Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the c4-5 level: a technical note.

Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the c4-5 level: a technical note.

Spine J. 2016 Feb 2;

Authors: Deng ZL, Chu L, Chen L, Yang JS

Abstract
BACKGROUND CONTEXT: With the continuous development of the spinal endoscopic technique in recent years, percutaneous endoscopic cervical discectomy (PECD) has emerged, which bridges the gap between conservative therapy and traditional surgery and has been mainly divided into the anterior transdiscal approach and the posterior interlaminar access. Because of the relatively more violation to the anterior nucleus pulposus, there is a higher potential of postoperative IVS decrease in anterior transdiscal approach than in posterior interlaminar access. In addition, when the herniated lesion is migrated upward or downward behind the vertebral body, both approach even ACDF are impractical and corpectomy is commonly considered as the only efficacious treatment. Anterior transcorporeal approach under endoscopy could enable an individual and adjustable trajectory within vertebral body under different conditions of disc herniation preserving the motion of adjacent segment, especially in a migrated or sequestered lesion.
PURPOSE: To first describe a novel anterior transcorporeal approach under endoscopy in which we addressed a migrated disc herniation at the C4-5 level.
STUDY DESIGN: Technical report PATIENT SAMPLE: A 37-year-old female patient presented with posterior neck pain and weakness of extremities for 9 months. On neurologic examination, tingling sensation and numbness were not obvious. However, the power of extremities was dramatically decreased at a level of 3. Hoffmann sign was positive in bilateral hand. Magnetic resonance imaging (MRI) showed a huge herniation of the C4-5 disc compressing the median area of the spinal cord. Besides the C4-5 disc herniation, preoperative computer tomography (CT) also detected that the herniated disc had partial calcification. A novel anterior transcorporeal approach of PECD, through the vertebral body of C5 was performed to address a migrated disc herniation at the C4-5 level.
OUTCOME MEASURES: The posterior neck pain was measured using the visual analog scale (VAS).
METHODS: A novel anterior transcorporeal approach under endoscopy was performed to address a migrated disc herniation at the C4-5 level.
RESULTS: This operation was accomplished in 75 minutes. Postoperatively, the drainage tube was retained into the drilling hole for 24 hours for avoiding from the possibility of hemotoma. The patient was advised to wear a neck collar for 3 weeks. Immediately after the operation, the posterior neck pain relieved from visual analog scale 7/10 preoperatively to 3/10; and the myodynamia of extremities improved stepwise. At 12 hours postoperatively, the range of motion was also improved. In the further follow-up, he was completely recovered from the preoperative symptoms, whose myodynamia of extremities is normal. Besides the postoperative MRI, a total removal of the herniated disc and the transcorporeal drilling tunnel are observed in CT. At postoperative 3-month follow-up, neither disc space narrowing nor instability was observed on CT, in which the bone defect after drilling tunnel was partially decreased indicating bone healing. There were no surgery-related complications, such as dysphagia, Horner's syndrome, recurrent laryngeal nerve palsy, vagus nerve injury, tracheoesophageal injury, cervical hematocele.
CONCLUSIONS: As an supplement to the described surgical approach of PECD, transcorporeal approach is a novel access for the treatment of CIVDH. The advantages of this approach is not only providing the view clear and decreasing the intraoperative iatrogenic injury to the but also avoiding the violation to the discal tissue. Theoretically, the potential of secondary decline of intervertebral height is low. However, as the limitation of one case, whether this transcorporeal approach is efficacious and reliable should be verified in the further comparative cohort study with a large volume of patients.

PMID: 26850173 [PubMed - as supplied by publisher]

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Which tinnitus-related characteristics affect current health-related quality of life and depression? A cross-sectional cohort study.

Which tinnitus-related characteristics affect current health-related quality of life and depression? A cross-sectional cohort study.

Psychiatry Res. 2016 Jan 28;

Authors: Weidt S, Delsignore A, Meyer M, Rufer M, Peter N, Drabe N, Kleinjung T

Abstract
Tinnitus is sometimes associated with lower health-related quality of life (HRQoL) and depressive symptoms. However, only limited evidence exists identifying which tinnitus characteristics are responsible for these associations. The aim of this cross-sectional study was to assess associations between tinnitus, HRQoL, depressive symptoms, subjective tinnitus loudness and audiometrically assessed tinnitus characteristics (e.g., hearing threshold). Two hundred and eight outpatients reporting tinnitus completed questionnaires on tinnitus (Tinnitus Handicap Inventory, THI), HRQoL (World-Health-Organisation Quality of Life Short Form Survey, WHOQOL-BREF), and depressive symptoms (Beck Depression Inventory, BDI), and underwent audiometry. Patients with higher THI scores exhibited significantly lower HRQoL, and higher depression scores. THI total-score, THI subscales, and subjective tinnitus loudness explained significant variance of WHOQOL-BREF and BDI. Audiometrically measured features were not associated with WHOQOL-BREF or BDI. Overall, we confirmed findings that different features of tinnitus are associated with HRQoL and depressive symptoms but not with audiometrically assessed tinnitus characteristics. Consequently, physicians should evaluate THI total score, its sub-scores, and subjective tinnitus loudness to reliably and quickly identify patients who potentially suffer from depressive symptoms or significantly lower HRQoL. Supporting these patients early might help to prevent the development of reactive depressive symptoms and impairment of HRQoL.

PMID: 26850646 [PubMed - as supplied by publisher]

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Cisternostomy for traumatic brain injury: pathophysiological mechanisms and surgical technical notes.

Cisternostomy for traumatic brain injury: pathophysiological mechanisms and surgical technical notes.

World Neurosurg. 2016 Feb 3;

Authors: Cherian I, Bernardo A, Grasso G

Abstract
OBJECTIVE: Traumatic brain injury (TBI) is one of the major challenges in health care, representing the third most frequent cause of death. Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies. Here we describe cisternostomy, an emerging surgical treatment for TBI treatment.
METHODS: Cisternostomy is a novel technique that incorporates knowledge of skull base and microvascular surgery. By opening the brain cisterns to atmospheric pressure, the technique could decrease the intracranial pressure due to a backshift of the cerebrospinal fluid (CSF)from the swollen brain to the cisterns through the Virchow-Robin spaces.
RESULTS: An increasing number of evidence has demonstrated a paravascular pathway that facilitates CSF flow from the subarachnoid space through the brain parenchyma. This network of paravascular channels, termed as "glymphatic" pathway, reduces considerably its activity following TBI thus participating in the development of brain edema formation. Cisternostomy, by opening the brain cisterns to atmospheric pressure could decrease the intracerebral pressure due to a backshift of CSF through the Virchow-Robin spaces.results CONCLUSIONS: In the current common practice, the surgical measures for TBI include external ventricular drainage insertion and decompressive craniectomy. There is evidence that both of these measures reduce intracranial pressure but the effect on the outcome, particularly in the long term, is equivocal. A new line of evidence supports cisternostomy as an emerging surgical treatment for TBI.

PMID: 26851743 [PubMed - as supplied by publisher]

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Track Recurrence After Robotic Transaxillary Thyroidectomy; A Case Report Highlighting The Importance of Controlled Surgical Indications and Addressing Unprecedented Complications.

Track Recurrence After Robotic Transaxillary Thyroidectomy; A Case Report Highlighting The Importance of Controlled Surgical Indications and Addressing Unprecedented Complications.

Thyroid. 2016 Feb 5;

Authors: Bakkar S, Frustaci G, Papini P, Fregoli L, Matteucci V, Materazzi G, Miccoli P

Abstract
BACKGROUND: Robot-assisted transaxillary thyroid surgery, widely accepted and used in Eastern countries, can be an appealing treatment option for both patients with major concerns regarding a cervical scar, and their surgeons. Patients are offered a scarless neck surgery, while their surgeons are offered improved dexterity and ergonomics compared to remote-access endoscopic thyroid surgery. However, validating any novel surgical procedure for thyroid pathology should be based on evidence regarding its feasibility, radicality and safety compared to the time-honored, safe and effective conventional open thyroidectomy. It should also be evaluated for potential risks that do not have conventional analogues.
PATIENT FINDINGS: We received a patient with surgical tract and cervical nodal recurrence, and distant metastasis following a two-stage robot-assisted surgery, and radioactive iodine ablation therapy for a papillary thyroid carcinoma that was initially regarded a single indeterminate nodule.
SUMMARY: This case emphasizes the importance of thoroughly evaluating the oncological safety of robot-assisted thyroid surgery, and points out the possibility of "malignant seeding along the surgical access" being an untraditional potential complication associated with the procedure.
CONCLUSIONS: While tailoring the surgical strategy undertaken to patients' concerns and desires is important, abiding to fundamental onco-surgical principles is a priority. Furthermore, unconventional complications associated with novel surgical procedures should be properly evaluated and addressed.

PMID: 26850129 [PubMed - as supplied by publisher]

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