RESUMO
We present a case of a ruptured pseudoaneurysm of the superficial temporal artery (STA) after surgery for intracranial hemorrhage. To our knowledge, only three similar cases have been reported. A 47-year-old man underwent left frontal craniotomy for a left frontal subcortical hematoma. The left STA was not identified during the surgery, and no STA bleeding was observed. The postoperative course was uneventful for 20 days, until the patient experienced a left-side headache and noticed a subcutaneous mass. The mass increase in size within 1 hour and arterial hemorrhage was observed through a tear in the wound. Findings on subsequent contrast computed tomography were consistent with a ruptured pseudoaneurysm arising from the left STA. Emergency evacuation of the hematoma and STA ligation were performed. Pathological findings were consistent with a pseudoaneurysm. STA pseudoaneurysms occasionally grow rapidly and can cause massive hematoma. Surgeons should carefully monitor for evidence of a pseudoaneurysm after craniotomy, even in the absence of intraoperative bleeding from the STA.
RESUMO
Background We adopted full-endoscopic lumbar discectomy (FELD) in 2019 with the assistance of the Japanese Society for Minimally Invasive and Endoscopic Techniques of Spinal Neurosurgery (JASMETS). This study analyzed short-term outcomes in our initial FELD cases and compared them with microdiscectomy cases performed during the same period. Methods FELD was performed in 21 patients over a period of 2 years and 6 months (15 men and 6 women; mean age, 57.0±17.0 years). The transforaminal approach was performed in 8 patients, the posterolateral approach in 3, and the interlaminar approach in 10. During the same period, microdiscectomy was performed in 30 patients. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores, operation time, blood loss volume, complications, and incidence of lumbar disc herniation recurrence were compared between the groups. Results Preoperative VAS and JOA scores did not significantly differ between the FELD and microdiscectomy groups. JOA and VAS scores significantly improved in both groups after surgery. Operation time and incidence of recurrence rate did not differ. Conclusion Spine surgeons who adopt FELD can achieve good surgical outcomes similar to those of microdiscectomy, even in the early period. Participation in JASMETS seminars and training and proctoring by a certified endoscopic spine surgeon were instrumental in our experience.
RESUMO
BACKGROUND: Patients with lumbar disc herniation at a level with significant stenosis due to ossification of the yellow ligament (OYL) may rarely present with rapid neurological deterioration warranting emergent surgery. CASE DESCRIPTION: A 40-year-old female developed an acute cauda equina syndrome (CES) attributed to an acute lumbar disc herniation and to marked canal stenosis due to OYL. As the patient underwent a 9 h delayed removal of the ossified ligament and discectomy, she sustained only minimal recovery. CONCLUSION: Patients diagnosed with acute lumbar disc herniation and severe stenosis due to OYL who present with acute CES warrant emergent surgical decompression to avoid permanent postoperative neurological sequelae.
RESUMO
Anterior spinal artery (ASA) aneurysms are rare, and the majority are associated with vascular lesions such as arteriovenous malformations, moyamoya disease, and aortic stenosis. Herein, we report a case of a ruptured anterior spinal artery aneurysm caused by bilateral vertebral artery (VA) occlusion, which was treated by coil embolization. An 83-year-old man was found collapsed at home, and was brought in by emergency. His consciousness level was I-1 on the Japan Coma Scale, and there were no symptoms such as paralysis in the extremities. Computed tomography showed Fisher 3 subarachnoid hemorrhage, while magnetic resonance angiography showed an aneurysm in the right VA. Digital subtraction angiography showed bilateral VA occlusion, and an aneurysm was found on the dilated ASA as a collateral circulation. Coil embolization was performed after confirmation of no hemodynamic problems. No postoperative adverse events were observed. Coil embolization may be an effective treatment for ruptured aneurysms of the ASA.
