Surgical Strategies for Cervical Spinal Neurinomas

Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.     

Mattress anastomosis in micro vascular reconstruction: technical note

Background

Superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis is a common procedure for neurosurgeons. The surgery necessarily requires accurate and speedy manipulation of microscope, for which a specific training is needed. Unexpected bypass occlusion sometimes happen during surgery.

Objective

Generally, conventional interrupted or continuous suture has been used for vascular anastomosis, despite various ideas have been attempted in the other surgery fields. We propose a horizontal mattress suture technique for intracranial microvascular bypass surgery. This is the first report ever published on intracranial vascular anastomosis.

Methods

We had four patients of STA-MCA bypass surgery with “mattress anastomosis” from March to May of 2012.

Results

During the procedure, there was no bypass occlusion and good patency was confirmed in all cases.

Conclusion

Intimae of the recipient and the donor blood vessel contact each other precisely with this technique. Although a long-term assessment of patency is needed, it is useful for the intracranial bypass surgery.     

Revisit of aneurysm clip closing forces: comparison of titanium versus cobalt alloy clip

Although closing force of cobalt alloy clip is well studied, there is only little information of titanium alloy clip available in the literature. In the present study, we examined and compared closing forces of various types and points of cerebral titanium and cobalt aneurysm clips for cerebral aneurysms. Straight, temporary, bayonet, angled, and fenestrated titanium or cobalt alloy clips were tested by measuring the closing forces at various points along their blade length. Closing forces of all the tested clips linearly increased from tip to base of clip blades. Sugita Titanium II clips had bigger closing forces than Elgiloy clips in all type clips except for the temporary clips. The closing forces of Sugita Titanium II and Yasargil titanium clips were similar in straight permanent type clip although there were some differences in closing forces between other types of Sugita and Yasargil clips. Our data showed that the closing forces differed depending not only on manufacturers but also on materials and shapes.     

Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke

Previous studies have shown that extracranial–intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an effective treatment for main trunk stenosis or occlusion in acute stage. The authors retrospectively reviewed 58 consecutive patients who underwent urgent EC-IC bypass for symptomatic internal carotid artery or the middle cerebral artery stenosis or occlusion between January 2003 and December 2011. Clinical characteristics and neuroimagings were evaluated and analyzed. Based on preoperative angiogram, responsible lesions were the internal carotid artery in 19 (32.8 %) patients and the middle cerebral artery in 39 (67.2 %). No hemorrhagic complication occurred. Sixty-nine percent of patients showed improvement of neurological function after surgery, and 74.1 % of patients had favorable outcome. Unfavorable outcome was associated with insufficient collateral flow and new infarction after bypass surgery.     

Hodgkin's disease of the thoracic vertebrae

Background contextHodgkin's disease rarely occurs in the spine, which is usually a setting for the advanced form of the disease.PurposeTo describe an unusual case of isolated, primary spinal Hodgkin's disease and to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the thoracic spine.Study design/settingA case report of a 28-year-old woman who presented with back pain and progressive weakness in the lower extremities as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae.MethodsWe report a new case of spinal cord compression resulting from Hodgkin's disease of the thoracic vertebrae. Decompression surgery was performed in the patient, followed by antibiotic treatment.ResultsAntibiotic therapy temporarily improved inflammation and fever. However, magnetic resonance imaging (MRI) evaluation showed that the inflammatory reaction in the lesion was not completely resolved. The disease progressed and later investigations revealed Hodgkin's disease, which improved with a course of chemotherapy and radiation.ConclusionsHodgkin's disease should be considered in the differential diagnosis of spinal neoplastic lesions with clinical features similar to spondylitis. Because MRI evaluation showed that the vertebral disc was maintained in this case, the presence of a tumor rather than inflammation should have been suspected.     

A Rapid Enzyme Immunoassay for Measurement of HBK in Blood

Abstract

An enzyme immunoassay has been developed for the measurement of HBK (4-amino-2-hydroxybutylyldibekacin) a new semisynthetic aminoglycoside antibiotic. Antisera were raised in rabbits by immunization with HBK conjugated to bovine serum albumin (BSA). 3′-Eno-HBK conjugated to alkaline phosphatase (ALP) was used as an enzyme labeled antigen. The antibody-bound drug was separated from free using goat anti-rabbit IgG serum. The assay can be completed within one hr by co-incubating the first and the second antibody. The present immunoassay allows detection of 10 ng HBK per ml of serum, and is applicable for monitoring HBK level in blood. HBK concentrations in human sera were determined by the immunoassay during and after infusion and the levels were compared with those determined by high performance liquid chromatography (HPLC) and antimicrobial assay.     

Ruptured cerebral aneurysms associated with arterial occlusion

Seven cases of ruptured cerebral aneurysm associated with an occlusion of a large cerebral artery are reported. All seven patients had never suffered from ischemic cerebrovascular disease before the aneurysmal rupture. All nine aneurysms, including the two unruptured ones, arose on the artery serving as an important collateral pathway, and eight of the nine were found in locations where saccular aneurysms are known to occur infrequently. The role of hemodynamic factors in the pathogenesis of these aneurysms is stressed.     

Double-insurance bypass for internal carotid artery aneurysm surgery

OBJECTIVE: The aim of this article is to present the usefulness of a double-bypass method in the surgical treatment of complex internal carotid artery (ICA) aneurysms. For patients with clippable but complex aneurysms of the ICA having poor collateral circulation, bypass surgery is needed before temporary occlusion of the ICA. We propose a double bypass for safety. METHODS: The superficial temporal artery was anastomosed to the distal cortical branch of the middle cerebral artery (MCA), followed by anastomosis between the radial artery and the inferior trunk of the MCA. For patients with clippable ICA aneurysms, the radial artery was temporarily anastomosed to the inferior trunk of the MCA by raising the ipsilateral forearm to the head after the radial artery was harvested. After the aneurysm had been clipped, the anastomosed radial artery was cut close to the anastomosed site and repositioned back to the original arm. RESULTS: This double-bypass procedure was performed in two patients, and no ischemic complications related to revascularization were observed. Temporary occlusion times of the MCA for superficial temporal artery-to-MCA anastomosis and radial artery-to-MCA anastomosis were 30 and 46 minutes in one patient and 28 and 55 minutes in another. CONCLUSION: This surgical procedure, which we called "double-insurance bypass," can reduce the risk of ischemic complications associated with revascularization of the ICA.     

Hydrothorax: an unexpected complication after laparoscopic myomectomy

We report a case of hydrothorax as a complication of laparoscopicmyomectomy in an otherwise healthy woman. The most likely causeof the patient’s hydrothorax was irrigation fluid movingfrom the peritoneal cavity into the pleural space via defectsin the diaphragm. Anaesthestists and surgeons should considerhydrothorax as a potential complication in any patient undergoinglaparoscopy. Br J Anaesth 2001; 87: 507–9