Selçuk Özdoğan

Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications.

Background and Context: Minimally invasive percutaneous vertebral augmentation techniques; vertebroplasty, and kyphoplasty have been treatment choices for vertebral compression fractures (VCFs). The purpose of this study is to evaluate the outcomes of the patients who underwent vertebroplasty or kyphoplasty regarding complications, correction of vertebral body height, kyphosis angle and pain relief assessment using visual analog score (VAS) for pain. Materials and Methods: A retrospective review of the hospital records for 100 consecutive patients treated with kyphoplasty or vertebroplasty in our department database. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in the study. Preoperative and postoperative VAS pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Mobilization and length of stay (LOS) were recorded. Results: One hundred patients were treated by 110 procedures. 64 patients were operated on due to osteoporosis (72 procedures). Twelve patients were operated on because of metastasis (13 procedures), 8 patients were operated on because of multiple myeloma (9 procedures). Five patients had two surgeries, 1 patient had 3 surgeries, and 1 patient had 5 surgeries. The mean preoperative VAS was 74.05 ± 9.8. In total, 175 levels were treated, 46 levels by kyphoplasty and 129 by vertebroplasty. The mean postoperative VAS was 20.94 ± 11.8. Most of the patients were mobilized in the same day they of surgery. Mean LOS was 1.83 days. Six patients had nonsymptomatic leakage of polymethlymethacrylate, and patient had epidural hematoma, which was operated on performing hemi-laminectomy. Conclusions: Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the stabilization of VCFs. However, complications should be kept in mind during decision making.

Encephalocraniocutaneous Lipomatosis: Haberland Syndrome

Patient: Male, 11 Final Diagnosis: Haberland syndrome Symptoms: Seizure Medication: — Clinical Procedure: Medical treatment Specialty: Neurosurgery Objective: Rare disease Background: Encephalocraniocutaneous lipomatosis (ECCL) was first announced as a new type of ectomesodermal dysgenesis in 1970 by Haberland and Perou. ECCL was first described in 1970, and approximately 60 cases have been reported since then. The classic triad of ECCL are skin, ocular, and central nervous system involvement, including conditions such as unilateral porencephalic cyst, ipsilateral lipomatous hamartoma of the scalp-eyelids-eye globe, cortical atrophy, cranial asymmetry, developmental delay, seizures, mental retardation, and spasticity of the contralateral limbs. The dermatological hallmark is a hairless fatty tissue nevus of the scalp called nevus psiloliparus. Case Report: An 11-year-old right-handed boy, born at full term, was referred to our clinic. His family had no consanguinity or history of neurocutaneous disease. The patient’s physical examination revealed a large hairless lesion on the right frontoparietal scalp called nevus psiloliparus. Beginning from the birth, a dermolipoma (an uncommon benign tumor) was reported to have occurred on the conjunctiva, mostly ipsilateral in his right eye and present on the ipsilateral side of the neurological abnormalities shown on magnetic resonance imaging and computed tomography. The patient had muscle weakness in left upper and lower extremities. He had a mild form of mental retardation. Conclusions: There is no specific treatment for ECCL. Management of ECCL is usually symptomatic. Surgical correction of a cutaneous lesion can be performed for cosmetic improvement. An early diagnosis of ECCL allows for early symptom treatment and improved patient quality of life.

Thoracic Epidural Hematoma Complicating Vertebroplasty

Patient: Female, 64 Final Diagnosis: Thoracic epidural hematoma Symptoms: Paraplegia Medication: — Clinical Procedure: Thoracal hemilaminectomy Specialty: Neurosurgery Objective: Diagnostic/therapeutic accidents Background: Percutaneous vertebroplasty procedures are commonly used to treat vertebral fractures. These techniques may be associated with major complications. Case Report: We present here a case of a 64-year-old female patient with T9 and T10 acute osteoporotic fractures, treated previously with vertebroplasty for four levels of osteoporotic vertebral fractures. The patient was treated by T9–T10 vertebroplasty. The post-operative neurological examination was normal. Two hours later, she progressively worsened and developed paraplegia. Magnetic resonance imaging (MRI) revealed a hyper-acute epidural hematoma over the T6 to T10 vertebrae. Evacuation of the epidural hematoma completely resolved her motor weakness. Previous literature reports one case with a thoracolumbar epidural hematoma over T11–L2 and another case with a L1 epidural hematoma after vertebroplasty. Conclusions: Percutaneous vertebroplasty is generally a safe procedure but can have rare complications. Epidural hematoma after vertebroplasty is one of the uncommon complications. Before percutaneous vertebroplasty, patients should be informed about these rare complications. Prognosis is very good if early intervention is possible.

Isolated C5 Vertebrae Dislocation with Trauma: An Extremely Rare Case of Isolated C5 Dislocation

Patient: Female, 36 Final Diagnosis: Isolated C5 vertebra dislocation Symptoms: Tetraplegia Medication: — Clinical Procedure: C5 corpectomy and anterior stabilization Specialty: Neurosurgery Objective: Rare disease Background: Total spondylolisthesis, or dislocation of 1 cervical vertebrae, is only caused by high-energy trauma and is usually fatal. Cervical spine fractures and dislocations often cause 3-column structural damage to the cervical spine, injury to the spinal cord, and precipitating alignment of the cervical vertebrae, as well as cervical instability, which are detrimental, show poor prognosis, and are associated with high rates of mortality rate and disability. Case Report: We report an extremely rare case of isolated C5 dislocation caused by falling out of a tree, with sudden tetraplegia. Conclusions: Total spondylolisthesis or dislocation of 1 cervical vertebrae can be surgically treated with anterior approach because it is possible to completely remove the vertebra body, intervertebral disc, and bone fragments, to directly decompress the spinal cord with stabilization.

Cauda equina cavernous hemangioma: very rare pediatric case

Dear Editor: Cavernous hemangiomas (CH) are rare vascular malformations in the central nervous system (CNS) characterized by abnormally dilated blood vessels, lined by a thin endothelium, without intervening normal nervous tissue. Intramedullary cavernomas are very rare [1]. They are usually solitary; although, they may be associated with CH in other organs or in the central nervous system. The most common clinical presentation is represented by a slowly progressive myelopathy, but subarachnoid hemorrhage and hematomyelia have also been described. The hemorrhage rate of symptomatic intramedullary CHs is 1.4–4.5% per lesion and per year [2]. A 13-year-old girl was admitted with the complaint of a 4-week history of back pain and right-side lower extremity weakness. A neurological examination revealed right extensor halluces longus (EHL) and anterior tibialis (AT) muscle weakness. Lumbar MRI revealed L1 intradural extramedullary lesion (Fig. 1a–c). We have also screened the entire neuroaxis, but we did not see any other intramedullary CH. After preoperative routine tests, we operated on the patient under general anesthesia. We excised the intradural CH after left-sided L1, L2 partial hemi-laminectomy, as described by Yasargil et al. for the removal of extramedullary and intramedullary tumors and AVMs (supplemental video file) [3]. A posterior midline longitudinal incision was made, and the subcutaneous tissues and lumbodorsal fascia of the affected side were divided. The supraspinal ligaments, interspinal ligaments, and tendinous insertions of the contralateral muscles were retained. The paraspinal muscles of the affected side were stripped, exposing the unilateral lamina to the inner edge of the articular process. Corresponding segments of the lamina were removed by a high-speed burr. Ligamentum flavum was removed and the dural sac was exposed. The oblique tilting of the operating table to the contralateral side (15–20 degrees) ensured an adequate surgical field for the procedure [3]. We used intraoperative ultrasound to localize the CH before opening the dura during surgery. Intraoperative neurophysiological monitoring was used to check nerve root potentials in order to preserve neural tissue. After opening the dura, we exposed the tumor. It was highly vascular with a prominent pulsation of the feeding arteries. The tumor was originating from a single nerve root, but it was adherent to the other cauda equina nerves. Using microneurosurgical technique under microscopic magnification, we dissected the tumor away from Electronic supplementary material The online version of this article (doi:10.1007/s00381-016-3286-9) contains supplementary material, which is available to authorized users.