Outcomes and technical issues of transcorporeal anterior cervical microforaminotomy in patients with cervical brachialgia

INTRODUCTION

Transcorporeal anterior cervical microforaminotomy is a motion-preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in the transuncal approach, there is a chance of vertebral artery injury and it also decreases disc height; hence, may alter the motion of that segment.

OBJECTIVE

Aim is to assess the outcome of surgery and its effectiveness.

METHODS

A total of 40 patients were observed retrospectively of which 33 were male and 7 were female. A single study of transcorporeal anterior cervical microforaminotomy was analyzed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who were not relieved by conservative treatment over 6-8 weeks in cervical disc prolapse were included in the study. Patients having more than one level of disease, features of myelopathy, or instability were excluded from the study.

RESULTS

All patients were pain-free postoperatively, although after one to two months 2 out of 40 patients developed brachialgia and required anterior cervical discectomy and fusion.

CONCLUSION

Transcorporeal microforaminotomy for brachialgia is a safe and effective approach that is motion preserving and minimally invasive as well.

[Gossypibomas in neurosurgery]

INTRODUCTION

The term «gossypiboma» comes from the Latin gossypium, which refers to a genus of cotton plants, and from the Swahili word boma, which translates as «place of concealment». It may be mistaken for tumorous lesions or abscesses due to the way it is encapsulated, as evidenced in imaging examinations, and its variable and non-specific clinical features, which give rise to difficulty in its diagnosis and significant morbidity.

AIM

To synthesise the available evidence on the presence of gossypibomas during neurosurgical procedures.

DEVELOPMENT

A review was performed that included a search for articles in English and Spanish published in the last 15 years in PubMed, Ebsco Host, Embase, Mediclatina, Cochrane, Lilacs and Scopus, between January and June 2019, using the keywords «gossypiboma», «textiloma», «neurosurgery» and «neurosurgical procedures». In all, a total of 630 articles were found in the search, although, after selecting them by title and abstract, 22 case report articles were included for this review process. Altogether 36 individuals were identified, of whom 21 (58.3%) were women, and whose mean age was 56.1 years. Surgical sponges were observed as gossypibomas in 20 cases (55.6%).

CONCLUSIONS

Gossypiboma is a complication secondary to surgical procedures that presents fairly unspecific signs and symptoms. The time that elapses before it appears usually ranges from a few days to several years after surgery and is correlated with multiple medical and legal implications.

External lumbar cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis of controlled trials

INTRODUCTION

External lumbar drainage is a promising measure for the prevention of delayed aneurysmal subarachnoid hemorrhage-related ischemic complications.

METHODS

Controlled studies evaluating the effects of external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage were included. Primary outcomes were: new cerebral infarctions and severe disability. Secondary outcomes were: clinical deterioration due to delayed cerebral ischemia, mortality, and the need of definitive ventricular shunting. Results were presented as pooled relative risks, with their 95% confidence intervals (95% CI).

RESULTS

A total of 6 controlled studies were included. Pooled relative risks were: new cerebral infarctions, 0.48 (95% CI: 0.32-0.72); severe disability, 0.5 (95% CI: 0.29-0.85); delayed cerebral ischemia-related clinical deterioration, 0.46 (95% CI: 0.34-0.63); mortality, 0.71 (95% CI: 0.24-2.06), and need of definitive ventricular shunting, 0.80 (95% CI: 0.51-1.24). Assessment of heterogeneity only revealed statistically significant indexes for the analysis of severe disability (I(2)=70% and P=.01).

CONCLUSION

External lumbar drainage was associated with a statistically significant decrease in the risk of delayed cerebral ischemia-related complications (cerebral infarctions and clinical deterioration), as well as the risk of severe disability; however, it was not translated in a lower mortality. Nevertheless, it is not prudent to provide definitive recommendations at this time because of the qualitative and quantitative heterogeneity among included studies. More randomized controlled trials with more homogeneous outcomes and definitions are needed to clarify its impact in patients with aneurysmal subarachnoid hemorrhage.

[Dural metastasis as the first manifestation of prostate cancer]

Metastases of prostate cancer to intracranial meninges are rare and often confused with meningiomas or chronic subdural hematomas. These usually occur in patients with a known cancer diagnosis in advanced stages of the disease, and only in some rare cases do its manifestations precede the detection of the primary tumour. The clinical presentation is unspecific. However, due to the affinity of this tumour for the base of the skull, it must be included in the differential diagnosis of men over 70 years of age with cranial nerve palsy. The treatment of these lesions has not been standardized. Within the therapeutic options we find surgical resection, chemotherapy, radiotherapy or a combination of these measures, and yet survival is poor. We present the case of a 77 year old male patient whose initial symptoms of prostate cancer were caused by a metastatic lesion to the dura, confirmed by histopathology. We also review the epidemiological, clinical and imaging highlights of this condition.

[Chiari type I malformation in a patient with Poland's syndrome]

Chiari malformation type I and Poland's syndrome are two rare diseases and their simultaneous presentation had not been previously described in the literature. We report the case of a 27 year old male with history of Poland's syndrome, who referred headache and motor impairment of the intrinsic muscles of the left hand. In a cervical spine MR a Chiari I malformation with syringomyelia from C1 to T2 was found, which was treated by foramen magnum decompression, dural plasty and removal of the posterior arch of the atlas. A discussion of the embryological mechanisms that might be involved in the coexistence of these two entities is presented, emphasizing the role of para-axial mesoderm.