Dural arteriovenous fistulas (AVFs) are uncommon, representing only 10% to 15% of all intracranial AVFs. Here we present the case of a patient with cerebral infarction who experienced a dural AVF after craniotomy for superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. A 48-year-old man presented with dysarthria and right side hemiparesis. A brain magnetic resonance imaging scan revealed multiple acute infarctions and severe stenosis of the left MCA. Therefore, STA-MCA bypass surgery was performed. A follow-up angiography performed 2 weeks after the surgery showed an abnormal vascular channel from the left middle meningeal artery (MMA) to the middle meningeal vein (MMV) just anterior to the border of the craniotomy margin. This fistula originated from a screw used for cranial fixation. The screw injured the MMA and MMV, and this resulted in the formation of a fistula. The fistula was successfully treated with transarterial embolization. Surgeons should be careful when fixing bones with screws and plates as fistulas can develop if vessels are injured.

ObjectiveThis study investigated the clinical and angiographic outcomes of treatment with stent-assisted coil embolization using the Solitaire AB stents for wide-necked intracranial aneurysms.MethodsFrom October 2010 to December 2011, 22 patients with aneurysms were treated with the Solitaire AB stent. One patient with a dissecting aneurysm was excluded, thus 21 patients with 21 wide-necked saccular aneurysms were included in this study. The technical success rate, procedure-related complications, initial and follow-up angiographic results, and clinical outcomes were retrospectively collected.ResultsThe locations of aneurysms were as follows: paraclinoid in 14, distal internal carotid artery in 4, and vertebral artery in 3 patients. All aneurysms were unruptured and less than 10 mm-sized. The mean dome-to-neck ratio of the aneurysms was 1.00 (range: 0.45-1.81). The mean follow-up duration was 12.1 (7-15) months after the initial procedure. The technical success rate was 21 (95.5%) of 22 patients with aneurysms. Fortunately, there were no procedure-related complications. Follow-up angiography showed that the rate of complete occlusion was 57.1%, neck remnants 38.1%, and incomplete occlusion 4.8%.ConclusionWe suggest that using Solitaire AB stent is technically feasible and safe in the stent-assisted coil embolization for wide-necked saccular intracranial aneurysms. To evaluate the long-term effects of this stent, further follow-up angiography is needed.

ObjectiveThe purpose of this large prospective study is to assess the association between the disappearance of the lateral spread response (LSR) before and after microvascular decompression (MVD) and clinical long term results over two years following hemifacial spasm (HFS) treatment.MethodsContinuous intra-operative monitoring during MVD was performed in 244 consecutive patients with HFS. Patients with persistent LSR after decompression (n=22, 9.0%), without LSR from the start of the surgery (n=4, 1.7%), and with re-operation (n=15, 6.1%) and follow-up loss (n=4, 1.7%) were excluded. For the statistical analysis, patients were categorized into two groups according to the disappearance of their LSR before or after MVD.ResultsIntra-operatively, the LSR was checked during facial electromyogram monitoring in 199 (81.5%) of the 244 patients. The mean follow-up duration was 40.9±6.9 months (range 25-51 months) in all the patients. Among them, the LSR disappeared after the decompression (Group A) in 128 (64.3%) patients; but in the remaining 71 (35.6%) patients, the LSR disappeared before the decompression (Group B). In the post-operative follow-up visits over more than one year, there were significant differences between the clinical outcomes of the two groups (p<0.05).ConclusionIt was observed that the long-term clinical outcomes of the intra-operative LSR disappearance before and after MVD were correlated. Thus, this factor may be considered a prognostic factor of HFS after MVD.

Background: COVID-19 and delayed hip surgery are well-known risk factors for thromboembolism in elderly patients.Case: We report the case of an 88-year-old female patient with COVID-19 and pulmonary thromboembolism (PTE) who underwent delayed hip surgery 21 days after the injury. Heparinization and inferior vena cava (IVC) filters were used to treat and prevent PTE. Transesophageal echocardiography (TEE) and extracorporeal membrane oxygenation (ECMO) sheaths were inserted as a precaution in case of emergencies during surgery; the procedure was performed without any specific event.Conclusions: COVID-19-infected patients suffering from a hip fracture have a high risk of thromboembolism, and therefore, require utmost attention for appropriate evaluation and prevention.