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Bratelj D, Jaszczuk P, Capone C, Dragalina C, Pötzel T, Fiechter M. Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values. Heliyon 2024; 10:e25670. [PMID: 38356492 PMCID: PMC10865310 DOI: 10.1016/j.heliyon.2024.e25670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/09/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Interbody cages are routinely used in lumbar reconstruction surgery of deformity cases for restoration of lordosis and sagittal balance of the spine. However, if hyperlordotic implants are inserted into the intervertebral space, special consideration has to be taken concerning the height of the neural foramen during cage implantation. The greater the lordotic angle of the cage is, the higher the posterior size of the cage needs to be in order to avoid neuroforaminal nerve root impingement. In this technical communication, we propose and clinically validate a stepwise mathematic model to predict neuroforaminal height in patients undergoing lumbar reconstruction with hyperlordotic cages. The length of the superior and inferior vertebral end plates including the height of the neural foramen are measured before implantation of the cage in standing sagittal view x-rays. By assumption of an isosceles triangle in combination with the posterior height and the lordotic angle of the cage, the neuroforaminal height after cage implantation can be estimated. By comparison of the predicted neuroforaminal height with age and sex dependent reference values, nerve root impingement can be avoided by selection of the necessary posterior height of the hyperlordotic cage while still gaining sufficient lumbar lordosis.
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Affiliation(s)
- Denis Bratelj
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Phillip Jaszczuk
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Crescenzo Capone
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Cristian Dragalina
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Tobias Pötzel
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Michael Fiechter
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
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Zekaj E, Callea M, Saleh C, Iess G, Jaszczuk P, Steiner LA, Kenstaviciute V, Servello D. How to avoid intraoperative complications of active paragangliomas? Surg Neurol Int 2023; 14:405. [PMID: 38053703 PMCID: PMC10695454 DOI: 10.25259/sni_620_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Background Paragangliomas (PGs) are very rare neuroendocrine tumors that can be found in unusual locations such as the spinal canal. Some PGs may be endocrinologically active, containing neurotransmitters such as noradrenaline, adrenaline, and serotonin. This can lead to unexpected neurotransmitter release during the removal of PGs, leading to a hypertensive crisis. Case Description We present two patients who underwent surgical removal of a secretory filum terminale PG. Conclusion If laboratory tests are suggestive of a secretory tumor, surgery should include anesthesiologic preparation similar to cases of pheochromocytoma.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
| | - Marcella Callea
- Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | | | - Guglielmo Iess
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
| | - Phillip Jaszczuk
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Luzius A Steiner
- Department of Anesthesia, Surgical Intensive Care, Preclinical Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Viktorija Kenstaviciute
- Department of Anesthesia, Surgical Intensive Care, Preclinical Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Domenico Servello
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy
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Bratelj D, Stalder S, Capone C, Jaszczuk P, Dragalina C, Pötzel T, Gebhard C, Fiechter M. Spinal cord tethering and syringomyelia after trauma: impact of age and surgical outcome. Sci Rep 2023; 13:11442. [PMID: 37454226 PMCID: PMC10349820 DOI: 10.1038/s41598-023-38565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Posttraumatic spinal cord tethering and syringomyelia frequently lead to progressive neurological loss. Although several studies demonstrated favourable outcome following spinal cord detethering with/without shunting, additional research is required as no clear consensus exists over the ideal treatment strategy and knowledge about prognostic demographic determinants is currently limited. In this investigation, we retrospectively investigated 67 patients (56 men, 11 women) who were surgically treated and followed for symptomatic spinal cord tethering and syringomyelia from 2012 to 2022 at our center. Age (B-coefficient 0.396) and severity of trauma to the spinal cord (B-coefficient - 0.462) have been identified as independent predictors for the rate of development of symptomatic spinal cord tethering and syringomyelia (p < 0.001). Following untethering surgery including expansion duraplasty with/without shunting, 65.9% of patients demonstrated an improvement of neurological loss (p < 0.001) whereas 50.0% of patients displayed amelioration of spasticity and/or neuropathic pain (p < 0.001). Conclusively, active screening for symptomatic spinal cord tethering and syringomyelia, particularly in younger patients with severe spinal trauma, is crucial as surgical untethering with/without shunting is able to achieve favourable clinical outcomes. This knowledge may enable clinicians to tailor treatment strategies in spinal cord injury patients suffering from progressive neurological loss towards a more optimal and personalized patient care.
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Affiliation(s)
- Denis Bratelj
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Susanne Stalder
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Crescenzo Capone
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Phillip Jaszczuk
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Cristian Dragalina
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Tobias Pötzel
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michael Fiechter
- Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, Switzerland.
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
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Fiechter M, Bratelj D, Jaszczuk P, Capone C, Dragalina C, Pötzel T. Multi-rod fixation in spinal neuroarthropathy: a novel surgical technique. J Spine Surg 2023; 9:176-185. [PMID: 37435331 PMCID: PMC10331497 DOI: 10.21037/jss-22-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/14/2023] [Indexed: 07/13/2023]
Abstract
Spinal cord injury (SCI) leads to compromised biomechanical stability due to impaired neuroprotection. This may trigger deformity and destruction of multiple segments of the spine which is known as spinal neuroarthropathy (SNA) or Charcot arthropathy. Surgical treatment of SNA is highly demanding in terms of reconstruction, realignment, and stabilization. In particular, construct failure due to the combination of high shear forces and reduced bone mineral density in the lumbosacral transition zone is a frequent complication in SNA. Notably, up to 75% of SNA patients need multiple revisions within the first year after surgery in order to achieve successful bony fusion. The purpose of this technical report is to present a novel surgical approach with higher overall construct stability to efficiently treat SNA and avoiding repetitive revisions. The new technique of triple rod stabilisation of the lumbosacral transition zone in combination with the introduction of tricortical laminovertebral (TLV) screws is demonstrated in three patients with complete SCI of the thoracic spinal cord. After surgery all patients reported an improvement of the Spinal Cord Independence Measure III (SCIM III) and none of the reported cases showed construct failure within an at least 9 months follow up period. Although TLV screws violate the integrity of the spinal canal, there were no complications with regard to cerebral spinal fluid fistulas and/or arachnopathies so far. The new concept of triple rod stabilization in combination with TLV screws provides improved construct stability in patients with SNA and thus could help to reduce revision and complications rates and improve patient outcome in this disabling degenerative disease.
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Affiliation(s)
- Michael Fiechter
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Denis Bratelj
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Phillip Jaszczuk
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Crescenzo Capone
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Cristian Dragalina
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Tobias Pötzel
- Department of Spine Surgery, Swiss Paraplegic Center, Nottwil, Switzerland
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Ciuffi A, Saleh C, Terreni MR, Jaszczuk P, Zekaj E, Menghetti C, Franzini A, Servello D. A cervical solitary fibrous tumor with intramedullary invasion. Surg Neurol Int 2022; 13:343. [PMID: 36128101 PMCID: PMC9479521 DOI: 10.25259/sni_538_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Solitary fibrous tumor is a tumor originating from the mesenchymal cells, which occurrence in the central nervous system is extremely rare and was described in few patients as to yet. We report on a 53-years old male patient presenting with right upper limb radicular pain and ipsilateral limbs paresis, who was diagnosed with a cervical spinal lesion which, after surgical resection, resulted to be a solitary fibrous tumor (SFT). We discuss imaging, clinical and histopathological findings to allow considering this tumor early in the differential diagnosis.
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Affiliation(s)
- Andrea Ciuffi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Lombardia, Italy,
| | - Christian Saleh
- Clinic for Forensics, University Psychiatric Clinic Basel, Basel, Switzerland,
| | - Maria Rosa Terreni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy,
| | - Phillip Jaszczuk
- Department of Spinal Surgery and Spinal Cord Surgery, Swiss Paraplegic Centre, Notwill, Switzerland,
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan,
| | - Claudia Menghetti
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan,
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Domenico Servello
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan,
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Zekaj E, Saleh C, Iess G, Ciuffi A, Jaszczuk P, Galbiati TF, Servello D. Pros of the contralateral (over-the-top) approach to intra/extraforaminal lumbar disc herniations at the L5-S1 level. Surg Neurol Int 2022; 13:243. [PMID: 35855125 PMCID: PMC9282753 DOI: 10.25259/sni_400_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Minimally invasive approaches to intra/extraforaminal lumbar disc herniations offer the benefit of less bone removal and reduced nerve root manipulation at the L5-S1 level. Moreover, the potential to better preserve stability.
Methods:
Here, we summarized the efficacy of the contralateral approach to intraforaminal/extraforaminal lumbar disc herniations particularly focusing on the L5-S1 level. Variables studied included the level of these disc herniations, their locations within the foramina, and the anatomy of the facet joints.
Results:
A major “pro” for the contralateral interlaminar procedure at the L5-S1 level is that it does not require facet joint removal, or with a spondylotic facet, <30% joint excision, to directly visualize the intraforaminal/ extraforaminal nerve root. It, therefore, reduces the risk of creating iatrogenic instability, while offering a higher certitude of adequate nerve root visualization, decompression, and safer disc removal.
Conclusion:
The contralateral interlaminar approach is more suitable for all types of intra/extraforaminal disc herniations at the L5/S1 level. The most specific benefit of this approach is its avoidance of disruption/significant removal (i.e., <30%) of the facet joint to adequately expose the foraminal L5 nerve root, and more safely remove the intra/extraforaminal disc herniation.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,
| | | | - Guglielmo Iess
- Department of Functional Neurosurgery, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,
| | - Andrea Ciuffi
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,
| | - Phillip Jaszczuk
- Department of Spinal Surgery and Spinal Cord Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Domenico Servello
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy,
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Saleh C, Ilia TS, Jaszczuk P, Hund-Georgiadis M, Walter A. Is transcranial magnetic stimulation as treatment for neuropathic pain in patients with spinal cord injury efficient? A systematic review. Neurol Sci 2022; 43:3007-3018. [PMID: 35239053 DOI: 10.1007/s10072-022-05978-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Neuropathic pain is a clinically relevant complication in individuals with spinal cord injury (SCI). Pharmacological pain treatment is often insufficient and leads to undesirable side effects. Thus, alternative therapeutic approaches such as repetitive transcranial magnetic stimulation (rTMS) are of critical importance. We aimed to evaluate the effectiveness of rTMS in neuropathic pain secondary to SCI. METHODS We conducted a systematic review using the PubMed/MEDLINE, EMBASE, and PsycInfo (via OVID) database up April 2021. Only randomized controlled trials were included. Results regarding the pain intensity scores were pooled using a random-effects model. RESULTS The search identified a total of 203 potential articles. Of these, eight randomized controlled trials (RCTs) met the eligibility criteria for qualitative synthesis providing the total data of 141 patients. All studies applied high-frequency rTMS. In seven studies, rTMS was applied over the motor cortex, and in one study over the left dorsolateral prefrontal cortex. Five studies reported a significant improvement in baseline pain scores after treatment, and three studies found a significant difference between sham vs. non-sham stimulation at any time. Six RCTs were included in the quantitative synthesis and showed a significant overall reduction of pain intensity in the rTMS groups compared with the sham groups (mean difference - 0.81, 95%CI - 1.45 to - 0.17). CONCLUSIONS Our findings indicate that high-frequency rTMS of the primary motor cortex and left dorsolateral prefrontal cortex might be promising stimulation targets for neuropathic pain in SCI.
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Affiliation(s)
- Christian Saleh
- Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland
| | - Tatiani Soultana Ilia
- Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland
| | - Phillip Jaszczuk
- Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland
| | - Margret Hund-Georgiadis
- Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland
| | - Anna Walter
- Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland.
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Angelidis P, Saleh C, Jaszczuk P, Seyam M, Ebner KA, Hund-Georgiadis M. SMART Syndrome (Stroke-like migraine attacks after radiation therapy): When to suspect it? Surg Neurol Int 2021; 12:561. [PMID: 34877047 PMCID: PMC8645481 DOI: 10.25259/sni_893_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a benign complication of brain radiation therapy, which presents circa a decade after radiation treatment. Symptoms are stroke-like deficits, epileptic seizures, and migraine. Cranial magnetic resonance imaging is characteristic for alterations in the form of unilateral cortical hyperintensities and gyriform enhancement, most prominent in the parieto-occipital regions. Prompt diagnosis is essential to avoid unnecessary investigations (e.g., brain biopsy and angiography). Case Description: We describe a 51-year-old female patient treated initially with cranial irradiation for a left-sided occipital metastatic lung adenocarcinoma. Five years later, she presented with migraine headache, aphasia, and a right sided hemiparesis. Conclusion: The triad of migraine, seizure, and hemiparesis within the context of a prior brain radiotherapy should promptly raise the suspicion of SMART syndrome. Prompt diagnosis is essential to avoid unnecessary invasive investigations.
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Affiliation(s)
- Petros Angelidis
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Christian Saleh
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Phillip Jaszczuk
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Muhannad Seyam
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
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Grigioni G, Saleh C, Jaszczuk P, Wand D, Wilmes S, Hund-Georgiadis M. Fragile-X-Associated Tremor/Ataxia Syndrome or Alcohol-Induced Cerebellar Degeneration? A Case Report. Case Rep Neurol 2020; 12:466-471. [PMID: 33442376 PMCID: PMC7772861 DOI: 10.1159/000511954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
Fragile-X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder that manifests with intention tremor, progressive gait ataxia, and cognitive impairment. The disease is genetically characterized by a premutation of the FMR1gene on the X-chromosome manifesting with a CGG triplet expansion between 55 and 200. Given the phenotypical variety of this disease, diagnosis is frequently delayed. We present and discuss a male patient whose diagnosis of FXTAS was delayed due to his concomitant alcohol abuse.
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Affiliation(s)
- Giulia Grigioni
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Christian Saleh
- Department of Neurophysiology and Neurology, University Hospital Basel, Basel, Switzerland
| | - Phillip Jaszczuk
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Dorothea Wand
- Department of Medical Genetic and Pathology, University Hospital of Basel, Basel, Switzerland
| | - Stefanie Wilmes
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
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Haering M, Saleh C, Jaszczuk P, Koehler M, Hund-Georgiadis M. Intrathecal pump catheter-tip granuloma recurrence with associated myelomalacia - How safe is intrathecal analgesic infusion therapy? A case report. Surg Neurol Int 2019; 10:62. [PMID: 31528400 PMCID: PMC6744822 DOI: 10.25259/sni-33-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/23/2019] [Indexed: 11/21/2022] Open
Abstract
Background: A serious complication of intrathecal (IT) infusion therapy for pain management is catheter-tip-associated granuloma. Catheter-tip granulomas can lead to permanent severe neurological sequelae if not promptly detected. Case Description: We report a patient with a recurrence of a catheter-tip granuloma causing a high-grade paresis of the lower extremities and we review briefly the literature. Conclusion: Patients with IT pump therapy presenting new neurological findings need prompt imaging of the spinal axis to rule out a catheter-tip granuloma. In case of catheter-tip granuloma, early surgical decompression is important.
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Affiliation(s)
- Moritz Haering
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Christian Saleh
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Phillip Jaszczuk
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Markus Koehler
- Department of Neurosurgery, Bethesda Hospital, Basel, Switzerland
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Jaszczuk P, Rogers GF, Guzman R, Proctor MR. X-linked hypophosphatemic rickets and sagittal craniosynostosis: three patients requiring operative cranial expansion: case series and literature review. Childs Nerv Syst 2016; 32:887-91. [PMID: 26510652 DOI: 10.1007/s00381-015-2934-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/14/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE A defect in a phosphate-regulating gene leads to the most common form of rickets: X-linked hypophosphatemic rickets (XLH) or vitamin D-resistant rickets (VDDR). XLH has been associated with craniosynostosis, the sagittal suture being the most commonly involved. METHODS We present three patients with rickets and symptomatic sagittal suture craniosynostosis all of whom presented late (>2 years of age). Two had a severe phenotype and papilledema, while the third presented with an osseous bulging near the anterior fontanel and experienced chronic headaches. RESULTS All underwent successful cranial vault expansion. CONCLUSIONS Rachitic patients with scaphocephaly should be screened for craniosynostosis.
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Affiliation(s)
- Phillip Jaszczuk
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Childrens Hospital Basel, Basel, Switzerland
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, DC, USA
| | - Raphael Guzman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Childrens Hospital Basel, Basel, Switzerland.
| | - Mark R Proctor
- Department of Neurosurgery, Children's Hospital Boston, Boston, MA, USA
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