CT scans, 98% of screws were classified as grade 1, and 2% as grade 2, while no screw was classified as grade 3 or 4. In patients operated without the O-arm precision was less, with a statistically significant difference between the two groups. No difference was noted in surgical time with the O-arm.
Conclusions
: Cone beam computed tomography with navigation (O-arm) has become a useful tool in all spine procedures with pedicular screw positioning. The main field of application, i.e., the field in which the technique has the greater clinical impact is posterior thoracic pedicular screw positioning, especially in the T1-T6 district. Other situations are C1-C2 posterior screwing with rotatory subluxation of C1, and lumbar screw positioning in degenerative deformity cases with posterior arthrosis. Systematic use of Navigation has also changed our surgical technique, because now we position all screws before doing any bony decompression, thus reducing blood loss and risk of neurological damage.
References
Trois graffites sur céramique du IIe s. ap. J.-C. (deux en latin et un en grec) furent découverts en 2009 sur le site romain d’Ocniţa (dép. de Vâlcea), en Dacie Inférieure. Ils livrent deux marques ...de propriété et sans doute une indication de capacité accompagnée de mentions énigmatiques.
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