Conrad T. E. Pappas

Outcome analysis in 654 surgically treated lumbar disc herniations.

This article reports the outcomes of 654 consecutive patients treated during a 4.5-year period. Patients had a microdiscectomy, a laminectomy plus microdiscectomy, or a decompressive laminectomy with a microdiscectomy. The causes of ruptured discs were lifting (31.4%), falls (10.2%), and sports (10.0%). Almost all patients had complained of leg pain (99%), and 79% had radicular pain in a dermatomal distribution. Thirty-three percent of the patients had been involved in industrial accidents, and 6% had legal claims pending during the surgical period. Almost 11% of the patients had complications, and there was one death caused by abdominal arterial bleeding. Patients were also rated according to the Prolo Functional-Economic Outcome Rating Scale to improve the ability to compare series in the future. Almost 80% of the patients had good outcomes as defined by scores on this scale of 8 (16.2%), 9 (33.2%), and 10 (26.9%). Several conclusions can be drawn from the results of this series: 1) most patients had good outcomes; 2) patients with nonindustrial injuries had better outcomes than did patients with industrial injuries; 3) professionals with legal concerns and laborers with industrial insurance had good outcomes; and 4) the Functional-Economic Outcome Rating Scale appears to be a useful tool for comparing different procedures more objectively and for comparing the outcomes across series.

Extracerebral Cavernous Angiomas of the Middle Fossa

Three cases of extracerebral cavernous angiomas of the cavernous sinus in the middle fossa are reported. These are rare lesions that primarily affect women and are usually associated with acute or subacute onset of visual symptoms: diplopia, exophthalmos, and decreased visual acuity. The growth of the lesion often erodes the bone in the area of the cavernous sinus. Angiography usually depicts a vascular mass. The lesions represent a formidable surgical problem because of their tendency to cause intraoperative life-threatening hemorrhages. Morbidity and mortality can be drastically reduced by not attempting to resect the lesion further after biopsy and by giving a course of radiation therapy before definitive surgical treatment.

Combined Approach For Lesions Involving the Cerebellopontine Angle and Skull Base: Experience with 20 Cases—Preliminary Report

Skull base tumors involving the clivus, petrous bone, and adjacent areas can be formidable lesions to successfully remove without causing significant neurologic deficits. At our institution in the last 5 years, twenty patients out of 103 patients with skull base tumors have undergone the supratentorial-infratentorial combined approach for removal of a neoplasm (nine schwannomas, six meningiomas, two epidermoids, one extensive basal cell carcinoma, one pontine cavernous malformation, and one basilar artery aneurysm). The average patient age was 43 years. The combined approaches in conjunction with the subtemporal exposure were retrosigmoid-retrolabyrinthine, retrosigmoid-translabyrinthine, or retrosigmoid-transcochlear. The choice depended upon the type and location of the lesion and the deficits noted preoperatively. Basically, the approach allowed communication of the middle fossa and posterior fossa by totally dividing the tentorium as much as necessary for effective surgical manipulations. Both sigmoid and superior petrosal sinuses are divided. There were no deaths. Postoperative neurologic deficits included temporary seventh nerve paralysis, sixth nerve weakness, fifth nerve sensory deficits, cerebrospinal fluid leaks, and hydrocephalus requiring a shunt. Overall, the results were very gratifying, considering the difficulties encountered in the surgical removal of these lesions.

Lumbar Stenosis in the Elderly

Summary:As the elder population lives longer, symptomatic lumbar stenosis will become a more frequent clinical entity. Once surgical decompression is considered, controversy exists as to when to fuse. In this study, 206 patients with symptomatic lumbar stenosis were treated initially by decompression only. After a mean follow-up of 28 months, six patients needed a subsequent operation for a fusion. A common denominator was not determined except for a possible grade II spondylolisthesis. Fusion with decompression is not routinely recommended unless grade II spondylolisthesis is co-existent.

Anatomical evaluation of the caudal regression syndrome (lumbosacral agenesis) with magnetic resonance imaging.

Caudal regression syndrome involves absence of the sacrococcygeal vertebrae with or without lumbar vertebral defects. Since the neurological condition of infants with this syndrome deteriorates, radiographic studies are important to rule out any surgically correctable lesion. A paraplegic male neonate with a vertebral canal ending at T11 is presented. This is the first report of using magnetic resonance imaging to evaluate the spinal cord and surrounding soft tissues involved in this syndrome. Magnetic resonance imaging provides more anatomical details than myelogram with computed tomography, which greatly aids in determining whether surgery is necessary.

Role of magnetic resonance imaging and three-dimensional computerized tomography in craniovertebral junction anomalies

The surgical management of craniovertebral junction abnormalities depends on accurate radiological identification of the static and dynamic relationships. Four cases are presented to show the importance of flexion/extension magnetic resonance imaging and three-dimensional computerized tomography scanning in the evaluation of these relationships. With these techniques, anterior and/or posterior decompressive procedures can be appropriately planned to reduce and stabilize craniovertebral abnormalities. Long-term neural deficits can be reversed by these procedures.