Anteroposterior Combined Surgery of a Rare Massive Epithelioid Hemangioendothelioma at the Cervicothoracic Junction

Intramedullary ependymomas should be treated with surgical resection. Different surgical techniques are described for these tumors, such as skipped and long-segment myelotomies. A 31-year-old male patient with a giant thoracic spinal cord ependymoma extending from the level of T5 to T10 was operated on with a skipped myelotomy technique. Although the patient had urinary incontinence and muscle weakness in both legs, the patient's complaints were nearly completely resolved in the fourth postoperative month. Operating with the smallest possible myelotomy has given us preferable results; however, more studies are needed to hypothesize the superiority of this technique over conventional myelotomy.

Section: Discussionmentioning

confidence: 82%

Giant Ependymoma Removal via a Skipped Myelotomy Technique

Gok,

Celik,

Yangi

et al. 2023

“…Clinical signs of SEHs may be rapid and acute or develop gradually [18]. Differential diagnosis is required because disorders progressing over time can be confused with other space-occupying lesions, such as spinal tumors or infections [19]. In our case, the patient presented with acute-onset low back pain and bilateral limb paralysis that progressed rapidly.…”

Section: Discussionmentioning

confidence: 90%

The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review

Kahraman,

Senturk

2023

Self Cite

Spinal epidural hematomas (SEHs)are space-occupying lesions that exert pressure on the spinal cord by rapidly accumulating blood between the dura and bone or ligament components. The annual incidence of spontaneous epidural hematoma is estimated to be one in one million. The predominant symptoms are back pain or neurological impairment, including sensory, motor, or autonomic dysfunction of the limbs below the hematoma level. Depending on the level and size of the hematoma and the affected cord, they cause neurological deficits. Neurological deficits are often reversible if diagnosed and treated early with surgical decompression. However, neurological deficits can become permanent if the patient is not operated on timely, and paraplegia or quadriplegia may occur. A 53-year-old man presented to our emergency department with acute-onset back pain and 36-hour-long, rapidly progressive paraparesis of both legs. On T1- and T2-weighted MRI scans, a hyperacute SEH was found as iso/hyperintense and hyperintense, respectively. Immediate decompressive laminectomy from T10 to L2 and hematoma evacuation were performed. It was challenging to remove the hematoma due to its firm consistency. Before performing a bilateral total laminectomy at five levels, the posterior spine was stabilized between T10 and L3 using transpedicular screws. Within 24 hours, the motor function of the lower limbs increased considerably. The patient could sit on a chair because of posterior stability. In addition to the importance of early diagnosis using imaging techniques, planning the extension of SEH surgery is crucial for the patient’s postoperative neurological recovery.

“…EF is a significant cause of failed back surgery (FBS), accounting for 10% to 24% of cases [6,7]. In the case of space-occupying lesions such as tumors [8], foreign bodies, or fibrotic tissues in the epidural area, patients may develop severe pain and neurological problems [9]. Fibrosis surrounds the periphery of the nerve root and can cause mechanical compression.…”

Section: Introductionmentioning

confidence: 99%

High-Frequency Bipolar Coagulation Limits Epidural Fibrosis in Lumbar Microdiscectomy

Yavuz,

Gok,

Yangi

et al. 2023

Background and aim: We propose a vast study to examine the effect of high-frequency bipolar coagulation used in the operating room to prevent the development of epidural fibrosis after lumbar microdiscectomy. Materials and methods: A total of 1004 participants were divided into two groups: no high-frequency bipolar coagulation (NC group) and high-frequency bipolar coagulation (C group). Postoperative epidural fibrosis, infection rates, reoperation status, and dural injury complications during the operation were recorded. Results: Considering the epidural fibrosis rates of the two groups, epidural fibrosis was seen in 10.6% of the patients in the NC group. In contrast, it was seen in only 6.2% of the patients in the C group. Conclusion: The complication of epidural fibrosis that develops after lumbar microsurgery operations both impairs patient comfort and brings with it the complications of reoperation. After performing hemostasis with bipolar, coagulating the annulus may effectively reduce epidural fibrosis and prevent reoperation.