Moodypatel7443

Desmoid fibromatosis is a locally aggressive myofibroblastic neoplasm. In this study, we report a case of desmoid fibromatosis in the paraspinal muscle that was misdiagnosed as intramuscular schwannoma through incisional biopsy at another hospital. We performed total excision of the mass lesion with a clear margin. We found that for an accurate diagnosis, magnetic resonance imaging, incisional biopsy and excisional biopsy were required.Iatrogenic vertebral artery injury (VAI) that occurs during cervical spine surgery can cause life-threatening complications, such as arteriovenous fistulas, catastrophic bleeding, neurological impairment, cerebral ischemia, and death. We report a case of dominant VAI during surgery and the treatment of a 60-year-old man diagnosed with a C1-2-3 metastatic spine tumor from urothelial carcinoma. Active bleeding occurred during tumor resection using pituitary forceps, immediately followed by gauze packing and manual compression. Post further resection, we found that the vertebral artery (VA) was completely severed. After temporary clamping on both sides of the damaged VA, an artificial graft anastomosis was performed. After verifying that the flow was intact using Doppler Sonography, Occiput-C1-4-5-6 posterolateral fusion was performed. Angiography was performed immediately after surgery. We found a thrombus occluding the left VA, and performed mechanical thrombectomy and stent insertion. The final angiography showed good VA flow with no emboli. In this case, VA anastomosis and endovascular treatment were performed within a relatively short period of time post VAI, and the patient was able to recover without any neurological deficits.The subaxial screw fixation technique is commonly used for fixation in a wide range of cervical diseases, including traumatic, degenerative, and neoplastic diseases, rheumatoid arthritis (RA), and spondyloarthropathy. Although it is regarded as a relatively safe procedure, several complications may be encountered during surgery, such as vertebral artery (VA) and nerve root injuries, facet violation, and mass fracture. We report a case of endovascular embolization after VA injury during a high cervical spinal surgery. A 48-year-old woman was scheduled for C-1-2-3 posterior fixation. Plain radiography of the cervical spine revealed a severely unstable state. During dissection around the C1 lateral mass on the right side, sudden brisk arterial bleeding was observed. On vertebral angiography, flow voiding was noted above the right V3 portion. After checking patent collateral flow from the contralateral VA, routine coil embolization was performed to pack the V3 segment. Iatrogenic vascular injuries due to spinal surgery are rare but serious complications. For patients with RA, we recommend careful preoperative evaluation before a high cervical surgical procedure to avoid iatrogenic VA injury and endovascular interventions that are safe and effective in the diagnosis and treatment of such vascular injuries.Spinal epidural abscess (SEA) is an unusual form of spinal infection. Performing multilevel laminectomies is controversial in cases of extensive SEA considering the long surgical time and mechanical instability. Here, we report the case of an older woman with extensive SEA and poor general condition who was successfully treated with a less invasive treatment, namely skipped laminotomy using a pediatric feeding tube. A 79-year-old woman complained of progressive weakness in both legs, fever, and back pain. An extensive epidural abscess from the T3 to L5 vertebrae was observed on thoracic and lumbar magnetic resonance imaging (MRI). We performed skipped laminotomy at the T8 and T12 levels, and a 5-Fr pediatric feeding tube was advanced from the caudal level toward the rostral area and rostral level toward caudal level into the dorsal epidural space. Subsequently, regurgitation was performed with saline through the pediatric feeding tube at each level. Following this, to further irrigate the unexposed epidural abscess through laminotomy, the epidural space was washed by continuous irrigation, and the irrigation system was maintained for 48 hours. Follow-up MRI performed 3 weeks after the procedure confirmed near complete removal of the abscess in the thoracic spine, with a small residual abscess in the lumbar spine.Cervical spontaneous spinal epidural hematoma (CSSEH) is a rare condition that can be potentially fatal if not properly diagnosed and managed. While prompt surgical decompression and evacuation of the hematoma are generally considered as the first line of treatment, mild cases that were managed through observation and conservative treatment have been reported. Our patient was a 24-year-old man who experienced two CSSEH events 8 months apart, both of which were managed conservatively. This was a rare case of recurrent CSSEH in which recovery was achieved without surgical intervention. We believe conservative treatment with close observation may be effective in CSSEH patients presenting with mild neurologic symptoms who have a tendency towards spontaneous neurologic improvement.Cervical spondyloptosis is defined as dislocation of the spinal column, most often caused by trauma. Due to transection of the spinal cord, severe neurological deficits are common. Here, we reviewed the case of a young man who presented with mental stupor and complete tetraplegia below the level of C5. The patient's left shoulder was sucked into a machine and subjected to strong lateral bending and distraction. Computed tomography (CT) scan and magnetic resonance imaging revealed fracture dislocation and complete transection of the spinal cord at the C5-6 level. read more Three-dimensional CT scan showed coronal and sagittal spondyloptosis. He underwent open reduction with two surgeries performed via the anterior and posterior approaches C5-6 anterior cervical discectomy and fusion and lateral mass screw fixation with allograft from C3 to C7. In addition, both ends of the huge dura defect were sutured. We report the clinical history, imaging findings, and surgical management of spondyloptosis with a complete transected spinal cord containing a considerable dura tear.This case report presents a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH). The cause and prognosis of CVT can vary; CVT caused by SIH is uncommon and difficult to diagnose and treat. In this case, magnetic resonance imaging myelography showed definite cerebrospinal fluid leakage, and the patient's symptoms did not improve after conventional treatment. Furthermore, subdural hematoma occurred, causing mental deterioration; however, it improved dramatically after the blood patch procedure and burr hole drainage, which was performed after early cessation of anticoagulant therapy.Although penetrating brain injury is rare, it is associated with high morbidity and mortality. In several studies, even if very few patients arrive at the hospital alive, half of them eventually die, and the other half have significant neurological sequelae. Cerebrospinal fluid (CSF) leakage caused by traumatic brain injury is common. Therefore, we should be aware of the complications, prognosis, and follow-up strategies of penetrating brain injuries. A 55-year-old man was brought to our hospital with diffuse cerebral contusion and skull fracture. Three weeks after successful surgery, the patient returned with a large amount of pneumocephalus and pneumoventricle caused by delayed CSF leakage. Fortunately, the patient was discharged without neurological deficits after reoperation. In the urgent situation of penetrating brain injury, the treatment and prognosis vary depending on the initial actions and clinical factors. In addition, we should be aware that a variety of complications, as well as CSF leakage, can occur in patients with penetrating brain injuries.Usually, acute subdural hematomas (ASDHs) result from head trauma and require urgent surgical treatment. However, there have been many reports of rapid spontaneous resolution of ASDHs since 1986. Recently, we experienced a case of a massive ASDH that resolved spontaneously within 1.5 days. A 76-year-old man was admitted to a local hospital after a head injury. According to his clinical records, his initial neurologic status was good (Glasgow Coma Scale score of 14). However, his head computer tomography (CT) scan demonstrated a massive ASDH to the right, with a significant midline shift. Based on his neurological status and general condition, surgery was not considered, and the patient was closely monitored in the intensive care unit. The next day, the patient was transferred to our hospital as requested by his family, after which his neurological state stabilized, and the customary follow-up brain CT was performed. It was about 32 hours after the patient's head injury, and it revealed an unexpected finding, near-total resolution of the ASDH. Herein, we review previously reported similar cases and relevant mechanisms of rapid resolution of the ASDH. We believe that neurosurgeons should comprehensively assess the patient's condition and CT findings and provide appropriate treatment, especially when surgical intervention is unnecessary.Although acute intracranial bleeding after burr hole drainage for chronic subdural hematoma (SDH) is rare, it could still occur and is associated with a poor clinical outcome. Although rare, most of them occur immediately or within a few days after drainage, especially in patients who are on antiplatelet drugs or anticoagulants. We report an unusual case of delayed-onset acute SDH that developed 14 days after burr hole drainage of chronic SDH in a 54-year-old man with liver cirrhosis and thrombocytopenia. The possible pathophysiological mechanisms of this rare entity are discussed, and the relevant literature is reviewed.Proptosis after a subgaleal hematoma (SGH) is a rare condition that may require immediate intervention to prevent visual loss. A 12-year-old boy presented with localized SGH in the left parietal area after hair-pulling. The SGH was massively expanded on the entire scalp on the 3rd day of the trauma. On the next day after the massive expansion, proptosis of the right eye occurred suddenly. Emergent needle aspiration of the SGH was performed, and the proptosis improved slightly. Fortunately, his vision did not deteriorate. After all, he was diagnosed with coagulation factor IX deficiency (hemophilia B). The supraorbital notch could be a passage of the SGH to extend into the subperiosteal space of the orbit.

Postoperative inflammation and infections are common complications of spinal surgery and have similar symptoms. However, postoperative infection may lead to a poor outcome and must be differentiated from postoperative inflammation. The objective of this study is determine the changing pattern of postoperative ESR and WBC counts, and investigate the effects of different variables.

A total of 61 patients who underwent spinal surgery were enrolled in this prospective study. The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were measured the day before surgery and on 1st, 3rd, 5th, 7th, and 14th postoperative days.

WBC counts increased on the 1st postoperative day in comparison with the preoperative day (

<0.001), and they gradually decreased until the preoperative value was reached on the 14th postoperative day (

=0.14). The ESR also increased postoperatively, reaching a peak on the 5th postoperative day in comparison with the preoperative day (

<0.001) and gradually decreased thereafter.