A sacral filum terminale arteriovenous fistula fed by a left T9 artery of Adamkiewicz

This is a case of 62-year-old patient presenting with tingling and numbness extending from the buttocks area towards the lower extremities and gait instability. Contrast Magnetic Resonance Imaging (MRI) and time-resolved imaging of contrast kinetics Magnetic Resonance Imaging (TRICKS MRI) raised suspicion for a possible dural arteriovenous fistula. Diagnostic Digital Subtraction Angiography (DSA) showed a filum terminale arterio venous fistula (AVF) fed by the left T9 from the anterior spinal artery of Adamkiewicz all the way down to the fistulous point at L5-S1. The patient underwent successful laminectomy of L5-S1 and clipping of the filum terminale arteriovenous fistula

Sphenopalatine Artery Pseudoaneurysm Formation Following Facial Trauma: A case Report and Literature Review

Facial fractures, specifically orbitozygomatic and zygomaticomaxillary complex fractures, are well-documented and common injuries. Pseudoaneurysm formation following cerebrovascular blunt trauma is a rarely experienced complication with an incidence rate of less than 1% with only a few cases reported in the literature. Traumatic pseudoaneurysm formation of the sphenopalatine artery (SPA), the deepest branch of the maxillary artery, is extremely rare due to the deep location of the SPA and its protection from bony landmarks. In craniofacial trauma, pseudoaneurysm formation is not apparent on physical examination due to its deep location and usually presents as persistent nasal bleeding. SPA pseudoaneurysms can present as complications of surgical osteotomies, endoscopic sinus surgeries, facial trauma, or even as a progression of nasopharyngeal cancer. Endovascular embolization provides, safe, quick, and effective treatment while minimizing the morbidity of extensive surgical exposure. In this case report we describe a sphenopalatine artery pseudoaneurysm formation post trauma to provide insight to these rare entities and highlight the importance of early detection and treatment

Surgical Evacuation for Chronic Subdural Hematoma: Predictors of Reoperation and Functional Outcomes

Background Although chronic subdural hematoma (CSDH) incidence has increased, there is limited evidence to guide patient management after surgical evacuation. Objective To identify predictors of reoperation and functional outcome after CSDH surgical evacuation. Methods We identified all patients with CSDH between 2010 and 2018. Clinical and radiographic variables were collected from the medical records. Outcomes included reoperation within 90 days and poor (3–6) modified Rankin Scale score at 3 months. Results We identified 461 surgically treated CSDH cases (396 patients). The mean age was 70.1 years, 29.7 % were females, 298 (64.6 %) underwent burr hole evacuation, 152 (33.0 %) craniotomy, and 11 (2.4 %) craniectomy. Reoperation rate within 90 days was 12.6 %, whereas 24.2 % of cases had a poor functional status at 3 months. Only female sex was associated with reoperation within 90 days (OR = 2.09, 95 % CI: 1.17–3.75, P = 0.013). AMS on admission (OR = 5.19, 95 % CI: 2.15–12.52, P \u3c 0.001) and female sex (OR = 3.90, 95 % CI: 1.57–9.70, P = 0.003) were independent predictors of poor functional outcome at 3 months. Conclusion Careful management of patients with the above predictive factors may reduce CSDH reoperation and improve long-term functional outcomes. However, larger randomized studies are necessary to assess long-term prognosis after surgical evacuation

The evolution of minimally invasive surgery in liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a malignant neoplasm associated with significant mortality worldwide. The most commonly applied curative options include liver resection and liver transplantation (LT). Advances in technology have led to the broader implementation of minimally invasive approaches for liver surgery, including laparoscopic, hybrid, hand-assisted, and robotic techniques. Laparoscopic liver resection for HCC or living donor hepatectomy in LT for HCC are considered to be feasible and safe. Furthermore, the combination of laparoscopy and LT is a recent impressive and promising achievement that requires further investigation. This review aims to describe the role of minimally invasive surgery techniques utilized in LT for HCC

Frailty and Liver resection: where do we stand?

As the world population is continuously aging, the number of older patients requiring liver surgery is also on the rise. Data have shown that age should not be a limiting factor for liver resection, as it cannot accurately predict postoperative outcomes. Instead, frailty can serve as a more reliable measure of the patient’s overall health and functional reserves. Several frailty assessment tools have been implemented for preoperative risk stratification before liver surgery, and higher scores have commonly been associated with postoperative morbidity, mortality, and length of hospital stay. However, no consensus has been reached on the most useful screening tool. Future studies should focus on comparing the currently available assessment tools, constructing a liver resection-specific tool, and assessing the role of frailty assessment tools in preoperative patient optimization

sj-docx-1-ine-10.1177_15910199241233333 - Supplemental material for Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020

Supplemental material, sj-docx-1-ine-10.1177_15910199241233333 for Utilization and reimbursement of diagnostic cerebral angiograms: A Medicare trends analysis from 2013 to 2020 by Avi A Gajjar, Michael M Covell, Najib Muhammad, Cathleen Kuo, Georgios S Sioutas, Mohamed M Salem, Sebastian Ivan Fras, Brian T Jankowitz, Jan-Karl Burkhardt and Visish M Srinivasan in Interventional Neuroradiology</p