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Anaesthesia Apr 1989Six patients were referred to our hospital with spinal arachnoiditis after epidural anaesthesia performed one month to 3 years before the onset of symptoms. None had had...
Six patients were referred to our hospital with spinal arachnoiditis after epidural anaesthesia performed one month to 3 years before the onset of symptoms. None had had previous lumbar surgery or trauma, intraspinal haemorrhage, infections or other known causative factors of arachnoiditis. All the patients were free of neurological symptoms before epidural anaesthesia and only two had transient distress in the period immediately following the procedure. The clinical signs and symptoms of spinal arachnoiditis were severe and in every case the diagnosis was confirmed by myelography. Three patients were confined to a wheelchair after 3 years of follow-up. To our knowledge, the anaesthetic procedures were performed according to standard methods. Arachnoiditis seems to be due to the epidural injection of foreign substances, and may be related to anaesthetic-vasoconstrictor solution or contaminants.
Topics: Adolescent; Adult; Anesthesia, Epidural; Arachnoiditis; Female; Humans; Male; Myelography
PubMed: 2719203
DOI: 10.1111/j.1365-2044.1989.tb11285.x -
Cancer Reports (Hoboken, N.J.) Aug 2022Prostate cancer is the most prevalent cancer in men. However, leptomeningeal involvement by prostate carcinoma is a rare event.
BACKGROUND
Prostate cancer is the most prevalent cancer in men. However, leptomeningeal involvement by prostate carcinoma is a rare event.
CASE
Here, we report a 69-year-old patient with castration-resistant metastatic prostate cancer who presented with headache and ataxia. Brain MRI revealed a huge invasive interaxial mass at right occipital lobe with diffuse thickening and enhancement of meninges, the arachnoid, and the pia mater, and he was diagnosed with leptomeningeal carcinomatosis. The patient received whole brain radiotherapy.
CONCLUSION
Despite the fact that brain and leptomeningeal metastases are not very common in patients with prostate cancer, signs and symptoms of nervous system disorders should be assessed carefully, and consideration of such unusual metastases must be considered.
Topics: Aged; Arachnoid; Humans; Magnetic Resonance Imaging; Male; Meningeal Carcinomatosis; Pia Mater; Prostatic Neoplasms
PubMed: 34089302
DOI: 10.1002/cnr2.1463 -
Neurologia Medico-chirurgica Apr 2019The "cerebrospinal fluid (CSF) circulation theory" of CSF flowing unidirectionally and circulating through the ventricles and subarachnoid space in a downward or upward... (Review)
Review
Changing the Currently Held Concept of Cerebrospinal Fluid Dynamics Based on Shared Findings of Cerebrospinal Fluid Motion in the Cranial Cavity Using Various Types of Magnetic Resonance Imaging Techniques.
The "cerebrospinal fluid (CSF) circulation theory" of CSF flowing unidirectionally and circulating through the ventricles and subarachnoid space in a downward or upward fashion has been widely recognized. In this review, observations of CSF motion using different magnetic resonance imaging (MRI) techniques are described, findings that are shared among these techniques are extracted, and CSF motion, as we currently understand it based on the results from the quantitative analysis of CSF motion, is discussed, along with a discussion of slower water molecule motion in the perivascular, paravascular, and brain parenchyma. Today, a shared consensus regarding CSF motion is being formed, as follows: CSF motion is not a circulatory flow, but a combination of various directions of flow in the ventricles and subarachnoid space, and the acceleration of CSF motion differs depending on the CSF space. It is now necessary to revise the currently held concept that CSF flows unidirectionally. Currently, water molecule motion in the order of centimeters per second can be detected with various MRI techniques. Thus, we need new MRI techniques with high-velocity sensitivity, such as in the order of 10 μm/s, to determine water molecule movement in the vessel wall, paravascular space, and brain parenchyma. In this paper, the authors review the previous and current concepts of CSF motion in the central nervous system using various MRI techniques.
Topics: Cerebral Ventricles; Cerebrospinal Fluid; Humans; Hydrodynamics; Magnetic Resonance Imaging; Subarachnoid Space
PubMed: 30814424
DOI: 10.2176/nmc.ra.2018-0272 -
Scientific Reports Jul 2023The cisterna magna has been defined as the space between the inferior margin of the cerebellar vermis to the level of the foramen magnum, while an enlarged dorsal...
The cisterna magna has been defined as the space between the inferior margin of the cerebellar vermis to the level of the foramen magnum, while an enlarged dorsal subarachnoid space at the occipito-cervical junction extending from the foramen magnum to the upper border of the axis (C2) is still ignored. Recently, the myodural bridge complex is proved to drive the cerebral spinal fluid flowing via this region, we therefore introduce the "occipito-atlantal cistern (OAC)" to better describe the subarachnoid space and provide a detailed rationale. The present study utilized several methods, including MRI, gross anatomical dissection, P45 sheet plastination, and three-dimensional visualization. OAC was observed to be an enlarge subarachnoid space, extending from the foramen magnum to the level of the C2. In the median sagittal plane, OAC was a funnel shape and its anteroposterior dimensions were 15.92 ± 4.20 mm at the level of the C0, 4.49 ± 1.25 mm at the level of the posterior arch of the C1, and 2.88 ± 0.77 mm at the level of the arch of the C2, respectively. In the median sagittal plane, the spino-dural angle of the OAC was calculated to be 35.10 ± 6.91°, and the area of OAC was calculated to be 232.28 ± 71.02 mm. The present study provides OAC is a subarachnoid space independent from the cisterna magna. Because of its distinctive anatomy, as well as theoretical and clinical significance, OAC deserves its own name.
Topics: Subarachnoid Space; Foramen Magnum; Neck; Spinal Cord; Cisterna Magna
PubMed: 37495633
DOI: 10.1038/s41598-023-38825-z -
Journal of Cerebral Blood Flow and... Jan 2022Growing evidence indicates that perivascular tissue is critical to modulate vessel function. We hypothesized that the arachnoid membrane surrounding middle cerebral...
Growing evidence indicates that perivascular tissue is critical to modulate vessel function. We hypothesized that the arachnoid membrane surrounding middle cerebral artery (MCA) regulates its function via sphingosine-1-phosphate (S1P)-induced vasoconstriction. The MCA from 3- to 9-month-old male and female wild-type (Oncine France 1 and C57BL/6) mice and sphingosine kinase 2 knockout (SphK2-/-) mice in the C57BL/6 background was mounted in pressure myographs with and without arachnoid membrane. Raman microspectroscopy and imaging were used for in situ detection of S1P. The presence of arachnoid tissue was associated with reduced external and lumen MCA diameters, and with an increase in basal tone regardless of sex and strain background. Strong S1P-positive signals were detected in the arachnoid surrounding the MCA wall in both mice models, as well as in a human post-mortem specimen. Selective S1P receptor 3 antagonist TY 52156 markedly reduced both MCA vasoconstriction induced by exogenous S1P and arachnoid-dependent basal tone increase. Compared to 3-month-old mice, the arachnoid-mediated contractile influence persisted in 9-month-old mice despite a decline in arachnoid S1P deposits. Genetic deletion of SphK2 decreased arachnoid S1P content and vasoconstriction. This is the first experimental evidence that arachnoid membrane regulates the MCA tone mediated by S1P.
Topics: Animals; Arachnoid; Female; Hydrazones; Lysophospholipids; Male; Mice; Mice, Knockout; Middle Cerebral Artery; Phosphotransferases (Alcohol Group Acceptor); Signal Transduction; Sphingosine; Sphingosine-1-Phosphate Receptors; Vasoconstriction
PubMed: 34474613
DOI: 10.1177/0271678X211033362 -
Neurology India 2022Microvascular decompression (MVD) of the trigeminal nerve is a well-accepted nondestructive procedure for trigeminal neuralgia. Usually, Teflon (PTFE) puff or felt graft...
BACKGROUND
Microvascular decompression (MVD) of the trigeminal nerve is a well-accepted nondestructive procedure for trigeminal neuralgia. Usually, Teflon (PTFE) puff or felt graft techniques, which are most commonly used, are associated with arachnoiditis and recurrence among other complications. We use the "sleeve graft" technique using PTFE to separate the neurovascular conflict and here we describe our experience with the same in 376 cases.
OBJECTIVES
To study the outcomes in 376 patients treated with sleeve graft technique for trigeminal neuralgia.
MATERIALS AND METHODS
For a period of 18 years, from 2002 to 2020, all cases of medically refractory trigeminal neuralgia were subjected to the "sleeve graft" technique for MVD. Pre- and post-operatively, pain score was given according to Barrow Neurological Institute pain intensity score. Cases were observed for any complications and pain relief in short and long-term follow-up.
RESULTS
In total, 376 cases of refractory primary trigeminal neuralgia cases, among which 198 patients underwent MVD with no prior intervention, 158 underwent MVD following percutaneous ablative procedure, 13 were "Revision MVD" previously done at other centers, and four were post gamma knife failure. There was no incidence of arachnoiditis or recurrence of symptoms. Further, 368 (97.8%) patients had complete recovery from symptoms while eight (2.2%) had partial recovery after 5 years of follow-up. Complications included hearing loss (n = 1), temporary hypoesthesia (n = 45), and permanent hypoesthesia (n = 7).
CONCLUSION
"PTFE Sleeve Graft" technique to remove the neurovascular conflict in micro vascular decompression (MVD) for trigeminal neuralgia is a safe and effective technique that yields better results.
Topics: Arachnoiditis; Decompression; Humans; Hypesthesia; Microvascular Decompression Surgery; Pain; Polytetrafluoroethylene; Retrospective Studies; Treatment Outcome; Trigeminal Neuralgia
PubMed: 36076637
DOI: 10.4103/0028-3886.355155 -
Turkish Neurosurgery 2011Surgery is the treatment of choice for children who had tethered cord syndrome (TCS). However, a detailed technique for the release of spinal cord is not described yet.... (Review)
Review
AIM
Surgery is the treatment of choice for children who had tethered cord syndrome (TCS). However, a detailed technique for the release of spinal cord is not described yet. The aims of this study are to present our series of TCS in children and to focus on the details of surgical technique. MATERIAL and
METHODS
Forty-nine children with tethered cord syndrome underwent surgical treatment for the release of spinal cord between 2004 and 2009. The mean age was 4.6 years (2 days-13 years). Twenty (40.8%) patients were female and 29 (59.2%) were male. Among the 49 children, 41 (83.7%) had different spinal malformations and 8 (16.3%) had no associated lesion. Sectioning of the filum terminale, cutting the arachnoid and fibrous bands, protection of the rootlets and correction of the associated malformations was the standard surgical method to release the spinal cord.
RESULTS
Neurological improvement was observed in 4 (8.2%) patients, while the neurological status was unchanged in the others. Cerebrospinal fluid fistula was the main complication and was observed in 3 patients. No mortality or neurological deterioration was encountered.
CONCLUSION
Spinal cord release with appropriate technique seems to be beneficial in maintaining neurological functioning in children with TCS.
Topics: Adolescent; Arachnoid; Cauda Equina; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Laminectomy; Lumbar Vertebrae; Male; Neural Tube Defects; Neurosurgical Procedures; Postoperative Complications; Spinal Cord; Spinal Cord Compression; Treatment Outcome
PubMed: 22194109
DOI: No ID Found -
Anaesthesia Dec 2012A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache.... (Review)
Review
A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later. We discuss the pathophysiology of adhesive arachnoiditis following central neuraxial anaesthesia and possible causative factors, including contamination of the injectate, intrathecal blood and local anaesthetic neurotoxicity, with reference to other published cases. In the absence of more conclusive data, practitioners of central neuraxial anaesthesia can only continue to ensure meticulous, aseptic, atraumatic technique and avoid all potential sources of contamination. It seems appropriate to discuss with patients the possibility of delayed, permanent neurological deficit while taking informed consent.
Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Intravenous; Anesthetics, Local; Arachnoiditis; Bupivacaine; Decompression, Surgical; Female; Fentanyl; Follow-Up Studies; Foramen Magnum; Humans; Hydrocephalus; Magnetic Resonance Imaging; Paraplegia; Pregnancy; Severity of Illness Index; Syringomyelia; Ventriculoperitoneal Shunt
PubMed: 23061983
DOI: 10.1111/anae.12017 -
British Journal of Anaesthesia Jun 2004
Topics: Anesthesia, Spinal; Arachnoiditis; Equipment Contamination; History, 20th Century; Humans; Paralysis; Syringes
PubMed: 15190588
DOI: No ID Found -
The Journal of Spinal Cord Medicine May 2022: A patient followed in the outpatient spinal cord injury support clinic at a VA Medical Center with a prior remote history of a gunshot wound to the back and multiple...
: A patient followed in the outpatient spinal cord injury support clinic at a VA Medical Center with a prior remote history of a gunshot wound to the back and multiple prior myelograms presented with a recurrent waxing and waning weakness of the left lower extremity and intermittent incontinence of bowel and bladder.: During the evaluation, the patient experienced an immediate albeit temporary improvement in symptoms after a diagnostic lumbar puncture performed for CT myelogram. The symptoms of myelopathy reoccurred several weeks, but then the patient had a similar experience with rapid improvement in symptoms after an accidental fall down a flight of steps. Subsequently, the foot weakness and incontinence returned one week later. The patient ultimately developed permanent improvement in signs and symptoms after surgical intervention which included intradural lysis of adhesions, incision of the arachnoid membrane and resection of a cystic lesion.: Patients who experience unexpected, albeit transient improvement in myelopathic symptoms who are known or suspected to have arachnoiditis should be evaluated for surgically remediable lesions. Remediation of these lesions can potentially improve long term outcome.
Topics: Arachnoid Cysts; Arachnoiditis; Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Spinal Cord Injuries; Wounds, Gunshot
PubMed: 33166210
DOI: 10.1080/10790268.2020.1830250