Neurosurgery
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The clinical and computed tomographic (CT) findings in a series of 161 consecutive patients operated upon for postraumatic extradural hematoma are analyzed. Thirteen (8%) patients had delayed epidural hematoma formation. The overall mortality for the series was 12%, significantly lower than that observed during the prior "angiographic" period at the same unit (30%). ⋯ There were no significant differences between these groups in age, sex, mechanism of injury, preoperative course of consciousness (lucid interval or not), or epidural hematoma location and shape. In contrast, significant differences were seen between the two subgroups in trauma-to-operation interval, hematoma volume, CT hematoma density (mixed low-high CT density vs. homogeneous hyperdensity), midline displacement, severity of associated intracranial lesions, and postoperative intracranial pressure (ICP). Patients comatose at operation usually evidenced a more rapid clinical deterioration (a shorter trauma-to-operation interval) and tended to have a large hematoma volume, a higher incidence of mixed CT density clot (hyperacute bleeding), more marked shift of midline structures, more severe associated lesions, and higher postoperative ICP levels.
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Case Reports
Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position.
We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. ⋯ The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.