Compressive Symptoms Research Articles

Early neurological changes in aging cervical spine: insights from PROMIS mobility assessment.

Many studies have shown that the prevalence of degenerative spinal cord compression increases with age. However, most cases at early stages are asymptomatic, and their diagnosis remains challenging. Asymptomatic cervical spinal cord compression (ASCC) patients are more likely to experience annular tears, herniated disks, and later develop symptomatic compression. Asymptomatic individuals do not typically undergo spinal cord imaging; therefore, an assessment test that is both sensitive and specific in diagnosing ASCC may be helpful. It has been demonstrated that the Patient Reported Outcome Measure Information System (PROMIS) mobility test is sensitive in detecting degenerative cervical myelopathy (DCM) symptoms. We investigated the use of the PROMIS mobility test in assessing clinical dysfunction in ASCC. In this study, 51 DCM patients and 42 age-matched healthy control (HC) were enrolled. The degree of cervical spinal cord compression was assessed using the high-resolution cervical spinal cord T2 Weighted (T2w) MRIs, which were available for 14 DCM patients. Measurements of the spinal cords anterior-posterior (AP) diameter at the region(s) that were visibly compressed as well as at different cervical spine levels were used to determine the degree of compression. The age-matched HC cohort had a similar MRI to establish the normal range for AP diameter. Twelve (12) participants in the HC cohort had MRI evidence of cervical spinal cord compression; these individuals were designated as the ASCC cohort. All participants completed the PROMIS mobility, PROMIS pain interference (PI), PROMIS upper extremity (UE), modified Japanese orthopedic association (mJOA), and neck disability index (NDI) scoring scales. We examined the correlation between the AP diameter measurements and the clinical assessment scores to determine their usefulness in the diagnosis of ASCC. Furthermore, we examine the sensitivity and specificity of PROMIS mobility test and mJOA. Compared to the HC group, the participants in the ASCC and DCM cohorts were significantly older (p = 0.006 and p < 0.0001, respectively). Age differences were not observed between ASCC and DCM (p > 0.999). Clinical scores between the ASCC and the HC group were not significantly different using the mJOA (p > 0.99), NDI (p > 0.99), PROMIS UE (p = 0.23), and PROMIS PI (p = 0.82). However, there were significant differences between the ASCC and HC in the PROMIS mobility score (p = 0.01). The spinal cord AP diameter and the PROMIS mobility score showed a significant correlation (r = 0.44, p = 0.002). Decreasing PROMIS mobility was significantly associated with a decrease in cervical spinal cord AP diameter independent of other assessment measures. PROMIS mobility score had a sensitivity of 77.3% and specificity of 79.4% compared to 59.1% and 88.2%, respectively, for mJOA in detecting cervical spinal cord compression. Certain elements of ASCC are not adequately captured with the traditional mJOA and NDI scales used in DCM evaluation. In contrast to other evaluation scales utilized in this investigation, PROMIS mobility score shows a significant association with the AP diameter of the cervical spinal cord, suggesting that it is a sensitive tool for identifying early disability associated with degenerative change in the aging spine. In a comparative analysis of PROMIS mobility test against the standard mJOA, the PROMIS mobility demonstrated higher sensitivity for detecting cervical spinal cord compression. These findings underscore the potential use of PROMIS mobility score in clinical evaluation of the aging spine.

Relationship between thyroid masses and compressive symptoms at King Fahd Hospital University, Eastern Province, Saudi Arabia

Objective: This study aimed to explore the factors affecting the incidence of compressive symptoms in patients with thyroid masses. Methods: A retrospective study was conducted on a population of 195 patients with thyroid masses obtained from King Fahd Hospital University medical system from 2010 to 2021. A questionnaire was formulated to collect data on patient-related and disease-related factors. Patients were contacted via phone calls or messages. Results: The study findings revealed that the most prevalent symptom was difficulty in swallowing. Furthermore, the incidence of compressive symptoms was significantly higher among patients with no chronic diseases (p0.05). Conclusions: The study indicated that the presence of chronic diseases might be associated with a lower incidence of thyroid mass compressive symptoms. Other patient-related and disease-related factors do not seem to have a significant impact on the incidence of compressive symptoms in patients with thyroid masses.

Posterior petrous meningioma with secondary trigeminal neuralgia: microsurgical resection after stereotactic radiosurgery (case report and literature review)

According to the literature, cerebellopontine angle tumors cause secondary trigeminal neuralgia and other symptoms of neurovascular compression in 1-9.9% of cases. We present a 58-year-old patient with left-sided secondary trigeminal neuralgia caused by ipsilateral posterior petrous meningioma. Stereotactic irradiation was followed by effective tumor growth control. However, residual trigeminal pain paroxysms significantly reduced the quality of life and required subsequent microsurgery. Trigeminal facial pain regressed after total resection of tumor. Considering this clinical case, we would like to discuss several issues: follow-up of meningioma requiring radiosurgery, course of secondary trigeminal neuralgia in a patient with apical petrous meningioma, characteristics of pain before and after radiosurgery, the best treatment option for these patients. Stereotactic radiosurgery seems unreasonable for CPA tumors with secondary trigeminal neuralgia. Indeed, persistent pain is possible even after tumor shrinkage. Moreover, primary stereotactic irradiation significantly complicates subsequent resection of tumor.

Disseminated Intracranial and Spinal Neurenteric Cysts: A Case Report and Literature Review

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22‐year‐old female presented to our institute with chronic headaches resistant to nonsteroidal anti‐inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow‐up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post‐treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring.

Late Presentation of a Primary Spinal Epidural Non-Hodgkin Lymphoma

Primary spinal epidural lymphomas (PSELs) constitute a unique subset of epidural tumors characterized by the exclusive presence of lymphoma within the epidural space at initial presentation, with no concurrent lymphoma in other sites. We aim to present a unique of PSEL and compare it with the present literature This case report presents a 65-year-old female with delayed-onset primary spinal epidural non-Hodgkin lymphoma (NHL). The patient exhibited paraplegia and walking difficulties, following a year of lower-extremity weakness and tingling sensations. Magnetic resonance imaging revealed a mass in the L1 through L3. Surgical decompression, stabilization, and tumor resection were performed. Microscopic examination confirmed NHL. Chemotherapy with the CHOP regimen was administered postsurgery. Subsequent follow-up revealed motoric and sensory improvements. PSEL primarily affects the thoracic spine and is more common in males. Patient age and gender impact prognosis. PSEL typically exhibits two phases – prodromal and rapid neurological deterioration. Surgical intervention coupled with chemotherapy is recommended, but the optimal surgical approach varies. Combined therapy could lead to improved disease-free survival. Cases of PSEL have shown potential for local and systemic relapse. Late presentation can still yield improvements with surgical and prompt chemotherapeutic intervention. Even without a prior history of malignancy or significant disease, PSEL should still be considered in patients presenting with spinal compression symptoms. Cases of delayed presentation, like the one presented here, can still benefit from surgical and prompt chemotherapeutic intervention.

Patient Experiences of Symptoms and Coping Strategies in the Early Postoperative Phase Following Hemithyroidectomy: A Qualitative Interview Study.

The aim was to explore patients' early experiences of symptoms after hemithyroidectomy and how these symptoms influenced their daily lives. An inductive explorative qualitative research design was performed. Sixteen patients from two hospitals were interviewed between two-three weeks after the surgery. All the patients experienced compression symptoms before the surgery. The study was analyzed with conventional manifest content analysis. The inductive analysis yielded two main categories and one subcategory. The two main categories were: Early postoperative symptoms that caused disadvantage in daily life and Early postoperative symptoms and coping strategies. The subcategory was: Early postoperative experiences of concerns about the future. Key points: 1. Patients experienced early postoperative symptoms that affected their lives in multiple levels, making them develop coping strategies and awaking concerns about remaining symptoms in the future. 2. The effect of hemithyroidectomy influenced patients' daily life in the early postoperative phase considerably. 3. The study shows that tailored preoperative patient information is important. The findings may guide professionals to tailored preoperative information to optimize the care for this patient group.

A Large Paraganglioma Neck – Managed Successfully by Transcervical Excision

Abstract Glomus vagale paraganglioma is a slow-growing, benign, and relatively uncommon tumor, accounting for &lt; 3% of head-and-neck paragangliomas. It predominantly arises from vagal nodose ganglion in the carotid sheath and mostly comprises extraadrenal nonchromaffin cells. It usually presents as an asymptomatic cervical mass but rarely can present with local compressive symptoms. Mostly paragangliomas are nonfunctional, however, functional paraganglioma needs to be ruled out by clinical examination (such as tachycardia, hypertension, and facial flushing) and laboratory investigation like vanillylmandelic acid in urine and serum. It also needs to be differentiated from other neck masses, for example, carotid body tumor, carotid aneurysm, nerve sheath tumor, etc., Imaging modalities such as ultrasonography, contrast-enhanced computed tomography or magnetic resonance imaging are required to characterize and diagnose such neck lesions and ascertain their relationship with the neck vessels. Surgical excision is considered the mainstay of treatment which mandates segmental resection of the vagus nerve and results in significant postoperative morbidity. We hereby report a case of 53-year-old female with a large, highly vascular glomus vagale tumor in the neck which was densely adherent to neck vessels (common carotid artery/internal carotid artery/external carotid artery and internal jugular vein) and presented with local compressive symptoms. The patient was successfully managed by preoperative angioembolization followed by transcervical excision of the tumor.

Cervical Artery Dissections-A Demographical Analysis of Risk Factors, Clinical Characteristics Treatment Procedures, and Outcomes-A Single Centre Study of 54 Consecutive Cases.

Cervical artery dissections (CAD) are a common cause of ischemic cerebrovascular events among the younger and middle-aged population. Altogether, CAD counts for up to 15% of all causes of stroke in patients aged 50 or younger. Among the known etiological causes, especially addressing the younger population with mechanical traumas and whiplash injuries are regarded as the main culprits. However, cases of spontaneous dissection are also widespread, with risk factors such as hypertension, migraine, and lifestyle factors increasing the risk of occurrence. Clinically, the symptoms associated with a cerebrovascular event caused by CADs are highly variable and can be classified as either compressive symptoms (such as Horner's syndrome and cervical pain) or stroke syndromes attributable to cerebral ischemia. Therefore, establishing an early diagnosis might be particularly challenging as it requires particular attention and quick clinical reasoning when interviewing the patient. With these certain particularities, our main focus was to conduct a prospective study involving up to 54 patients who were diagnosed with CAD in our clinical facility between January 2015 and December 2022, with the focus of assessing certain individual parameters attributable to each patient and their influence and prognosis value for their short and long term evolution. An important emphasis was placed on parameters such as topographical localization, clinical presentation, severity of the questioned cerebrovascular event, outcomes, and causative factors. Statistical validity tools were applied when possible.

Rubber band syndrome, a diagnostic dilemma: case series

Elastic bands or threads are worn on the wrist, ankle, fingers and sometimes neck, in many religious societies of India as part of their rituals or decorative purpose. It tends to stay hidden in the skin crease. When worn for a long duration, there is gradual, painless penetration of the band through the soft tissue. In neglected cases, re-epithelisation of skin over the buried band occurs. There is subsequent soft tissue infection and features suggestive of compression of the underlying connective tissue. In this article, we present a series of three cases with Rubber Band Syndrome, difficult to diagnose due to forgotten history. They were confirmed to have been suffering from Rubber Band Syndrome only after intra-operative finding of an embedded elastic band in soft tissue during surgical exploration. The buried rubber band was removed and circumferential fibrous tissue were excised followed by physiotherapy and rehabilitation. Aim was to emphasize on need of maintaining a high index of suspicion to diagnose Rubber Band Syndrome in cases, especially in young children, older individuals and people with cognitive impairment, presenting with linear, circumferential scar having compression symptoms. Surgical removal of buried rubber band was successful in all cases. Post-operative follow-up over a mean period of one year have shown a surprisingly good outcome with respect to limb function. A high index of suspicion is required to diagnose Rubber Band Syndrome in cases, especially in young children, older individuals and people with cognitive impairment, presenting with linear, circumferential scar having compression symptoms. It can be treated permanently by a simple surgery of foreign body removal and excision of circumferential fibrous tissue followed by physiotherapy and rehabilitation.

Spinal Plasmacytoma Transformed Into Solitary Sacral Amyloidoma: A Case Report

Amyloidoma is a rare complication of plasmacytoma, that can involve the spine and present with compressive neurological symptoms. It is usually a diagnosis of exclusion, and is difficult to differentiate from other plasma cell disorders on imaging. Definite diagnosis requires a tissue biopsy. The treatment requires a multidisciplinary approach, with input from haematology, neurology, neurosurgery, and radiology for the optimum course of action, depending on the patient’s comorbidities and performance status. The authors hereby present a case of solitary sacral amyloidoma in a 52-year-old African American female. Only three other cases of solitary sacral amyloidoma have been reported in the literature.

A Review on Hashimoto’s Thyroiditis

Hashimoto's thyroiditis (HT) is an autoimmune thyroid disorder first described by Japanese physician Haraku Hashimoto in 1912 characterized by lymphocytic infiltration of the thyroid parenchyma and is influenced by immune system instability. The onset of autoimmunity may be influenced by innate and acquired immune responses. Thyroid autoantibodies (TAbs) are the primary biochemical feature. Epidemiological studies show AITD (autoimmune thyroid disease) risk is higher in women and is age-related. Risk factors include high iodine consumption, selenium insufficiency, infectious disorders, and specific medications. Genetic predisposition and environmental factors also contribute to HT. Pregnancy and sex steroids play a role in the development of autoimmune thyroiditis, with older women being more susceptible. The immune system is modified during pregnancy, with progesterone playing a significant role. About 20% of postpartum thyroiditis patients eventually develop HT. The symptoms include dysphonia, dyspnea, and dysphagia, with primary hypothyroidism causing greater systemic symptoms. Diagnosis involves circulating thyroid-specific antibodies, ultrasound examination, increased thyroid stimulating hormone, and normal serum thyroid hormone levels. Ultrasonography is crucial for diagnosing Hashimoto's thyroiditis, distinguishing it from other thyroid disorders like Graves' disease (GD). The treatment comprises levothyroxine, which effectively lowers thyroid volume, as well as vitamin D deficiency and replacement. Autoimmune thyroiditis (AIT) surgery has traditionally been reserved for people who have discomfort or compressive symptoms from goitre or co-existing malignant thyroid nodules. Thyroidectomy has lately been advocated as a treatment option for decreasing TPOAbs, as the presence of such antibodies is linked to a worse quality of life even in euthyroid patients.&#x0D; Keywords: Hashimoto’s thyroiditis (HT), Autoimmune thyroid disease (AITD), Autoimmune thyroiditis (AIT) Vitamin D , Levothyroxine

The risk analysis index demonstrates superior discriminative ability in predicting extended length of stay in pituitary adenoma resection patients when compared to the 5-point modified frailty index

ObjectiveTo compare the predictive abilities of two frailty indices on post-operative morbidity and mortality in patients undergoing pituitary adenoma resection. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was used to retrospectively collect data for patients undergoing pituitary adenoma resection between 2015-2019. To compare the predictive abilities of two of the most common frailty indices, the 5-point modified frailty index (mFI-5) and the risk analysis index (RAI), receiver operating curve analysis (ROC) and area under the curve (AUC)/Cstatistic were used. ResultsIn our cohort of 1,454 patients, the RAI demonstrated superior discriminative ability to the mFI-5 in predicting extended length of stay (C-statistic 0.59, 95% CI 0.56-0.62 vs. C-statistic 0.51, 95% CI: 0.48-0.54, p = 0.0002). The RAI only descriptively appeared superior to mFI-5 in determining mortality (C-statistic 0.89, 95% CI 0.74-0.99 vs. Cstatistic 0.63, 95% CI 0.61-0.66, p=0.11), and NHD (C-statistic 0.68, 95% CI 0.60-0.76 vs. C-statistic 0.60, 95% CI: 0.57-0.62, p=0.15). ConclusionsPituitary adenomas account for one of the most common brain tumors in the general population, with resection being the preferred treatment for patients with most hormone producing tumors or those causing compressive symptoms. Although pituitary adenoma resection is generally safe, patients who experience post-operative complications frequently share similar pre-operative characteristics and comorbidities. Therefore, appropriate pre-operative risk stratification is imperative for adequate patient counseling and informed consent in these patients. Here we present the first known report showing the superior discriminatory ability of the RAI in predicting eLOS when compared to the mFI-5.

Hemithyroidectomy, does the indication influence the outcome?

PurposeHemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case of the latter, one could consider the approach to be rather extensive since the majority of patients have no symptoms and will have benign disease. The aim of this study is to investigate the complication rates of diagnostic hemithyroidectomy and to compare it with the complication rates of compressive symptoms hemithyroidectomy.MethodsData from patients who had undergone hemithyroidectomy either for compression symptoms or for excluding malignancy were extracted from a well-established Scandinavian quality register (SQRTPA). The following complications were analyzed: bleedings, wound infections, and paresis of the recurrent laryngeal nerve (RLN). Risk factors for these complications were examined by univariable and multivariable logistic regression.ResultsA total of 9677 patients were included, 3871 (40%) underwent surgery to exclude malignancy and 5806 (60%) due to compression symptoms. In the multivariable analysis, the totally excised thyroid weight was an independent risk factor for bleeding. Permanent (6–12 months after the operation) RLN paresis were less common in the excluding malignancy group (p = 0.03).ConclusionA range of factors interfere and contribute to bleeding, wound infections, and RLN paresis after hemithyroidectomy. In this observational study based on a Scandinavian quality register, the indication “excluding malignancy” for hemithyroidectomy is associated with less permanent RLN paresis than the indication “compression symptoms.” Thus, patients undergoing diagnostic hemithyroidectomy can be reassured that this procedure is a safe surgical procedure and does not entail an unjustified risk.

Pediatric neuroblastoma with intraspinal extension: the role of surgical management.

Neuroblastoma with spinal involvement accounts for up to 30% of pediatric spinal tumors and can cause profound neurological deficits. Chemotherapy is the preferred treatment option, but in select patients resection may be indicated. The goal of this study was to identify preoperative factors that led to early surgical intervention, with a specific emphasis on identifying differences on long-term neurological function and spinal deformity in the recent treatment era. A retrospective chart review was performed on all children diagnosed with neuroblastoma at a single institution from 2007 to 2020. Patient demographics, symptoms (motor deficit and sphincter dysfunction), and tumor characteristics (e.g., 123I metaiodobenzylguanidine [MIBG] avidity, MYCN amplification, chromosomal abnormality, pathology, catecholamine secretion, and stage) were recorded. Spine involvement included neural or vertebral extension, spinal cord compression, and/or T2 signal change on MRI. Survival, neurological status (motor deficit, sphincter dysfunction), and spine deformity at last follow-up were compared using univariate and multivariate analyses. The variables that contributed to neurological and deformity outcome were assessed with binomial logistic and linear regression models using R software. Seventy-seven of the 160 patients with neuroblastoma had spinal neuroblastoma, meaning either bone metastases alone (n = 43) or intraspinal extension with or without neurological deficit (n= 34). Most patients with spinal neuroblastoma were treated with chemotherapy and/or radiation therapy (97% and 57%, respectively). Resection of the spinal tumor was performed in 14 (18%) patients, all of whom also received chemotherapy. Between the surgical and nonsurgical patients, no baseline demographic differences were found. However, surgical patients were more likely to present with either motor deficits (50% vs 5%, p = 0.0011) or bladder/bowel dysfunction (14% vs 0%, p 0.035), and a shorter median time to onset of neurological symptoms (33 vs 80 days, p = 0.0096). Surgical patients also had a significantly shorter median overall survival (33.0 vs 54 months, p = 0.014). Of the 14 patients who underwent spine surgery, 2 patients underwent surgery at the time of diagnosis while the remaining 12 underwent initial chemotherapy followed later by resection. The 2 patients who underwent initial surgery had excellent outcomes, with neither long-term motor or bowel/bladder deficits nor spinal deformity. Surgical patients had shorter overall survival. However, the 2 patients with radiographic evidence of cord compression and acute neurological symptom onset who underwent initial, immediate surgery within 3 days of diagnosis had fewer long-term neurological deficits than surgical patients who underwent initial trials of chemotherapy. Thus, acute decompression may provide benefit in carefully selected patients with acute neurological deficits and cord compression on imaging.

Clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch EndoprosthesisProvision of Services for People with Vascular Disease 2021

Isolated aneurysms of the iliac arteries are extremely rare. They most frequently occur in the common iliac artery (CIA) and are least frequent in the external iliac artery (EIA).1 Most (95%) affected patients are male and the median age of diagnosis is in the seventh decade of life.2 The underlying pathology of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. This includes degenerative aneurysm, pseudoaneurysm, penetrating ulcer, post-dissection aneurysm mycotic aneurysm, and traumatic aneurysm.3 Unlike patients with abdominal aortic aneurysms, those with iliac artery aneurysms present with symptoms of compression of other structures, particularly the ureter, sacral plexus and iliac veins. Reported growth rate of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. Ruptured isolated iliac artery aneurysms are associated with significant mortality,4 which is higher when treatment is undertaken as an emergency rather than an elective surgical procedure. Effective and timely intervention is therefore essential to improve survival. The aim of surgical treatment is to exclude the aneurysm from the circulation to prevent further growth and rupture. Traditional open surgical repair (OSR) was the mainstay of treatment but is technically challenging due to the location of the aneurysms in the pelvis and a frequent prior history of abdominal aortic aneurysms.1 Endovascular repair (EVAR) of isolated iliac artery aneurysms is a less invasive alternative to OSR. It is performed by a combination of branch-vessel coil embolisation and stent grafting, and has potential advantages over OSR in reducing perioperative morbidity and mortality.5 This supplement is a report of a satellite symposium held during the Vascular Societies' Annual Scientific Meeting in November 2022. It reviews clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch Endoprosthesis.

Anaesthetic management of a bleeding intratracheal mass

A long-standing thyroid mass can have varied presentation depending on the metabolic, compressive or invasive symptoms. The most apparent symptom of thyroid mass is goitre, which if ignored can prove to be catastrophic as in our case. It is uncommon for thyroid mass to present as airway bleeding. However, a patient with long standing goitre presented with frank hemoptysis to our hospital. Radiological study revealed a thyroid mass, infiltrating the tracheal wall and extending into the tracheal lumen. A bleeding intratracheal mass presents a multifactorial challenge to an anaesthetist. Authors present anaesthetic management of a case of infiltrating thyroid malignancy presenting as a bleeding intratracheal mass. The haemostasis and airway patency were restored until definitive surgery was planned. The need for tracheostomy could be avoided in this case. A meticulously planned airway management along with multi-disciplinary approach are important for management of bleeding intratracheal mass.

Executive summary of the expert consensus document from the Spanish Society of Neurosurgery and the Spanish Society of Endocrinology and Nutrition: Clinical recommendations on the perioperative management of pituitary tumors

Pituitary tumors (PT) account for 15% of intracranial tumors affect 10.7%–14.4% of the population although the incidence of clinically relevant PT is 5.1 cases/100,000 inhabitants. Surgical treatment is indicated in PTs with hormone hypersecretion (except for prolactin-producing PTs) and those with local compressive or global neurological symptoms. Multidisciplinary care, is essential for patients with PTs, preferably delivered in a center of excellence and based on a well-defined care protocol. In order to facilitate and standardize the clinical procedures for this type of tumor, this document gathers the positioning of the Neuroendocrinology Knowledge Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Society of Neurosurgery (SENEC) on the management of patients with PTs and their preoperative, surgical and postoperative follow-up.

Absence of musculocutaneous nerve associated with the presence of an accessory head of the biceps brachii muscle: report of a bilateral case and its clinical implications

The anatomical variants of the biceps brachii muscle (BBM) are frequent, mostly unilaterally than bilaterally, and are associated with supernumerary muscle bellies, the total absence of the muscle or one of its heads, and variations in the points of origin and insertion. In the same way, the variants of the musculocutaneous nerve (MCN) can include alterations in its course, number of branches, or anatomical relations, whereas its absence is considered an atypical variation. The aim of this work was to report the absence of musculocutaneous nerve associated with the presence of one accessory head of the biceps brachii muscle. Dissection of a female cadaver, fixed in 10% buffered formaldehyde, which did not present previous surgeries in the studied area was performed. Variations were noted in both upper limbs related to accessory muscle bellies and change in innervation. Anatomical relations of muscles and nerves were determined by following proximal to distal ends, relation, vascularization, and innervation pattern. The absence of MCN associated with the presence of one accessory head of the BBM were found bilaterally. These anatomical variations are atypical. Clinically, these variations can produce compressive symptoms that could generate confusing diagnostics and conduce to unnecessary procedures on the arm, inducing iatrogenic actions.

Radiographic and clinical features of thoracic intradural extramedullary epidermoid tumor: Illustrative case

Spinal epidermoid tumors are uncommon benign neoplastic lesions arising from heterotopic epidermal rest-cells. These lesions rarely occur in the thoracic region (&lt;0.8%) and can present with symptoms of spinal cord and nerve root compression.

The clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis

Objective: To investigate the clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique in treating mixed cervical spondylosis. Methods: A retrospective cohort study. A retrospective analysis was made of 128 cases of mixed cervical spondylosis with symptoms of spinal cord and nerve root compression and complete follow-up data admitted to the Department of Spinal Surgery, Affiliated Hospital of Jining Medical University from January 2016 to June 2022. Of the patients, there were 90 males and 38 females with a mean age of (58.5±9.8) years. Before February 2018, 72 cases were treated with posterior cervical open-door expansive laminoplasty (single-door group), and after February 2018, 56 cases were treated with posterior cervical open-door expansive laminoplasty combined with Key-hole technique (combined group). There was no significant difference between the two groups in age, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score of pain and Cobb angle of imaging before operation. The operation time, intraoperative blood loss, postoperative JOA score, VAS score and Cobb angle of imaging were compared between the two groups. Results: Both groups of patients successfully completed the operation. Operation time [M(Q1, Q3)]: 89.0 (68.5, 104.5) min in the single-door group and 90.0 (72.8, 108.8) min in the combined group, there was no statistical difference between the two groups (P=0.640). The intraoperative blood loss in the single-door group was 100 (100, 200) ml, and it was 100(100, 200) ml in the combined group, there was no significant difference between the two groups (P=0.680). Postoperative JOA scores increased significantly, while VAS scores decreased significantly in both groups. At the last follow-up, the JOA and VAS scores of the combined group were better than those of the single-door group (both P<0.05). Conclusion: The posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis can effectively remove the compression on the cervical spine without causing cervical instability.