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1.
Oper Neurosurg (Hagerstown) ; 20(3): 282-288, 2021 02 16.
Article in English | MEDLINE | ID: mdl-33372208

ABSTRACT

BACKGROUND: Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined. OBJECTIVE: To define the protocol of action for massive bleeding from an artery in the posterior fossa. METHODS: The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication. RESULTS: Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery. CONCLUSION: The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.


Subject(s)
Chordoma , Skull Base Neoplasms , Basilar Artery/diagnostic imaging , Basilar Artery/surgery , Endoscopy , Humans , Surgical Instruments
2.
Clin Neurol Neurosurg ; 107(3): 223-9, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15823679

ABSTRACT

Chronic subdural haematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. To evaluate the clinical features, computed tomography findings, surgical results, and complications our series was statistically analysed to elucidate the factors affecting the post-operative outcome. A retrospective study (1980-2002) of the records of 1000 patients harbouring 1097 chronic subdural haematoma treated with burr-hole craniotomy with closed-system drainage was carried out. The series included 628 males and 372 females, age range 12-100 years, mean age 72.7+/-11.4 years. The mean interval from trauma to appearance of clinical symptoms was 49.1+/-7.4 days (15-751). The principal symptom was headache (29.7%) in the over 70s, and behavioural disturbance (33.8%) in the under 70s. The CSDH was right sided in 432 patients, left sided in 471, and bilateral in the remaining 97 cases. Post-operative complications occurred in 196 patients and 21 patients died in hospital. Poor prognosis was related to patient's age (>70) and clinical grade on admission (grades 0-2 versus grades 3-4).


Subject(s)
Craniotomy , Drainage , Hematoma, Subdural, Chronic/surgery , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Female , Hematoma, Subdural, Chronic/diagnostic imaging , Hematoma, Subdural, Chronic/etiology , Humans , Length of Stay , Male , Middle Aged , Radiography , Recurrence , Retrospective Studies , Severity of Illness Index , Treatment Outcome
3.
Neurosurg Rev ; 27(4): 259-62, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15108049

ABSTRACT

Acute spontaneous subdural haematoma (SDH) is rarely associated with rupture of intracranial saccular aneurysm. We report our experience with four cases of non-traumatic SDHs secondary to rupture of an intracranial aneurysm and discuss the diagnosis and management of this condition. We retrospectively reviewed of four cases of acute SDH due to cerebral aneurysm rupture confirmed by cerebral angiography and surgery. Patients were evaluated using the Glasgow Coma Scale (GCS) and subarachnoid grade of the World Federation of Neurosurgical Societies (WFNS) and outcome with the Glasgow Outcome Scale (GOS). Of the 232 patients with non-traumatic subarachnoid haemorrhage (SAH) treated between 1993 and 2002, only four patients (1.72%) presented SDH due to aneurysmal rupture. The SAH grade on admission was grade IV in one patient and V in the other three. In all cases the aneurysm was located in the posterior communicating artery. Spontaneous acute SDH secondary to aneurysm rupture has been rarely reported. We suggested that timely SDH removal and aneurysmal clipping surgery should be performed in such patients, including those in poor neurological condition.


Subject(s)
Aneurysm, Ruptured/complications , Hematoma, Subdural, Acute/etiology , Intracranial Aneurysm/complications , Adult , Aged , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/surgery , Female , Hematoma, Subdural, Acute/diagnosis , Hematoma, Subdural, Acute/surgery , Humans , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/surgery , Middle Aged
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