Turk Neurosurg
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Review Case Reports
Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.
Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF). Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with thoracic epidural blood patching. ⋯ Epidural blood patch was performed at the T1-2 level, the presumed location of the leak due to presence of a bone spur on computed tomography and the large corresponding CSF collection. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his SDH. Through this case and review of the literature, we aim to demonstrate that directed cervical or thoracic blood patching should be considered for SIH as an alternative to the conventional lumbar blood patch.
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To compare the safety and efficacy of spinal anesthesia (SA) in patients undergoing lumbar microdiscectomy (LM). ⋯ In patients who undergo lumbar disc surgery, SA is a good alternative for experienced surgeons because of a more comfortable healing process.
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From January 2007 to April 2012, we performed 2427 surgical clippings for unruptured intracranial aneurysms (UIAs). Among these patients, two cases showed symptomatic and angiographic cerebral vasospasm in the delayed post-operative period without a complicated event. ⋯ The pathogenesis and characteristics of these rare occurrences are reviewed from our two cases and previous literature. For clipping of UIAs, it should be kept mind that neurological symptoms are caused by delayed cerebral vasospasm, and careful observation with proper conservative treatment are necessary to ensure favorable outcomes.
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Remote intraparenchymal hemorrhage after clipping of a ruptured aneurysm is rare. The pathogenesis is variable, and the therapeutic strategies remain controversial, because the natural history is unclear. Here we report a woman with subarachnoid hemorrhage (SAH), who had an aneurysm of the anterior communicating artery identified by computed tomography angiography (CTA). ⋯ CT images performed immediately after surgery showed that two intraparenchymal hemorrhages were present contralateral to the site of the operation. After conservative treatment, the patient recovered, but still displayed a movement disorder in the left limb. SAH induced-vasospasm, defective vascular autoregulation, excessive drainage of the cerebrospinal fluid, a change in the intracranial pressure after craniotomy, and brain shift may contribute to the pathogenesis of remote hemorrhage after surgery.
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Unexpected bleeding from the dural sinus can sometimes occur when performing a dural opening during microvascular decompression. We conducted dural opening safely by performing indocyanine green (ICG) videoangiography before making a dural incision. We introduce two specific cases in which surgery was performed to treat a trigeminal neuralgia. ⋯ Using a microscope equipped with fluorescent filters, real-time flow assessment of the underlying veins was done. ICG videoangiography allowed for a clear confirmation of the margins of the dural sinus as well as the vascular structures at the surface of the cerebellum, which were clearly seen through the dura mater. Performing ICG videoangiography prior to dural opening makes it possible to safely perform dural opening.