Pseudoaneurysm of the superficial temporal artery: a complication of botulinum toxin injection.

Pseudoaneurysms of the superficial temporal artery (STA) must be considered in the differential diagnosis of masses of the lateral forehead and temporal fossa. Although the first reported case of a temporal artery aneurysm was by Thomas Bartholin in 1740, this lesion receives scant mention in the plastic and maxillofacial surgical literature. A history of recent blunt trauma or surgery to the forehead combined with a pulsatile bruit should direct the physician to this diagnosis. A case of pseudoaneurysm arising from the frontal branch of the left STA 2 months after Botox injection is presented. The patient underwent embolization of the STA with Onnix. A similar case was previously reported once in the world literature.

Effect of age and lordotic angle on the level of lumbar disc herniation.

It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA), as measured by Cobb's method. We followed retrospectively lumbosacral spine MRI's of 1419 patients with symptomatic disc herniation. Pearson's correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student's t-test was applied to assess gender differences. Young patients were found to have higher LLA (R = 0.44, P < 0.0001) and lower levels of disc herniation (R = 0.302, P < 0.0001), whereas older patients had higher level herniation in lower LLA group (mean LLA 28.6° and 25.4°) and lower level herniation in high LLA group (mean LLA 33.2°). We concluded that Lumbar lordotic Cobb's angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women (R = 0.341, P < 0.0001).

Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery.

BACKGROUND: Intraoperative somatosensory evoked potential (SSEP) monitoring during cervical spine surgery is not a universally accepted standard of care. Our retrospective study evaluated the efficacy and cost-effectiveness of intraoperative SSEP in a single surgeon's practice. MATERIALS AND METHODS: Intraoperative SSEP monitoring was performed on 210 consecutive patients who had cervical spine surgery: anterior cervical approach 140 and posterior approach 70. They were screened for degradation or loss of SSEP data. A cost analysis included annual medical costs for health and human services, durable goods and expendable commodities. RESULTS: Temporary loss of the electrical wave during cauterization resolved upon discontinuation of the cautery. We had no loss of cortical wave with preservation of the popliteal potential. A drop in the amplitude of the cortical wave was observed in three patients. This drop was resolved after hemodynamic stabilization in the first patient, readjusting the bone graft in the second patient, and interrupting the surgery in the third patient. The additional cost for SSEP monitoring was $835 per case and the total cost of the surgery was $13,835 per case. By spending $31,546 per year on SSEP, our institution is saving a total cost ranging from $64,074 to $102,192 per patient injured per year. CONCLUSION: Intraoperative SSEP monitoring is a reliable and cost-effective method for preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise, and the immediate alteration of the anesthetic or surgical technique.