Traumatic arteriovenous fistula from internal maxillary artery following trigeminal balloon compression.

We describe the development of a direct traumatic arteriovenous fistula arising from the internal maxillary artery after an uneventful percutaneous trigeminal balloon compression for trigeminal neuralgia, and its management through embolization and radiosurgery.

Early mobilisation does not increase the complication rate from unintended lumbar durotomy.

BACKGROUND: Unintended durotomy is a well-recognised complication of lumbar spine surgery. Reported complications include headaches, intracranial haematomata, pseudomeningocoele and infection. Methods of intraoperative repair vary and although post-operative flat bed rest is advocated by some, there is no consensus on duration. We reviewed a series of unintended durotomies that occurred in our institution and reviewed them to compare management strategies and outcome. METHODS: A retrospective analysis was conducted of adult patients who experienced an unintended durotomy during surgery for lumbar degenerative disease in our neurosurgical unit over a 15-month period. Post-operative complications were followed up for a minimum of 3 months. RESULTS: 1125 patients underwent elective or emergency decompressive lumbar spine surgery. 45 (4%) dural tears were identified; all were repaired intra-operatively with suturing, Tisseal thrombin glue or both. Absence of leakage was confirmed on Valsalva manoeuvre for all cases, before wound closure. 28 patients were mobilised within 24 hrs of surgery, 16 patients between 24-48 hours and 1 patient after 48 hours. Seven patients (16%) with a dural tear experienced a complication. There was no statistically significant relationship between time to post-operative mobilisation and complication rate (p = .76). There was a significantly longer inpatient stay when patients were on bed rest for longer (2 tailed test significant at the 2% level). CONCLUSION: Duration of post-operative bed rest was not related to complication rate but led to delays in discharge. We did not find evidence that early mobilisation lead to increased likelihood of complications.

Idiopathic normal pressure hydrocephalus: an important differential diagnosis.

Idiopathic normal pressure hydrocephalus, an uncommon but important differential diagnosis for ataxia, cognitive impairment and urinary incontinence, is surgically treatable, unlike many of its differential diagnoses. This article discusses its assessment, investigation and therapeutic interventions.