Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials a...Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.展开更多
NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual i...NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The authors describe a 51-year-old woman who had a NFMA (35 × 24 × 25 mm). The vision was reduced to 7/10 in the both eyes. A transnasal transsphenoidal surgery was performed and the tumor was successfully resected. Postoperatively, the patient had visual (9/10) and headache improvement. This case highlights a rare presentation of non-functioning pituitary macroadenoma.展开更多
Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors desc...Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.展开更多
The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates ver...The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. A 32-year-old man presented to us after traffic accident. In our patient, unstable fracture-dislocation of the lumbar spine at the L2-L3 level due to traffic accident occurred. The vertebral bodies were fractured and the anterior dislocation happened without spinal cord injury. The patient was a candidate for an open reduction and internal fixation surgery. The posterolateral approach was performed. After insertion of all the pedicle screws, the rods were transversally placed on L2-L3-L4 vertebral bodies and tightened. The reduction of the dislocations was carried out by pushing downwards (foreside) L2 and L4 vertebras and upwards (backside) L3 vertebrae, simultaneously. After securing the reduction of the dislocations, the rods were opened and placed along the spinal column and tightened. This technique is more effective when the pedicle of fractured vertebrae is intact.展开更多
文摘Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.
文摘NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The authors describe a 51-year-old woman who had a NFMA (35 × 24 × 25 mm). The vision was reduced to 7/10 in the both eyes. A transnasal transsphenoidal surgery was performed and the tumor was successfully resected. Postoperatively, the patient had visual (9/10) and headache improvement. This case highlights a rare presentation of non-functioning pituitary macroadenoma.
文摘Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.
文摘The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. A 32-year-old man presented to us after traffic accident. In our patient, unstable fracture-dislocation of the lumbar spine at the L2-L3 level due to traffic accident occurred. The vertebral bodies were fractured and the anterior dislocation happened without spinal cord injury. The patient was a candidate for an open reduction and internal fixation surgery. The posterolateral approach was performed. After insertion of all the pedicle screws, the rods were transversally placed on L2-L3-L4 vertebral bodies and tightened. The reduction of the dislocations was carried out by pushing downwards (foreside) L2 and L4 vertebras and upwards (backside) L3 vertebrae, simultaneously. After securing the reduction of the dislocations, the rods were opened and placed along the spinal column and tightened. This technique is more effective when the pedicle of fractured vertebrae is intact.
