Iatrogenic Common Iliac Vessel Injury During Routine Degenerative Lumbar Spine Surgery: Report of 2 Cases and Review of Literature.

BACKGROUND: Injury of the iliac vessels is a rare complication of lumbar spine surgery with potentially life-threatening consequences. We present 2 cases of iliac vessel injury that were treated with minimally invasive techniques. CASE DESCRIPTION: The first case was a laceration of the common iliac artery during a simple L4-L5 discectomy in which the injured artery was secured by stent implantation. The second case was an example of injury to the left iliac common vessel leading to acute lower limb ischemia and arteriovenous fistula formation after lumbar spinal canal stenosis surgery. The patient was treated in 2 steps. First, a temporary femorofemoral bypass was implanted to revascularize the right lower limb. The second step involved stent implantation in the right common iliac artery to close the arteriovenous fistula. Both patients were treated without extensive laparotomy and had good clinical outcomes. CONCLUSIONS: This case series emphasizes the benefit of quick minimally invasive vascular repair available in multidisciplinary centers.

Elective Management of Unruptured Intracranial Aneurysms in Elderly Patients in a High-Volume Center.

BACKGROUND: The number of elderly patients with unruptured intracranial aneurysms is increasing with time in aging populations; however, the choice of the proper treatment method remains inconclusive. The goal of the study is to evaluate the possible complications and treatment outcome among elderly patients with unruptured intracranial aneurysm. METHODS: We analyzed 139 patients >65 years old, hospitalized between 2007 and 2017 in the high-volume neurosurgical center and diagnosed with unruptured intracranial aneurysm. From their medical records, we obtained medical history and aneurysm characteristics. Patients functional status was measured by modified Rankin Scale score on admission and at discharge. RESULTS: Seventy-two patients (55.97%) underwent aneurysm clipping and 39 (27.04%) coiling. Eighteen patients (11.90%) required stent assisted coiling and 4 (5.00%) had a single stent placement. A total of 133 patients (95.71%) had good treatment outcomes (modified Rankin Scale score 0-3, surgical 0.32 ± 1.03 vs. endovascular group 0.40 ± 1.12, P = 0.65). Complete or near-complete occlusion in the endovascular group was achieved in 83% directly after treatment and in 89% at 6-12 months after procedure. The microsurgical group presented 100% occlusion at follow-up. CONCLUSIONS: Despite the high prevalence of comorbidities in the age group >65 years old, the vast majority of patients in our series treated invasively for unruptured intracranial aneurysms presented with good treatment outcomes. Based on our results, among elderly patients, modern microsurgical as well as endovascular management of brain aneurysms in a high-volume center seems to be a safe and effective method of treatment.

Predictive factors of complications post intracranial meningioma surgery leading to early unplanned reoperations - a single center study.

INTRODUCTION: Complications occurring after neurosurgical procedures which lead to reoperations are associated with poor treatment outcomes. The aim of our study was to establish predictive factors of unplanned early reoperations after intracranial meningioma removal. MATERIALS AND METHODS: We retrospectively analyzed 177 patients who underwent craniotomy due to an intracranial meningioma. Early reoperation was de ned as reoperation during the same hospital stay. We used a χ2 test for proportional values and t-test and Mann-Whitney U tests as appropriate for continuous variables. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses. RESULTS: A total of 13 (7.34%) patients underwent unplanned early reoperation. These patients underwent retrosigmoid craniotomies (25.00% vs. 6.40%; p = 0.047), suffered from ischemic heart disease (66.67% vs. 6.64%; p <0.01) and atrial fibrillation (60.00% vs. 6.25%; p <0.01), were receiving heparin (50.00% vs. 6.74%; p <0.01) and anticoagulants (66.67% vs. 6.21%; p <0.01) significantly more often than the general study population. In multivariate logistic regression analysis anticoagulant use (OR: 31.463; 95% CI: 1.139-868.604; p = 0.04) and retrosigmoid craniotomy (OR: 6.642; 95% CI: 1.139-38.73; p = 0.034) remained independently associated with a higher risk of early reoperation. CONCLUSIONS: Patients who underwent retrosigmoid craniotomy, those with a history of ischemic heart disease or atrial fibrillation and those who take heparin or anticoagulants are more likely to require early reoperation. Retrosigmoid craniotomy and anticoagulant use are independent risk factors for early reoperation.