British journal of neurosurgery
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Balloon test occlusion of carotid artery is a useful procedure in managing patients with internal carotid aneurysms and psuedoaneurysms. Previous studies using intravenous sodium nitroprusside for hypotensive challenge yielded false-negative results for haemodynamic ischaemia, highlighting the difference between pharmacological and compensatory vasodilatory responses. We reviewed our management result of a combined approach of clinical assessment and angiographic assessment of venous drainage using intravenous labetalol for hypotensive challenge. ⋯ A combined approach of clinical assessment and angiographic assessment of venous drainage, using intravenous labetalol for hypotensive challenge, is effective in screening out patients who were at a risk for ischaemia after internal carotid artery occlusion and can serve as a guideline for the selection of patients requiring extracranial-intracranial bypass.
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Review Case Reports
Spinal subdural haematoma concurrent with cranial subdural haematoma: Report of two cases and review of literature.
Subdural haematomas co-existing in the cranium and spine are considered extremely rare. We report 2 cases demonstrating the condition described here with a review of literature. One of these 2 patients was the first case in which the spinal lesion was found before the cranial lesion. ⋯ There is a possibility that the incidence of spinal subdural haematoma concurrent with cranial subdural haematoma could be underestimated because the doctor had not obtained CT or MRI of the brain. Doctors should aware of such a condition and check patients with spinal subdural haematoma for neurological signs derived from brain lesions. Spontaneous resolution of spinal subdural haematoma was observed; therefore, surgery for this condition should be indicated only for patients with moderate or severe paraparesis or paraparesis deteriorated.
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We describe a case of postoperative stroke in a patient undergoing anterior cervical discectomy caused by a combination of intraoperative retraction of an atherosclerotic carotid vessel and arterial hypotension.
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Intraoperative ultrasound (IOUS) has been described to be useful during central corpectomy for compressive cervical myelopathy. This study aimed at documenting the utility of IOUS in oblique cervical corpectomy (OCC). Prospective data from 24 patients undergoing OCC for cervical spondylotic myelopathy and ossified posterior longitudinal ligament (OPLL) were collected. ⋯ Craniocaudal spinal cord motion was noted after the completion of the corpectomy. IOUS is an inexpensive and simple real-time imaging modality that may be used during OCC for cervical spondylotic myelopathy. It is helpful in identifying the vertebral artery and determining the trajectory of approach, however, it has limited utility in patients with OPLL due to artifacts from residual ossification.
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A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.