Surg Neurol
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Annually, 2 million people in the United States develop deep venous thrombosis (DVT), and nearly 100,000 sustain fatal pulmonary emboli. Prophylaxis against DVT/pulmonary embolism (PE) is a critical issue, and options include elastic stockings, intermittent pneumatic compression stockings, low-dose unfractionated heparin (5000 U every 8-12 hours), and low molecular-weight heparin (ie, enoxaparin and dalteparin). The risks and benefits associated with different prophylaxis regimens used in the prevention of DVT and PE in neurosurgical procedures were analyzed. ⋯ Although mechanical prophylaxis provided effective prophylaxis against DVT/PE in many series, the added efficacy of low-dose heparin regimens has to be weighed against risks of major postoperative hemorrhages and their neurological sequelae.
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Digital subtraction angiography (DSA) is considered the gold standard in the evaluation of cerebrovascular structures. Recently, 3-dimensional DSA (3D-DSA) has been increasingly used to obtain detailed information about the morphology and dimensions of intracranial aneurysms. We report the case of a patient who presented with a distal pericallosal artery aneurysm, which appeared by 2D imaging to be a fusiform, possible mycotic aneurysm. This was then revealed to be a saccular bifurcation aneurysm by 3D-DSA. This additional information changed the treatment plan for this patient from medical management to a surgical approach. ⋯ 3D-DSA was used to evaluate a small, distal pericallosal artery aneurysm and revealed a saccular bifurcation aneurysm not visualized with magnetic resonance angiography and conventional DSA. This additional resolution permitted the team to consider a surgical approach for a patient who would otherwise have been treated medically. This high-resolution technique is particularly useful in guiding clinical decision making in the context of aneurysms that carry a relatively broad differential diagnosis, potentially high interventional risk, and unclear morphology.
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Posterolateral lumbar fusion (PLF) is the most popular technique for stabilizing the lumbar spine. Biomechanically, PLF decreases segmental motion in the posterior column, which presumably reduces facet joint pain. Posterior lumbar interbody fusion (PLIF) may decompress nerve roots by distracting the collapsed disc space, and achieving optimal fusion in relation to load-bearing capacity. The purpose of the study was to examine the role of interbody fixation vs pedicle fixation in transverse lumbar fusion and to assess treated and adjacent disc space height changes over time. ⋯ Disc space height does not seem to impact clinical outcome in lumbar fusion, and efforts to maintain it may be unwarranted.
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Vertebral artery (VA) transection is a rarely described entity that may present dramatically with a life-threatening external hemorrhage. ⋯ Bleeding related to VA transection can be managed safely by means of endovascular combined approaches.
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The objective of this study was to examine early changes of intracranial pressure (ICP) and brain oxygenation before, during, and after cerebral angiography in patients with poor-grade subarachnoid hemorrhage (SAH). ⋯ This study documented several fluctuations in the brain oxygenation of patients with poor-grade SAH during angiography. Patients with severe intracranial angiographic arterial caliber reduction at this time have an increased risk for impaired brain oxygenation.