World Neurosurg
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Symptomatic postoperative spinal epidural hematoma is a serious complication that may occur after lumbar spine surgery. We analyzed epidural hematoma using postoperative magnetic resonance imaging (MRI) after biportal endoscopic spinal surgery and its impact on clinical outcome. ⋯ The incidence of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery according to postoperative MRI was higher than expected, regardless of the patients' postoperative symptoms. Postoperative hematoma has a decisive influence on postoperative results, and revision surgery might be necessary if canal encroachment is >50% with concomitant symptoms.
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Arachnoiditis ossificans (AO) is a rare entity characterized by the presence of calcified plaques formed by the metaplasia of arachnoid cells. Over 50 cases of AO have been reported, with predisposing factors including spinal trauma, hemorrhage, vascular abnormalities, and infection. The administration of oil-based contrast during myelography as an independent risk factor or in conjunction with other spinal pathology has been described in 9 cases. ⋯ In addition to acute inflammation, oil-based contrast myelography also leads to arachnoiditis, calcification, and retained mass lesions because of its chronic inflammatory properties and slow resorptive rate. Three decades after its replacement with water-based contrast material, the chronic sequelae of oil-based contrast myelography may continue to manifest clinically and on CT imaging. Because of calcifications often encasing the spinal cord or nerve roots, management of AO is challenging, and neurologic deficits may persist even after surgery.
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Stent-assisted coiling is recognized as effective to induce progressive occlusion and prevent recurrence of aneurysm. The long-term effects of stent-assisted coiling of sidewall-type and terminal-type aneurysms were comparatively analyzed focusing on the different hemodynamic characteristics. ⋯ Stent-assisted coiling allows higher coil packing for sidewall-type aneurysms, but the indication should be carefully considered for terminal-type aneurysms.
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Locked-in syndrome (LIS) is a rare neurologic disorder characterized as quadriplegia with anarthria. The diagnosis of LIS is challenging and requires a high index of suspicion. The syndrome is typically caused by an infratentorial lesion to the ventral pons, regardless of etiology. LIS secondary to supratentorial injury is extremely rare, and to our knowledge, this is the first reported case. ⋯ This is a unique case of incomplete LIS after supratentorial injury. Initial ICU care and early rehabilitation likely played a major role in the full recovery of this patient. The influence of etiology and site of injury on outcome prognosis is also suggested. Although severe diffuse brain injury may occur in the face of an unremarkable computed tomography (CT) scan, the emerging role of magnetic resonance imaging in optimally evaluating traumatic brain injury with discordant clinical and CT information is highlighted and is useful in cases of LIS where prognosis prediction is important.
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Surgeries for deep and eloquent cerebral lesions require a detailed knowledge of normal brain anatomy and accurate planning. Important parts of brain anatomy are the cerebral blood supply and collateral circulation system. In addition to well-known cortical and basal (circle of Willis) anastomoses, there is also a deep interarterial anastomotic circle that is not described in the literature. ⋯ Epithalamic anastomoses provide an additional mechanism of blood distribution that may play a role during surgical interventions or stroke.