Showing 11 results for Epidural
Ali Ashraf, Gita Khanjanian, Shahrokh Yousefzadeh-Chabok, Babak Alijani, Neda Ebrahimpour, Tahere Chavoshi,
Volume 1, Issue 1 (6-2015)
Abstract
Background & Aim: Although most patients experience severe pain after major spinal fixation surgery, little attention has been paid to control it with a multi-modal approach. The aim of this study is to select appropriate method of pain management after spinal surgery. Methods &
Materials/Patients: This study was a randomized clinically controlled trial in candidates of spondylolisthesis and spinal fixation surgery under general anesthesia. 90 patients were divided into three groups, as follows: 1) Intervention group of epidural fentanyl (F): patient-controlled analgesia (PCA) pump infused 100 µg of fentanyl and 98cc of normal saline at the rate of 3-5 ml/h in the epidural space via an epidural catheter placed by surgeon 2) Intervention group of epidural fentanyl-bupivacaine (FB): PCA pump infused 100 µg of fentanyl and bupivacaine 0.125% at the rate of 3-5 ml/h in the epidural space. 3) IV morphine group (M): No medication was received epidurally. In case of visual analog scale (VAS) score more than four, one mg of IV morphine bolus was administered to patient. The blood pressure, heart rate, respiratory rate and pain severity were recorded at the moment of patient’s transfer from recovery room to the ward and compared in three groups every six hours for 24 hours. The results of this study were analyzed by statistical tests including repeated measures ANOVA, Kruskal-Wallis, Fisher’s exact test and SPSS software 16. P values less than 0.05 were considered statistically significant.
Results: The results of the study showed that VAS score in fentanyl-bupivacaine group was significantly lower than that in the two other groups during the first 18 hours. However, VAS score in all groups decreased at 24th hour postoperatively (less than three) suggesting that there was no statistically significant difference between the three groups. In this study, no serious and severe complications were observed except for a few cases of nausea in the control group.
Conclusion: Epidural analgesia with fentanyl-bupivacaine is a safe and effective way to postoperative pain management in listhesis and spinal surgeries.
Hamid Etemadrezaie, Samira Zabihian, Humain Baharvahdat, Babak Ganjeifar,
Volume 1, Issue 3 (12-2015)
Abstract
Background & Importance: Acute epidural hematoma is a very rare complication of ventriculoperitoneal shunt insertion. The insertion of a ventriculoperitoneal shunt can cause sudden decompression of the brain, subsequent to which epidural hematoma occurs due to CSF drainage. To our knowledge, there are only a few cases of acute epidural hematoma in the literature which required acute evacuation.
Case Presentation: In this report, we present a case of epidural hematoma close to ventriculoperitoneral shunt insertion site in a 30-year-old man after failure of endoscopic surgery for opening of the wall of a suprasellar arachnoid cyst. Secondary to communication between cyst and ventricles and clinical symptoms and sings, the patient underwent the shunt insertion. The patient became comatose two hours following the insertion of the shunt, developing a voluminous right temporo-parietal epidural hematoma that had to be evacuated immediately. Here, we intend to discuss both the pathophysiology and treatment.
Conclusion: Development of epidural hematoma after ventriculoperitoneal shunt surgery is a devastating complication. Dehisensce formation between the skull and dura matter, which may be facilitated by lax adhesion between the two, is a common underlying pathology. We recommend a close post-surgical observation for immediate diagnosis and reoperation of this event.
Willem Guillermo Calderon-Miranda, Nidia Escobar Hernandez, Luis Rafael Moscote Salazar,
Volume 1, Issue 3 (12-2015)
Abstract
Background & Importance: Infections of the craniocervical junction are rare.
Case Presentation: We present a case of infection by methicillin-sensitive Staphylococcus aureus and Streptococcus mitis that was not previously reported.
Conclusion: Neurosurgeons must suspect for diagnosis and initiate broad antimicrobial therapy, including active agents against gram-negative and then initiate a targeted therapy. The purpose of this report is to highlight the importance of early diagnosis for a successful medical treatment.
Parviz Samadi-Motlagh, Mohammad Shimia, Moslem Shakeri, Azad Mohammadzadeh, Firooz Salehpour, Atta Mahdkhah, Farhad Mirzaiee,
Volume 2, Issue 3 (12-2016)
Abstract
Introduction: Traumatic brain injury is considered as the major cause of mortality and hospitalization of about ten million people across the globe. Most of these patients are young and active people suffering disabilities. Tranexamic acid therapy is commonly used to reduce blood loss and need for blood transfusions in surgical cases. This study aimed at investigating the effect of tranexamic acid drug in patients with epidural hematoma.
Methods &Materials/Patients: In a clinical trial study, 100 patients with acute epidural hematoma diagnosed with traumatic brain injury were enrolled. The patients in two groups were matched for age and sex. We treated 50 patients with tranexamic acid drug that were compared with 50 patients in the control group. Hematoma size variations (diameter and volume) between the two groups were studied.
Results: We studied 100 patients with traumatic brain injury with a mean age of 34.2 ± 7.9. Of the patients, 69% were male, and 31% were female. Hematoma occurrence rate was 33%, 39%, and 28% in parietal, frontal, and temporal region, respectively. Hematoma diameter was 3.71 ± 1.8 mm after treatment with tranexamic acid, and 4.03 ± 1.6 mm in the control group. There was no statistically significant difference between the two groups. The volume of hematoma was 8.04 ± 3.2 cc in patients treated with tranexamic acid, and 10.4 ± 3.7 cc in the control group. There was statistically significant difference between the two groups.
Conclusion: According to our study, tranexamic acid drug can be effective on bleeding control in patients with acute epidural hematoma. The role of these drugs in elective surgeries has been proven. In cases of brain trauma, they can be useful and improve the prognosis of patients.
Amir Abbas Ghasemi, Atta Mahdkhah, Amir Kamalifar, Samar Kamalifar,
Volume 4, Issue 1 (1-2018)
Abstract
Spontaneous Spinal Epidural Hematoma (SSEH) is a rare spinal condition. Early surgical intervention is generally indicated to prevent serious permanent neurological deficits. We encountered a case of spontaneous spinal epidural hematomas associated with motor weakness that was treated successfully by surgical evacuation.
Luiz Alves Vieira Netto, Luís Felipe Araújo Peres, Nayara Matos Pereira, Alice Jardim Zaccariotti, Vladimir Arruda Zaccariotti, Romulo Alberto Silva Marques, João Batista Arruda, Edésio Martins, Rodrigo Alves de Carvalho Cavalcante2,
Volume 7, Issue 1 (1-2021)
Abstract
Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization.
Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively.
Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox).
Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.
Vaner Köksal, Mahmoud Osama, Mohammed Ali Alvi,
Volume 7, Issue 2 (4-2021)
Abstract
Background and Importance: Brown-Sequard Syndrome (BSS) is a rare neurological condition resulting from a hemisection injury to or unilateral compression on the spinal cord. The common causes of BSS that are amenable to be treated surgically can be divided into traumatic and non-traumatic injuries. Traumatic injuries are often reported as the main cause of BSS. However, non-traumatic injuries of the spinal cord are more seen in recent years. This study aims to classify and update surgically treatable causes of BSS.
Case Presentation: Retrospective data of 17 patients operated for BSS between 2008 and 2020 were included. The long-term outcomes of these patients were evaluated. In addition, a comprehensive search in PubMed, Scopus, and CINAHL was conducted for the retrieval of all relevant studies.
Results: Magnetic Resonance Image (MRI) of our patients revealed Cervical Disc Herniation (CDH), spinal canal stenosis with cervical spondylosis, epidural hematoma, and ossification of the posterior longitudinal ligament. The postoperative outcomes of our cases ranged from partial to complete recovery. While the patients with acute epidural hemorrhage achieved complete recovery after surgery, neurological deficits in the other patients, especially those with severe cervical spinal canal stenosis, persisted despite adequate surgical decompression. The systematic literature review revealed that CDH is the most common non-traumatic surgically treatable cause of BSS, followed by spinal cord herniation and spinal epidural hematoma.
Conclusion: Non-traumatic injuries of the spinal cord accompanied by narrowed cervical spinal canal pathologies are prominent surgically treatable causes of BSS. Contrary to the definition made 100 years ago, BSS can occur spontaneously due to underlying pathologies rather than major traumatic injuries.
Pavithran Vadakkam Muriyil, Rajeev Mandaka Parambil, Shanavas Cholakkal, Akhil Mohan, Vishal Mangala,
Volume 7, Issue 2 (4-2021)
Abstract
Background and Aim: Spontaneous Intracranial Hypotension (SIH) is a rare cause of headaches. It commonly presents with newly-developed persistent postural headaches and resolves with conservative treatment but rarely becomes a life-threatening disease. We retrospectively reviewed all cases of SIH patients treated in our institution for over ten years. Their clinical and radiological findings and the treatment given were analyzed. Their outcomes were assessed at a minimum of one year of follow-up.
Materials and Methods: We retrospectively reviewed all cases of SIH patients treated in our institution over ten years. Clinicoradiological aspects, as well as the treatment given, were analyzed. The outcome was assessed at a minimum of one year of follow-up.
Results: Six cases of SIH were studied. The Mean±SD age of the study population was 41.6±2.87 years. Four cases (66%) were female. The most common symptom was orthostatic headache which was present in all of them. The Mean±SD duration of symptoms before the diagnosis of SIH was 3±1.78 months. Four cases were managed conservatively, while one patient was managed with surgery and the other with epidural patch repair. The exact site of the leak could be delineated in 2 cases (33%). Two patients who were managed invasively for Cerebrospinal Fluid (CSF) the leak had a subdural hematoma. All patients had a favorable outcome at one year of follow-up.
Conclusion: Prompt and early identification of changes in symptom pattern and the onset of subdural hematoma are essential markers of shifting to definitive management rather than continuing conservative measures. Subdural hematoma, secondary to SIH, warrants evacuation if it causes clinical deterioration.
Jayaprakash Duraisamy, P.r Rajkumar, K.s Thirumurthy, Akshay Rajkumar,
Volume 8, Issue 1 (1-2022)
Abstract
Background and Importance: Spinal epidural hematoma (EDH) is a rare clinical condition that occurs spontaneously in patients with a spine injury. Most patients require laminectomy and evacuation of spinal EDH. Magnetic resonance imaging (MRI) of the spine with magnetic resonance angiography is the chosen radiological investigation. This study aims to review cases with spinal EDH and discuss its etiology, pathogenesis, investigations, and various management strategies.
Case Presantation: This is a retrospective analysis study of five spinal EDH cases admitted at our institute from August 2020 to August 2021. Four patients underwent laminectomy and evacuation, while one was managed conservatively because of rapid clinical improvement. The patients’ functional outcomes were assessed by using American spinal cord injury association impairment scale (AIS) before and after treatment. Four of the five patients who participated in this study had significant neurological improvement. One of the patients who presented late to us had poor neurological recovery despite the surgical intervention.
Conclusion: Surgical evacuation of spinal EDH within 48 hours of the onset of symptoms ensures good clinical recovery. Spontaneous resolution is possible in some cases if patients have an improvement in their neurological status early in the course of the disease. Hence, we conclude that prompt treatment in spinal EDH patients ensures maximum functional recovery. Patients with spinal EDH need close follow-up and periodical neurological examination.
Sajag Kumar Gupta, Mohd Faheem,
Volume 9, Issue 0 (1-2023)
Abstract
Background and Aim: We assessed surgical cases with giant epidural hemorrhages that have a significant influence on therapeutic as well as clinical prognosis.
Methods and Materials/Patients: A total of 112 cases underwent surgery for epidural hemorrhage in an Emergency Neurosurgical Department of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India (a rural hospital), between January 1, 2022, and March 31, 2023. We defined giant epidural hemorrhage as a quantity of more than 80 cc. The therapeutic and prognostic features of 15 people with giant epidural hemorrhage with a hematoma volume of 80 cc were studied further.
Results: The most prevalent age group was between 20 and 40 years (53.33%). M2 response (60%) represented the most frequent motor movement among giant epidural hemorrhage victims who underwent surgery. The majority of them (86.66%) suffered from serious brain damage. The Glasgow Coma Scale (GCS) score on admission, pupil alterations, and motor movement were all associated with the prognosis of giant epidural hemorrhage surgery.
Conclusion: Giant epidural hemorrhage > 80 cc performs badly. The GCS on admission, pupil alterations, and motor movement are all markers of the operative prognosis of a large epidural hemorrhage.
Vikrant Yadav, Nityanand Pandey, Ravi Shankar Prasad,
Volume 10, Issue 0 (1-2024)
Abstract
Background and Importance: Epidural hematoma (EDH) and subdural hematoma (SDH) are intracranial emergencies and are extremely lethal if not treated promptly. The coexistence of both of these entities in a patient with traumatic brain injury (TBI) leads to a catastrophe of events. Occurrence
of both EDH and SDH, on the same side after single trauma is extremely rare. Sometimes, the EDH volume compresses underlying SDH, which in turn leads to radiological obliteration of SDH, leading to misjudgment in surgical planning.
Case Presentation: The authors present two cases of TBIs, in which patients were initially operated on EDH, but later, postoperative scans revealed SDH on the same side, which was not visible in preoperative scans. Identification of SDH in postoperative scans prompted a second surgery.
Conclusion: EDHs and SDHs are fatal types of TBIs if left untreated. A large-sized hematoma needs surgical evacuation as early as possible. Intraoperative dural pulsation and bulge determine the decision for durotomy. In both index cases, delay in presentation, extent of primary brain
injury, and radiological limitations in diagnosing both EDH and SDH leading to further delay in the complete evacuation of hematoma were the chief reasons for the poor prognosis. Through this article, the authors want to emphasize the fact that surgeons should consider this type of radiological phenomenon, which in turn is useful in maximizing the limited resources of hospitals and minimizing the surgical burden of the patients.
