Hiroshi Kageyama : Spinal malignant melanotic nerve sheath tumor with atypical magnetic resonance imaging findings: A case report, Surgical Neurology International, 15, 250, 2024.
(要約)
Malignant melanotic nerve sheath tumors (MMNSTs) are relatively rare, comprising <1% of all neoplastic peripheral nerve lesions. Here, we describe a 79-year-old male who presented with atypical magnetic resonance imaging (MRI) findings of an MMNST. A 79-year-old male presented with lower back pain, paraparesis, and bladder/bowel dysfunction. The MRI showed an intradural extramedullary (IE) lesion at the T9-T10 level with low-signal intensity on T1-weighted images (WI) and high intensity on T2-WI, which markedly enhanced with contrast. The IE nerve root involved with the tumor was completely removed surgically. The lesion was confirmed to be an MMNST. In the absence of metastases, adjuvant therapy was deemed unnecessary. One year later, the lesion has not recurred. A 79-year-old male patient presented with a T9-T10 MR intradural lesion that was pathologically proved to be an MMNST, which was treated with gross total surgical resection (i.e., removal of the involved nerve root alone).
Yu Otake, Fumitake Tezuka, Kazuta Yamashita, Masatoshi Morimoto, Kosuke Sugiura, Makoto Takeuchi, Shunsuke Tamaki, Junzo Fujitani, Hiroshi Kageyama and Koichi Sairyo : Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report., The Journal of Medical Investigation : JMI, 71, 1.2, 179-183, 2024.
(要約)
Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.
(キーワード)
Humans / Female / Aged, 80 and over / Anesthesia, Local / Spinal Fractures / Spinal Stenosis / Decompression, Surgical / Endoscopy / Osteoporotic Fractures / Lumbar Vertebrae / Radiculopathy
Koichi Sairyo, Yutaro Kanda, Kozaburo Mizutani, Masashi Kumon, Saori Soeda, Fumiaki Makiyama, Ryota Mio, Masatoshi Morimoto, Shunsuke Tamaki, Keisuke Nishidono, Kosuke Sugiura, Makoto Takeuchi, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Hiroshi Kageyama and Junzo Fujitani : Transforaminal full-endoscopic decompression under local anesthesia for foraminal stenosis due to stable L5 isthmic spondylolisthesis, a technical note and review:Pars crisscross decompression., The Journal of Medical Investigation : JMI, 71, 3.4, 191-196, 2024.
(要約)
Foraminal stenosis is one of the types of lumbar spinal stenosis. The pathology can be treated minimally invasively by full-endoscopic spine surgery (FESS). The final challenge in transforaminal FESS is foraminal stenosis in patients with stable isthmic spondylolisthesis at L5. This article provides a step-by-step explanation of how to achieve complete decompression. A cannula of 8 mm in diameter is docked at the base of the superior articular process of the sacrum. The pars crisscross that consists of the superior articular process at S1, the floating lamina, the inferior articular process at L4, and the pars ragged edge is then clearly seen endoscopically. Visualization of the pars crisscross is key to successful decompression. Starting with the superior articular process at S1, followed by partial removal of the floating lamina. Next, the tip of the inferior articular process at L4 is removed. The pars ragged edge is then carefully shaved. Finally, decompression of the exiting nerve root at L5 is confirmed. This report provides the first step-by step description of full-endoscopic decompression of foraminal stenosis under local anesthesia in patients with stable L5 isthmic spondylolisthesis, which we have named "full-endoscopic pars crisscross decompression". J. Med. Invest. 71 : 191-196, August, 2024.