Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Observational Study
Reduced middle cerebral artery velocity during cross-clamp predicts cognitive dysfunction after carotid endarterectomy.
Transcranial Doppler (TCD) is a useful monitor that can be utilized during carotid endarterectomy (CEA). Cognitive dysfunction is a subtler and more common form of neurologic injury than stroke. We aimed to determine whether reduced middle cerebral artery (MCA) mean velocity (MV) predicts cognitive dysfunction and if so, whether a threshold of increased risk of cognitive dysfunction can be identified. ⋯ Reduced MCA-MV during cross-clamp is a predictor of cognitive dysfunction exhibited 24 hours after CEA. MCA-MV reduced to <72% of baseline, or a ≥28% reduction from baseline, is the threshold most strongly associated with increased risk of cognitive dysfunction. These observations should be considered by all clinicians that utilize intraoperative monitoring for CEA.
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Minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) has demonstrated efficacy in the treatment of lumbar degenerative diseases. Use of this procedure for thoracolumbar junction disc herniation remains challenging. Reports concerning MIS-TLIF at the thoracolumbar junction are rare. ⋯ There were no other major complications at last follow-up. MIS-TIF is a safe and effective procedure for disc herniation in the thoracolumbar junction. Occurrence of non-union is relatively high compared to previous findings.
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Case Reports
Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device.
Coil migration during endovascular treatment of intracranial aneurysms occurs in 2-6% of cases. As endovascular coiling of aneurysms has become increasingly popular and as endovascular technology continues to rapidly evolve, the prevalence of intraprocedural coil migration will invariably rise. Since coil masses are highly thrombogenic, migration out of the aneurysm sac into the parent artery may result in large territory infarcts which subsequently manifest as significant neurological morbidity. ⋯ This case illustrates the first use of the Trevo device for retrieval of migrated coils during endovascular treatment of an intracranial aneurysm to our knowledge. Due to the lack of guidelines defining the standard management of intraprocedural coil migration, current strategies are based on retrospective review of published reports and expert opinion. We present a unique and effective method for endovascular retrieval of displaced coils using a Trevo Stentriever device.