Foot Drop After Iliocaval Vein Stenting: Radicular Syndrome from Stent Misplacement in Spinal Canal.

BACKGROUND: Endovascular procedures have become more and more prevalent in both general vascular and neurosurgical practices. Because these procedures rely on real-time bidimensional control through fluoroscopic guidance, they can be prone to spatial misplacement in the third dimension when not controlled in 2 different radiologic planes. CASE DESCRIPTION: We report a unique complication of an iliocaval vessel stenting procedure with misplacement of a venous stent in the spinal canal. This case illustrates the close vascular relationship between the large venous vessels of the abdomen and pelvis and epidural plexus of the spinal canal. CONCLUSIONS: The complex venous anatomy of the lumbar region and lumbar epidural space is illustrated in this unique case. We believe this may serve both vascular surgeons and neurosurgeons in their daily practice.

Degenerative Disc Disease Mimicking Spondylodiscitis with Bilateral Psoas Abscesses.

BACKGROUND: Sequestered disc fragments may present as a lesion with peripheral enhancement on magnetic resonance imaging. When located in the psoas muscle compartment, this finding could mimic an abscess. CASE DESCRIPTION: We describe a case of a 52-year-old man who returned from Togo after 2 years of living in precarious conditions. He was afebrile and complaining of lumbar back pain. The magnetic resonance imaging showed L3 and L4 vertebral body enhancement with bilateral psoas lesions in continuity with the disc space, suggesting spondylodiscitis with a differential diagnosis of inflammatory herniated disc. A computed tomography-guided biopsy of the right psoas lesion was performed to rule out spondylodiscitis. Histology was compatible with extruded disc material. CONCLUSION: Herniated disc fragments should be considered as a differential diagnosis of psoas abscesses. Coronal plane images may show the continuity of bilateral herniated disc fragments, mimicking psoas abscesses.

Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study.

OBJECTIVE: Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI. METHODS: Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications. ResULTS: This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant intraoperative brain swelling was documented in 50.6% of the procedures. Surgery-related complications occurred in 89 cases (32%). CONCLUSION: This study highlights the lack of standardized and systematic documentation of technical aspects of surgical treatment of patients presenting with severe TBI in Switzerland. Technical strategies such as size of craniectomy and the use of perioperative ICP measurement were not documented in a standardized manner. A prospective systematic surgical documentation system might contribute to future formulation of recommendations for the surgical treatment of patients presenting with severe TBI in Switzerland.

Solitary fibrous tumour with intramedullary component: case report and review of the literature.

Solitary fibrous tumours (SFTs) are rare WHO grade I mesenchymal neoplasms that were first described in the visceral pleura. A wide variety of locations of SFT have been reported but only twelve cases of intramedullary solitary fibrous tumour. We report a case of thoracic spinal cord SFT. A 49-year-old woman presented with clinical signs of dorsal myelopathy. Magnetic resonance imaging revealed an intradural mass at level T9-T10 which showed imaging features consistent both for an intra- and an extramedullary location of a solid tumour. Imaging findings were confirmed during surgery which was successful in resecting the extramedullary component. The intramedullary component could only be partially resected. Solitary fibrous tumour is a rare pathological entity in the central nervous system. The course of intramedullary SFT is unknown and careful long-term follow-up is recommended.

[When should a patient with low back pain/sciatica be referred to the emergency ward?]. / Quand référer aux urgences un patient présentant une lombalgie/ lombosciatalgie aiguë?

Low back pain and sciatica are common causes of medical consultation. The medical history and the physical examination are essential in their management. The primary care physician initiates treatment and relies on his physical examination to identify "red flags" that require further investigations. Regarding sciatica, it is essential to identify 3 clinical entities that require prompt referral to the emergency department for prompt neurosurgical management. These include hyperalgic sciatica, sciatica with motor deficits and the cauda equina syndrome. Sciatica with sensory deficits do not require emergency department referral.