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    Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: Case report and review of the relevant literature
    (Springer-Verlag, 2001) Döşoğlu, Murat; İş, Merih; Gezen, Ferruh; Ziyal, M.
    Posterior epidural migration (PEM) of free disc fragments is rare, and reported PEM patients usually presented with radicular signs. An uncommon case involving a patient with cauda equina syndrome due to PEM of a lumbar disc fragment is reported with a review of the literature. The patient described in this report presented with an acute cauda equina syndrome resulting from disc fragment migration at the L3-L4 level that occurred after traction therapy for his lower back pain. The radiological characteristics of the disc fragment were the posterior epidural location and the ring enhancement. A fenestration was performed and histologically confirmed sequestered disc material was removed. An early postoperative examination revealed that motor, sensory, urological, and sexual functions had been recovered. At late followup, the patient was doing well after 18 months. Sequestered disc fragments may occasionally migrate to the posterior epidural space of the dural sac. Definite diagnosis of posteriorly located disc fragments is difficult because the radiological images of disc fragments may mimic those of other more common posterior epidural lesions.
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    The surgical anatomy of six variations of the extreme lateral approach
    (Turkish Neurosurgical Society, 1999) Ziyal, M.; Salas, Eduardo; Sekhar, Laligam N.
    The extreme lateral transcondylar approach (ELA) is used to access lesions that are located or extend superior to the middle clivus, inferior to the upper cervical spine, and lateral to the foramina jugulare. Different combinations of drilling of several bone structures, including the occipital condyle, the C1 and C2 facets and laminae, and the jugular tubercle and process, coupled with suboccipital craniotomy, equip the surgeon with different ways of approaching the region of interest. In order to fully understand the options for ELA, it is useful to clarify the variations of this approach. This study involved the bilateral use of 10 complete cadaveric head specimens and includes the description and discussion of six different variations of ELA relative to lesion location and the need for subsequent occipito-cervical fusion. The ELA options are as follows: 1. Retrocondylar approach (RCA) 2. Partial transcondylar approach (PTCA) 3. Transtubercular approach (TTA) 4. Transcondylar approach (TCA) 5. Transjugular approach (TJA) 6. Transfacetal approach (TFA).