Spinal chronic subdural hematoma mimicking intradural tumor in a patient with history of Hemophilia A: case report.

A 22-year-old man with medical history of Hemophilia A was admitted with a 3- month history of low back pain radiating to the right leg. Neurological examination revealed no abnormalities. Spinal magnetic resonance imaging (MRI) with gadolinium enhancement revealed an intradural extramedullary mass at the level of L1 reported as an intradural tumor. The patient was operated after Factor VIII replacement. Intraoperatively, the lesion was found to be a pure subdural hematoma. The histopathological examination revealed pure chronic hematoma. Postoperatively the patient's complaints showed improvement and he was discharged with no complications. Although MRI is the gold standard of diagnosis for spinal intradural tumors, some mass lesions remain difficult to diagnose. Spinal chronic subdural hematoma should be considered in the differential diagnosis in these patients, especially in those with coagulopathies, even in the absence of a history of trauma.

Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap: technical note.

OBJECTIVE: Postoperative cerebrospinal fluid (CSF) leak is a common complication in the practice of neurosurgery, and various surgical techniques were described to overcome and manage this problem. Besides not applying watertight closure of the duraplasty, the inviability and the poor vascularization of the graft and/or the dura (eg, reoperations, multiple operations, or cranial radiotherapy) may lead to delayed healing of the suture site and resultant persistent CSF leaks. We present a simple technique that uses on-site muscle flap with pedicle to supply and vascularize the autologous fascia lata, preserving the viability of the graft and reenforcing its healing ability. METHODS: We applied this technique in 6 patients with postoperative CSF leaks. After harvesting a fascia lata graft with appropriate size from the patients, the graft was sutured to dural defect in watertight fashion. The suboccipital, temporal, and temporal muscles in 4 patients who had posterior fossa duraplasty, in 1 patient who had pterional craniotomy, and in 1 patient who had subtemporal craniotomy, respectively, were dissected, stretched, and sutured to the fascia graft covering the dura graft suture site and then reinforced by Tisseel fibrin glue (Baxter Healthcare Corporation, Deerfield, IL). Postoperatively, CSF lumbar drain was kept open for 72 hours with pressure wound dressing. The technical nuances are illustrated. RESULTS: Cerebrospinal fluid leaks were controlled successfully in 5 patients without recurrence. One patient with posterior fossa duraplasty had recurrence of CSF leak that required reexploration 21 days after the first surgery and a second dural repair in a site distant from the fascia lata attachment. During reexploration intraoperatively, the fascia lata graft was inspected and studied, which has shown the healing of the dura graft site and the graft neovascularization. CONCLUSIONS: Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap is an effective technique to control CSF leak, especially when dura is poorly vascularized and less viable. The unfortunate recurrence of CSF leak and reexploration in the seventh patient helped us to observe the effectively healed dural defect with profound early postoperative vascularization of the graft, supporting our idea about the effectiveness of this technique.

[Surgical treatment of essential hypertension resistant to medical treatment: Report of two cases]. / Medikal tedaviye dirençli esansiyel hipertansiyonda cerrahi tedavi: iki vakanin sunumu.

OBJECTIVE: To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective treatment modality in the treatment of "essential" hypertension. METHODS: Two patients with medically refractory hypertension underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as renal diseases, carcinoid syndrome, pheochromocytoma were ruled out before surgery. Indications for surgery included mainly systolic blood pressures greater than 180 mm Hg or uncontrolled blood pressures under three or more medications. RESULTS: Both patients experienced more than 20 mm Hg reduction in systolic blood pressure although the number of medications was decreased after surgery. CONCLUSION: Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective modality in the treatment of "essential" hypertension.