A Case Series of Late Vascular Lesions of Traumatic Etiology: Endovascular and Surgical Approaches.

There is a broad spectrum of pathology in traumatic vascular injury. Arteriovenous fistula (AVF) is an abnormal communication between the high-flow arterial system and the low-flow venous network, directly connecting the afferent artery and nearby draining veins without the regular intervention of the capillary bed. Most of these fistulas occur due to incidental or iatrogenic injury. A retrospective review of procedures performed by an endovascular surgeon in a tertiary center identified 15 cases of vascular injuries that encompassed all these different clinical scenarios, including post-traumatic, iatrogenic, or spontaneous origin. The information collected, including patient age, sex, previous symptoms, and treatment, was gathered from medical records. In addition, information on procedural technique, endovascular devices used, and specific intraprocedural details were collected from procedure notes and angiographic images. A broad spectrum of injuries can present as late trauma complications (over three months); endovascular treatment is a safe and effective approach for intracranial and extracranial injuries. Endovascular treatment can be a sole option or adjuvant to other hybrid therapies and has emerged as essential for treating these lesions as a first option. We have described standard techniques to treat different vascular pathologies, sometimes with limited resources.

Cauda Equina Syndrome in a Patient with Intradural Schwannoma at the Same Level as an Acute L2 Compression Fracture.

Intradural tumors are found often as either incidental findings or during evaluation during magnetic resonance imaging (MRI) for lumbar and/or radicular pain. This patient presented with an acute L2 compression fracture, however, the initial MRI identified a large spinal mass separate from the fracture but at the same level. The patient had acute upper lumbar pain after a fall but the neurologic examination also revealed findings of early cauda equina syndrome with muscle weakness, asymmetric leg numbness, and urinary incontinence. Further history revealed the patient had been using a cane for several months and having difficulty walking with some upper lumbar pain but had not seen a physician. The differential was an extruded disc associated with the fractured endplate versus a tumor. Because of the neurologic symptoms, emergency open decompression combined with multilevel screw fixation was performed. At the time of the laminectomy, the dura bulged posteriorly, no ventral disc was found, and a 3-cm intradural schwannoma was successfully excised with rapid neurologic recovery. The article will review the relationship of cauda equina syndrome with osteoporotic fractures and the rarity of actual true disc extrusion with compression fractures, as well as the more common relationship of finding cauda equina syndrome with intradural tumors when there is severe canal stenosis as seen in this unusual case.