Turk Neurosurg
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Vertebral artery injury including thrombosis, arteriovenous fistula (AVF), pseudo-aneurysm and hemorrhage may be iatrogenic or due to penetrating or blunt trauma. Although mostly asymptomatic, vertebral artery injury may also present with vertebrobasilar insufficiency findings, cephalgia, radicular pain or myelopathy due to blockade of arterial flow, arterial steal phenomenon and venous hypertension. ⋯ Endovascular treatment is now used more commonly. We present a case with sharp bread knife injury of the vertebral artery that was also complicated with a vertebrojugular fistula and pseudo-aneurysm together with the diagnostic and management options and a review of the current literature.
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Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. ⋯ Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.
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Review Case Reports
Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.
Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF). Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with thoracic epidural blood patching. ⋯ Epidural blood patch was performed at the T1-2 level, the presumed location of the leak due to presence of a bone spur on computed tomography and the large corresponding CSF collection. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his SDH. Through this case and review of the literature, we aim to demonstrate that directed cervical or thoracic blood patching should be considered for SIH as an alternative to the conventional lumbar blood patch.
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The surgical treatment of spinal metastases is still controversial. Due to developments in diagnostic imaging there has been a great evolution in minimally invasive surgical techniques for the spinal surgery. Most of the patients with spinal metastases are debilitated and under high risk of major surgical morbidity and mortality. ⋯ Minimal invasive techniques represent major advance in minimizing approach related morbidity in the treatment of spinal tumors. Because of the evolution of minimally invasive surgical techniques for the spinal surgery, minimally invasive techniques are alternative treatment to standard open approaches for the treatment of metastatic spinal tumors. Due to less complication rates there has been a trend toward the minimalization of spine surgery.
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This study aimed to investigate the operative procedure for neuroendoscope-assisted microscopic resection of petroclival meningioma to improve prognosis. ⋯ Neuroendoscope-assisted microscopic resection for petroclival meningioma can improve the total and subtotal resection rates of the tumor. Moreover, this method does not increase postoperative short-term and long-term complications.