Transient ISS after FD deployment is a common asymptomatic finding on mid-term angiographic follow-up. Complete resolution or improvement at long-term follow-up is seen in most patients who are maintained on dual antiplatelet therapy.
Background: Pedicle screw instrumentation of the posterior cervical spine is the most secure form of fixation available to surgeons. It has not achieved widespread use yet in the Middle East, mostly due to concerns regarding its feasibility in the target population. A detailed morphometric analysis of the lower cervical spine pedicles using computerized tomography (CT) was proposed to address this issue.Methods: Two hundred and seventy patients were enrolled in the study. CT scans were reviewed by two experienced assessors, and measurements of pedicle width (PW), height (PH), and transverse angle (TA) were recorded for all patients. Interobserver and intraobserver reliability were calculated using the kappa statistic. Sex differences were also recorded and analyzed. The t test was used to assess for any significant differences in measurements due to sex (P , .05).Results: The mean PW varied from 4.4 mm in C3 to 6.1 mm in C7. The mean PH was 6.4 mm in C3 and 6.8 mm in C7. Pedicle TA varied from 42 to 51 degrees between the different levels. Sex differences were observed and were statistically significant for PW and PH. Interobserver reliability was high for PW and PH, but was low for TA. Intraobserver reliability was 0.99 for both assessors.Conclusion: This study provides reliable PW and PH measurements and demonstrates that cervical pedicle screw instrumentation is feasible in our local population. Significant variability exists, however, and each patient must be addressed individually for best results.Level of Evidence: 3.Clinical Relevance: This study shows that the morphology of the subaxial cervical pedicle permits instrumentation in a majority of cases of our target population.
Reversible cerebral vasoconstriction syndrome (RCVS) is an essential but often unrecognized cause of intracranial haemorrhage. While there are no specific causes of the syndrome, associations with many clinical conditions and drugs have been observed, and calcium channel blockers (CCBs) are often used to relieve the symptoms. This is a case of RCVS that was triggered by the sudden withdrawal of nifedipine, a CCB.
Summary:
Arteriovenous malformations (AVMs) are rare lesions formed by direct connection of arteries and veins bypassing capillary beds. AVM locations can vary; however, extracranial AVMs remain the least common. The vast majority of these malformations are congenital and can be triggered by hormonal changes. A 49-year-old woman presented with a progressive right-sided upper eyelid swelling over the past 12 years. The patient had mechanical ptosis and mild impairment of the right visual field. The swelling was compressible with a thrill, and bruits were heard. The patient was diagnosed with AVM using cerebral angiography. Preoperative endovascular embolization was not possible; however, surgical excision was successfully done with no complications. AVMs and fistulas are high-flow vascular lesions that usually occur during childhood and progress with time. Only a few cases of face and eyelid AVMs have been reported in the literature. Diagnosis of these anomalies is mostly made based on clinical presentation and radiographic imaging such as angiography. Treatment options remain controversial, and management should be individualized for each patient. Endovascular embolization followed by surgical excision is advisable in many cases. Due to its rare entity, information regarding the best management options for AVMs is limited. Reducing the risk of bleeding and achieving total resection is the goal of treatment. Long-term follow-up is required in these patients because recurrent cases of AVMs have been reported.
Background:
Factors like parent satisfaction and expert opinion have been proposed as outcome measures related to craniosynostosis (CS) surgery. However, there is no real tangible score for CS surgery outcomes. In our study, we aimed to explore different factors considered as a tangible outcome measure of CS surgery.
Methods:
A retrospective cohort study of 23 patients with CS who were operated on in a tertiary care university hospital. Parents were interviewed to assess their satisfaction of aesthetic outcome. This was correlated to two expert opinions and to the amount of skull expansion.
Results:
The mean follow-up duration was 2.24 ± 1.12 years. Twelve of the 23 fathers were satisfied, whereas 11 of the 23 mothers were satisfied. The overall combined satisfaction rate of both parents was on the higher side with no difference in between. There was a significant association between expansion rate of 7.65 ± 4.99% and the overall parent’s satisfaction (P = 0.002). Additionally, there was a good correlation between both experts with statistically significant association (P = 0.004). No correlation was found between the parents’ satisfaction and the experts’ opinions.
Conclusions:
The study is valuable, as it investigates the relationship between the expansion rate, parents’ satisfaction, and expert opinion as predicted values of craniosynostosis surgery. The overall satisfaction correlated significantly well with the expansion rate. However, such numerical assessment is not a real guide for assessing clinical outcomes‚ as no association was found between expansion rate, satisfaction rate, and expert opinion.
Suppl. 2 -S44 minimally invasive ICH evacuation were included retrospectively if follow-up computed tomography (CT) scans were available for analysis. Hematoma cavity volumes were calculated from the immediate post-procedural and three-month follow-up CT scans using the Analyze Pro software. Results: Twenty patients had follow-up CT scans at a mean time of 93 days from hematoma evacuation. The average cavity size at follow-up was 11938.12 mm 3 (SD: 6996.49). The change in cavity size compared to the prior CT was 6396.74 mm 3 (median 2542; range: -1030-27543; SD: 8472.45). This represented mean growth in cavity volume of 54%. Conclusions: This study provides preliminary data describing increase in cavity size after endoscopic minimally invasive evacuation of ICH. Comparison to atrophy in conservatively-managed patients is a further planned avenue of research.
Background Rapid development of new devices and techniques in endovascular neurosurgery allows treatment of complex intracranial vascular lesions. These treatments, however, are not without risk. We report a case of unusual vascular laceration during stent-assisted coiling of a posterior inferior cerebellar artery (PICA) aneurysm. Case presentation A 75-year-old female with a recurrent, previously coiled PICA aneurysm developed avulsion of the parent vessel followed by fatal bleeding while an attempt was made to place a microcatheter across the aneurysmal neck for stent-assisted coiling. Conclusions Pathological examination was performed to understand the mechanism of the rupture. The most likely mechanism was straightening of the significant vascular tortuosity, excessive tension on the vessel origin and avulsion upon advancement of the microcatheter over the microguidewire.
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