Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre's experience using the far lateral approach

OBJECTIVES

Since the turn of the century, minimally invasive surgery has become increasingly widespread. Discectomy surgery has evolved from wide open to microscopic and now endoscopic. This study aims to demonstrate that transforaminal endoscopic discectomy is an alternative and safe approach for degenerative disk surgery.

PATIENTS AND METHODS

Two year retrospective assessments of patients who underwent transforaminal endoscopic discectomy at a tertiary neurosurgical center in the United Kingdom by a single surgeon. Under strict confidentiality, data was collected from online patient data and PACS systems. Patient feedback was achieved using phone call follow up and clinic appointments. Standard statistical analysis was performed.

RESULTS

201 patients had endoscopic discectomy and the mean age was 41 years. Male:female ratio was 1.3:1.0. Mean time of onset of symptoms was 5.5 months and the most common level was L4/5 (53%). All endoscopic discectomies were performed under local anesthesia. Theater time was on average 110 min. 10 patients were lost to follow up. 95% of patients were discharged within 7h post operatively. Visual acuity score of the pain dropped from an average of 7/10 pre-operatively to 0-1/10 in 95% of patients two weeks post operatively. 87% patients went back to their normal daily activities within two weeks. There were no cases of CSF leak, hematoma formation or wound infection. 1% of patients developed a nerve root injury. 6% of patients had recurrent herniation and require microdiscectomy.

CONCLUSION

Endoscopic discectomy can be an alternative approach to microdiscectomy. While it can take more expertise to perform endoscopic discectomy, our data shows that the far lateral endoscopic discectomy using the TESSYS technique has comparable outcomes to microdiscectomy.

Eccrine Angiomatous Hamartoma: A Clinicopathological Study of 26 Cases

BACKGROUND

Eccrine angiomatous hamartoma (EAH) is a rare benign cutaneous tumor characterized by the proliferation of eccrine glands and capillaries.

OBJECTIVE

The aim of this study was to summarize the clinicopathological characteristics of EAH.

METHODS

A retrospective chart review was performed on all patients diagnosed with EAH from 1977 to 2012 in the Union Hospital, Wuhan, P.R. China, and the clinicopathological features were compared with the cases reported in the literature.

RESULTS

A total of 26 patients with EAH were identified. The male:female ratio was 1.2:1. EAH most commonly presents as a solitary (80.8%) plaque (50.0%) on the lower extremities (61.5%). Most patients presented with hyperhidrosis localizing to the lesion. Although most patients did not have major pain or anatomic deformity, one patient had severe pain as well as difficulty walking and moving, necessitating leg amputation. The histopathological findings showed typical features of EAH.

CONCLUSION

EAH is a rare but characteristically benign skin hamartomatous condition. In rare occasions it can be associated with severe structural and functional impairment.

Porokeratosis with follicular involvement: report of three cases and review of literatures

Porokeratosis is characterized clinically by annular plaques with a distinct peripheral keratotic ridge and histologically by the cornoid lamella. Porokeratosis with follicular involvement is rarely reported. To provide the basis of that follicular porokeratosis is a clinical variant or not. Biopsy was taken from three patients who were diagnosed porokeratosis. Routine stain was made and reviewed the literatures about well-documented cases of porokeratosis with follicular involvement. Porokeratosis with follicular involvement may have some clinical features: asymptomatic, erythematous, brownish or skin-color, less than 1 cm in the areas excluding palm and plantar, which commonly involved on middle-age. But there have still not enough proof as an independent clinical variant.

Follicular hybrid cyst: a combination of bullous pilomatricoma and epidermoid cyst

The follicular hybrid is composed of more than two components of pilosebaceous unit. There are several studies of hybrid cyst, combination of trichilemmal and epidermoid cyst was the most frequently reported. In this paper, we reported one case of hybrid cyst composed of bullous pilomatricoma and epidermoid cyst. A 14-year-old girl was complaint of a solitary flesh-colored to erythematous nodule with flaccid appearance sized 3.2 × 1.8 cm in diameter on her right upper back for one year. The histologic findings showed there were edema and proliferation of capillaries in the superficial dermis, a cyst in the middle to deep dermis. There were laminated keratins in the cystic space. The cyst wall was composed of two different components, one was composed of epithelial cells containing of granular layer, and another consisted of basophilic cells, transient cells and shadow cells. The cyst not related with Gardner's syndrome. Hybrid cyst such as trichilemmal cyst, epidermoid and pilomatricoma cysts maybe have same clinical features or mimicking each others, but we can distinguish them from histopathology evaluation.