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At least 271 records · Page 15Linked to original sources

PubMed1991

Metastatic juvenile pilocytic astrocytoma. Case report.

The authors report the case of a metastatic juvenile pilocytic astrocytoma of the hypothalamic region in a 10-year-old boy. Eight years after craniotomy and radiation therapy, the tumor spread via cerebrospinal fluid pathways to the left cerebellar tonsil and the lumbosacral region. Histological evaluation of both the original hypothalamic and the new lumbosacral masses showed features of a slow-growing juvenile pilocytic astrocytoma with no evidence of malignant transformation. The clinical implications and possible mechanisms of metastatic spread are discussed.

Astrocytoma↗

PubMed1995

The use of self-retaining retractors in surgery for spinal cord tumors: technical note.

Self-retaining retractors may be useful in spinal tumor surgery. In this study, the tumors were retracted away from the surrounding tissue by pronged hooks attached to flexible self-retaining retractors; by this process, we could avoid placing pressure on the spinal cord. A clear dissection plane was exposed between the underside of the tumor and the surrounding spinal cord, so that the surgeon had both hands free to perform the operation. Two retractor base systems were used: 1) Sugita's multipurpose headframe for the cervical region, and 2) a newly designed U-shaped, table-fixed retractor base for the thoracic and lumbosacral regions. Most retracting instruments used in cranial surgery can be used with either system.

Humans↗

PubMedDate not supplied

Selection of the appropriate surgical approach for intervertebral disc disease.

In no other area of veterinary surgery is the selection and performance of the appropriate surgical approach more important than neurosurgery. An adequate, atraumatic, and anatomically sound exposure is an important part of the battle in most orthopaedic procedures and is an even more important consideration when related to neurosurgery. The delicate and often unforgiving nature of the tissue involved dictates that careful planning and attention to detail become high priority concerns for the veterinary neurosurgeon. Most veterinarians recommend surgery for dogs with severe impairment, recurrent disease, and progressively deteriorating neurologic signs. Difficulties remain in the timing of surgery and in the choice of what surgical approach is most appropriate for the neurologically impaired dog in question. Surgical approaches in the cervical region include ventral and dorsal. In the thoracolumbar spine, either dorsal or dorsolateral approaches are used. In the lumbosacral region, a dorsal approach is preferred. The objective of this chapter will be to compare and contrast each of these approaches and to guide the reader in the selection of the appropriate approach for each patient.

Animals↗

PubMed1989

Arginine8-vasopressin reduces spinal cord blood flow after spinal subarachnoid injection in rats.

Arginine8-vasopressin (AVP) causes hindlimb paralysis, loss of nociceptive responsiveness and increased arterial pressure after spinal subarachnoid injection in rats. In these experiments, the effects of paralytic intrathecal doses of AVP on rat brain and spinal cord blood flow, vascular resistance and cardiac output were measured using radiolabeled microspheres. Ten minutes after injection, AVP (10-100 pmol) elevated mean arterial pressures significantly, increased vascular resistances in thoracic and lumbosacral spinal cord and reduced blood flow to the lumbosacral spinal cord without altering cardiac output, total peripheral resistance and blood flow to brain and other spinal cord regions. Lumbosacral blood flows remained significantly reduced 30 min after injection of 100 pmol of AVP, and recovered to pretreatment base-line levels by 60 min postinjection. Lactic acid concentrations were elevated significantly in spinal cerebrospinal fluid samples removed 5 to 15 min after AVP injection (100 pmol). The selective AVP V1 receptor antagonist [1-(beta-mercapto-beta,beta-cyclopentamethylene propionic acid), 2-(O-methyl)tyrosine] arg8-vasopressin, which previously blocked the effects of AVP on hindlimb motor and nociceptive function, in these experiments also blocked the AVP-induced increases in arterial pressure and reductions in lumbosacral perfusion. Intravenous infusion of the vasodilators papaverine and nifedipine failed to block AVP-induced hindlimb paralysis. Nifedipine, however, did accelerate subsequent recovery of hindlimb motor function, although it did not alter the lumbosacral blood flow reductions measured at 10 and 30 min after AVP injection. These findings indicate that AVP has significant vascular effects in the rat spinal cord that are associated with ischemia and neurological dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2000

Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions.

The superior gluteal vessel has been reported as a recipient in free-tissue transfer for the coverage of complex soft-tissue defects in the lumbosacral region, where a suitable recipient vessel is difficult to find. The characteristics of proximity, vessel caliber, and constancy make the superior gluteal vessel preferable to previously reported recipient vessels. However, there are technical difficulties in microsurgery (e.g., short pedicle length and deep location) and muscle injury (transection of the muscle) associated with use of the superior gluteal vessel. The purpose of this article is to present a modification of an approach to the gluteal vessel to alleviate technical difficulties and minimize muscle injury. From August of 1997 to January of 1999, six patients received microvascular transfer of the latissimus dorsi muscle or myocutaneous flap to the sacral (4) and ischial (2) regions. The causes of defects were tumor (1), trauma (1), and pressure sores (4). A muscle-splitting approach was used on the superior gluteal vessel and was later applied to the inferior gluteal vessel. The gluteus maximus muscle was split as needed in the direction of its fibers, and the perforators were dissected down to the superior or inferior gluteal artery and vein deep into the muscle. The follow-up period ranged from 6 to 22 months, and all of the flaps survived with complete recovery of the lesion. The major drawbacks of using the superior and inferior gluteal vessels can be overcome with the muscle-splitting approach, which provides increased accessibility and additional length to the vascular pedicle while causing minimal injury to the muscle itself. It also proves to be an easy, safe, and reliable method of dissection. When free-tissue transfer to sacral, gluteal, and ischial regions is indicated, the muscle-splitting approach to the superior and inferior gluteal vessels is a recommended option in the selection of a recipient vessel.

Adult↗

PubMed1997

Chronic intractable headache in a patient with Marfan's syndrome.

A 30-year-old woman with Marfan's syndrome had chronic intractable headaches and spontaneous intracranial hypotension. The pain was concentrated over the occipitonuchal region, had elements of both migraine and tension headache, and was often aggravated by postural change. Myelography showed multiple, large, lumbosacral arachnoid diverticula. Radioisotope cisternography revealed a halolike accumulation in the lumbosacral region and rapid uptake of isotope in the urinary bladder, indicating cerebrospinal fluid leakage. Epidural blood patching brought immediate relief from the positional headaches. We concluded that patients with Marfan's syndrome and undifferentiated chronic headaches should be radiologically evaluated for spinal meningeal defects.

Adult↗

PubMed1984

Case report of infarction in the region of the posterior spinal arteries.

Spinal cord infarction in the region of the posterior spinal arteries is reported in a 62-year-old woman. The softening was restricted to the lumbosacral region involving two segments. Sectioning the affected and adjacent segments serially no occlusion was found in the posterior spinal arteries. Besides the circumscribed infarction the microscopic picture of the spinal cord was characteristic of vascular myelopathy. The underlying disorders of the previously reported cases and the predisposing factors contributing to the development of infarction are discussed. It is concluded that an insufficient anastomotic network plays the essential role in the pathogenesis of the spinal cord infarction.

Arteries↗

PubMed1997

Closure of upper extremity soft-tissue defects using the new "supra-crest" fasciocutaneous free flap.

A fasciocutaneous island (15 x 10 cm) can be elevated from the inferolateral abdominal wall in a region encompassing the iliac crest and extending to the lower costal margin. This new fasciocutaneous flap was named the "supra-crest flap," in accordance with its anatomic location and vascular pattern. The blood supply stems from the direct cutaneous branches of the lumbar arteries (L2-3), which pierce the abdominal musculature approximately 2.0 cm above the iliac crest in the midaxillary line. The arteries and two vena comitantes have an average external diameter of 2.0 mm, and their dissection can be extended deep into the iliac fosa to provide a pedicle 8 or more cm in length. Two cutaneous nerves accompany the lumbar arteries, furnishing the possibility of a sensate flap. These structures have been transferred as a free flap with the donor site concealed by conventional underwear and bathing suits. Additionally, this region could be harvested as an island flap wherein the arc of rotation may be sufficient to cover defects of the thoracic wall and lumbosacral regions.

Adolescent↗

PubMed1996

Epidural lipomatosis in a six-year-old dachshund.

A six-year-old female dachshund was examined because of intermittent lameness in its left pelvic limb and periodic back pain. Myelography, epidurography and computed tomography (CT) revealed a dorsal displacement of the dural sac in the lumbosacral region caused by a soft tissue mass which had the specific density of fat. The mass was removed via a dorsal laminectomy in the lumbosacral area and a histological examination confirmed that it was adipose tissue. The clinical signs resolved after the surgery and a follow-up CT five months later showed no evidence of compression of the dural sac. The diagnosis of epidural lipomatosis in this dog was based on the clinical findings, the results of diagnostic imaging, and the surgical and histological findings, all of which revealed many similarities with epidural lipomatosis in man.

Animals↗

PubMed1982

Nociception is enhanced by the intrathecal injection of 5-methoxy-N,N-dimethyltryptamine in the rat.

The effect of 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) at the spinal cord level on nociceptive reflexes was tested using the tail-flick assay in rats. 5-MeODMT was injected directly into the spinal subarachnoid space of conscious rats via a permanently indwelling intrathecal cannula. Administration of 100 micrograms/rat of 5-MeODMT into the thoracic region, using a 4 cm long cannula, reduced the average percent of control reaction time by 14%. The injection of the same dose of 5-MeODMT into the lumbosacral region, via an 8.6 cm long cannula, decreased the average percent of control reaction time by 25%. The ability of 5-MeODMT to mimic the facilitatory (hyperalgesic) effect on nociception of similar doses of tryptamine, in contrast to the antinociceptive (analgesic) effect of serotonin, suggests an interaction of 5-MeODMT with tryptaminergic rather than serotonergic receptors in the spinal cord.

Animals↗

PubMed1975

Neural intersegmental connection in the spinal root and ganglion region of the rat.

A study has been made of the macroscopic, microscopic and electron-microscopical appearance of intersegmental neural connections in the rat. Macroscopically, spinal roots and ganglia of adjacent segments were frequently observed to be linked by discrete, slender strands, mainly in the lumbosacral region where the roots are long. When examined under the light microscope, even the smallest was found to contain as many as 72 myelinated fibres with a range of diameters between 1.5-14 mu-m. The were commonly accompanied by blood vessels. Connections, when present, contributed to as much as 6-28% of the total number of myelinated axons in dorsal roots. Under the electron microscope, links between dorsal roots, or between dorsal roots and adjacent ganglia, contained unmyelinated fibres comparable in numbers to those found in the dorsal roots themselves. In links between ventral roots and ganglia the numbers of unmyelinated fibres proportionally exceeded those found in ventral roots. The presence of these connections may account for the reported finding of undamaged nerve fibres in the dorsal roots after dorsal root sectioning or ganglionectomy and in the ventral roots after ventral root sectioning.

Animals↗

PubMed1982

Evidence that secondary neurulation occurs autonomously in the chick embryo.

Other investigations have demonstrated that pressure, exerted by fluid contained within the lumen of the closed neural tube, plays an important role in the morphogenesis of cranial regions of chick embryos. In this study, we investigated whether this pressure is involved also in the formation of the secondary portion of the neural tube--the portion formed by canalization of a solid mass of cells. To determine this, the posterior neuropore was prevented from closing (resulting in myeloschisis localized to he lumbosacral region) by removing the portion of the vitelline membrane covering the embryo, and reincubating for various periods. Secondary neurulation occurred normally in embryos exhibiting lumbosacral myeloschisis, demonstrating that this process occurs autonomously in chick embryos. Additional experimental studies are needed to ascertain what specific mechanisms cause the secondary portion of the neural tube to form.

Animals↗

PubMed2006

Segmental organization of spinal reflexes mediating autonomic dysreflexia after spinal cord injury.

Spinal cord injuries above mid-thoracic levels can lead to a potentially life-threatening hypertensive condition termed autonomic dysreflexia that is often triggered by distension of pelvic viscera (bladder or bowel). This syndrome is characterized by episodic hypertension due to sudden, massive discharge of sympathetic preganglionic neurons in the thoracolumbar spinal cord. This hypertension is usually accompanied by bradycardia, particularly if the injury is caudal to the 2nd to 4th thoracic spinal segments. The development of autonomic dysreflexia is correlated with aberrant sprouting of peptidergic afferent fibers into the spinal cord below the injury. In particular, sprouting of nerve growth factor-responsive afferent fibers has been shown to have a major influence on dysreflexia, perhaps by amplifying the activation of disinhibited sympathetic neurons. Using a model of noxious bowel distension after complete thoracic spinal transection at the 4th thoracic segment in rats, we selectively altered C-fiber sprouting, at specified spinal levels caudal to the injury, with microinjections of adenovirus encoding the growth-promoting nerve growth factor or the growth-inhibitory semaphorin 3A. This was followed by assessment of physiological responses to colorectal distension and subsequent histology. Additionally, anterograde tract tracers were injected into the lumbosacral region to compare the extent of labeled propriospinal rostral projections in uninjured cords to those in cords after complete 4th thoracic transection. In summary, overexpression of chemorepulsive semaphorin 3A impeded C-fiber sprouting in lumbosacral segments and mitigated hypertensive autonomic dysreflexia, whereas the opposite results were obtained with nerve growth factor overexpression. Furthermore, compared to naïve rats, there were significantly more labeled lumbosacral propriospinal projections rostrally after thoracic injury. Collectively, our findings suggest that distension of pelvic viscera increases the excitation of expanded afferent terminals in the disinhibited lumbosacral spinal cord. This, in turn, triggers excitation and sprouting of local propriospinal neurons to relay visceral sensory stimuli and amplify the activation of sympathetic preganglionic neurons in the thoracolumbar cord, to enhance transmission in the spinal viscero-sympathetic reflex pathway. These responses are manifested as autonomic dysreflexia.

Adrenergic Fibers↗

PubMed1989

Microsurgical unilateral approaches for spinal tumour surgery: eight years' experience in 256 primary operated patients.

A series of 256 consecutive patients suffering from spinal tumours was studied with respect to the value of bilateral or unilateral surgical approaches. The case material included 152 extradural, 87 intradural, extramedullary and 17 intramedullary tumours. The cervical spinal cord was involved in 43, the thoracic in 152 and the lumbosacral region in 61 cases. Hemilaminectomy was chosen mainly for juxtamedullary tumours, while laminectomy was used for intramedullary tumours. No remarkable difference regarding the choice of approaches was found in extradural tumours. More than 60% of cervical or lumbosacral tumours were managed using unilateral procedures. A higher rate of surgical radicality but fewer complications, shorter stay in hospital and better early results were achieved using hemilaminectomy especially in patients with juxtamedullary tumours. From the observations it may be concluded that the results do not depend on the type of surgical approach but are closely related to the histology and location of tumours. Under the prerequisite of exact pre-operative definition of tumour location, unilateral approaches are advantageous for all kinds of spinal tumours especially for juxtamedullary benign tumours.

Adolescent↗

PubMed1986

Changes of neurotransmitter systems in chronic relapsing experimental allergic encephalomyelitis in rat brain and spinal cord.

Catecholamine and indoleamine neurotransmitters, together with some of their precursors and metabolites, were determined using HPLC in three brain and two spinal cord regions of Lewis rats with chronic relapsing allergic encephalomyelitis and of control rats injected with complete Freund's adjuvant. Three attacks and two recovery phases were investigated. Changes are found mainly in the spinal cord. In the lumbosacral region both 5-hydroxytryptamine and noradrenaline are reduced during the entire course of the disease, whereas in the craniothoracal region 5-hydroxytryptamine is unchanged and only noradrenaline is reduced during the attacks, returning to normal during the first recovery. The precursors tyrosine and tryptophan are greatly elevated during the first two attacks in both regions. The 5-hydroxytryptamine turnover marker 5-hydroxyindoleacetic acid is increased in the first attack in both regions, then it decreases in the later stages, indicating destruction of nerve fibers. On the fourth and seventh days after inoculation values are generally not significantly different from controls in all regions. The possible correlation of neurochemical results with neurological signs is discussed.

Animals↗

PubMed1994

T-cadherin expression delineates specific regions of the developing motor axon-hindlimb projection pathway.

T-cadherin is a unique member of the cadherin family anchored to the membrane by a glycosyl phosphatidylinositol moiety (Ranscht and Dours-Zimmermann, 1991). T-cadherin's distribution in the developing motor axon pathway was mapped by immunocytochemistry in the chick lumbosacral region as spinal neurons project to and innervate hindlimb muscle. On growing motor axons, T-cadherin was expressed biphasically. Initially, uniform T-cadherin expression occurred on motor neurons as they projected between the spinal cord and the base of the hindlimb (stage 21-24), and then decreased as the axons sorted to form dorsal, ventral and muscle nerve trunks (stage 25-27). Later, as motor axons entered and formed terminal axon arbors and synapses in muscle (stages 28-36), expression reoccurred heterogeneously among motor neuron pools. Thus, T-cadherin may guide the growth and fasciculation of all motor neurons during early axon extension, but only affect particular populations during the later expression period. In the mesenchyme of the motor axon pathway, T-cadherin was restricted to regions avoided by growing axons: the posterior-half sclerotome before and during the projection of motor axons through the T-cadherin-negative anterior half, and the extrasynaptic surfaces of developing muscle. The temporal and spatial expression patterns of T-cadherin and neurite outgrowth-promoting N-cadherin were complementary both in nerve and muscle tissues. Thus, in the posterior sclerotome and in maturing muscle, T-cadherin may act as a negative regulator that works in concert with neurite growth-promoting molecules to guide motor axons to their peripheral targets.

Animals↗

PubMed2005

[An autopsy case of origin-unidentified meningeal carcinomatosis presenting with monoradiculopathy multiplex in the lower extremities].

A 54-year-old man with a history of partially dissected epidermoid cyst in the left cerebellopontine angle suffered from a slowly progressive dysesthesia and weakness in the lower extremities and trunk. Neurological examination revealed segmental muscular weakness and sensory disturbance in those regions, giving rise to the possibility of monoradiculopathy multiplex, as well as loss of tendon reflexes, dysuria and right facial nerve palsy. Electrophysiological studies indicated irregular motor axonopathy or neuronopathy and interruption of more central sensory pathways than the lumbosacral spinal nerve roots with spared peripheral sensory nerves. Although MRI demonstrated enhanced lesions in the cauda equina and lumbosacral leptomeninges, CSF cytology or a cauda equina biopsy showed no malignancy. His symptoms gradually progressed and he died 15 months after the onset. The autopsy failed to reveal any tumors in the general systemic internal organs. Histopathology demonstrated meningeal carcinomatosis with squamous-type carcinoma cells scattered in the cerebrospinal leptomeninges, and perineurium in almost all the spinal and cranial nerve roots, causing severe axonal degeneration. The dorsal root ganglions escaped tumor cell invasion. Absence of the malignant tumors in the systemic organs and the history of the operated epidermoid cyst indicate that the tumor may be the cause of the meningeal carcinomatosis in this case. Meningeal carcinomatosis almost always shows rapid progression and extremely poor prognosis with several month survival in general, and little attention has been paid that it can exhibit symptoms and signs of segmental involvement in the lumbosacral regions. Our present case prompts us to bear in mind that patients with this condition can survive fairly long, and raises the possibility that a careful neurological examination with segmental involvement will reveal such a feature more frequently than considered so far in this condition.

Carcinoma, Squamous Cell↗

PubMed1985

Spinal cord blood flow following subarachnoid tetracaine.

Spinal cord and spinal dural blood flow in the cervical, thoracic and lumbosacral regions were measured in dogs using the radioactive microsphere technique. Measurements were taken before and 20 and 40 minutes after lumbar subarachnoid injection of one of the following: physiologic saline; tetracaine 20 mg or tetracaine 20 mg with epinephrine 200 micrograms. No significant change in spinal cord or spinal dural blood flow occurred following subarachnoid physiologic saline or tetracaine with epinephrine. Dogs receiving subarachnoid tetracaine demonstrated a significant increase in lumbosacral spinal cord, and thoracic and lumbosacral dural blood flow at 20 and 40 minutes following injection. Cervical dural blood flow was significantly increased at 40 minutes after subarachnoid tetracaine. Lumbar subarachnoid tetracaine (20 mg) produces a regional spinal cord and generalized dural hyperemia which is prevented by the addition of epinephrine (200 micrograms).

Anesthesia, Spinal↗