Context: Venous thromboembolism (VTE) is a devastating complication of intracranial tumor surgery. The present study helps identify patients at the greatest risk of developing VTE. Aims: The aim of the study was to evaluate the incidence of and risk factors for VTE following craniotomy for intracranial tumors. Setting and Designs: This was a retrospective cohort study. Methods: Data from the institutional database (between January 2017 and December 2018) were reviewed. Consecutive patients with intracranial tumors who underwent craniotomy were included. Statistical Analysis Used: Patient characteristics were reported as descriptive data, and factors associated with VTE development were analyzed by the Cox regression model. Results: The study identified 177 patients. The incidence of VTE was 10.2% (deep-vein thrombosis [DVT], 8.5%; pulmonary embolism [PE] 1.7%; and simultaneous DVT and PE, 1.7%). In univariate analysis, VTE development was associated with diabetes mellitus (DM), operative duration of >420 min, blood transfusion, and new-onset postoperative motor deficits. DM and new-onset postoperative motor deficits were statistically significant factors in multivariable analysis, with hazard ratios of 4.52 (95% confidence interval [CI] = 1.38–14.82) and 3.46 (95% CI = 1.17–10.23), respectively. Conclusions: Postcraniotomy VTE was detected in 10.2% of patients with intracranial tumors. Risk factors for VTE included DM and new-onset postoperative motor deficits. Hence, intracranial tumor patients with these risk factors are the most likely to require VTE prophylaxis with an anticoagulant.

Context: Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is the fatal complication following spine surgery and the appropriate perioperative prophylaxis is still debated. Aims: The aim of this study is to evaluate the incidence of along with risk factors for postoperative VTE in surgically treated extramedullary spinal tumor patients. Setting and Designs: The study design involves single institute and retrospective cohort study. Subjects and Methods: The cohort database was reviewed between the periods of January 2014 and June 2019. Patients undergoing surgery for spine tumor, extradural tumor, and intradural extramedullary were consecutively collected. Statistical Analysis Used: The incidence of VTE and clinical factors reported to be associated with VTE were identified, and then analyzed with an appropriate Cox regression model. Results: The study identified 103 extramedullary spinal tumor patients. Three patients (2.9%) were diagnosed with a proximal leg DVT, while symptomatic PE did not identify. Risk factors associated with DVT occurrence were as follows: operative time ≥8 h (Hazard ratio [HR] 13.98,P= 0.03) and plasma transfusion (HR 16.38,P= 0.02), whereas plasma transfusion was the only significant factor, after multivariate analysis (HR 11.77,P= 0.05). Conclusions: Patients who underwent surgery for extramedullary spinal tumors showed a 2.9% incidence of DVT. The highest rate of DVT was found in patients who received plasma transfusion. More attention should be paid on perioperative associated factors for intensive prevention coupled with early screening in this group.

Background Traumatic atlantoaxial (upper cervical spine) leads to instability in weightbearing movement and neurological deficit. Presently, C1 (axial) lateral mass or pedicle screws for fixation are the most popular because of excellent mechanical performance for internal fixation. C1 pedicle screw fixation can reduce intraoperative blood loss and postoperative occipital neuralgia more than C1 lateral mass screws. However, screws cannot be inserted completely through the pedicle in some patients due to C1 size. Objective We aimed to determine the ideal pedicle screw entry point, angle of screw projection, and pedicle height in the Thai population. Methods Patient data were collected and measured using the INFINITT program at Mukdahan Hospital from September 2020 to June 2021. The C1 measurements, i.e., distance from the midline to the medial edge of the posterior arch (DPA) and medial edge transverse foramen (DTF), angle of screw projection, and length and height of the pedicle were recorded. Descriptive statistics and t-test were used to analyze the data. Results The mean Thai pedicle dimensions were DPA = 14.17 mm (range: 11.19–19.70 mm), DTF = 22.09 mm (range: 18.13–26.44 mm), ideal screw entry point = 18.13 mm (range: 15.19–22.00 mm), ideal angle of screw projection medial angulation = 2.67 degrees (range: 0–7 degrees), and height of posterior arch (pedicle) = 4.77 mm (range: 2.68–7.22 mm). Forty of 167 patients (24.0%) had a pedicle height less than 4.0 mm (bilateral 11 patients and unilateral 29 patients). Conclusions The ideal C1 pedicle screw entry point is approximately 18.13 mm from the midline. In the Thai samples with C1 pedicle height less than 4.0 mm, the screws cannot be inserted completely through the pedicle. Therefore, screw insertion should be partially through the pedicle (notching technique).

Background: Traumatic upper cervical spine leads to instability and neurological deficit. At present, C2 (axis) pedicle or lamina screws for fixation are popular because further external immobilization is not needed. However, these techniques demand experience inserting the screws and carry the risk of vertebral artery or spinal cord injury. In some patients, the C2 screws cannot be inserted because of limited C2 size. Objective: To determine the width, length, height, and angle in the C2 pedicle and lamina in the Thai population. Materials and Methods: Patient data were collected from the Picture Archiving and Communication System at the Faculty of Medicine, Prince of Songkla University from January 2016 to December 2017. The C2 parameters, i.e., width, length, height, and angle of the pedicle and lamina were recorded. Results: The CT C-spine scans of 270 patients were enrolled. The mean Thai C2 pedicle dimensions were width 5.51 mm, length 23.78 mm, angle 39.04°, and height 8.64 mm. The mean C2 lamina dimensions were width 5.88 mm, length 32.17 mm, angle 49.46°, and height 12.27 mm. Twenty-four patients from the 270 patients (8.8%) had a pedicle width <3.5 mm but all patients had a lamina width ≥3.5 mm. Conclusion: In the Thai samples, 8.8% had a C2 pedicle width <3.5 mm which would not allow insertion of screws; however, they could be replaced with lamina screws since the lamina width was ≥3.5 mm. In this study, all of the patients who could not be inserted pedicle can be replaced with lamina screws inserted.