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Biomedical subjects

S S Rengachary

Publications and source records attributed to S S Rengachary.

At least 19 recordsLinked to original sources

The role of vertebroplasty in metastatic spinal disease.

Many advances have been made in the treatment of metastatic spinal disease over the last few decades. Radiotherapy offers benefit and pain relief to many patients; however, this modality provides minimal vertebral stabilization. Surgical management consists of decompression and complex fusions. Vertebroplasty offers an adjuvant therapy to both radiotherapy and surgery by providing additional stabilization and pain relief. The results of case studies suggest that including vertebroplasty in the management of these patients is beneficial. In this article the authors review the role of vertebroplasty in metastatic spinal disease.

Bone Cements↗

Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury.

BACKGROUND: Decompressive craniectomy has historically served as a salvage procedure to control intracranial pressure after severe traumatic brain injury. We assessed the safety and feasibility of performing craniectomy as the initial surgical intervention. METHODS: Of 29 consecutive patients undergoing emergent decompression for severe traumatic brain injury with horizontal midline shift greater than explained by a removable hematoma, 17 had traditional craniotomy with or without brain resection and 12 underwent craniectomy. RESULTS: The craniectomy group had lower Glasgow Coma Scale scores at surgery (median, 4 vs. 7; p = 0.04) and more severe radiographic injuries (using specific measures). Mortality, Glasgow Outcome Scale scores, Functional Independence Measures, and length of stay in both the acute care setting and the rehabilitation phase were similar between the surgical groups. CONCLUSION: Despite more severe injury severity, patients undergoing initial craniectomy had outcomes similar to those undergoing traditional surgery. A randomized evaluation of the effect of early craniectomy on outcome is warranted.

Adult↗

Nimodipine-induced acute hypoxemia: case report.

OBJECTIVE AND IMPORTANCE: Nimodipine is commonly used to improve neurological outcomes after subarachnoid hemorrhage. Although nimodipine reportedly has high specificity for the cerebral vasculature, adverse systemic effects such as hypotension have been described. This case report describes a patient with traumatic subarachnoid hemorrhage who experienced two episodes of previously undescribed, life-threatening hypoxemia that was directly related to nimodipine therapy. CLINICAL PRESENTATION: The patient experienced acute hypoxemia (partial pressures of oxygen of 32.9 and 58.7 mm Hg), on two separate occasions (3 d apart), that was temporally related to single doses of nimodipine therapy for traumatic subarachnoid hemorrhage. Other disease- and medication-related causes did not explain these episodes. INTERVENTION: After the inspired oxygen concentration was increased to 100% (both episodes) and the positive end expiratory pressure was increased to 7.5 mm Hg (first episode), the arterial oxygen saturation of the patient returned to baseline levels (>99%) within 40 minutes in each instance. Nimodipine therapy was discontinued after each episode. CONCLUSION: It is hypothesized that, in the presence of concomitant adult respiratory distress syndrome, nimodipine increased ventilation/perfusion ratio mismatch, through its direct vasodilatory effects on the pulmonary artery, and possibly interfered with the reflex hypoxic pulmonary vasoconstriction necessary to maintain adequate oxygenation for this patient. Clinicians should carefully monitor the oxygenation status of patients when nimodipine therapy is initiated.

Acute Disease↗

Ivory osteoma of the cervical spine: case report.

OBJECTIVE AND IMPORTANCE: We report a unique case of ivory osteoma of the cervical spine. CLINICAL PRESENTATION: The clinical presentation was one of polyradicular deficit without myelopathy after trauma. The imaging characteristics and histology of the lesion were those of a classic ivory osteoma. INTERVENTION: A complete surgical excision of the lesion was accomplished. CONCLUSION: We think we have recorded the only well-documented case of ivory osteoma affecting the spine.

Adult↗

Brain wounds and their treatment in VII Corps during Operation Desert Storm, February 20 to April 15, 1991.

OBJECTIVE: To evaluate field neurosurgery supporting VII Corps during combat in Operation Desert Storm. RESULTS: (1) Only 1 of 22 patients who had a head wound died. (2) The one computed tomography unit in a forward hospital worked well, aiding diagnosis and surgical management. The occurrence of hematoma at a distance from the missile track has been worrisome to past field neurosurgeons, but none of 9 patients who had predebridement scans had a distant clot. (3) The number of brain wounds was fewer than expected for Americans, and the wounds were basilar in location. Iraqis, by contrast, had wounds that were randomly distributed about the head. CONCLUSIONS: (1) Although computed tomography is a useful diagnostic adjunct, its availability should not be a sine qua non for forward neurosurgery. (2) The current Kevlar helmet design appears successful.

Adolescent↗

Craniocephalic disproportion with increased intracranial pressure and brain herniation: a new clinical syndrome in anemic patients: report of two cases.

OBJECTIVE AND IMPORTANCE: We describe a new clinical syndrome in two patients with chronic anemia. The major manifestation of the syndrome is herniation of the brain resulting in death caused by longstanding craniocephalic disproportion. The disproportion was caused by extreme thickening of the cranium because of erythroid hyperplasia. CLINICAL PRESENTATION: Two patients with known chronic anemia presented with chronic increase in intracranial pressure with acute deterioration resulting in brain herniation. INTERVENTION: Despite maximum medical therapy, both patients died as a result of uncontrollable increase in intracranial pressure. CONCLUSION: Patients with chronic anemia presenting with progressive headaches should be monitored for this newly described clinical phenomenon.

Adult↗

Transdiaphragmatic ventriculoperitoneal shunting: technical case report.

OBJECTIVE AND IMPORTANCE: This report describes an important technical modification in ventriculoperitoneal shunting. CLINICAL PRESENTATION: A young woman presented with shunt malfunction caused by occlusion of the peritoneal catheter. Conventional sites for placement of distal catheter were unavailable or had been used up. INTERVENTION: After the installation of a ventriculopleural shunt resulted in pleural effusion, it was converted to a transdiaphragmatic ventriculoperitoneal shunt, resulting in an excellent clinical outcome. CONCLUSION: The suprahepatic subdiaphragmatic space can be directly accessed in some selected patients with extensive peritoneal adhesions, resulting in successful ventriculoperitoneal shunting.

Adult↗

Extradural ecchordosis physaliphora of the thoracic spine: case report.

OBJECTIVE AND IMPORTANCE: We report an unusual case of ecchordosis physaliphora of the thoracic spine. CLINICAL PRESENTATION: The clinical presentation was one of disabling thoracic radicular pain without objective neurological deficit. The imaging characteristics of the lesion were those of a cyst containing aqueous fluid. There was no bone destruction. INTERVENTION: Gross total removal of the lesion was accomplished. CONCLUSION: We present the only well-documented case of thoracic extradural ecchordosis physaliphora and discuss the relationship between the notochord, ecchordosis physaliphora, and chordoma. We provide a comprehensive list of lesions exhibiting physaliphorous cells.

Adult↗

The history of spinal biomechanics.

The history of spinal biomechanics has its origins in antiquity. The Edwin Smith surgical papyrus, an Egyptian document written in the 17th century BC, described the difference between cervical sprain, fracture, and fracture-dislocation. By the time of Hippocrates (4th century BC), physical means such as traction or local pressure were being used to correct spinal deformities but the treatments were based on only a rudimentary knowledge of spinal biomechanics. The Renaissance produced the first serious attempts at understanding spinal biomechanics. Leonardo da Vinci (1452-1519) accurately described the anatomy of the spine and was perhaps the first to investigate spinal stability. The first comprehensive treatise on biomechanics, De Motu Animalium, was published by Giovanni Borelli in 1680, and it contained the first analysis of weight bearing by the spine. In this regard, Borelli can be considered the "Father of Spinal Biomechanics." By the end of the 19th century, the basic biomechanical concepts of spinal alignment and immobilization were well entrenched as therapies for spinal cord injury. Further anatomic delineation of spinal stability was sparked by the anatomic analyses of judicial hangings by Wood-Jones in 1913. By the 1960s, a two-column model of the spine was proposed by Holdsworth. The modern concept of Denis' three-column model of the spine is supported by more sophisticated testing of cadaver spines in modern biomechanical laboratories. The modern explosion of spinal instrumentation stems from a deeper understanding of the load-bearing structures of the spinal column.

Biomechanical Phenomena↗

Localized cystic subdural hygroma: case report.

We report a new variant of subdural hygroma previously undocumented in the literature. A 29-year-old man had a skull mass and a progressive headache of 6 to 7 years duration. He was involved in a car crash 8 years earlier and had an unrecognized skull fracture. During surgery the lesion was found to be a localized, cystic subdural hygroma communicating with the subarachnoid space through a narrow opening. This lesion is unique because: (1) the subdural hygroma was limited by an adhesion between the dura and the arachnoid; (2) the actual communication between the subdural hygroma and the subarachnoid space was clearly identified; and (3) localized bulging of the skull is exceptional for a subdural hygroma. Differentiation from more common cystic lesions such as congenital arachnoid cysts, traumatic arachnoid cysts, intradiploic arachnoid cysts, and chronic subdural hematomas is discussed.

Adult↗

Lipofibromatous hamartoma of the median nerve: case report with magnetic resonance imaging correlation.

The authors report a case of lipofibromatous hamartoma of the median nerve in a patient who presented with symptoms of carpal tunnel syndrome. The diagnosis was made by magnetic resonance imaging and confirmed by intraoperative findings and histological diagnosis; distinctive magnetic resonance imaging features of this entity are described. In this patient, surgery was limited to biopsy to confirm the diagnosis and external neural decompression, which helped to stop the progression of the symptoms. In their review of the literature, the authors found four types of lipomatous masses in the extremities affecting the function of peripheral nerves, commonly the median nerve. Treatment and the extent of surgery differ for each patient, based on the anatomical findings and extent of neurological deficit. The etiology, pathogenesis, differential diagnosis, and surgical management of lipofibromatous hamartoma are described.

Carpal Tunnel Syndrome↗

Spinal arterial aneurysm: case report.

Isolated aneurysms of the spinal artery (not associated with arteriovenous malformations) are exceptionally rare. Fewer than 17 cases have been reported in the literature. We report a case of an isolated spinal artery aneurysm causing acute subarachnoid hemorrhage. Spinal artery aneurysms are contrasted with the more common intracranial aneurysms in terms of presentation and pathogenesis. The various clinical presentations of spinal artery aneurysms are discussed as well. A summary of all reported cases of spinal aneurysms, with and without associated arteriovenous malformations, is listed.

Aneurysm↗

The sinking bullet.

We report a case of a missile injury to the brain with an unusual complication. The bullet migrated by its mere weight to a distant location through the brain parenchyma after it initially lodged in a superficial site. Instances of similar phenomena reported in the literature are reviewed.

Adolescent↗

Granulocytic sarcoma presenting as an epidural mass with cord compression.

Granulocytic sarcoma (GS) usually occurs during the course of, or as a presenting sign of myelogenous leukemia. Rarely it is found before peripheral blood or bone marrow evidence of leukemia is present. We describe a man who presented with low back pain and lower extremity weakness. He had spinal cord compression due to GS without evidence of leukemia. Only four such instances have been previously reported. Such aleukemic presentations of GS are frequently misdiagnosed. The chloroacetate esterase stain and electron microscopy are useful in demonstrating the myeloid origin of GS cells. GS lesions are probably best treated by localized radiation therapy and systemic chemotherapy.

Humans↗

Occult intrasacral meningocele: clinical and radiographic diagnosis.

We evaluated four patients who had occult intrasacral meningocele with multimodality radiographic imaging techniques. The clinical features, radiological findings, gross appearances of the lesion at surgery, surgical technique, histopathological features of the cyst wall, and surgical outcome are described. The role of magnetic resonance imaging in the preoperative evaluation compared with standard radiographic techniques is discussed. Theories regarding the pathogenesis of this lesion are reviewed.

Female↗

Intradiploic arachnoid cysts. Report of two cases.

Two patients are presented in whom cranial arachnoid cysts developed as diverticuli of the arachnoid membrane through small defects in the dura mater, eroded through the inner table, expanded within the diploe, and eroded the outer table of the skull. Based on observations at the time of surgery and the histological examination of these lesions, it is proposed that they are congenital in origin. Previously reported cases of "traumatic arachnoid cyst without fracture," "intradiploic cerebrospinal fluid fistula," and "middle fossa pitholes" appear to represent the same pathological process as the lesions reported in this paper. It is proposed that "intradiploic arachnoid cyst" is the most appropriate term by which these lesions should be described.

Aged↗