Objective: : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4–8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4–8 weeks of antibiotic treatment is sufficient. Methods: : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results: : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4–8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.
Accidents, Traffic ; Brain Infarction* ; Cerebellum ; Cerebral Angiography ; Dizziness ; Headache ; Humans ; Infarction ; Middle Aged ; Occipital Lobe ; Quadriplegia ; Spinal Cord Compression ; Vertebral Artery*

Cubital tunnel syndrome (CuTS) is a prevalent but often under-recognized compressive neuropathy of the upper extremities, involving the entrapment of the ulnar nerve within the cubital tunnel at the elbow. CuTS is common, but remains relatively unfamiliar to many neurosurgeons compared to other neuropathies. It frequently presents with sensory disturbances and motor deficits in the hand, particularly affecting the ulnar digits, and it may be linked to specific usage patterns or even considered a form of neurotrauma. Its diagnosis typically involves a clinical assessment supplemented by imaging and electrophysiological studies to evaluate the extent of nerve involvement. While conservative management may be sufficient in the early stages, surgical intervention is often necessary for advanced cases, and various techniques offer differing outcomes. This review underscores the importance of a thorough anatomical understanding in guiding an accurate diagnosis and effective treatment, ultimately contributing to improved patient outcomes. These insights are essential for clinicians encountering the complexities of CuTS in diverse clinical scenarios.

Cubital tunnel syndrome (CuTS) is a prevalent but often under-recognized compressive neuropathy of the upper extremities, involving the entrapment of the ulnar nerve within the cubital tunnel at the elbow. CuTS is common, but remains relatively unfamiliar to many neurosurgeons compared to other neuropathies. It frequently presents with sensory disturbances and motor deficits in the hand, particularly affecting the ulnar digits, and it may be linked to specific usage patterns or even considered a form of neurotrauma. Its diagnosis typically involves a clinical assessment supplemented by imaging and electrophysiological studies to evaluate the extent of nerve involvement. While conservative management may be sufficient in the early stages, surgical intervention is often necessary for advanced cases, and various techniques offer differing outcomes. This review underscores the importance of a thorough anatomical understanding in guiding an accurate diagnosis and effective treatment, ultimately contributing to improved patient outcomes. These insights are essential for clinicians encountering the complexities of CuTS in diverse clinical scenarios.

Cubital tunnel syndrome (CuTS) is a prevalent but often under-recognized compressive neuropathy of the upper extremities, involving the entrapment of the ulnar nerve within the cubital tunnel at the elbow. CuTS is common, but remains relatively unfamiliar to many neurosurgeons compared to other neuropathies. It frequently presents with sensory disturbances and motor deficits in the hand, particularly affecting the ulnar digits, and it may be linked to specific usage patterns or even considered a form of neurotrauma. Its diagnosis typically involves a clinical assessment supplemented by imaging and electrophysiological studies to evaluate the extent of nerve involvement. While conservative management may be sufficient in the early stages, surgical intervention is often necessary for advanced cases, and various techniques offer differing outcomes. This review underscores the importance of a thorough anatomical understanding in guiding an accurate diagnosis and effective treatment, ultimately contributing to improved patient outcomes. These insights are essential for clinicians encountering the complexities of CuTS in diverse clinical scenarios.

Cubital tunnel syndrome (CuTS) is a prevalent but often under-recognized compressive neuropathy of the upper extremities, involving the entrapment of the ulnar nerve within the cubital tunnel at the elbow. CuTS is common, but remains relatively unfamiliar to many neurosurgeons compared to other neuropathies. It frequently presents with sensory disturbances and motor deficits in the hand, particularly affecting the ulnar digits, and it may be linked to specific usage patterns or even considered a form of neurotrauma. Its diagnosis typically involves a clinical assessment supplemented by imaging and electrophysiological studies to evaluate the extent of nerve involvement. While conservative management may be sufficient in the early stages, surgical intervention is often necessary for advanced cases, and various techniques offer differing outcomes. This review underscores the importance of a thorough anatomical understanding in guiding an accurate diagnosis and effective treatment, ultimately contributing to improved patient outcomes. These insights are essential for clinicians encountering the complexities of CuTS in diverse clinical scenarios.

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors.
Diagnosis, Differential ; Epidural Neoplasms ; Epidural Space ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage* ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Paraparesis ; Sensation ; Spinal Cord ; Spinal Cord Diseases* ; Spine

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.
Arm ; Contusions ; Craniotomy ; Emergency Service, Hospital ; Empyema ; Empyema, Subdural* ; Head ; Hemorrhage ; Humans ; Maxilla ; Middle Aged ; Mycobacterium tuberculosis ; Neurologic Examination ; Orbit ; Radius ; Ribs ; Scapula ; Seizures ; Skull Fractures* ; Skull* ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; Zygoma

Epithelioid hemangioendothelioma (EHE) is a rare benign vascular tumor, affecting fewer than one in a million individuals. Spinal EHE is exceptionally rare. This case report presents a case of recurrent spinal EHE, focusing on its clinical manifestation and providing a brief overview of its genetic characteristics. Seven years prior, a patient underwent subtotal resection of a lumbar and retroperitoneal EHE. Due to severe intraoperative bleeding, part of the lumbar spine mass was left unresected and subsequently treated with a moderate dose of radiation therapy. More recently, the patient presented with bilateral lower extremity weakness and urinary incontinence. Imaging studies revealed metastases in the thoracic and sacral bones, along with regrowth in the anterior portion of the previously treated spinal EHE. The patient underwent a series of operations to address both the regrowth and metastases, followed by intensity-modulated radiation therapy to target the remaining tumor tissue while minimizing damage to surrounding structures. Although EHE is generally considered benign, this indolent tumor has a tendency for persistent regrowth and metastasis. This case highlights the importance of radical resection and the potential role of higher radiation doses in preventing recurrence. Molecular testing may aid in achieving an accurate diagnosis and guiding effective treatment strategies.

Epithelioid hemangioendothelioma (EHE) is a rare benign vascular tumor, affecting fewer than one in a million individuals. Spinal EHE is exceptionally rare. This case report presents a case of recurrent spinal EHE, focusing on its clinical manifestation and providing a brief overview of its genetic characteristics. Seven years prior, a patient underwent subtotal resection of a lumbar and retroperitoneal EHE. Due to severe intraoperative bleeding, part of the lumbar spine mass was left unresected and subsequently treated with a moderate dose of radiation therapy. More recently, the patient presented with bilateral lower extremity weakness and urinary incontinence. Imaging studies revealed metastases in the thoracic and sacral bones, along with regrowth in the anterior portion of the previously treated spinal EHE. The patient underwent a series of operations to address both the regrowth and metastases, followed by intensity-modulated radiation therapy to target the remaining tumor tissue while minimizing damage to surrounding structures. Although EHE is generally considered benign, this indolent tumor has a tendency for persistent regrowth and metastasis. This case highlights the importance of radical resection and the potential role of higher radiation doses in preventing recurrence. Molecular testing may aid in achieving an accurate diagnosis and guiding effective treatment strategies.