We describe the nuances in intraoperative and postoperative management.
CLINICAL PRESENTATION: A 31-year-old woman who recently received a diagnosis of with LDS type II presented to neurosurgical attention for management of an unruptured right ophthalmic artery aneurysm. The patient underwent a right pterional craniotomy for clipping of the aneurysm, with lumbar drain placement before the procedure. Papaverine had to be used several times to counteract vasospasm of the vessels during arachnoid dissection. Because of vascular reactivity, temporary clipping was not used, and the aneurysm was clipped successfully.
CONCLUSION: LDS is
a newly described disorder that warrants awareness in the neurosurgical community because of its association with intracerebral aneurysms as well as craniosynostosis (19%), scoliosis (20%), cervical spine instability (7%), hydrocephalus, and Arnold-Chiari malformation. When selleck chemical clipping aneurysms in these patients, the surgeon should be aware of the potential for severe vascular reactivity during dissection and avoid temporary clipping when possible. Avoidance of lumbar drainage intraoperatively reduces the risk of intracranial
hypotension after removal.”
“Objective: The purpose of this study was to evaluate the difference in amputation-free survival and patency rates of infra-inguinal bypass grafts in patients U0126 order with critical leg ischemia (CLI) with vein conduits Sitaxentan with an internal diameter <3 mm compared to those with vein conduits with a diameter of >= 3 mm.
Methods: Retrospective analysis of all consecutive patients with CLI undergoing infra-inguinal bypass. Preoperative duplex scan mapping and measurement of potential vein grafts
were performed on all patients. Patients were recruited in a 1-year duplex scan graft surveillance program. Primary end points were amputation-free survival and patency rates at 1 year postoperatively. Kaplan-Meier and chi(2) test were used for statistical analysis.
Results: Between January 2004 and April 2010, 157 consecutive patients with CLI underwent 171 bypasses using vein conduits ( 111 men, 46 women; median age, 75 years; range, 45-96 years). Ninety-three bypasses (54.4%) were performed for tissue loss, 44 (25.7%) for gangrene, and for rest pain. Of the 157 patients, 113 (72.0%) had diabetes mellitus, 40 (25.5%) hid renal impairment, 131 (83.4%) had hypertension, and 64 (40.8%) had ischemic heart disease. Femoropopliteal bypass was performed in 38 cases (22.2%), whereas 133 (77.8%) of the bypasses were femoro-distal. Autogenous great saphenous vein (GSV) was used in all cases. All grafts were reversed. The diameter of 31 (18%) vein conduits measured <3 mm (range, 2-2.9 mm) on preoperative duplex scan. One hundred thirty-four grafts had at least 1-year follow-up.