World Neurosurg
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Case Reports
Association Between Klippel-Trenaunay Syndrome and Spontaneous Intracranial Hypotension: A Report of Four Patients.
Klippel-Trenaunay syndrome (KTS) is associated with a wide variety of vascular and neurologic abnormalities, including venolymphatic malformations. A recent report postulated that patients with KTS may also be predisposed to spontaneous intracranial hypotension. We reviewed brain magnetic resonance imaging from 67 patients with KTS and unexpectedly noted findings of cerebrospinal fluid (CSF) hypotension in 4 of them. ⋯ Patients with KTS have an increased incidence of CSF hypotension. While it is possible that intrinsic dural weakness may be responsible for this association, we hypothesize that these patients are also predisposed to developing CSF venous fistulas. Paraspinal and epidural venolymphatic malformations have been described in multiple patients with CSF venous fistulas. Such malformations were present in 2 of our 4 patients who underwent spine imaging. Patients with KTS with orthostatic headaches may benefit from brain and spine magnetic resonance imaging to assess for evidence of CSF hypotension and venolymphatic malformations. Decubitus digital subtraction myelography may also have a role in these patients if CSF venous fistulas are suspected.
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The predictive ability of Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI) have been compared in orthopedic and gastrointestinal surgery; however, their predictive ability for complications secondary to spine surgery and posterior cervical decompression and fusion (PCDF) specifically is understudied. This study examines the predictive ability of the ECI and CCI for complications and morbidity following PCDF. ⋯ ECI showed superior predictive ability to the CCI in predicting 8 of the 18 complications that were analyzed and inferior in none.
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Microvascular decompression (MVD) is a commonly performed procedure to treat trigeminal neuralgia and hemifacial spasm. Knowledge of the variable anatomy of the cerebellopontine angle is crucial to avoid injury to cranial nerves. ⋯ Careful review of imaging before surgery is recommended in order to preempt such unusual anatomic variations.
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This paper retrospectively analyzed 28 cases of children diagnosed with repeated intestinal malformations in our hospital from October 2014 to November 2016. The characteristics of ultrasound sonograms of children were evaluated. The images of intestinal repetitive malformations were classified and summarized to identify their common sites, the characteristics of various types of ultrasound sonograms, the main points of ultrasound diagnosis and identification, and the experience of ultrasound workers in daily inspection of children with repetitive malformations of the digestive tract. ⋯ This study found that the ultrasound diagnosis of children with intestinal repetitive deformities has a high detection rate, clear images, clear anatomic levels, and clear blood flow conditions. Compared with other imaging methods, ultrasound has strong operability, real-time dynamics, strong specificity, and no radiation, and things are not easily misdiagnosed and missed. Therefore, ultrasound can be used as the preferred method for preoperative diagnosis, differential diagnosis, and postoperative follow-up review of repeated intestinal malformations in children.
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Posttraumatic syringomyelia is a significant source of disability following spinal cord injury (SCI). Despite this, its etiology and optimal treatment remain controversial. Early identification of and intervention at a presyrinx state may halt progression. Here, we present a unique case illustrating the continuum between presyrinx and syrinx in an adult following severe distraction cervical SCI and traumatic brain injury, resulting in both tethered spinal cord and posttraumatic hydrocephalus and subsequent isolated fourth ventricle. The interplay between these etiologic factors and their therapeutic implications are discussed. ⋯ Cognizance of the possible presence of multiple etiologic contributors to posttraumatic syringomyelia and an intricate understanding of their interplay are crucial to the optimal management of this complex pathology.