Surgical neurology international
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Spinal cord stimulators (SCSs) are gaining increasing indications and utility in an expanding variety of clinical conditions. Complications and initial expenses have historically prevented the early use of SCS therapy despite ongoing efforts to educate and promote its utilization. At present, there exists no literature evidence of SCS implantation in a chronically anticoagulated patient, and neuromodulation manufacturers are conspicuously silent in providing warnings or recommendations in the face of anticoagulant use chronically. It would appear as through these issues demand scrutiny and industry as well as neuromodulation society advocacy and support in terms of the provision of coherent guidelines on how to proceed. ⋯ Our literature search did not reveal any evidence of SCS therapy among patients with chronic anticoagulation. This case illustrated a complicated clinical case scenario wherein a percutaneous SCS implantation would normally be contraindicated due to severe thoracic spinal stenosis and chronic anticoagulation which could lead to possible paralysis or even a lethal consequences associated with the possible formation of a thoracic epidural hematoma.
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Spontaneous epidural hematoma arising from the ligamentum flavum is a rare cause of acute spinal cord compression. There are only four reports in the cervical spine literature, and all were managed with surgery. Here, we describe an acute case of a spontaneous epidural hematoma arising from the ligamentum flavum in the cervical spine successfully managed without surgery. ⋯ Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.
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Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare. ⋯ Simultaneous decompressive laminectomy of L3-4 and S1-2 effectively decompressed the syringomyelia while allowing for excision/biopsy of a space occupying lesion at the former and untethering and Tarlov cyst fenestration at the latter levels.
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Awake craniotomy is currently the gold standard for aggressive tumor resections in eloquent cortex. However, a significant subset of patients is unable to tolerate this procedure, particularly the very young or old or those with psychiatric comorbidities, cardiopulmonary comorbidities, or obesity, among other conditions. In these cases, typical alternative procedures include biopsy alone or subtotal resection, both of which are associated with diminished surgical outcomes. ⋯ Resting state functional connectivity MRI integrated with intraoperative neuronavigation software can provide an alternative option for functional cortical mapping in the setting of an aborted awake craniotomy.
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Case Reports
Superficial temporal artery pseudoaneurysm presenting as a growing, pulsatile, and tender mass.
Superficial temporal artery (STA) pseudoaneurysms have been reported in the literature since the mid of seventeenth century from Bartholin, however, there is an increasing number of cases, suggesting a diversity of etiological factors. Among these, traumatic events, even of an iatrogenic nature, have been identified as causative factors for nonspontaneous STA pseudoaneurysms. Regional pain and tenderness, troublesome pulsations of the mass, cosmetic concerns as well as the risk of bleeding warrant a thorough evaluation and a definite interventional approach to the condition. ⋯ STA pseudoaneurysms require a careful evaluation and a conclusive approach in order to avoid the risk of a growing mass and other nonremote complications such as bone erosions and bleeding. Different treatment options are available, including endovascular obliteration and embolization, however, surgical removal after ligation of the afferent and efferent segments of the vessel seem to be highly effective.