Laser-Assisted Excision of Coil Mass While Clipping Recurrent Intracranial Aneurysms After Prior Endovascular Coiling: Our Initial Experience.

BACKGROUND: Excision of coil mass during clipping of recurrent or residual aneurysms after prior endovascular coiling is challenging. We evaluated the use of the carbon dioxide laser for safe and effective removal of coils during aneurysm surgery. Two cases are presented. CASE DESCRIPTION: The first patient was a 56-year-old man with a previously coiled ruptured anterior communicating artery aneurysm. Angiography at 3-year follow-up showed recurrent aneurysm, which could not be coiled again owing to technical reasons. An aneurysm clip could not be safely applied owing to the weight of the coil mass compromising the parent vessel lumen. Laser-assisted coil mass resection was performed before permanent clip application. Intraoperative cerebral angiography showed complete obliteration of the aneurysm. The second patient was a 69-year-old woman with a previously coiled unruptured middle cerebral artery aneurysm. Angiography at 2-year follow-up showed recurrence of the aneurysm, which could not be coiled again owing to technical reasons. Laser-assisted coil mass resection was performed before the aneurysm was safely clipped. Intraoperative angiography showed complete obliteration of the aneurysm. No complications occurred using the carbon dioxide laser. At 1-year follow-up, both patients were asymptomatic with no evidence of aneurysmal recurrence. CONCLUSIONS: Excision of coil mass is required while treating recurrent and/or residual intracranial aneurysms that were previously treated by endovascular technique. The use of carbon dioxide laser assistance while retrieving these coils is safe and effective.

Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

Anatomical complications of epidural anesthesia: A comprehensive review.

Epidural anesthesia is a versatile technique widely used in treating lumbar spinal pain syndromes. Complications during these procedures can arise either from needle placement or from administration of medication. Potential risks include infection, hematoma, intravascular or subdural injections of medication, direct nerve trauma, air embolism, entry into a disc space, urinary retention, radiation exposure, and hypersensitivity reactions. The objective of this article is to review the complications of lumbar epidural injections and discuss the potential pitfalls related to these procedures. We searched Medline comprehensively for relevant case reports, clinical trials, and review articles. Complications from lumbar epidural injections are extremely rare. Most if not all of them can be avoided by careful techniques with accurate needle placement, sterile precautions, and a thorough understanding of the relevant anatomy and contrast patterns on fluoroscopic imaging. Clin. Anat. 30:342-346, 2017. © 2017 Wiley Periodicals, Inc.

Unusual Manifestation of Superior Mesenteric Artery Syndrome in a Female Patient: A Case Presentation.

Superior mesenteric artery (SMA) syndrome is a rare clinical entity. We report a female patient presenting with abdominopelvic pain and diagnosed with superior mesenteric artery syndrome. Direct venography revealed a large ovarian varix that was treated with hysterectomy and unilateral oophorectomy. SMA syndrome can have many presentations often with small bowel obstruction. Obstruction of only the ovarian vein with resultant ovarian varix is an unusual presentation.