[A Case of Rectus Sheath Hematoma Presenting Immediately after a Lumboperitoneal Shunt and Requiring Emergency Surgery:Importance of Abdominal Anatomy Knowledge].

As the incidence of idiopathic normal-pressure hydrocephalus (iNPH) rises in an aging society, the number of cerebrospinal fluid (CSF) shunts performed increases every year. The morbidity of iNPH in patients>65 years of age has been reported as 1.4%-2.9% in Japan. CSF shunts are rarely associated with mortality and are generally safe to perform, but subcutaneous hematomas and intestinal injuries are the major potential complications of the abdominal surgery for CSF shunts. In this report, we describe an uncommon case of rectus sheath hematoma (RSH) that occurred immediately after a lumboperitoneal shunt and required emergency surgery. RSHs have a reported mortality rate of 4% and require appropriate treatment. Many neurosurgeons rarely have in-depth knowledge of abdominal anatomy. To safely perform CSF shunting, we underscore the importance of precise knowledge of the abdominal anatomy, especially the features of blood vessels.

Stent-assisted Coil Embolization to Treat Extracranial Carotid Artery Aneurysm 13 Years after Endarterectomy: A Case Report.

Development of extracranial carotid artery aneurysm (ECCA) after carotid endarterectomy (CEA) is a rare complication, occurring in connection with <1% of all CEAs. The main causes are infection, suture failure, and degeneration of arterial wall or patch. The traditional treatment has been operative repair, which can present a significant technical challenge owing to reoperative neck inflammation and potential cranial nerve injuries. Here, we report a case of successful stent-assisted coil embolization for right noninfectious ECCA. A 63-year-old female was admitted to our hospital for a 3-cm pulsating mass in her right midneck. Doppler examination and digital subtraction angiography revealed a large (15 mm) ECCA at the right common carotid artery (CCA). Thirteen years earlier, eversion CEA with patch angioplasty and abbreviation of the internal carotid artery (ICA) had been performed for a symptomatic 80% diameter stenosis with transient ischemic attack at another hospital. As the patient refused blood transfusion for religious reasons, we treated her with stent-assisted coil embolization, which achieved nearly complete obliteration of the aneurysm while preserving the parent artery patency. Three months after initial treatment, ultrasound revealed complete occlusion of the ECCA, but also showed stent shortening. Hence, we performed an additional stent placement so as to overlap the previous stent by 2.5 cm. Six months after initial treatment, carotid duplex ultrasound confirmed a good outcome. This procedure is an excellent choice for high-risk patients, and a larger case series is needed to establish this technique as the treatment of choice for ECCAs.