Do Sang Cho

Spontaneous Resolution of Nontraumatic Acute Spinal Subdural Hematoma

Spinal subdural hematoma (SSDH) is an extremely uncommon condition. Causative factors include trauma, anticoagulant drug administration, hemostatic disorders, and vascular disorders such as arteriovenous malformations and lumbar punctures. Of SSDH cases, those that do not have any traumatic event can be considered cases of nontraumatic acute spinal subdural hematoma, which is known to have diverse clinical progress. Treatment typically consists of surgical decompression and cases in which the condition is relieved with conservative treatment are rarely reported. We report two nontraumatic acute spinal subdural hematoma patients who were successfully treated without surgery.

Management of Proximal Iliac Artery Injury during Lumbar Discectomy with Stent Graft

Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management. Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.

Broken Mayfield Head Clamp

The Mayfield head clamp is the most frequently used head clamp system in the field of neurosurgery. In many cases, surgery is performed with complete reliance on the safety of the MHC. However, we experienced an extremely rare case in which the MHC accidentally broke while installing this system for immobilization of the head and neck. This is a case report with a brief review of the literature. The patient was a 58-year-old female who was scheduled to undergo cervical laminoplasty under the diagnosis of degenerative spondylotic cervical stenosis. In an attempt to install an MHC, we fixed three pins in the scalp; however, the arm of the MHC system broke when force was applied from both directions. Fortunately, the patient remained in a stable position and did not sustain an injury to the head or neck. Fixation was performed using another MHC, and the surgery was performed successfully. The patient was discharged after surgery with no specific complications related to the MHC system. The authors experienced an extremely rare case of MHC breakage during application and report the importance of properly managing and maintaining the instruments in order to prevent fatal injury.