Traumatic retroclival epidural hematoma associated with reversible ipsilateral internal carotid artery stenosis.

INTRODUCTION: Traumatic retroclival epidural hematoma is rare. It is more common in pediatrics than in adults. Although it has been known that these cases are frequently associated with abducens nerve palsy, internal carotid artery stenosis is rarely found with those hematomas. CASE REPORT: An 8-year-old girl was transferred to our hospital following a traffic accident. She had clear consciousness with right abducens nerve palsy. Computed tomography revealed the left side of both retroclival hematoma without clival fracture and subarachnoid hemorrhage at the Sylvian fissure. She also had a fracture of left femoral neck and ipsilateral lung contusion. Magnetic resonance imaging revealed a retroclival hematoma located in the epidural space and severe stenosis of left internal carotid artery (ICA) from the cavernous to supraclinoid portion without evidence of brain contusion. She was managed conservatively, and her right abducens nerve palsy recovered completely without deterioration of other neurological findings. Neuroradiological findings suggested this ICA stenosis as traumatic dissection. She was discharged home 2 months after the traffic accident. CONCLUSION: Retroclival epidural hematoma without clival fracture associated with ipsilateral ICA stenosis is extremely rare. Although the exact mechanism of the ICA stenosis remains unclear, cerebral vascular events should be considered in the cases with traumatic retroclival hematoma.

[Lumbo-peritoneal Shunt Ventral Catheter Placement Using the Lateral Approach without Repositioning].

We reported 10 cases of lumbo-peritoneal(L-P)shunt placement using the lateral approach without repositioning. Each patient was placed in a left lateral position under general anesthesia and fixed so that the spine did not rotate. The skin incision on the flank was made at the height of the L4 vertebral body, 4 cm in the left-right direction and 3cm in front of the vertebral body. The external oblique, internal oblique, and transverse abdominal muscles were dissected to reach the peritoneum and confirm that the intestinal tract was peristaltic below the peritoneum. The peritoneum was lifted with hooked tweezers in order to separate them from the intestinal tract, and the peritoneum was incised with a scalpel to reach the peritoneal cavity. Using a finger and a shunt passer, the ventral catheter was guided between the muscle layers. Preoperative abdominal CT showed that all 10 kidneys in this case series were cephalic from the predicted approach route. The ascending colons of three patients were partially in contact with the predicted approach route. During surgery, a ventral catheter could be inserted in all 10 cases. Postoperative abdominal CT showed no intraperitoneal hemorrhage or invasion into the retroperitoneal cavity of the ventral catheter. During the follow-up period, no invasion into the abdominal wall or infection was observed. The average operation time was 52.2 minutes. In order to avoid invasion into the retroperitoneal cavity, a surgical incision was performed without complications by incising the outer side of the lower abdomen and approaching via the external oblique aponeurosis.