The 'stitched sling retraction' technique shows promising preliminary results in recurrent cases of trigeminal neuralgia after previous microvascular decompression(s). Since it is a 'transposing' technique, it might be associated with less recurrence rates (due to resuming of the neurovascular conflict) than the classic interposing technique, which uses a prosthesis between the offending vessel and the trigeminal nerve.

Background:Rupture of the intracranial aneurysms is associated with a high risk of bleeding and a high incidence of mortality if left untreated.Objectives:The aim of this study is to report our experience in managing intracranial aneurysms using coil embolization and to report the 6-month follow-up outcome of the patients.Patients and Methods:From January 2010 to December 2012, a series of 90 nonrandomized consecutive patients (mean age: 44.6 ± 14.9 years) with intracranial aneurysms underwent endovascular coil embolization in our center. We excluded patients with dissecting, blood blister-like, or false aneurysms. All patients were evaluated by four-vessel angiography to determine the shape, size, number and location of the aneurysms. We recommended a six-month follow-up control angiography. However, only 38 of them participated in this follow-up imaging. The data were analyzed by chi-square, fisher exact and t-tests and alpha was considered lower than 5%.Results:Immediately after the procedure, the total occlusion was seen in 76 (86.4%), subtotal occlusion in six (6.8%), and partial occlusion in six patients (6.8%). There was no significant relationship between the aneurysm size, aneurysm neck size, and location of the aneurysm with total or subtotal occlusions. Eleven patients (12.5%) experienced some complication during the procedure including two tears, three focal neurological signs, three vision disturbances, and three bleedings in the aneurysm. Major complications were significantly higher in the posterior aneurysm compared to the anterior ones (55.6% versus 44.4% of the major complications; P value = 0.015). Among patients who underwent control angiography, 34 patients (89.4%) had no change, two (5.3%) had new growth and two (5.3%) had widening of the neck after 6 months follow-up. Although aneurysms that remained unchanged after six months follow-up angiography had total occlusion after the procedure, it was 50% for aneurysms that had any changes in 6 months follow-up angiography (P value = 0.01).Conclusion:Coil embolization showed successful outcomes in the treatment of intracranial aneurysms with a low complication rate.

Injection of 100 microg hyperbaric neostigmine intrathecally was effective for pain relief, and reduced post-operative opiate demand.

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Background: Blood loss during spinal decompression and fusion is high and at times more than the patient's total estimated blood. Increased blood loss may increase the risks of morbidity and eventually length of hospital stay (LOS). Objectives: The aim of this study was to identify predictor factors of blood transfusion requirements and the length of hospital stay in adult patients who underwent lumbosacral surgery. Materials and Methods:This was a multicenter cross-sectional study to predict factors of hospital length of stay (LOS) and intraoperative red cell transfusion in patients undergoing major posterior lumbar spinal surgeries. In this study, 298 patients who needed spinal surgery were enrolled. Results: Multiple linear regression results revealed the following information. Among variables that had significant association with the volume of intraoperative blood loss, considerable predictors were the number of level fused (R 2 = 0.42), mean intraoperative SBP (R 2 = 0.22), length of operation (R 2 = 0.31) and increasing age (R 2 = 0.37). Significant predictors for the length of hospital stay were increasing age (R 2 = 0.22), much more comorbid conditions (R 2 = 0.30), operation length (R 2 = 0.27), the number of level fused (R 2 = 0.21) and the volume of intraoperative blood loss (R 2 = O.29). The results of logistic regression revealed that length of operation, preoperative Hb value, number of level fused and mean intraoperative SBP considerably predicted the need for intraoperative blood transfusion. Conclusions: Diminishing intraoperative SBP could decrease intraoperative blood loss and eventually less red cell transfusion and shorter LOS. Besides, correcting preoperative anemia in female patients before elective surgeries could decrease a need for red cell transfusions and ultimately decreased red cell transfusion complication rate and shorter hospital LOS.

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