Pseudoaneurysms of the superficial temporal artery are mostly traumatic in origin. Here, a case of a superficial temporal artery aneurysm that emerged following a recraniotomy is presented. A 59-year-old woman was admitted with subarachnoid hemorrhage. She underwent a pterional craniotomy and clipping of a saccular aneurysm of middle cerebral artery bifurcation. A control digital subtraction angiography on the 3rd postoperative day revealed partial filling of the aneurysm and a revision was performed. The second control digital subtraction angiography on the 4th postoperative day of the revision showed a pseudoaneurysm of the left superficial temporal artery. The pseudoaneurysm was excised successfully under local anesthesia. In conclusion, pseudoaneurysm of the superficial temporal artery should be considered among the early postoperative complications of the surgical procedures at the superficial temporal artery territory. Although some conservative approaches are used, excision of the aneurysm is recommended for treatment.KeywOrds: Aneurysm, Craniotomy, DSA, Pseudoaneurysm, Superficial temporal artery ÖZYüzeysel temporal arter yalancı anevrizmaları çoğunlukla travması sonrası oluşurlar. Bu yazıda yinelenen kranyotomi sonrasında ortaya çıkan bir yüzeysel temporal arter yalancı anevrizması sunulmaktadır. 59 yaşındaki kadın hasta subaraknoidal kanama sebebiyle getirildi. Pteriyonel kranyotomi ile orta serebral arter bifurkasyon anevrizması kliplenmesi ameliyatı yapıldı. Postoperatif üçüncü günde yapılan kontrol dijital anjiyografi anevrizmada kısmi dolum kusuru gösterdiği için klip düzeltme ameliyatı yapıldı. Düzeltme ameliyatından sonraki 4. günde yapılan ikinci dijital anjiyografi incelemesinde sol yüzeysel temporal arterde bir adet yalancı anevrizma olduğu görüldü. Bu yalancı anevrizma lokal anestezi ile eksize edildi. Sonuçta, yüzeysel temporal arter bölgesindeki cerrahi girişimlerin erken komplikasyonlar arasında yalancı anevrizmaları da düşünmek gerekir. Yalancı anevrizmaların tedavisinde tutucu yöntemler kullanılsa da, tedavi için cerrahi çıkarım önerilmektedir.
Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as “BT.” Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.
Those patients at or under the age of 3, with severe head injury, cerebral edema, intraparenchymal hemorrhage, or depressed skull fracture, have a higher incidence of PTEE. Moreover, because the GOS of these patients are prone to be worse, antiepileptic therapy in acute stage may be effective in preventing the secondary brain damage.
The rate of vascular variations in patients with aneurysms was 57.8%. Arterial hypoplasia and aplasia were the most common variations. ACS was the most common region that variations were located in; they were mostly detected on the right side. Coexistence of ACoA aneurysm was higher than PCoA and MCA aneurysms. In the PCS variations group, PCoA aneurysms were the most common aneurysms that accompanying the variation and multiple variations were more common than in the other two groups. The variations in MCS were most common in males.
AIm: To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine Thoracolumbar Injury Classification System have any superiority to each other regarding the reliability of their recommendations in the surgical management of unstable thoracolumbar burst fractures. mATERIAl and mEThODS: Fifty-five consecutive patients with thoracolumbar burst fractures undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. TLICS and AO systems were compared based on patients' American Spinal Injury Association (ASIA) scores and they were analyzed for their safety and reliability.RESulTS: A total of 55 patients were studied. Neurological deficits were detected in 18 patients and the remaining 37 patients had normal neurological functions. All the patients with neurological deficits received >4 points according to TLICS. There were 14 patients with incomplete spinal cord injury and all of them received >4 points according to TLICS (p<0.01). On the other hand; 8 of these 14 patients received 4 points according to the AO system. None of the 37 patients without neurological deficit received <4 points of TLICS whereas 18 of these 37 patients received 3 AO points, to whom AO recommends conservative treatment despite the fact that they had unstable burst fractures (p<0.01). CONCluSION:Recommendations of TLICS might be more reliable than those of AO particularly for guiding the surgical management of unstable thoracolumbar burst fractures without neurological deficit. However, this conclusion needs to be verified with further multicenter prospective studies.
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