Upper thoracic spine lesions are characterized by delayed diagnosis due to nonspecific symptoms and its anterior aspect (T1 - T4) is difficult to be approached surgically. This retrospective clinical study was done to...Upper thoracic spine lesions are characterized by delayed diagnosis due to nonspecific symptoms and its anterior aspect (T1 - T4) is difficult to be approached surgically. This retrospective clinical study was done to assess the efficacy of mini thoracotomy approach in management of these lesions. We studied 14 cases with upper thoracic spine different pathological lesions at levels (T1 - T4). These lesions were indicated for anterior approach surgery. Radiological assessment included plain X-ray, MRI and CT scan thoracic spine. The anaesthesia was specifically selective intubation and unilateral ventilation. All patients were operated upon through mini inter-costal thoracotomy approach (left sided in 13 patients and right sided in 1patient). Out of 14 patients there were 7 males and 7 females. The age range was 20 - 55 years (mean 38.7 years). Preoperative symptoms included vague nonspecific upper thoracic pain in 11 patients, lower limbs weakness in 6 patients, sphincteric disturbance in 5 patients, upper thoracic kyphotic deformity in 4 patients, severe brachialgia in 3 patients and neck pain in 2 cases. The operative time was ranged from 90 - 210 minutes (mean 152 m). Blood loss ranged from 250 to 750 cc (mean 464 cc). Chest tube drainage was inserted in all patients. There were no intra-operative or post-operative surgically related complications and no patients needed ICU admission. The lesions were neoplasms in 8 patients, traumatic fracture dislocation in 3 cases, tuberculous spondylodiscitis in 2 cases and degenerative disc prolapse in 1 case. All patients improved post-operative as regard their pre-operative complaints except one patient. During the follow up period, no mortality was recorded. In conclusion, mini thoracotomy approach seems to be ideal only for patients with mono- or bi-segmental pathology involving the upper thoracic spine.展开更多
Peripheral nerve sheath tumors (PNSTs) are not rare tumors. Its sound management is complete surgical excision. The aim of this study was to describe clinical presentation, accuracy of different investigations and ide...Peripheral nerve sheath tumors (PNSTs) are not rare tumors. Its sound management is complete surgical excision. The aim of this study was to describe clinical presentation, accuracy of different investigations and ideal surgical approaches in relation to outcomes. The study is a prospective and included 26 surgically treated large PNSTs in 22 patients operated through different surgical approaches according to the site of the tumors. The fellow up period was 6 - 60 months. The mean age was 41.8 years, 9 were males and 13 were females. The common presentations were pain in 12 lesions, swelling in 8 lesions, neural deficits in 4 lesions and positive Tinel’s test in 2 lesions. These lesions were excised through 6 surgical approaches. Histopathological examination showed 20 benign and 6 malignant lesions. Five cases of malignant peripheral nerve sheet tumors (MPNSTs) had local recurrent, 4 cases had distant metastasis, 4 cases received chemotherapy and radiotherapy, and 4 cases were died in the postoperative fellow up period. It was concluded that surgical approaches to the PNSTs, depends on their locations. Adequate exposure with minimal dissection minimized the neurological deficit and decreased rate of local recurrence.展开更多
文摘Upper thoracic spine lesions are characterized by delayed diagnosis due to nonspecific symptoms and its anterior aspect (T1 - T4) is difficult to be approached surgically. This retrospective clinical study was done to assess the efficacy of mini thoracotomy approach in management of these lesions. We studied 14 cases with upper thoracic spine different pathological lesions at levels (T1 - T4). These lesions were indicated for anterior approach surgery. Radiological assessment included plain X-ray, MRI and CT scan thoracic spine. The anaesthesia was specifically selective intubation and unilateral ventilation. All patients were operated upon through mini inter-costal thoracotomy approach (left sided in 13 patients and right sided in 1patient). Out of 14 patients there were 7 males and 7 females. The age range was 20 - 55 years (mean 38.7 years). Preoperative symptoms included vague nonspecific upper thoracic pain in 11 patients, lower limbs weakness in 6 patients, sphincteric disturbance in 5 patients, upper thoracic kyphotic deformity in 4 patients, severe brachialgia in 3 patients and neck pain in 2 cases. The operative time was ranged from 90 - 210 minutes (mean 152 m). Blood loss ranged from 250 to 750 cc (mean 464 cc). Chest tube drainage was inserted in all patients. There were no intra-operative or post-operative surgically related complications and no patients needed ICU admission. The lesions were neoplasms in 8 patients, traumatic fracture dislocation in 3 cases, tuberculous spondylodiscitis in 2 cases and degenerative disc prolapse in 1 case. All patients improved post-operative as regard their pre-operative complaints except one patient. During the follow up period, no mortality was recorded. In conclusion, mini thoracotomy approach seems to be ideal only for patients with mono- or bi-segmental pathology involving the upper thoracic spine.
文摘Peripheral nerve sheath tumors (PNSTs) are not rare tumors. Its sound management is complete surgical excision. The aim of this study was to describe clinical presentation, accuracy of different investigations and ideal surgical approaches in relation to outcomes. The study is a prospective and included 26 surgically treated large PNSTs in 22 patients operated through different surgical approaches according to the site of the tumors. The fellow up period was 6 - 60 months. The mean age was 41.8 years, 9 were males and 13 were females. The common presentations were pain in 12 lesions, swelling in 8 lesions, neural deficits in 4 lesions and positive Tinel’s test in 2 lesions. These lesions were excised through 6 surgical approaches. Histopathological examination showed 20 benign and 6 malignant lesions. Five cases of malignant peripheral nerve sheet tumors (MPNSTs) had local recurrent, 4 cases had distant metastasis, 4 cases received chemotherapy and radiotherapy, and 4 cases were died in the postoperative fellow up period. It was concluded that surgical approaches to the PNSTs, depends on their locations. Adequate exposure with minimal dissection minimized the neurological deficit and decreased rate of local recurrence.
