The majority of DVTs occurred within the first week after a neurosurgical procedure. There was a linear correlation between the duration of surgery and DVT occurrence. Use of early subcutaneous heparin (at either 24 or 48 hours) was associated with a 43% reduction of developing a lower-extremity DVT, without an increase in surgical site hemorrhage. There was no association of pharmacological prophylaxis with overall PE occurrence.
Vasospasm after resection of skull base tumors is a rare complication that often produces serious ischemic sequelae. In four of the authors' recent cases, vasospasm complicated the patient's postoperative course. A review of the literature produced a number of cases that can help determine possible causes of vasospasm after tumor resection, ways to prevent it, and methods to evaluate it when it occurs. The cause appears to be multifactorial and the surgical approach may contribute to the pathogenesis of vasospasm. Physicians must have a high degree of suspicion to detect vasospasm at an early stage of skull base surgery. Cerebral blood flow measurement and transcranial Doppler are useful monitoring tools.
We conducted a retrospective study of51 cases ofspontaneous transtemporal cerebrospinalfiuid (CSF) leakage in 48 adults who had presented to our tertiary care academ ic ref erral center between July 1, 1988, and June 30, 2002. All pati ents had undergone high-resolution temporal bone computed tomography, and 26 patients had undergone magnetic resonance imaging. All pati ents were treated with a middle f ossa craniotomy to repair the CSF fistulae. During a mean fo llow-up of 4.9 years, 46 of the 48 pati ents (95.8%) had expe rienced a complete cessation of CSF leakage (49 of 51 cases [96.1 %1). The 2 pat ients whose leakage recurred were successf ully managed with a subtotal petrosectomy with occlusion of the eustachian tube and obliterati on of the middle ear and mastoid. No pat ient developed meningitis.
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