Multiple dural arteriovenous shunts in a 5-year-old boy.
(9/692)
We describe a rare case of multiple dural arteriovenous shunts (DAVSs) in a 5-year-old boy. MR imaging performed at 1 year of age showed only a dilated anterior part of the superior sagittal sinus; however, angiography at 5 years of age revealed an infantile-type DAVS there and two other DAVSs of the adult type. The pathophysiological evolution of DAVSs in children and their treatment strategies are discussed. (+info)
Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: an experimental study.
(10/692)
One of the most common complications of lumbar spine surgery is peridural fibrosis, a fibroblastic invasion of the nerve roots and the peridural sac exposed at operation. Peridural fibrosis may produce symptoms similar to those the patient experienced preoperatively and, if another spinal operation is necessary, may increase the risk of injury at reexposure. In a controlled study in dogs, we assessed the use of expanded polytetrafluoroethylene (ePTFE) as a barrier to postoperative invasion of fibrous tissue into the laminectomy defect. In 14 dogs, a two-level laminectomy was done, at L4-L5 and L6-L7. In 12 dogs, an ePTFE membrane was placed directly over the dorsal surface of the laminectomy defect at L4-L5 and within the defect (over the surface of the dura) at L6-L7. No material was implanted in two dogs (controls). Tissue for histologic studies was obtained from the controls and from ten dogs with the membrane 12 weeks postoperatively. Two dogs with the membrane underwent reoperation. The study found that there was no peridural fibrosis in seven of the ten specimens in which the ePTFE membrane had been placed directly on the dorsal surface of the laminectomy defect, some peridural fibrosis in all specimens in which the membrane had been placed within the defect, and extensive fibrosis in controls. The ePTFE membrane created an excellent plane of dissection for reoperation. No foreign-body reactions to the membrane or membrane-related infections occurred. We conclude that the ePTFE spinal membrane, when properly implanted, is an effective barrier to postsurgical fibrous invasion of the vertebral canal. Clinical studies of use of this material in spinal surgery are warranted. (+info)
Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study.
(11/692)
Peridural fibrosis developing after laminectomy may cause pain that can necessitate reoperation. Many materials have been used as a barrier to invasion of fibrous tissue into the vertebral canal, but the ideal material has not been found. Various studies in animals have achieved favourable results with an expanded polytetrafluoroethylene (ePTFE) membrane. In a prospective, randomized study, we compared postoperative results in 33 patients who had an ePTFE membrane implanted to cover the defect caused by laminectomy during lumbar spine decompression with the results in 33 patients in whom no material was implanted. At operation, an ePTFE membrane was placed after the decompression procedure to cover the laminectomy defect completely. Systematic clinical and MRI follow-up evaluations of patients with and without the membrane were conducted 3, 6, 12, and 24 months postoperatively. The effect of ePTFE membrane implantation over laminectomy sites on postoperative peridural fibrosis, pain and neurological claudication was assessed. The ePTFE-membrane group had a significantly lower rate of epidural fibrosis on MRI (P<0.0001) and of clinical manifestations of radiculalgia (P = 0.002) compared with the no-material group. Epidural fibrosis that occurred in the ePTFE group was generally less extensive than that in the no-material group. There was no significant difference in the rate of postoperative claudication in the two groups. Significantly more seromas occurred in the ePTFE group (P = 0.0002). There were no infections or other complications in either group. The results showed that placement of an ePTFE spinal membrane over the laminectomy defect produced by lumbar spine surgery provided a physical barrier to invasion of fibrous tissue into the vertebral canal, and patients with the membrane had less postoperative radicular pain. (+info)
Functional prognosis after treatment of spinal dural arteriovenous fistulas.
(12/692)
Functional prognosis after treatment for spinal dural arteriovenous fistulas (SDAVFs) was retrospectively analyzed in 13 consecutive patients aged 38 to 73 years (mean 57 years) treated during the last 5 years. The duration of symptoms before diagnosis ranged from 3 to 72 months (mean 23 months). Neurological symptoms were examined before and 6 months after the treatment. Seven patients underwent embolization as the initial treatment. In four of six patients, N-butyl 2-cyanoacrylate (NBCA) embolization achieved complete obliteration of SDAVF. The other two patients with incomplete embolization and one embolized with polyvinyl alcohol particles underwent subsequent surgical treatment. Six patients were treated by direct surgery. Complete disappearance of SDAVF was confirmed in all nine patients treated surgically. Improvement of gait and micturition disturbance after the treatment was noted in six of 10 and three of six patients, respectively. Long duration of symptoms and high grade of neurological symptoms were associated with a poor functional outcome. NBCA embolization and surgery are curative treatments for SDAVF, but the functional prognosis is not always satisfactory. Embolization is the first choice of treatment for SDAVF because it is less invasive and relatively safe. However, when complete obliteration is not achieved, prompt surgery is recommended because a long duration of symptoms will result in a poor functional prognosis. (+info)
Mesh-and-glue technique to prevent leakage of cerebrospinal fluid after implantation of expanded polytetrafluoroethylene dura substitute--technical note.
(13/692)
Expanded polytetrafluoroethylene (ePTFE) can be used as a dura substitute but is associated with leakage of cerebrospinal fluid (CSF) through the suture line. Fibrin glue alone may not prevent this problem. This new method for sealing the suture line in ePTFE membrane uses an absorbable polyglycoic acid mesh soaked with fibrinogen fluid placed on the suture line. Thrombin fluid is then slowly applied to the wet mesh, forming a large fibrin membrane reinforced by the mesh over the suture line. Only one of 33 patients in whom this technique was used had CSF leakage, whereas 12 of 59 patients in whom a dural defect was closed with ePTFE alone showed postoperative subcutaneous CSF collection (p < 0.05). Our clinical experiences clearly show the efficacy of the mesh-and-glue technique to prevent CSF leakage after artificial dural substitution. Mesh and glue can provide an adequate repair for small dural defect. The mesh-and-glue technique may also be used for arachnoid sealing in spinal surgery. (+info)
Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: report of two cases.
(14/692)
We present two cases of dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem. Both cases were detected by MR imaging and showed significant improvement on MR images after transvenous embolization. (+info)
Sclerosing spinal pachymeningitis. A complication of intrathecal administration of Depo-Medrol for multiple sclerosis.
(15/692)
Reported complications of intrathecal steroid therapy include aseptic meningitis, infectious meningitis, and arachnoiditis. We report a case of sclerosing spinal pachymeningitis complicating the attempted intrathecal administration of Depo-Medrol for multiple sclerosis. The lesion is characterised by concentric laminar proliferation of neomembranes within the subdural space of the entire spinal cord and cauda equina, resulting from repeated episodes of injury and repair to the spinal dura mater by Depo-Medrol. There is clinical and laboratory evidence that Depo-Medrol produces meningeal irritation and that the vehicle is the necrotising fraction. (+info)
Intracranial dural fistula as a cause of diffuse MR enhancement of the cervical spinal cord.
(16/692)
Spinal MR findings are reported in a patient with progressive myelopathy and intracranial dural arteriovenous fistula draining into spinal veins. Associated with previously reported abnormalities on T1 weighted and T2 weighted images, postcontrast T1 weighted images disclosed diffuse intense enhancement of the cervical cord itself. This enhancement decreased after endovascular treatment. (+info)