The Experts below are selected from a list of 792 Experts worldwide ranked by ideXlab platform
Angelo Franzini - One of the best experts on this subject based on the ideXlab platform.
-
surgical fat patch improves secondary intracranial hypotension orthostatic headache associated with lumbosacral Dural Ectasia
World Neurosurgery, 2017Co-Authors: Elena Beretta, Andrea Franzini, Roberto Cordella, Vittoria Nazzi, Laura Valentini, Angelo FranziniAbstract:Background Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and Dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. Case Description A 37-year-old woman developed secondary intracranial hypotension caused by lumbosacral iatrogenic Dural Ectasia following detethering surgery. An orthostatic headache was the mainstay of her clinical picture, and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time ( Conclusion Volumetric reduction of the epiDural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the Dural sac is hypothesized.
-
Surgical "Fat Patch" Improves Secondary Intracranial Hypotension Orthostatic Headache Associated with Lumbosacral Dural Ectasia.
World neurosurgery, 2017Co-Authors: Elena Beretta, Andrea Franzini, Roberto Cordella, Vittoria Nazzi, Laura Valentini, Angelo FranziniAbstract:Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and Dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. A 37-year-old woman developed secondary intracranial hypotension caused by lumbosacral iatrogenic Dural Ectasia following detethering surgery. An orthostatic headache was the mainstay of her clinical picture, and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time (<1 month). Altered compliance of the Dural spinal sac was suspected. Therefore thecal sac remodeling by placing autologous fat at the level of the Dural Ectasia was performed, improving the symptoms for 2 years. Volumetric reduction of the epiDural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the Dural sac is hypothesized. Copyright © 2017 Elsevier Inc. All rights reserved.
Paul David Sponseller - One of the best experts on this subject based on the ideXlab platform.
-
ten year clinical and imaging follow up of Dural Ectasia in adults with marfan syndrome
The Spine Journal, 2013Co-Authors: Addisu Mesfin, John A Carrino, Nicholas U. Ahn, Paul David SponsellerAbstract:Abstract Background context Dural Ectasia in the lumbosacral spine is a common feature of Marfan syndrome and is associated with low back pain and surgical complications, but its natural history is unknown. Purpose To evaluate the natural history of Dural Ectasia in adults with Marfan syndrome by determining if, over time, symptoms associated with Dural Ectasia worsen, Dural Ectasia imaging findings worsen, or spondylolisthesis/spondylolysis develops or worsens. Study design Prospective cohort study. Patient sample For our prospective follow-up study, we enrolled 20 patients with Marfan syndrome and Dural Ectasia who, from 1998 through 1999, had undergone magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbosacral spine and had completed the Oswestry Disability Index (ODI) questionnaire. Of the 20, five did not meet the inclusion criterion of a completed 2009 ODI questionnaire and were excluded. The remaining 15 patients (mean age, 49.6 years; mean follow-up, 10.5 years) formed our study group. Outcome measures The ODI, MRI-based qualitative and quantitative measurements, CT-based quantitative measurements. Methods We performed matched-pair analyses via Student t test and Wilcoxon signed-rank test of the ODI scores (15 pairs), Dural volume of L5–S2 (eight pairs), Dural sac ratio (DSR) of L4–S2 (nine pairs), development/progression of spondolysthesis/spondylolysis (11 pairs), and Fattori qualitative grading of Dural Ectasia size (10 pairs). Significance was set at p Results We found no statistical differences in the 1998/1999 and 2009 ODI scores (25.8 vs. 22.2 points), Dural volume (70.4 vs. 73.9 cm3), or DSR (0.68, 0.78, 2.04, and 58.1 vs. 0.69, 0.83, 2.30, and 70.20). There was also no development or progression of spondylolisthesis/spondylolysis and no increase in Dural Ectasia size. Conclusions During this 10-year period, the natural history of Dural Ectasia in adults with Marfan syndrome was not associated with a significant increase in ODI scores, Dural Ectasia size, or with the development/progression of spondylolisthesis or spondylolysis.
-
Characterization of the symptoms associated with Dural Ectasia in the Marfan patient.
American journal of medical genetics. Part A, 2005Co-Authors: Jared R H Foran, Reed E Pyeritz, Harry C Dietz, Paul David SponsellerAbstract:Dural Ectasia, an expansion of the Dural sac surrounding the spinal cord, is one of the most common orthopedic manifestations of Marfan syndrome. The purpose of the present study was to characterize the clinical symptoms associated with Dural Ectasia in patients with Marfan syndrome and to understand the effects of symptomatic Dural Ectasia on the overall health of affected patients. Twenty-two volunteers aged 9-55 years with Marfan syndrome, and Dural Ectasia diagnosed by MRI or CT, filled out a "symptoms" questionnaire and completed an SF-36 health survey. Overall, It appears that the symptoms associated with Dural Ectasia have a marked impact on the overall health of patients with Marfan syndrome. Based on our findings, a "classic" picture of Dural Ectasia in the Marfan patient may consist of low back pain, headache, proximal leg pain, weakness and numbness above and below the knee, and genital/rectal pain. Symptoms, when present, are typically moderate to severe, occur several times per week (often daily), are commonly exacerbated by upright posture, and are not always relieved by recumbency.
-
Dural Ectasia and back pain: review of the literature and case report.
Journal of spinal disorders & techniques, 2002Co-Authors: Leelakrishna Nallamshetty, Nicholas U. Ahn, Uri M. Ahn, Peter S. Rose, Jacob M. Buchowski, Hema S. Nallamshetty, Paul David SponsellerAbstract:Dural Ectasia is defined as a ballooning of the Dural sac which is more common in patients with connective tissue disorders such as the Marfan syndrome. Several studies have shown that Dural Ectasia may be associated with such conditions as back pain, headaches, radiculopathies, or incontinence. We present a case of a 52 year old woman with Marfan syndrome who presented with a significantly large anterior sacral meningocele without having associated symptoms. In light of this case, we recommend that asymptomatic Marfan patients with Dural Ectasia should be closely observed without need for immediate surgical intervention.
-
Dural Ectasia and conventional radiography in the Marfan lumbosacral spine.
Skeletal radiology, 2001Co-Authors: Nicholas U. Ahn, Uri M. Ahn, Leelakrishna Nallamshetty, Peter S. Rose, Jacob M. Buchowski, Elizabeth Garrett, Khaled M. Kebaish, Paul David SponsellerAbstract:Objective. To determine how well conventional radiographic findings can predict the presence of Dural Ectasia in Marfan patients.
-
Dural Ectasia is associated with back pain in Marfan syndrome.
Spine, 2000Co-Authors: Nicholas U. Ahn, Paul David Sponseller, Leelakrishna Nallamshetty, Brian S. Kuszyk, Uri Ahn, Simion J ZinreichAbstract:Study Design. A cross-sectional age- and sex-matched study comparing the prevalence and size of Dural Ectasia in two groups of patients with Marfan syndrome. Group I comprised patients with moderate to severe back pain and Group II comprised patients without back pain. Objectives. To determine whether the presence and size of durai Ectasia is associated with back pain in patients with Marfan syndrome. Summary of Background Data. Dural Ectasia is present in more than 60% of patients with Marfan syndrome. Moderate to severe back pain is present in more than 50% of patients with Marfan syndrome. Most cases of significant low back pain in patients with Marfan syndrome do not have a clear cause. It would be useful for the clinician to know whether Dural Ectasia may be a cause of back pain in patients with Marfan syndrome with no other source. Methods. Thirty two volunteers aged 30-50 with Marfan syndrome were enrolled as age- and sex-matched pairs with significant back pain (Group I) and without back pain (Group II). A completed questionnaire, physical examination, and magnetic resonance image of the lumbosacral spine were obtained. Durai volume caudal to L5 was calculated from the magnetic resonance data by specially designed software. Results. Dural Ectasia was present in 76% of the patients in Group I, and 41% of the patients in Group II. The proportion of patients with Dural Ectasia was significantly higher in Group I. Furthermore, the mean Dural volume was significantly higher in Group I, and a significant correlation between Dural volume and Oswestry pain score was noted. Conclusions. The presence and size of Dural Ectasia are associated with back pain in the Marfan syndrome. However, a high prevalence of Dural Ectasia (41%) exists even in patients with Marfan syndrome without back pain. The mere presence of Dural Ectasia therefore does not necessarily mean the patient will be symptomatic even though the two are associated.
Elena Beretta - One of the best experts on this subject based on the ideXlab platform.
-
surgical fat patch improves secondary intracranial hypotension orthostatic headache associated with lumbosacral Dural Ectasia
World Neurosurgery, 2017Co-Authors: Elena Beretta, Andrea Franzini, Roberto Cordella, Vittoria Nazzi, Laura Valentini, Angelo FranziniAbstract:Background Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and Dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. Case Description A 37-year-old woman developed secondary intracranial hypotension caused by lumbosacral iatrogenic Dural Ectasia following detethering surgery. An orthostatic headache was the mainstay of her clinical picture, and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time ( Conclusion Volumetric reduction of the epiDural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the Dural sac is hypothesized.
-
Surgical "Fat Patch" Improves Secondary Intracranial Hypotension Orthostatic Headache Associated with Lumbosacral Dural Ectasia.
World neurosurgery, 2017Co-Authors: Elena Beretta, Andrea Franzini, Roberto Cordella, Vittoria Nazzi, Laura Valentini, Angelo FranziniAbstract:Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and Dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. A 37-year-old woman developed secondary intracranial hypotension caused by lumbosacral iatrogenic Dural Ectasia following detethering surgery. An orthostatic headache was the mainstay of her clinical picture, and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time (<1 month). Altered compliance of the Dural spinal sac was suspected. Therefore thecal sac remodeling by placing autologous fat at the level of the Dural Ectasia was performed, improving the symptoms for 2 years. Volumetric reduction of the epiDural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the Dural sac is hypothesized. Copyright © 2017 Elsevier Inc. All rights reserved.
Nicholas U. Ahn - One of the best experts on this subject based on the ideXlab platform.
-
ten year clinical and imaging follow up of Dural Ectasia in adults with marfan syndrome
The Spine Journal, 2013Co-Authors: Addisu Mesfin, John A Carrino, Nicholas U. Ahn, Paul David SponsellerAbstract:Abstract Background context Dural Ectasia in the lumbosacral spine is a common feature of Marfan syndrome and is associated with low back pain and surgical complications, but its natural history is unknown. Purpose To evaluate the natural history of Dural Ectasia in adults with Marfan syndrome by determining if, over time, symptoms associated with Dural Ectasia worsen, Dural Ectasia imaging findings worsen, or spondylolisthesis/spondylolysis develops or worsens. Study design Prospective cohort study. Patient sample For our prospective follow-up study, we enrolled 20 patients with Marfan syndrome and Dural Ectasia who, from 1998 through 1999, had undergone magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbosacral spine and had completed the Oswestry Disability Index (ODI) questionnaire. Of the 20, five did not meet the inclusion criterion of a completed 2009 ODI questionnaire and were excluded. The remaining 15 patients (mean age, 49.6 years; mean follow-up, 10.5 years) formed our study group. Outcome measures The ODI, MRI-based qualitative and quantitative measurements, CT-based quantitative measurements. Methods We performed matched-pair analyses via Student t test and Wilcoxon signed-rank test of the ODI scores (15 pairs), Dural volume of L5–S2 (eight pairs), Dural sac ratio (DSR) of L4–S2 (nine pairs), development/progression of spondolysthesis/spondylolysis (11 pairs), and Fattori qualitative grading of Dural Ectasia size (10 pairs). Significance was set at p Results We found no statistical differences in the 1998/1999 and 2009 ODI scores (25.8 vs. 22.2 points), Dural volume (70.4 vs. 73.9 cm3), or DSR (0.68, 0.78, 2.04, and 58.1 vs. 0.69, 0.83, 2.30, and 70.20). There was also no development or progression of spondylolisthesis/spondylolysis and no increase in Dural Ectasia size. Conclusions During this 10-year period, the natural history of Dural Ectasia in adults with Marfan syndrome was not associated with a significant increase in ODI scores, Dural Ectasia size, or with the development/progression of spondylolisthesis or spondylolysis.
-
Cauda equina syndrome resulting from treatment of Dural Ectasia with fibrin glue injection.
Journal of spinal disorders & techniques, 2006Co-Authors: Glenn D. Wera, Uri M. Ahn, Clayton L. Dean, Shane J. Nho, Ezequiel H. Cassinelli, Raymond W. Liu, Gunnar B. J. Andersson, Nicholas U. AhnAbstract:The use of fibrin glue injection to treat symptomatic Dural Ectasia is controversial. A case of cauda equina syndrome following percutaneous fibrin glue injection is presented, followed by a review of Dural Ectasia and its possible treatments.
-
Dural Ectasia and back pain: review of the literature and case report.
Journal of spinal disorders & techniques, 2002Co-Authors: Leelakrishna Nallamshetty, Nicholas U. Ahn, Uri M. Ahn, Peter S. Rose, Jacob M. Buchowski, Hema S. Nallamshetty, Paul David SponsellerAbstract:Dural Ectasia is defined as a ballooning of the Dural sac which is more common in patients with connective tissue disorders such as the Marfan syndrome. Several studies have shown that Dural Ectasia may be associated with such conditions as back pain, headaches, radiculopathies, or incontinence. We present a case of a 52 year old woman with Marfan syndrome who presented with a significantly large anterior sacral meningocele without having associated symptoms. In light of this case, we recommend that asymptomatic Marfan patients with Dural Ectasia should be closely observed without need for immediate surgical intervention.
-
Dural Ectasia and conventional radiography in the Marfan lumbosacral spine.
Skeletal radiology, 2001Co-Authors: Nicholas U. Ahn, Uri M. Ahn, Leelakrishna Nallamshetty, Peter S. Rose, Jacob M. Buchowski, Elizabeth Garrett, Khaled M. Kebaish, Paul David SponsellerAbstract:Objective. To determine how well conventional radiographic findings can predict the presence of Dural Ectasia in Marfan patients.
-
Dural Ectasia is associated with back pain in Marfan syndrome.
Spine, 2000Co-Authors: Nicholas U. Ahn, Paul David Sponseller, Leelakrishna Nallamshetty, Brian S. Kuszyk, Uri Ahn, Simion J ZinreichAbstract:Study Design. A cross-sectional age- and sex-matched study comparing the prevalence and size of Dural Ectasia in two groups of patients with Marfan syndrome. Group I comprised patients with moderate to severe back pain and Group II comprised patients without back pain. Objectives. To determine whether the presence and size of durai Ectasia is associated with back pain in patients with Marfan syndrome. Summary of Background Data. Dural Ectasia is present in more than 60% of patients with Marfan syndrome. Moderate to severe back pain is present in more than 50% of patients with Marfan syndrome. Most cases of significant low back pain in patients with Marfan syndrome do not have a clear cause. It would be useful for the clinician to know whether Dural Ectasia may be a cause of back pain in patients with Marfan syndrome with no other source. Methods. Thirty two volunteers aged 30-50 with Marfan syndrome were enrolled as age- and sex-matched pairs with significant back pain (Group I) and without back pain (Group II). A completed questionnaire, physical examination, and magnetic resonance image of the lumbosacral spine were obtained. Durai volume caudal to L5 was calculated from the magnetic resonance data by specially designed software. Results. Dural Ectasia was present in 76% of the patients in Group I, and 41% of the patients in Group II. The proportion of patients with Dural Ectasia was significantly higher in Group I. Furthermore, the mean Dural volume was significantly higher in Group I, and a significant correlation between Dural volume and Oswestry pain score was noted. Conclusions. The presence and size of Dural Ectasia are associated with back pain in the Marfan syndrome. However, a high prevalence of Dural Ectasia (41%) exists even in patients with Marfan syndrome without back pain. The mere presence of Dural Ectasia therefore does not necessarily mean the patient will be symptomatic even though the two are associated.
S. Rajasekaran - One of the best experts on this subject based on the ideXlab platform.
-
Transient paraplegia due to accidental intrathecal bupivacaine infiltration following pre-emptive analgesia in a patient with missed sacral Dural Ectasia
Spine, 2010Co-Authors: P. Rishimugesh Kanna, Chelliah Sekar, Ajoy Prasad Shetty, S. RajasekaranAbstract:A case report with review of the literature. To highlight the need for careful magnetic resonance imaging evaluation for the presence of incidental lumbosacral Dural anomalies before attempting caudal epiDural interventions. Pre-emptive analgesia through the caudal epiDural route provides good postoperative pain relief in spine surgeries. Several precautions have been advised in the literature. Presence of sacral-Dural Ectasia should be considered a relative contraindication for this procedure. A 50-year old woman underwent posterior instrumented spinal fusion for L4-L5 spondylolisthesis under general anesthesia. She received single shot caudal epiDural analgesia at the start of the procedure. After complete emergence from anesthesia, she had complete motor and sensory loss below the T12 spinal level, which reversed to normal neurology in 6 hours. Retrospective evaluation of the patient's magnetic resonance imaging showed an ectatic, low lying lumbosacral Dural sac which had been overlooked in the initial evaluation. The drugs given by the caudal route have been accidentally administered into the thecal sac causing a brief period of neurologic deficit. This unexpected complication has been reported only in the pediatric literature before. It is important to look for the presence of lumbosacral Dural anomalies before planning caudal epiDural injections in adults also. Sacral Dural Ectasia and other lumbosacral anomalies must be recognized as contraindications for caudal epiDural pre-emptive analgesia for spine surgery. Other modes of postoperative pain relief should be tried in these patients.
-
transient paraplegia due to accidental intrathecal bupivacaine infiltration following pre emptive analgesia in a patient with missed sacral Dural Ectasia
Spine, 2010Co-Authors: Rishimugesh P Kanna, Chelliah Sekar, Ajoy Prasad Shetty, S. RajasekaranAbstract:Study design A case report with review of the literature. Objective To highlight the need for careful magnetic resonance imaging evaluation for the presence of incidental lumbosacral Dural anomalies before attempting caudal epiDural interventions. Summary of background data Pre-emptive analgesia through the caudal epiDural route provides good postoperative pain relief in spine surgeries. Several precautions have been advised in the literature. Presence of sacral-Dural Ectasia should be considered a relative contraindication for this procedure. Methods A 50-year old woman underwent posterior instrumented spinal fusion for L4-L5 spondylolisthesis under general anesthesia. She received single shot caudal epiDural analgesia at the start of the procedure. Results After complete emergence from anesthesia, she had complete motor and sensory loss below the T12 spinal level, which reversed to normal neurology in 6 hours. Retrospective evaluation of the patient's magnetic resonance imaging showed an ectatic, low lying lumbosacral Dural sac which had been overlooked in the initial evaluation. The drugs given by the caudal route have been accidentally administered into the thecal sac causing a brief period of neurologic deficit. Conclusion This unexpected complication has been reported only in the pediatric literature before. It is important to look for the presence of lumbosacral Dural anomalies before planning caudal epiDural injections in adults also. Sacral Dural Ectasia and other lumbosacral anomalies must be recognized as contraindications for caudal epiDural pre-emptive analgesia for spine surgery. Other modes of postoperative pain relief should be tried in these patients.
