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Lim Z, Gu TY, Tai BC, Puhaindran ME. Survival outcomes of malignant peripheral nerve sheath tumors (MPNSTs) with and without neurofibromatosis type I (NF1): a meta-analysis. World J Surg Oncol 2024; 22:14. [PMID: 38191386 PMCID: PMC10775467 DOI: 10.1186/s12957-023-03296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Malignant peripheral nerve sheath tumors (MPNSTs) are malignancies that demonstrate nerve sheath differentiation in the peripheral nervous system. They can occur sporadically or be associated with neurofibromatosis type 1 (NF1), an autosomal dominant neurocutaneous disorder, with up to 13% of patients developing MPNSTs in their lifetimes. Previous studies have suggested conflicting findings regarding the prognosis of NF1 for patients with MPNSTs. The elucidation of NF1 as an independent prognostic factor on mortality has implications for clinical management. We aim to investigate the role of NF1 status as an independent prognostic factor of overall survival (OS) and disease-specific survival (DSS) in MPNSTs. METHODS An electronic literature search of PubMed and MEDLINE was performed on studies reporting OS or DSS outcomes of MPNSTs with and without NF1. A grey literature search by reviewing bibliographies of included studies and review articles was performed to find pertinent studies. Data was extracted and assessed in accordance with the PRISMA guidelines. A meta-analysis was performed to calculate hazard ratios (HRs) using a random-effects model. The primary and secondary outcomes were all-cause and disease-specific mortality, respectively, with NF1 as an independent prognostic factor of interest. RESULTS A total of 59 retrospective studies involving 3602 patients fulfilled the inclusion criteria for OS analysis, and 23 studies involving 704 MPNST patients were included to evaluate DSS outcomes. There was a significant increase in the hazard of all-cause mortality (HR 1.63, 95% CI 1.45 to 1.84) and disease-specific mortality (HR 1.52, 95% CI 1.24 to 1.88) among NF1 as compared to sporadic cases. Subgroup analyses and meta-regression showed that this result was consistent regardless of the quality of the study and year of publication. CONCLUSION NF1 is associated with a substantially higher risk of all-cause and disease-specific mortality. This finding suggests that closer surveillance is required for NF1 patients at risk of developing MPNSTs.
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Affiliation(s)
- Zhixue Lim
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Tian Yuan Gu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive, #10-01, Singapore, 117549, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive, #10-01, Singapore, 117549, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mark Edward Puhaindran
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Keorochana G, Tantrakansakun C, Suriyonplengsaeng C, Jaipanya P, Lertudomphonwanit T, Leelapattana P, Chanplakorn P, Kraiwattanapong C. The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study. Global Spine J 2023:21925682231217251. [PMID: 37983557 DOI: 10.1177/21925682231217251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
STUDY DESIGN Cadaveric anatomical studies. OBJECTIVE This study aims to investigate the anatomical relationship between bony landmark "V point", dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD). METHOD 10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root. RESULT The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38 mm to 3.37 ± 1.46 mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16 mm at C3/4, .45 ± 1.23 mm at C4/5, .43 ± 1.01 at C5/6, -.43 ± 1.86 mm at C6/7 and -1.5 ± 1.2 mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18 mm to 4.45 ± 2.57 mm, increasing caudally. CONCLUSION In performing PECF or PECD, a 3-4 mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4 mm is recommended, especially in cranial direction.
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Affiliation(s)
- Gun Keorochana
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chakkraphan Tantrakansakun
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pilan Jaipanya
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Thamrong Lertudomphonwanit
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pittavat Leelapattana
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Kraiwattanapong
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Shi J, He KX, Dong YB, Liu YH, Lu C, Li WX. Intracapsular Enucleation of Brachial Plexus Schwannoma With Intraoperative Neuromonitoring: A Case Series Study and a Review of Literature. EAR, NOSE & THROAT JOURNAL 2023:1455613231198422. [PMID: 37740422 DOI: 10.1177/01455613231198422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE Brachial plexus schwannoma (BPS) is a rare clinical entity that poses a significant challenge for head and neck surgeons due to its neuroanatomical complexity and potential severe complications, such as major motor or sensory neurological deficits or pain of the corresponding upper extremity. This article summarizes our experience in its diagnosis and intracapsular enucleation with intraoperative neuromonitoring (INM). METHODS A retrospective review of BPS cases treated at our tertiary medical institution was conducted between April 2020 and May 2023. The clinical and demographic data were retrieved from case notes. RESULTS Totally, 3 cases were included. All 3 patients were male, aged 43 to 54 years (median age = 52). The presenting symptom was a palpable supraclavicular mass in all these cases (2 on the left side and 1 on the right side). Neuromonitoring was performed with a 4-channel nerve integrity monitor, with the electrodes placed in the upper arm and forearm muscles, as demonstrated in the literature. After exposing the mass and identifying its origin from the brachial plexus, a unipolar stimulating probe was used to stimulate the tumor surface or the nerves with a 1.0-mA current, and a longitudinal incision into the tumor capsule was made along a carefully mapped line with no INM response. Then the mass was carefully exposed and meticulously dissected from its capsule to achieve an intact enucleation. Immediate postoperative neurological deficit was documented in Case 1 as a mild grasping weakness. The recovery of the other 2 patients was uneventful. The follow-up duration was 7 to 38 months (median = 8 months). The minor motor deficit of Case 1 recovered completely 1 month after surgery. No recurrence of BPS was observed. CONCLUSIONS Intracapsular enucleation with INM could result in complete removal of BPS and minimal postoperative neurological deficit, whose recovery was quick and satisfactory.
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Affiliation(s)
- Juan Shi
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan He
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu-He Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Pisapia JM, Adeclat G, Roberts S, Li YR, Ali Z, Heuer GG, Zager EL. Tumors of the brachial plexus region: A 15-year experience with emphasis on motor and pain outcomes and literature review. Surg Neurol Int 2023; 14:162. [PMID: 37292396 PMCID: PMC10246342 DOI: 10.25259/sni_163_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
Background Brachial plexus region tumors are rare. In this study, we reviewed our experience with resection of tumors involving or adjacent to the brachial plexus to identify patterns in presentation and outcome. Methods We report a retrospective case series of brachial plexus tumors operated on by a single surgeon at a single institution over 15 years. Outcome data were recorded from the most recent follow-up office visit. Findings were compared to a prior internal series and comparable series in the literature. Results From 2001 to 2016, 103 consecutive brachial plexus tumors in 98 patients met inclusion criteria. Ninety percent of patients presented with a palpable mass, and 81% had deficits in sensation, motor function, or both. Mean follow-up time was 10 months. Serious complications were infrequent. For patients with a preoperative motor deficit, the rate of postoperative motor decline was 10%. For patients without a preoperative motor deficit, the rate of postoperative motor decline was 35%, which decreased to 27% at 6 months. There were no differences in motor outcome based on extent of resection, tumor pathology, or age. Conclusion We present one of the largest recent series of tumors of the brachial plexus region. Although the rate of worsened postoperative motor function was higher in those without preoperative weakness, the motor deficit improves over time and is no worse than antigravity strength in the majority of cases. Our findings help guide patient counseling in regard to postoperative motor function.
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Affiliation(s)
- Jared M. Pisapia
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
| | - Giscard Adeclat
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanford Roberts
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yun R. Li
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Zarina Ali
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory G. Heuer
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eric L. Zager
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Shekouhi R, Chim H. Patient demographics, tumor characteristics, and outcomes following surgical treatment of benign and malignant brachial plexus tumors: a systematic review. Int J Surg 2023; 109:972-981. [PMID: 37097618 PMCID: PMC10389507 DOI: 10.1097/js9.0000000000000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/15/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Various treatment options have been introduced for the management of primary tumors of the brachial plexus (BP), ranging from conservative therapy to wide local excision with/without postoperative chemoradiotherapy. However, no consensus exists regarding optimal treatment strategies based on collated and published data. OBJECTIVE The aim of this study was to investigate the clinicopathological characteristics and outcome of patients with primary tumors of the BP who underwent surgical treatment. DATA SOURCES A systematic search of the four main online databases, including Web of Science (WOS), PubMed, Scopus, and Google Scholar, was conducted. STUDY SELECTION All related articles addressing the clinical outcome and role of surgical interventions for management of primary tumors of the BP. INTERVENTION Optimal surgical and radiotherapeutic interventions for benign and malignant lesions based on the pathologic characteristics and location of primary BP tumors. RESULTS A total of 687 patients (693 tumors) with a mean age of 41.7±8.7 years old were evaluated. In total, 629 (90.8%) tumors were benign, and 64 (9.2%) were malignant, with a mean tumor size of 5.4±3.1 cm. The location of the tumor was reported for 639 patients. For these tumors, 444 (69.5%) originated from the supraclavicular region, and 195 (30.5%) were infraclavicular. The trunks were the most common location for tumor involvement, followed by the roots, cords, and terminal branches. Gross total resection was achieved in 432 patients and subtotal resection (STR) was performed in 109 patients. With neurofibromas, STR still resulted in good outcomes. The outcomes following treatment of malignant peripheral nerve sheath tumors were poor regardless of the type of resection. In general, symptoms related to pain and sensory issues resolved rapidly postoperatively. However, the resolution of motor deficits was often incomplete. Local tumor recurrence occurred in 15 (2.2%), patients and distant metastasis was observed in only eight (1.2%) cases. The overall mortality was 21 (3.1%) patients among the study population. LIMITATIONS The main limitation was the lack of level I and II evidence. CONCLUSIONS The ideal management strategy for primary BP tumors is complete surgical resection. However, in some cases, particularly for neurofibromas, STR may be preferable to preserve maximal neurological function. The degree of surgical excision (total or subtotal) mainly depends on the pathological characteristics and primary location of the tumor.
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Affiliation(s)
- Ramin Shekouhi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida
- Lilian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
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Saifi AM, Kapoor P, Bajaj A, Agarwal A. Sinonasal and Infratemporal Schwannoma: Rare Case Report with Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:234-241. [PMID: 37206829 PMCID: PMC10188860 DOI: 10.1007/s12070-022-03424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Schwann cells are responsible for the production of the myelin sheath around the axons of the peripheral nervous system. Benign neoplasms which originate from Schwann cells are hence termed Schwannomas or Neurilemmomas. They present as slow-growing, solitary, encapsulated, benign masses usually in association with nerve trunks. Schwannomas are relatively rare tumors with 25-45% occurring in the head and neck region. These case reports aim to describe the presentations, work-up, and treatment of two patients with head and neck schwannoma in atypical locations. Both patients had a history of gradually increasing swelling, the first originating from the sino-nasal region and the second from the temporal/ infratemporal region. Complete surgical excision of the tumor was done in both cases with no reported recurrence at 18 months follow-up. The final diagnosis was made based on histopathology and immunohistochemistry findings. Schwannomas often present a diagnostic dilemma and should be considered a possibility in all head and neck tumors. Recurrence is rare.
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Affiliation(s)
- Aamir Malick Saifi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, 70/71 New Azad Puram, Chawani Ashraf Khan, Hartman College Road, Bareilly, Uttar Pradesh 243122 India
| | | | - Ankita Bajaj
- Hira Hospital Dental and Maxillofacial, Bareilly, India
| | - Arjun Agarwal
- Department of Surgical Oncology, Rohilkhand Medical College and Hospital, Bareilly, India
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Platt A, Fessler RG, Traynelis VC, O’Toole JE. Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1573-1582. [PMID: 34879736 PMCID: PMC9393980 DOI: 10.1177/21925682211055094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority. METHODS This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty. RESULTS In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I2 = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I2 = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group. CONCLUSIONS There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.
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Affiliation(s)
- Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA,Andrew Platt, Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, IL 60612 USA.
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John E. O’Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Roh JL. Function-preserving intracapsular enucleation of brachial plexus schwannomas: Is it safe and effective? Oral Oncol 2022; 134:106102. [PMID: 36055126 DOI: 10.1016/j.oraloncology.2022.106102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Brachial plexus schwannomas are rare diseases treated by complete resection, leading to potential neurological deficits. Intracapsular enucleation is an acceptable alternative to preserve the involved nerve function. This study has examined the safety and effectiveness of intracapsular enucleation in preserving nerve function. This observational study included 19 consecutive patients with brachial plexus schwannomas originating from the roots (42 %), the trunks (37 %), and the cords (21 %). After enucleation, immediate sensory and motor weakness occurred in 21 % and 11 % of patients, and other early complications did not happen. No patients had neural deficits at postoperative one year and recurrence for a median follow-up of 72 months. In conclusion, function-preserving intracapsular enucleation via a lateral collar incision is a safe and effective treatment for brachial plexus schwannomas.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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9
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Suárez C, López F, Rodrigo JP, Mendenhall WM, de Bree R, Mäkitie AA, Vander Poorten V, Takes RP, Bondi S, Kowalski LP, Shaha AR, Fernández-Alvarez V, Gutiérrez JC, Zidar N, Chiesa-Estomba C, Strojan P, Sanabria A, Rinaldo A, Ferlito A. Benign Peripheral Non-cranial Nerve Sheath Tumors of the Neck. Adv Ther 2022; 39:3449-3471. [PMID: 35689724 DOI: 10.1007/s12325-022-02191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
Benign peripheral non-cranial nerve sheath tumors are rare lesions, including both schwannomas and neurofibromas. These tumors arise from Schwann cells, and may originate from any peripheral, cranial, or autonomic nerve. Most of them are localized and sporadic but multifocal systemic forms can occur. Cervical sympathetic chain, brachial plexus, cervical plexus and spinal roots and nerves are the major nerve systems commonly affected. Dumbbell-shaped intra- and extradural tumors occur most commonly in the cervical spine, as well as purely extradural and paravertebral tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques and surgical innovations such as endoscopically assisted approaches and robotic surgery. Microsurgical intracapsular excision of the tumor helped by the use of intraoperative fluorescent dyes and intraoperative neurophysiological monitoring minimize postoperative neural deficit, since most schwannomas are encapsulated. Most tumors can be removed with a low rate of complications and recurrence. Radiotherapy should be considered for growing lesions that are not amenable to surgery. In asymptomatic patients, observation and serial scans is an option for elderly infirm patients.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Avenida de Roma s/n, 33011, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefano Bondi
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and University of São Paulo Medical School, São Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Julio C Gutiérrez
- Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastián, Spain
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, 050010, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, 050021, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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10
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Coric D, Rossi V. Percutaneous Posterior Cervical Pedicle Instrumentation (C1 to C7) With Navigation Guidance: Early Series of 27 Cases. Global Spine J 2022; 12:27S-33S. [PMID: 35393883 PMCID: PMC8998482 DOI: 10.1177/21925682211029215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN This is a technique paper describing minimally invasive, navigated, percutaneous pedicle screw fixation of the cervical spine. In addition, we include a retrospective feasibility analysis of our initial experience with 27 patients undergoing this procedure. OBJECTIVE The purpose of this study is to describe the technique of MIS navigated percutaneous cervical pedicle screw instrumentation and to report our initial experience. METHODS This is a retrospective review of 27 patients undergoing MIS navigated percutaneous posterior cervical pedicle screw fixation at 2 institutions. We describe the technique and report the radiographic outcomes and all intraoperative and postoperative complications. RESULTS A total of 27 patients underwent MIS navigated percutaneous pedicle screw fixation. Indications included odontoid fracture, subaxial fracture dislocations and burst fracture, pathological fracture, and degenerative spondylosis. There were no nerve root or vascular injuries. There were no spinal cord injuries. Two screws required repositioning intraoperatively, and 1 patient required reoperation for symptomatic malpositioned screw. CONCLUSIONS MIS navigated percutaneous posterior pedicle screw fixation can be performed safely. These constructs are biomechanically superior with neurovascular complication rates comparable to traditional lateral mass screw technique. While the current indications for this technique are relatively limited, the evolution of MIS cervical decompression techniques as well as navigation and robotics will provide an expanded role for percutaneous cervical pedicle screw instrumentation.
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Affiliation(s)
| | - Vincent Rossi
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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11
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Mikula AL, Smith BW, Lakomkin N, Doan MK, Jack MM, Bydon M, Spinner RJ. A significant association between C5 nerve sheath tumors and new postoperative weakness. J Neurosurg Spine 2021; 35:638-643. [PMID: 34359025 DOI: 10.3171/2021.2.spine202139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine if patients with nerve sheath tumors affecting the C5 spinal nerve are at greater risk for postoperative weakness than those with similar tumors affecting other spinal nerves contributing to the brachial plexus. METHODS A retrospective chart review (1998-2020)identified patients with pathologically confirmed schwannomas or neurofibromas from the C5 to T1 nerves. Patients with plexiform nerve sheath tumors, tumors involving more than 1 nerve, and malignant peripheral nerve sheath tumors were excluded. Collected variables included basic demographics, tumor dimensions, its location relative to the dura, involved nerve level, surgical approach, extent of resection, presenting symptoms, postoperative neurological deficits, and recurrence rate. RESULTS Forty-six patients (23 men, 23 women) were identified for inclusion in the study with an average age of 47 ± 17 years, BMI of 28 ± 5 kg/m2, and follow-up of 32 ± 45 months. Thirty-nine patients (85%) had schwannomas and 7 (15%) had neurofibromas. Tumors involved the C5 (n = 12), C6 (n = 11), C7 (n = 14), C8 (n = 6), and T1 (n = 3) nerves. Multivariable logistic regression analysis with an area under the curve of 0.85 demonstrated C5 tumor level as an independent predictor of new postoperative weakness (odds ratio 7.4, p = 0.028). Of those patients with new postoperative weakness, 75% improved and 50% experienced complete resolution of their motor deficits. CONCLUSIONS Patients with C5 nerve sheath tumor resections are at higher odds of new postoperative weakness. This may be due to the predominant single innervation of shoulder muscle targets in contrast to other upper extremity muscles that receive input from 2 or more spinal nerves. These findings are important for clinical decision-making and preoperative patient counseling.
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Affiliation(s)
- Anthony L Mikula
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Brandon W Smith
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Nikita Lakomkin
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | - Megan M Jack
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohamad Bydon
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Robert J Spinner
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
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Gaba S, Mohsina S, John JR, Tripathy S, Sharma RK. Clinical Outcomes of Surgical Management of Primary Brachial Plexus Tumors. Indian J Plast Surg 2021; 54:124-129. [PMID: 34239232 PMCID: PMC8257325 DOI: 10.1055/s-0041-1731252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction
This study evaluates the clinical presentation, tumor characteristics, and clinical outcomes of surgically treated benign and malignant brachial plexus tumors (BPTs).
Methods
A prospective study of patients with BPTs from June 2015 to August 2020 was conducted. All patients underwent surgical resection with microneurolysis and intraoperative electrical stimulation to preserve the functioning nerve fascicles.
Results
Fourteen patients with 15 BPTs underwent surgical resection. Mean age was 37.8 ± 12.3 years; with male to female ratio 4:10. The clinical presentations were swelling (100%), pain (84.6%), and paresthesia (76.9%). The lesions involved roots (5/15), trunk (5/15), division (1/15), and cords (4/15). Thirteen patients had benign pathology (8 schwannomas, 3 neurofibromas, 2 lipomas) and two had malignant neurofibrosarcoma. Gross total resection was achieved in all cases except a dumbbell tumor. The mean follow-up period was 24 ± 5 months. Postoperatively, all patients reported improvement in pain and paresthesia with no new sensory deficit. All patients had developed initial motor weakness (Grades 2–4); however, full power (Grade 5) was recovered by 3 to 5 months.
Conclusion
Total resection can be achieved by appropriate microneural dissection and electrophysiologic monitoring and is potentially curative with preserving function.
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Affiliation(s)
- Sunil Gaba
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Subair Mohsina
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jerry R John
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satyaswarup Tripathy
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramesh Kumar Sharma
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Fiani B, El-Farra MH, Dahan A, Endres P, Taka T, Delgado L. Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes. Clin Transl Oncol 2021; 23:1263-1271. [PMID: 33449268 DOI: 10.1007/s12094-020-02549-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. METHODS The authors performed an extensive review of the published literature (PubMed) focusing on "brachial plexus tumors" that identified invasion of the cervicothoracic spine. RESULTS The search yielded 2774 articles pertaining to "brachial plexus tumors". Articles not in the English language or involving cervicothoracic spinal invasion were excluded. CONCLUSIONS Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.
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Affiliation(s)
- B Fiani
- Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Drive, Palm Springs, CA, 92262, USA.
| | - M H El-Farra
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - A Dahan
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - P Endres
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - T Taka
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - L Delgado
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
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Lee DY, Chi JY, Seok J, Han S, Lee MH, Jeong WJ, Jung YH. Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring. Clin Exp Otorhinolaryngol 2020; 13:203-208. [PMID: 32241087 PMCID: PMC7248612 DOI: 10.21053/ceo.2019.01207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the feasibility of brachial plexus schwannoma enucleation under intraoperative neuromonitoring. Methods Five patients who were treated for brachial plexus schwannoma under intraoperative neuromonitoring from 2008 to 2018 were included in this retrospective review. Neuromonitoring was performed with a 100-μV event threshold of the neuromonitoring system (NIM-2 or 3) at the deltoid, biceps brachii, triceps brachii, and brachioradialis muscles. Patient characteristics, tumor size and location, intraoperative neuromonitoring findings, and postoperative function were evaluated. Results The intraoperative neuromonitoring findings were in accordance with the preoperative assessment of the included nerve root. Three patients had no postoperative morbidity, one patient had temporary paresthesia of the forearm for 2 months, and one patient mild loss of grip strength for 1 month. Conclusion Intraoperative neuromonitoring of the arm and forearm muscles during enucleation of brachial plexus schwannoma promoted confident and successful surgery with minimal postoperative morbidity.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jeong-Yeon Chi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungjun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min-Hyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Cervical posterior foraminotomy: how i do it. Acta Neurochir (Wien) 2020; 162:675-678. [PMID: 31938822 DOI: 10.1007/s00701-020-04221-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cervical pathologies are addressed through a variety of anterior and posterior approaches and minimally invasive procedures have been successfully applied during the last decades. Posterior cervical foraminotomy (PCF) should be proposed with isolated foraminal stenosis. METHOD We provide a step-by-step description of PCF through the use of tubular retractors. Its advantages and limitations were detailed. CONCLUSION PCF performed with tubular retractors represent a safe and efficient alternative to address an isolated level disease with unilateral radiculopathy. The risk of mechanical instability is limited when only the medial third of the facet is drilled. Patients present rapid functional recovery.
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Sagar P, Sharma S, Thakur K, Kumar D. Giant cervico-pectoral schwannoma. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_12_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Oshima Y, Kato S, Doi T, Matsubayashi Y, Taniguchi Y, Tanaka S. Comparison of microendoscopic selective laminectomy versus conventional laminoplasty in patients with degenerative cervcical myelopathy: a minimum 2-year follow-up study. BMC Musculoskelet Disord 2019; 20:471. [PMID: 31651296 PMCID: PMC6814118 DOI: 10.1186/s12891-019-2884-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/03/2019] [Indexed: 11/14/2022] Open
Abstract
Background Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years. Methods Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3–6 or C3–7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5–6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5–6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups. Results Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group. Conclusion Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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18
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Du Q, Lei LQ, Cao GR, Kong WJ, Ao J, Wang X, Wang AS, Liao WB. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report. BMC Musculoskelet Disord 2019; 20:280. [PMID: 31182078 PMCID: PMC6558825 DOI: 10.1186/s12891-019-2659-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH). Methods Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation. Results The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative. Conclusion This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure. Trial registration Numbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry. Electronic supplementary material The online version of this article (10.1186/s12891-019-2659-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qian Du
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Lan-Qiong Lei
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Guan-Ru Cao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.,Translational Research Institute, School of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - An-Su Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China. .,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Jung IH, Yoon KW, Kim YJ, Lee SK. Analysis According to Characteristics of 18 Cases of Brachial Plexus Tumors : A Review of Surgical Treatment Experience. J Korean Neurosurg Soc 2018; 61:625-632. [PMID: 30196660 PMCID: PMC6129745 DOI: 10.3340/jkns.2018.0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/21/2018] [Indexed: 01/13/2023] Open
Abstract
Objective Because the anatomical structure of the brachial plexus is very complex, surgical treatment of tumors in this region is challenging. Therefore, a lot of clinical and surgical experience is required for successful treatment; however, many neurosurgeons have difficulty accumulating this experience owing to the rarity of brachial plexus tumors. The purpose of this report is to share our surgical experience with brachial plexus tumor with other neurosurgeons.
Methods The records of 18 consecutive patients with brachial plexus tumors who underwent surgical treatment between January 2010 and December 2017 in a single institution were retrospectively reviewed. The surgical approach was determined according to the tumor location and size, and intraoperative neurophysiological monitoring (IONM) was used in most of cases to prevent iatrogenic nerve injury during surgery. In addition, to evaluate the differences in tumor characteristics according to pathologic diagnosis, the tumors were divided twice into two groups, based on two separate classifications, and statistical analysis was performed.
Results The 18 brachial plexus tumors comprised 15 (83.3%) benign peripheral nerve sheath tumors including schwannoma and neurofibroma, one (5.6%) malignant peripheral nerve sheath tumor, one (5.6%) benign tumor of non-neural sheath origin (neurogenic cyst), and one (5.6%) metastatic tumor (papillary carcinoma). The authors analyzed relationship between tumor size/location and tumor characteristic parameters such as age, size, right-left, and pathology. There were no statistically significant differences except a tendency of bigger tumor size in young age.
Conclusion For a successful surgical outcome, an appropriate surgical approach is essential, and the appropriate surgical approach is determined by the location and size of the tumor. Furthermore, applying IONM may prevent postoperative complications and it is favorable option for brachial plexus tumors surgery.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Kyeong-Wook Yoon
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Young-Jin Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Sang Koo Lee
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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Desai KI. The Surgical Management of Symptomatic Benign Peripheral Nerve Sheath Tumors of the Neck and Extremities: An Experience of 442 Cases. Neurosurgery 2018; 81:568-580. [PMID: 28475798 DOI: 10.1093/neuros/nyx076] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The occurrence of benign peripheral nerve sheath tumors (PNSTs) is not uncommon. The surgical excision of symptomatic benign PNSTs along with preservation of the affected nerve and its function is an ideal treatment option. OBJECTIVE To analyze the outcome with respect to morbidity, extent of resection, and recurrence, and to review and compare our results with those reported in literature. METHODS A retrospective review of clinical and radiological findings of 442 patients with benign PNSTs involving the neck and extremities treated surgically from 2000 to 2014 was performed. RESULTS In our series, benign PNSTs involved the extremities in 290 (65.6%) patients and the brachial plexus in 146 (33%) patients, and 6 (1.4%) patients had tumors of the extracranial portion of the vagus and hypoglossal nerves in the neck. The mean age of patients was 38 yr. The presenting features were painful mass and paresthesia. Preoperative motor weakness in the extremity was noted in 15.6% of patients. The common nerves involved by the tumors were the ulnar nerve (15.8%), sciatic nerve (12.7%), and upper cervical roots (11.5%). The excision was total in 81.2%, gross total (>90%) in 17.9%, and subtotal (>50%) in 0.9% patients. In 17.6% of patients, there was severe postoperative neurogenic pain. In 28 (6.3%) patients, a new motor deficit was noted following surgery. Recurrence was seen in 2 patients in our series. The mean follow-up was 30.2 mo. CONCLUSION Benign PNSTs have excellent clinical outcome, and the goal for surgical treatment is total to gross total excision of the tumor with neural preservation.
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Affiliation(s)
- Ketan I Desai
- Department of Neurosurgery, P D Hinduja National Hospital, Mumbai, India
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Simó M, Navarro X, Yuste VJ, Bruna J. Autonomic nervous system and cancer. Clin Auton Res 2018; 28:301-314. [DOI: 10.1007/s10286-018-0523-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/15/2018] [Indexed: 02/06/2023]
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Head and Neck Schwannomas: A Surgical Challenge-A Series of 5 Cases. Case Rep Otolaryngol 2018; 2018:4074905. [PMID: 29686918 PMCID: PMC5857344 DOI: 10.1155/2018/4074905] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. They originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25–45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2–5% of neurogenic tumors. Methods We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves. Result Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one. Conclusion Head and neck schwannoma though rare should be considered as a differential diagnosis of a unilateral slow growing mass in the head and neck region, particularly in an adult. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time, and histopathology is the gold standard for diagnosis. As a rule, treatment is surgical and dictated by the location of the tumor and nerve of origin. Due to its rarity, complex anatomical location and morbidity risk postexcision, they can pose a formidable challenge to surgeons. This study aims to describe the presentation, workup, surgical technique, and outcome.
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Lee BH, Hyun SJ, Park JH, Kim KJ. Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report. KOREAN JOURNAL OF SPINE 2017; 14:89-92. [PMID: 29017303 PMCID: PMC5642101 DOI: 10.14245/kjs.2017.14.3.89] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.
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Affiliation(s)
- Byoung Hun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Hwa Park
- Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Sayari AJ, Tuchman A, Cohen JR, Hsieh PC, Buser Z, Wang JC. Risk and Cost of Reoperation After Single-Level Posterior Cervical Foraminotomy: A Large Database Study. Global Spine J 2017; 7:116-122. [PMID: 28507880 PMCID: PMC5415152 DOI: 10.1177/2192568217694004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To examine the risk of undergoing another cervical spine surgery after single-level posterior cervical foraminotomy (PCF) and analyze the costs of such reoperations. METHODS Using the PearlDiver database, we created database algorithms to identify cohorts of patients who underwent single-level PCF and also had various reoperations of interest, within 1, 2, and 4 years of follow-up. We also identified the per-patient average charge (PPAC) for each reoperation cohort. RESULTS In the Medicare cohort, the incidence of any reoperation was 8.3%, 9.8%, and 10.5% within 1, 2, and 4 years of follow-up, respectively. The PPAC was $8520 for the initial PCF procedure. When a second cervical surgery was performed, the PPAC was $70 349 for anterior fusion, $15 760 for posterior decompression alone, and $77 976 for posterior decompression and fusion. In the UnitedHealth cohort, the incidence of any reoperation was 13.6%, 16.7%, and 17.0% within 1, 2, and 4 years of follow-up, respectively. CONCLUSIONS The overall incidence of another cervical spine operation was slightly higher in the Medicare population to that in previous literature, but much higher in the UnitedHealth population. The most common reoperation after PCF varied between the Medicare and UnitedHealth datasets, and costs varied widely based on the procedure performed. This study provides pertinent information that surgeons can use to discuss the risk of reoperation with their patients.
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Affiliation(s)
- Arash J. Sayari
- University of Southern California, Los Angeles, CA, USA,University of Miami, Miami, FL, USA
| | | | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Elaine Stevely Hoffman Medical Research Center, HMR 710, 2011 Zonal Ave, Los Angeles, CA 90033, USA.
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Gordillo M. Neurofibroma solitario en raíz cervical C7. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2016. [DOI: 10.1016/j.ricma.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Los neurofibromas (NF) son tumores que se originan en la vaina de los nervios periféricos. Son poco frecuentes (un 30% aproximadamente de todos los tumores nerviosos) pero tan solo un 1% afectan al plexo cervical supraclavicular. Su desarrollo es lento e insidioso y a menudo confundido con otras patologías como son las neuropatías por compresión o las tendinopatías.Se presenta un caso localizado en la raíz C7 de una mujer de 48 años diagnosticada y tratada durante un año de tendinopatía de «De Quervain».
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Abstract
Percutaneous endoscopic cervical discectomy has evolved as an efficient, minimally invasive spine surgery for cervical disc herniation or radiculopathy. The development of the working channel endoscope makes definitive decompression surgery through a percutaneous approach feasible. There are two methods of approach to target the pathology: anterior and posterior approach. The approach can be determined according to the zone of pathology or the surgeon's preference. The most significant benefits of this endoscopic surgical technique are minimal access tissue trauma and early recovery from the intervention. However, this technique is still evolving and have a steep learning curve. Extensive development of surgical technique and working channel endoscopes will enable us to treat cervical disc herniation more practically. The objective of this review is to describe the cutting-edge techniques of endoscopic surgery in the cervical spine and to discuss the pros and cons of these minimally invasive surgical techniques.
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Affiliation(s)
- Yong Ahn
- a Department of Neurosurgery , Nanoori Hospital , Seoul , Republic of Korea
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Krisht KM, Karsy M, Shah LM, Schmidt MH, Dailey AT. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor. Surg Neurol Int 2016; 7:S64-6. [PMID: 26904368 PMCID: PMC4743268 DOI: 10.4103/2152-7806.174889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/01/2015] [Indexed: 12/21/2022] Open
Abstract
Background: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass.
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Affiliation(s)
- Khaled M Krisht
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Lubdha M Shah
- Department of Radiology, University of Utah, Salt Lake City, Utah 84132, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
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Efficacy of Posterior Segmental Decompression Surgery for Pincer Mechanism in Cervical Spondylotic Myelopathy: A Retrospective Case-controlled Study Using Propensity Score Matching. Spine (Phila Pa 1976) 2015; 40:1807-15. [PMID: 26192723 DOI: 10.1097/brs.0000000000001055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case-controlled study using propensity score matching. OBJECTIVE We aimed to evaluate the efficacy of cervical microendoscopic laminoplasty (CMEL) of the articular segment in patients with cervical spondylotic myelopathy (CSM) by comparing the clinical results of CMEL with conventional expansive laminoplasty (ELAP) for CSM. SUMMARY OF BACKGROUND DATA A total of 259 patients undergoing CMEL or ELAP surgery for CSM at authors' institute were reviewed. METHODS The patients were matched according to calculated propensity scores in a logistic regression model adjusted for age, sex, and preoperative severity of disorders and divided into the CMEL and ELAP groups. All patients were followed postoperatively for more than 2 years. The preoperative and 2-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), recovery rates, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), axial pain (visual analog scale), and the Short Form 36 questionnaire (SF-36). RESULTS There were 71 patients in each group (47 males and 24 females each). The mean ages of the CMEL and ELAP groups were 63.8 and 62.8 years, respectively. There was no significant difference in the preoperative JOA score between groups. The mean numbers of surgically affected levels in the ELAP and CMEL groups were 3.2 and 1.8 discs, respectively (P ≤ 0.05). The groups exhibited similar recoveries of JOA, JOACMEQ, and SF-36 scores postoperatively. Sagittal alignment was maintained in both groups. However, postoperative neck axial complaints were significantly reduced in the CMEL group. CONCLUSION CMEL may be a useful and effective surgical procedure for CSM, providing similar results as ELAP. CMEL for CSM is indicated for posterior decompression of the articular segment along with a pincer mechanism. This minimally invasive technique may have potential advantages compared with conventional ELAP, and may provide an alternative surgical option. LEVEL OF EVIDENCE 4.
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Kim CH, Kim KT, Chung CK, Park SB, Yang SH, Kim SM, Sung JK. Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:3005-12. [PMID: 26298479 DOI: 10.1007/s00586-015-4198-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/15/2015] [Accepted: 08/16/2015] [Indexed: 12/12/2022]
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Combined Video-Assisted Thoracic Surgery and Posterior Spinal Surgery for the Treatment of Dumbbell Tumor of the First Thoracic Nerve Root. Asian Spine J 2015; 9:595-9. [PMID: 26240720 PMCID: PMC4522451 DOI: 10.4184/asj.2015.9.4.595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023] Open
Abstract
Although several cases of a dumbbell tumor of thoracic nerve roots have been reported, reports on the surgical procedures for a dumbbell tumor of the first thoracic (T1) nerve root are rare. Surgeons should be cautious, especially when performing a surgical procedure for a dumbbell tumor of the T1 nerve root because the tumor is anatomically located adjacent to important organs and because the T1 nerve root composes the lower trunk of the brachial plexus with the eighth cervical nerve root. We present cases with dumbbell tumors of the T1 nerve root that were treated with combined surgical treatment to remove the tumor. We first performed video-assisted thoracic surgery (VATS) to release the organs anteriorly and then performed posterior spinal surgery in the prone position. The combined VATS and posterior spinal surgery may become a standard surgical procedure for the treatment of dumbbell tumors of the T1 nerve root.
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Lee HJ, Kim JH, Rhee SH, Gong HS, Baek GH. Is surgery for brachial plexus schwannomas safe and effective? Clin Orthop Relat Res 2014; 472:1893-8. [PMID: 24562874 PMCID: PMC4016461 DOI: 10.1007/s11999-014-3525-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Schwannomas rarely are found in the brachial plexus, and although they are benign, they present significant challenges to surgical treatment. To our knowledge, there are few studies investigating the surgical outcomes of patients with brachial plexus tumors. QUESTIONS/PURPOSES We analyzed the outcomes of 19 patients with brachial plexus schwannomas and asked: (1) How do these patients present? (2) Where are the tumors located in the brachial plexus? (3) What are the complications and neurologic results of patients after excision of the tumor? METHODS From February 2002 to August 2012, one orthopaedic hand surgeon treated 19 patients with schwannomas of the brachial plexus. We retrospectively reviewed the medical records and MRI data of all patients. There were 11 women and eight men, with a mean age of 50.2 years (range, 32-63 years). The tumor was located on the right side in eight patients and on the left in 11 patients. We evaluated neurologic deficits preoperatively and neurologic deficits and local recurrence of tumors postoperatively. Minimum followup was 12 months (mean, 37.2 months; range, 12-90 months). RESULTS The most common initial presentation was a palpable mass. The masses were located at all levels along the brachial plexus, including the root, trunk, cord, and terminal branches. The smallest mass was 1.5 × 1.5 × 0.5 cm and the largest was 11 × 10 × 6 cm. Fourteen of the 19 patients did not have any postoperative neurologic deficits. All the removed masses were proven histologically to be schwannomas. Of the five patients who had postoperative neurologic deficits, three had transient sensory deficits, one had weakness of the flexor pollicis longus and second flexor digitorum profundus, and another had weakness of the extensor pollicis longus. No recurrence was observed during the followup period. CONCLUSIONS Schwannomas of the brachial plexus are a potentially curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve symptoms with minimal morbidity. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hyuk Jin Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea
| | - Jeong Hwan Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea
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Tschoe C, Holsapple JW, Binello E. Resection of Primary Brachial Plexus Tumor via a Modified Supraclavicular Approach. J Neurol Surg Rep 2014; 75:e133-5. [PMID: 25083372 PMCID: PMC4110154 DOI: 10.1055/s-0034-1376423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/24/2014] [Indexed: 10/29/2022] Open
Abstract
Benign peripheral nerve sheath tumors are generally considered curable lesions, and surgical resection is recommended as the primary line of treatment. When these tumors occur in the brachial plexus, they are most frequently accessed via the supraclavicular approach. Traditional descriptions of this approach have included either transection of sternocleidomastoid (SCM) muscle fibers or disarticulation of the clavicular head of the SCM muscle. This report presents a simple and easy-to-adapt modification of the supraclavicular approach that offers greater preservation of the SCM muscle. The modification primarily consists of the creation of an intramuscular window between the sternal and clavicular heads of the SCM via the splitting and dilation SCM muscle fibers. This technique minimizes the disruption of SCM muscle tissue compared with previous descriptions and may be associated with improved postoperative pain and return to function.
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Affiliation(s)
- Christine Tschoe
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, United States
| | - James W Holsapple
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Emanuela Binello
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, United States
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Simon NG, Cage T, Narvid J, Noss R, Chin C, Kliot M. High-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection. J Neurosurg 2014; 120:1113-7. [PMID: 24628610 DOI: 10.3171/2014.2.jns131975] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The goals of the present study were to demonstrate the ability of high-resolution ultrasonography to delineate normal nerve fascicles within or around peripheral nerve sheath tumors (NSTs). A blinded examiner evaluated 2 patients with symptomatic upper limb NSTs with high-resolution ultrasonography performed in the perioperative suite using a portable ultrasonography system. Ultrasonographic examinations located the tumor mass and identified the normal nerve fascicles associated with the mass. The locations of normal nerve tissue were mapped and correlated with results of MR tractography, operative inspection, and intraoperative electrophysiological monitoring. The study demonstrated a close correlation between normal nerve fascicles identified by ultrasonography, MR tractography, and intraoperative electrophysiological mapping. In particular, ultrasonographic examinations accurately identified the surface regions of the tumor without overlying normal nerve tissue. These preliminary data suggest that preoperative ultrasonographic examinations may provide valuable information, supplementary to the information obtained from intraoperative electrophysiological monitoring. Identification of normal nerve tissue prior to surgery may provide additional information regarding the risk of iatrogenic nerve injury during percutaneous tumor biopsy or open resection of the tumor and may also aid in selecting the optimum surgical approach.
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Surgical planning and neurological outcome after anterior approach to remove a disc herniation at the C7-T1 level in 19 patients. Spine (Phila Pa 1976) 2014; 39:E219-25. [PMID: 24477083 DOI: 10.1097/brs.0000000000000109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to report the neurological presentation, outcome and surgical planning in a series of patients with a symptomatic single-level C7-T1 disc herniation who underwent anterior surgical discectomy and fusion. SUMMARY OF BACKGROUND DATA Disc herniations at C7-T1 are uncommon, and there are few large series in the literature describing anterior treatment of such herniations. METHODS We performed a retrospective study of patients who underwent surgery for a C7-T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging. The location of the herniated disc in the spinal canal was determined using a T2 axial magnetic resonance imaging and classified as central, foraminal, and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council. The disc space was approached anteriorly by a standard cervical supramanubrial Smith-Robinson approach. RESULTS We identified 19 patients who had undergone C7-T1 discectomy and fusion. The mean age of the sample was 54.26 ± 8.65 years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15/19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 ± 15.10 months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9/19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed. CONCLUSION An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication. LEVEL OF EVIDENCE 4.
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Cervical microendoscopic discectomy and fusion: does it affect the postoperative course and the complication rate? A blinded randomized controlled trial. Spine (Phila Pa 1976) 2013; 38:2064-70. [PMID: 24026156 DOI: 10.1097/01.brs.0000435030.96058.bf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A blinded randomized controlled trial. OBJECTIVE The purpose of this study was to evaluate the cervical microendoscopic discectomy and fusion. SUMMARY OF BACKGROUND DATA Minimally invasive treatment of spinal disorders allows surgeons to have direct access to the pathology with a reduced surgical morbidity, which is reflected over the improved postoperative course. Minimally invasive techniques for cervical discectomy including the posterior microendoscopic discectomy and the percutaneous endoscopic discectomy have a high success rate but are limited by the narrow range of indications. Lately, preliminary reports about cervical microendoscopic discectomy and fusion (CMEDF) showed high success rates without restrictions in the indications. METHODS Seventy consecutive patients were randomly assigned in 2 equal groups, the first operated by the "gold standard" anterior cervical discectomy and fusion and the second by CMEDF. Blinding included the patient-until dressing removal, the evaluating physician, and the radiologist throughout the entire study. The mean follow-up period was 28 months and outcome has been assessed using the Japanese Orthopaedic Association score, Odom criteria and the visual analogue scale. In addition, the operative time, complication rate, hospitalization, and the postoperative analgesic doses were recorded. RESULTS The functional outcome of the CMEDF at the final follow-up was 91% good to excellent. Results in the open group were very similar. Meanwhile, CMEDF demonstrated improved cosmesis, reduced laryngopharyngeal complication rate, postoperative analgesics, and hospital stay. CONCLUSION The results of the CMEDF are very promising. However, a much larger patient series from multicenter studies is still required for drawing up a final conclusion. LEVEL OF EVIDENCE 1.
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Rashid M, Salahuddin O, Yousaf S, Qazi UA, Yousaf K. Schwannoma of the brachial plexus; report of two cases involving the C7 root. J Brachial Plex Peripher Nerve Inj 2013; 8:12. [PMID: 24180468 PMCID: PMC3953679 DOI: 10.1186/1749-7221-8-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
Brachial plexus schwannomas are rare tumors. They are benign nerve sheath tumors and only about 5% of Schwannoma arise from the brachial plexus. They pose a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present two cases who presented with a supraclavicular swelling, that were proven to be schwannoma on histopathology.
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Neurological outcome following resection of benign presacral neurogenic tumors using a nerve-sparing technique. Dis Colon Rectum 2013; 56:1185-93. [PMID: 24022536 DOI: 10.1097/dcr.0b013e31829e4e4f] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Benign presacral nerve sheath tumors represent up to 10% of all presacral tumors. Limited data exist regarding the impact of the surgical technique on neurological outcomes following resection. OBJECTIVE The aim of this study was to test our hypothesis that a nerve-sparing resection technique results in the improvement of preoperative neurological dysfunction and minimal postoperative neurological morbidity. DESIGN This study is a case series of all patients with benign neurogenic presacral tumors operated on by the same 2 surgeons between 2004 and 2010 at our institution. SETTINGS This study was performed at a tertiary care center. PATIENTS Adult patients with benign presacral neurogenic tumors who underwent a nerve-sparing resection were included. MAIN OUTCOME MEASURES Postoperative urogenital, anorectal, and lower-extremity neurological functions were analyzed. RESULTS Seventeen patients were identified with a mean age of 40 years; 14 were women. Preoperatively, 13 patients had symptoms from neurological dysfunction or presumed mass effect of the tumor. The mean tumor size was 7.4 cm. The pathology was a schwannoma in 12 patients and neurofibroma in 5 patients. Mortality was nil, and 30-day morbidity was noted in 3 patients (hemorrhage, ileus, acute respiratory distress syndrome, deep vein thrombosis, and transient foot drop). Mean follow-up was 36 months. Of the 13 symptomatic patients, 7 achieved complete resolution of symptoms and 5 had improved, but persistent symptoms. None of the 4 asymptomatic patients developed postoperative neurological dysfunction. LIMITATIONS Small sample size was a limitation of this study. CONCLUSIONS With the use of a nerve-sparing technique, function-preserving resection can be safely completed with an overall improvement in symptoms.
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Surgical treatment of typical peripheral schwannomas: the risk of new postoperative deficits. Acta Neurochir (Wien) 2013; 155:1745-9. [PMID: 23873125 DOI: 10.1007/s00701-013-1818-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/03/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although peripheral schwannomas can be resected without postoperative neurological complications, surgeons must anticipate the possibility that new neurological deficits could develop. In order to evaluate the risk of neurological complications in the surgical treatment of these tumours, we performed a retrospective review of cases involving schwannomas in the extremities, as well as an analysis of the related literature. METHOD We reviewed a combined series of 72 schwannomas from the extremities presenting for surgical excision. Meticulous analysis of the files was undertaken, searching for pre-operative findings that could be more frequent in patients with surgical complications. The incidence, severity, and transitory nature of post-operative complications in our series was observed and compared against the literature. RESULTS Eleven patients (15.2 %) developed new neurological deficits after surgery: sensory disturbance in seven cases, motor weakness in three, and a single wound hematoma. Most of these complications were temporary. Statistical analysis demonstrated a positive relationship between the presence of complications and both patient age under 50 years (p = 0.02) and tumours greater than 3 cm in greatest diameter (p = 0.02). CONCLUSIONS Although relatively infrequent, the potential for novel post-operative deficits after the surgical treatment of peripheral schwannomas does exist and should be included during pre-operative counseling.
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Preoperative symptoms and postoperative sequelae of intrathoracic neurogenic tumors: a single institution's experience. Gen Thorac Cardiovasc Surg 2013; 61:699-705. [PMID: 23852427 DOI: 10.1007/s11748-013-0285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Most intrathoracic neurogenic tumors are resected for therapeutic diagnosis; many adult tumors are benign. However, few studies have reported the preoperative symptoms, postoperative modalities, and sequelae of these tumors. We focused on and evaluated the diversity and postoperative prognosis of these tumors. METHODS We assessed 31 consecutive cases of intrathoracic neurogenic tumors resected at Tsuchiura Kyodo General Hospital between 1988 and 2012. Two cases involved multiple tumors; therefore, complete resection or enucleation was performed only in the remaining 29 cases. The patients' clinical records were investigated retrospectively. RESULTS All tumors were benign. Five cases (16.1 %) presented with preoperative symptoms; 2 cases with non-neurologic symptoms (dysphagia due to tumor oppression and a massive hemothorax with neurofibromatosis type 1) improved after surgery, but 3 others with neurologic symptoms (back pain, hand motor paralysis, and Horner's syndrome) did not. Ten cases (32.3 %) presented with postoperative modalities or sequelae. Eight cases presented with neurologic sequelae (Horner's syndrome, 4 cases; grip weakness, 3 cases; hypohidrosis, 3 cases; and hand numbness, 2 cases). All the patients presenting with neurologic sequelae had tumors proximal to the first or second thoracic vertebra; no tumors proximal to or under the third thoracic vertebra caused neurologic sequelae. Severe neurologic sequelae in daily life were observed in 2 cases, but they did not radically improve. CONCLUSIONS While the non-neurologic symptoms caused by intrathoracic neurogenic tumors can be resolved by resection, the neurologic symptoms may not improve. Tumors proximal to the first or second thoracic vertebra can cause postoperative neurologic sequelae.
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Patel ML, Sachan R, Seth G, Radheshyam. Schwannoma of the brachial plexus: a rare cause of monoparesis. BMJ Case Rep 2013; 2013:bcr2012008525. [PMID: 23632608 PMCID: PMC3645221 DOI: 10.1136/bcr-2012-008525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Munna Lal Patel
- Department of Internal Medicine, CSM Medical University, Lucknow, Lucknow, Uttar Pradesh, India.
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Operative Management of a Sacral Gunshot Injury via Minimally Invasive Techniques and Instrumentation. Asian Spine J 2013; 7:44-9. [PMID: 23508557 PMCID: PMC3596584 DOI: 10.4184/asj.2013.7.1.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 08/04/2012] [Accepted: 08/20/2012] [Indexed: 01/19/2023] Open
Abstract
Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation.
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Soltani AM, Francis CS, Kane JT, Kazimiroff PB, Edgerton BW. Neural sheath tumors of the brachial plexus: a multidisciplinary team-based approach. Ann Plast Surg 2013; 71:80-3. [PMID: 23392262 DOI: 10.1097/sap.0b013e31827100d8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral tumors of the brachial plexus, although rare, provide an opportunity for the plastic surgeon to coordinate a multidisciplinary team and achieve excellent outcomes. Most of the case series are reported from the neurosurgical literature. We report on the experience of the Kaiser Permanente Brachial Plexus Clinic over a recent 2-year period. A retrospective review was conducted to examine the medical records, radiographic images, operative reports, and pathologic findings of 13 consecutive patients with peripheral nerve sheath tumors of brachial plexus origin. Of the 10 patients requiring surgical exploration, 90% had significant improvement or resolution of pain, with sensory and motor recovery showing mixed results. Average follow-up consisted of 2 years with occupational therapy beginning shortly after operative intervention. Our results are similar to or better than those published in the literature. The plastic surgeon with subspecialty training can safely and successfully treat tumors of the brachial plexus by implementing a multidisciplinary approach.
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Affiliation(s)
- Ali M Soltani
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Grisold W, Briani C, Vass A. Malignant cell infiltration in the peripheral nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:685-712. [PMID: 23931810 DOI: 10.1016/b978-0-444-52902-2.00040-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The peripheral nervous system can be affected by malignancies involving different mechanisms. Neoplastic nerve lesion by compression, invasion, and infiltration is rare and occurs in particular in leukemia (neuroleukemiosis) and lymphoma (neurolymphomatosis). Its occurrence is much rarer in cancer, and even less so in sarcoma. The neoplastic infiltration of peripheral nerves by solid tumors is characterized by specific topographical sites such as the base of the skull, the ear, nose and throat region, and the cervico-brachial plexus as well as the lumbar and sacral plexus. Rarely malignant invasion affects the cranial nerves of the face where it can spread centripetally. Autonomic nerves and ganglia can also be affected. The retrograde spread of cancer in nerves is a bad prognostic sign. The clinical diagnosis is determined by tumor type, the pattern of involvement, and often pain.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser-Franz-Josef Hospital, Austrian Cluster for Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
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Kolberg M, Høland M, Agesen TH, Brekke HR, Liestøl K, Hall KS, Mertens F, Picci P, Smeland S, Lothe RA. Survival meta-analyses for >1800 malignant peripheral nerve sheath tumor patients with and without neurofibromatosis type 1. Neuro Oncol 2012; 15:135-47. [PMID: 23161774 PMCID: PMC3548581 DOI: 10.1093/neuonc/nos287] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
There are conflicting reports as to whether malignant peripheral nerve sheath tumor (MPNST) patients with neurofibromatosis type 1 (NF1) have worse prognosis than non-NF1 MPNST patients. Large clinical studies to address this problem are lacking due to the rareness of MPNST. We have performed meta-analyses testing the effect of NF1 status on MPNST survival based on publications from the last 50 years, including only nonoverlapping patients reported from each institution. In addition, we analyzed survival characteristics for 179 MPNST patients from 3 European sarcoma centers. The meta-analyses including data from a total of 48 studies and >1800 patients revealed a significantly higher odds ratio for overall survival (OR(OS)) and disease-specific survival (OR(DSS)) in the non-NF1 group (OR(OS) = 1.75, 95% confidence interval [CI] = 1.28-2.39, and OR(DSS) = 1.68, 95% CI = 1.18-2.40). However, in studies published in the last decade, survival in the 2 patient groups has been converging, as especially the NF1 group has shown improved prognosis. For our own MPNST patients, NF1 status had no effect on overall or disease-specific survival. The compiled literature from 1963 to the present indicates a significantly worse outcome of MPNST in patients with NF1 syndrome compared with non-NF1 patients. However, survival for the NF1 patients has improved in the last decade, and the survival difference is diminishing. These observations support the hypothesis that MPNSTs arising in NF1 and non-NF1 patients are not different per se. Consequently, we suggest that the choice of treatment for MPNST should be independent of NF1 status.
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Affiliation(s)
- Matthias Kolberg
- Department of Cancer Prevention, Institute for Cancer Research, the Norwegian Radium Hospital, Montebello, Oslo University Hospital, NO-0424 Oslo, Norway.
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Abstract
Minimally invasive spine surgery (MISS) techniques were developed to address morbidities associated with open spinal surgery approaches. MISS was initially applied for indications such as the microendoscopic decompression of stenosis (MEDS)-an operation that has become widely implemented in modern spine surgery practice. Minimally invasive surgery for MEDS is an excellent example of how an MISS technique has improved outcomes compared with the use of traditional open surgical procedures. In parallel with reports of surgeon experience, accumulating clinical evidence suggests that MISS is favoured over open surgery, and one could argue that the role of MISS techniques will continue to expand. As the field of minimally invasive surgery has developed, MISS has been implemented for the treatment of increasingly difficult and complex pathologies, including trauma, spinal malignancies and spinal deformity in adults. In this Review, we present the accumulating evidence in support of minimally invasive techniques for established MISS indications, such as lumbar stenosis, and discuss the need for additional level I and level II data to demonstrate the benefit of MISS over traditional open surgery. The expanding utility of MISS techniques to address an increasingly broad range of spinal pathologies is also highlighted.
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Massicotte E, Foote M, Reddy R, Sahgal A. Minimal Access Spine Surgery (MASS) for Decompression and Stabilization Performed as an Out-Patient Procedure for Metastatic Spinal Tumours Followed by Spine Stereotactic Body Radiotherapy (SBRT): First Report of Technique and Preliminary Outcomes. Technol Cancer Res Treat 2012; 11:15-25. [DOI: 10.7785/tcrt.2012.500230] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a novel approach in the treatment of spinal metastases with epidural disease and mechanical instability using a combined minimal access spine surgery (MASS) technique followed by spine stereotactic body radiotherapy (SBRT). This study was performed as a retrospective review of the first ten consecutive patients treated with this combined approach. The MASS technique was based on a tubular retraction system to gain access for decompression and mechanical stabilization achieved using methyl-methacrylate (MMA) applied under direct visualization. SBRT consisted of one to five image-guided high dose per fraction treatments. Eight patients were symptomatic at baseline. Pain, disability, and quality of life (QOL) were prospectively determined using the visual analogue score (VAS), Oswestry Disability Index (ODI), and Short-Form-36 version 2, respectively. The median follow-up was 13 months (range, 3–18). MASS successfully decompressed each patient. The median blood loss was 335 ml. Following MASS, the median time to SBRT treatment planning was 6.5 days and subsequent median time to treatment was 7 days. Local control was observed in 7 of the 10 patients. Improvements in VAS, ODI and QOL were observed post-SBRT. We report preliminary efficacy for our MASS-SBRT combined approach for patients with spinal metastases, mechanical pain and epidural disease.
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Affiliation(s)
- Eric Massicotte
- Division of Neurosurgery and Krembil Neuroscience-Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Foote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rajesh Reddy
- Division of Neurosurgery and Krembil Neuroscience-Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Barakat M, Hussein Y. Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1383-8. [PMID: 22270247 DOI: 10.1007/s00586-012-2158-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 12/17/2011] [Accepted: 01/11/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anatomical study of the relationship among the cervical nerve roots, intervertebral disc, and lateral mass is important for the neurosurgeon to avoid complications of posterior cervical foraminotomy. METHODS Six adult cadavers were studied. The muscles of the back of the neck were removed to expose the cervical vertebrae posteriorly from C3 to C7. We measured the length, height, extent, and angulations of the nerve roots from the medial point of the facet (MPF) after a total laminectomy, then after one-half facetectomy. The height, width, anteroposterior diameter of the lateral mass, then the height and anteroposterior diameter of the neural foramen were also measured. RESULTS After total laminectomy from C3 to C7, all measures were taken from MPF showed that the mean length of the exposed root was 6.5-8.8 mm while vertical distance was 4-5.4 mm and the horizontal distance was 5.1-7.1 mm. Following a medial one-half facetectomy; the mean length of the exposed root was 8.9-12.3 mm, the vertical distance was 5.5-7.3 mm while the horizontal distance was 7.1-9.8 mm. The mean angulations of the nerve roots were 50.9-53.3º. There was a significant difference after total laminectomy and medial one-half facetectomy. CONCLUSION Anatomic and morphologic study of the cervical nerve roots and their relationships to the lateral mass and the intervertebral disc are useful landmarks to reduce the operative complications of the posterior foraminotomy.
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Affiliation(s)
- Mohamed Barakat
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Abstract
Although direct neoplastic involvement of muscle tis-sue is surprisingly rare, considering the large amount of body mass that is represented by muscle tissue, the most important and unresolved muscle effect is muscle cachexia.Other associations, such as inflammatory, paraneo-plastic, toxic, and several extremely rare associations,have been described. Drug-induced toxicity and radiation recall syndrome need to be taken into consideration when muscle symptoms appear in patients with cancer.
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Abstract
Abstract
Primary benign brachial plexus tumors are rare. They pose a great challenge to the neurosurgeon, because the majority of patients present with minimal or no neurological deficits. Radical to complete excision of the tumor with preservation of neurological function of the involved nerve is an ideal surgical treatment option with benign primary brachial plexus tumor surgery. We present a review article of our 10-year experience with primary benign brachial plexus tumors surgically treated at King Edward Memorial Hospital and P.D. Hinduja National Hospital from 2000 to 2009. The clinical presentations, radiological features, surgical strategies, and the eventual outcome following surgery are analyzed, discussed, and compared with available series in the world literature. Various difficulties and problems faced in the management of primary benign brachial plexus tumors are analyzed. Irrespective of the tumor size, the indications for surgical intervention are also discussed. The goal of our study was to optimize the treatment of patients with benign brachial plexus tumors with minimal neurological deficits. It is of paramount importance that brachial plexus tumors be managed by a peripheral nerve surgeon with expertise and experience in this field to minimize the neurological insult following surgery.
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Affiliation(s)
- Ketan I. Desai
- P. D. Hinduja National Hospital and Medical Research Center, Mumbai, India
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Mawatari T, Baba T, Satoh H, Morishita K, Izumiyama O, Watanabe A. Example of evoked potential monitoring for a neurogenic tumor positioned high in the mediastinum. Ann Thorac Cardiovasc Surg 2011; 17:297-300. [PMID: 21697795 DOI: 10.5761/atcs.cr.09.01456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 04/05/2010] [Indexed: 11/16/2022] Open
Abstract
Excision of a neurogenic tumor of the brachial plexus positioned high in the mediastinal space could potentially result in a functional disorder of the arm. We report on a case in which we performed evoked potential monitoring on a tumor located high in the mediastinum. We found large potential changes in the median and ulnar nerve areas and had a concern that the excision might injure the brachial plexus. We did a biopsy and intraoperative rapid histological diagnosis, which promptly revealed that the tumor was not malignant. Thus, we decided not to excise the tumor because the procedure could possibly injure nerves in the arm.
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Affiliation(s)
- Tohru Mawatari
- Department of Thoracic and Cardiovascular Surgery, Hakodate Municipal hospital, Hakodate, Hokkaido, Japan.
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