Surgical neurology international
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Spontaneous epidural hematoma arising from the ligamentum flavum is a rare cause of acute spinal cord compression. There are only four reports in the cervical spine literature, and all were managed with surgery. Here, we describe an acute case of a spontaneous epidural hematoma arising from the ligamentum flavum in the cervical spine successfully managed without surgery. ⋯ Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.
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Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare. ⋯ Simultaneous decompressive laminectomy of L3-4 and S1-2 effectively decompressed the syringomyelia while allowing for excision/biopsy of a space occupying lesion at the former and untethering and Tarlov cyst fenestration at the latter levels.
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Case Reports
Superficial temporal artery pseudoaneurysm presenting as a growing, pulsatile, and tender mass.
Superficial temporal artery (STA) pseudoaneurysms have been reported in the literature since the mid of seventeenth century from Bartholin, however, there is an increasing number of cases, suggesting a diversity of etiological factors. Among these, traumatic events, even of an iatrogenic nature, have been identified as causative factors for nonspontaneous STA pseudoaneurysms. Regional pain and tenderness, troublesome pulsations of the mass, cosmetic concerns as well as the risk of bleeding warrant a thorough evaluation and a definite interventional approach to the condition. ⋯ STA pseudoaneurysms require a careful evaluation and a conclusive approach in order to avoid the risk of a growing mass and other nonremote complications such as bone erosions and bleeding. Different treatment options are available, including endovascular obliteration and embolization, however, surgical removal after ligation of the afferent and efferent segments of the vessel seem to be highly effective.
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Treatment of low-pressure hydrocephalus (LPH) may require prolonged external ventricular drainage (EVD) at sub-zero pressures to reverse ventriculomegaly. Endoscopic third ventriculostomy (ETV) has been used in the treatment of noncommunicating hydrocephalus; however, indications for ETV are expanding. ⋯ ETV can be used successfully in the management of refractory LPH to decrease the duration of EVD.
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Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. ⋯ Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures.