World Neurosurg
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Case Reports
An unexpected intradural lumbar disc herniation found during transforaminal endoscopic surgery.
Intradural disk herniation (IDH) is defined as the displacement of the intervertebral disk nucleus pulposus into the dural sac. In this lumbar lesion, the affected level differs from that of a traditional extradural herniation: 55% of cases occur at the level of L4-5, 16% at L3-4, and 10% at L5-S1. Upper lumbar IDH is extremely rare. We present a case of an IDH at the level of L2-3 that was diagnosed during endoscopic surgery. ⋯ If there is any preoperative clinical or radiologic suspicion of IDH, a microscopic surgical approach should be considered to be the first-line option, as this is a safe and effective method for achieving IDH removal and dura repair without a postoperative neurologic deficit. Even during endoscopic surgery, if the surgeon expects even minor complications, we suggest converting to open surgery. In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage.
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The optimal surgical approach for multilevel degenerative cervical myelopathy (DCM) is unclear, and there is significant variation in practice patterns. We sought to compare inpatient complications and costs of anterior (ACDF) versus posterior cervical decompression and fusion (PCDF). ⋯ At a national level, for multilevel DCM, we found PCDF to be associated with greater LOS, in-hospital costs, and general medical and surgical complications. ACDF carried higher risk of postoperative hematoma, hoarseness, and dysphagia.
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Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. ⋯ Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.
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An aneurysm embedded in a pituitary adenoma is rare, and treatment for both the aneurysm and pituitary adenoma is complex and controversial. ⋯ A combined endoscopic endonasal and bilateral subfrontal approach is effective for a pituitary adenoma associated with an ICA-SHA aneurysm.
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A considerable number of patients with subarachnoid hemorrhage (SAH) develop vasospasms of the infratentorial arteries. Transcranial Doppler sonography (TCD) is used to screen for vasospasm. In this study, we used a technical modification that combines TCD with an image guidance device that the operator can use to navigate to the ultrasonic window and to predefined intracranial vascular targets. Our aim was to analyze the feasibility, spatial precision, and spatial reproducibility of serial image-guided TCD of infratentorial and-for comparison-supratentorial arteries in the clinical setting of monitoring for vasospasm after SAH. ⋯ Image-guided TCD is feasible for supratentorial and infratentorial arteries. It shows high spatial precision and reproducibility. This study provides a basis for future clinical studies on image-guided TCD for post-SAH vasospasm screening.