摘要:

The objective of this review is to contribute information that improves surgical outcomes and to provide management guidelines for various lesions of the brachial plexus. This review was based on the analysis of 1,019 cases of brachial plexus injuries, entrapment, and tumors that were surgically treated at Louisiana State University Medical Center between 1968 and 1998. We describe surgical outcomes of 859 cases, excluding 160 thoracic outlet syndrome cases. Mechanisms of injury included 509 stretch injuries, 118 gunshot wounds (GSWs), 71 lacerations, and 161 neural sheath tumors. Functional outcomes after surgical repair are encouraging. A functional recovery of grade 3 or better was seen in 87% of the stretch injury cases having lesions in continuity, 71% of those repaired with sutures, and 53% of those that underwent graft repairs. In the GSW group, 129 of 202 of the injured plexus elements that had suffered complete loss recovered to grade 3 or better levels. In comparison, 85 of the 91 lesions with incomplete loss of function eventually recovered. Of the lacerating injuries that were repaired, more than 65% of the elements recovered to a grade 3 or better level. Of the 161 neural sheath tumors arising from brachial plexus, most schwannomas and solitary neurofibromas were resected without significant deficits. These surgical results suggest that surgical exploration and repair of brachial plexus lesions are technically feasible and may obtain favorable outcomes if patients are selected appropriately. This review provides management guidelines that may enhance functional outcomes of brachial plexus surgery.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study designThree groups of patients with low back pain, with or without sciatica, caused by degenerative disc disease were treated by lumbar interbody fusion.ObjectivesTo determine the differences, if any, in clinical outcomes, fusion status, and cost-effectiveness among patients who underwent three variations of lumbar interbody fusion surgery.Summary of background dataLumbar interbody fusion is an accepted treatment option in the management of patients with degenerative disc disease. Controversy with regard to interbody fusion centers on indications for surgery, surgical technique, and interpretation of results. Reported costs vary significantly among different surgical treatments, whereas patient outcomes have varied little.Materials and methodsProspective study of 46 patients who underwent 1 of 3 lumbar interbody fusion procedures was conducted. Group 1 had anterior lumbar interbody fusion using Ray threaded fusion cages (ALIF/TFC). Group 2 underwent posterior lumbar interbody fusion with Ray threaded fusion cages (PLIF/TFC). Patients in group 3 underwent posterior lumbar interbody fusion with concomitant posterior stabilization (PLIF/Plate). Clinical outcomes were assessed using the Prolo socioeconomic/functional improvement scale at 6 weeks, 6 months, 1 year, and 2 years after surgery. Fusion status was determined from flexion-extension, lateral, and anterior-posterior radiographs. Cost comparisons were made through data obtained from patient chart entries and billing records.ResultsSatisfaction and willingness to undergo the procedure again was reported in all but 1 case. Clinical outcomes at 1 year after surgery (P < 0.0001) were significantly increased with 28% of patients reporting excellent results, 41% reporting good results, 11% fair, and 20% poor. Similar results were reported at 2 years after surgery. Although all 46 (100%) of the patients met the outlined criteria for arthrodesis at 12 months after surgery, 4 (0.09%) patients reported persistent back pain requiring additional surgery at adjacent vertebral levels. There were no significant statistical differences among the 3 treatment groups except for operative time, anesthesia time, and cost. The total cost for PLIF/TFC and PLIF/Plate was significantly higher than for the ALIF/TFC group (P < 0.01). The mean combined costs, including surgeons' fees and instrumentation, averaged $12,040 for ALIF/TFC, $13,675 for PLIF/TFC, and $15,432 for PLIF/Plate.ConclusionThe results of this study demonstrate that there are no significant differences in clinical outcomes among the 3 treatment groups. Significant statistical differences were observed in operative time, including anesthesia time, and cost. Based on these data, it is difficult to justify (from a fiscal point of view) routine use of PLIF/Plate technique as a cost-effective treatment modality for patients with degenerative disc disease.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Intracranial extraskeletal mesenchymal chondrosarcoma is a malignant tumor reported in fewer than 40 cases in the published literature. This case report describes a 60-year-old black man who developed blindness as a presenting symptom of an intracranial tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) studies revealed the presence of a large bifrontal mass with calcification and edema that appeared to arise from the anterior aspect of the falx. Following craniotomy and gross total resection, the tumor was diagnosed by histologic characteristics as a mesenchymal chondrosarcoma. The tumor demonstrated the two distinguishing mesenchymal chondrosarcoma components: poorly differentiated spindle cells with hyperchromatic nuclei (in some areas with an appearance suggestive of hemangiopericytoma) and well differentiated cartilage containing areas of calcification and bone formation. The patient was treated with adjuvant radiation therapy. Nevertheless, the tumor recurred, and 27 months after craniotomy the patient succumbed to the disease. Pertinent literature is reviewed concerning the diagnosis, treatment, and prognosis of this tumor. Although 4 decades have passed since this tumor was first identified as a distinctive entity, gross total resection remains the mainstay of treatment. Adjuvant therapies of radiation and chemotherapy show promise, but prognosis is one of recurrence, sometimes metastasis, and ultimately death.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Ventral spondylodesis by autologous bone grafting in cases of degenerative disease of the cervical spine bears the disadvantage of the complication of pain at the iliac crest. The question is if these problems can be avoided by implanting intervertebral disc spacers. Between September 1997 and December 2000, we operated on 145 patients suffering from degenerative diseases, including osteochondrosis and/or disc prolapse, of the cervical spine. Without any patient diagnosis selection, we implanted various randomly chosen disc spacer types, including 52 titanium disc spacers (Cespace) by Aesculap, 40 titanium spacers by Weber, 36 titanium spacers by Intromed, and 17 carbonium spacers by AcroMed, through anterior access and after microsurgical discectomy and removal of the dorsal osteophytes by a high-speed drill. We evaluated the handling, radiographic contrast, and costs of implantation as well as the clinical outcome after 3 months and 1 year, respectively. All four disc spacer models are suitable for the anterior spondylodesis of the cervical spine. The titanium spacer by Weber features good handling characteristics and a moderate purchase price. Cost efficiency and easy handling characterize the Intromed cage. The radiographic contrast of the carbonium spacer by AcroMed is insufficient for a controlled implantation in some cases, especially in the lower cervical spine. The handling is good, but the price is high. The AcroMed and Intromed spacers show a tendency to penetrate the base and/or cartilaginous plate of the adjacent vertebrae. Results lead us to favor the Aesculap Cespace, which impresses us by its handling and moderate price. The final assessment depends on the long-term clinical outcome for the cases studied.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The objective of this study was to assess the value of the application of frameless stereotaxy in craniotomy procedures. During the period from November 1997 to June 2002, using the SurgiScope and Stealth Station frameless stereotaxy image-guided neuronavigation system, 465 craniotomy procedures were performed, including surgery for 206 gliomas, 46 arteriovenous malformations (AVMs), 35 aneurysms, 37 meningiomas, 69 cavernous angiomas, 11 pituitary adenomas, 9 schwannomas, 8 cases of epilepsy, 6 angioblastomas, 5 metastases, 3 frameless biopsies, and 30 other lesions such as craniopharyngiomas, germinomas, and brain abscesses. In each of these cases, the patient's magnetic resonance imaging (MRI) data were loaded into the neuronavigation system, which allowed for three-dimensional rebuilding of the data set and simulation of surgical planning and procedures. In the course of the operation, the system allowed for patient registration, reference arc registration, instrument registration, and real-time positioning and guidance. All intracranial lesions and critical anatomical structures were accurately located and positioned. The computer showed an estimated error of within 2 mm. Postoperative neurologic complications occurred in 22 patients (4.7%). There was no incident of operative death. The use of a frameless stereotaxy image-guided neuronavigation system is most valuable in craniotomy procedures, especially in those cases with lesions located in the deep center of the brain. In addition, its accuracy of location is of great importance in protecting the normal brain tissues and in resecting the lesions completely. Such an application is changing the way in which surgeons perform craniotomies and is the foundation of minimally invasive neurosurgical procedures.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID