Neurosurgery

Cơn đau rễ thần kinh kéo dài hoặc tái phát sau phẫu thuật cột sống thắt lưng cùng thường liên quan đến sự chèn ép rễ thần kinh và thường được điều trị bằng phẫu thuật lặp lại hoặc, như phương án cuối cùng, bằng kích thích tủy sống (SCS). Chúng tôi đã tiến hành một thử nghiệm có kiểm soát, ngẫu nhiên, nhằm kiểm tra giả thuyết của chúng tôi rằng SCS có khả năng mang lại kết quả thành công cao hơn so với phẫu thuật lặp lại theo các tiêu chí tiêu chuẩn về giảm đau và kết quả điều trị, bao gồm cả việc sử dụng tài nguyên chăm sóc sức khỏe sau đó.

To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data.

The Nationwide Inpatient Sample database (year 2000) was analyzed retrospectively. We reviewed 7.45 million patient admissions for primary International Classification of Diseases, 9th Revision, procedure codes 023 to 0243 (ventricular shunts to peritoneal, atrial, pleural, and urinary systems for initial placement, revision, and removal); admissions listing ventriculostomy placement (code 022) were excluded from analysis.

Five thousand five hundred seventy-four admissions were identified. Admission sources primarily were routine (58.8%) and the emergency department (32.4%). Admission types primarily were elective (43.3%), emergent (33.2%), and urgent (21.9%). The top three primary diagnoses treated were shunt malfunction (40.7%), noncommunicating hydrocephalus (16.6%), and communicating hydrocephalus (13.2%). Shunt infection was the primary diagnosis in 7.2% of admissions. Age frequency of admissions was nonparametric, being highest for infants; the average stay was 8.4 ± 0.2 days (standard error range, 0–243 d). The most common procedures were ventriculoperitoneal shunt placement (43.4%) and ventricular shunt replacement (42.8%); ventricular shunt removal occurred in 7.3% of admissions, whereas ventricle-to-thorax (0.6%), ventricle-to-circulatory system (0.5%), and ventricle-to-urinary system (0.05%) shunts were rare. Average cost was $35,816 ± $810 (standard error range, $137–$814,748). Primary payers primarily were private insurers (43.8%), Medicare (26.0%), and Medicaid (24.5%). Disposition mainly was routine (78.4%, with home health care in 6.5%), and inpatient mortality was 2.7%. There was no socioeconomic disproportion in treatment with respect to average household income.

Ventricular shunts as primary procedures constitute a significant medical and economic problem.

Oncocytoma in the central nervous system is extremely unusual. The first reported example of oncocytoma in a melanocytoma of the spinal cord was successfully excised, and its pathological appearance is described.

A 71-year-old woman presented with a 25-year history of back pain and myelographic evidence of a lumbar spinal cord mass. After declining surgical treatment for two decades, she elected eventually to have the mass excised. Preoperative magnetic resonance imaging revealed a large intraspinal mass that spanned spinal levels L3 through S1.

The mass was excised en bloc through posterior laminectomies, and histopathological analysis revealed a benign neoplasm composed predominantly of monotonous sheets of plump oncocytes. Electron microscopy confirmed that the cytoplasm of the oncocytes was packed full of mitochondria. Focal areas of the tumor contained spindle cells, with abundant intracytoplasmic granular deposits of brown melanin pigment that contained melanosomes. Positive Fontana-Masson, HMB-45, and S-100 staining confirmed the final diagnosis of melanocytoma, oncocytic variant.

The first reported case of oncocytoma arising in spinal melanocytoma is described. After surgical excision, the patient recovered completely and has remained free of symptoms for 4 years.