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Ultrasound-Guided Posterolateral Approach for Midline Calcified Thoracic Disc Herniation
Tan, Lee A.,Lopes, Demetrius K.,Fontes, Ricardo B.V. The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.6
Objective : Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. Methods : We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. Results : The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. Conclusion : Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.
Jacquelyn A. Corley,Manish K. Kasliwal,Lee A Tan,Demetrius K. Lopes 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3
With rapidly increasing numbers of neuroendovascular procedures performedannually in recent years, use of arterial closure devices after femoral arteryaccess has been exceedingly common secondary to reduced time tohemostasis, decreased patient discomfort, earlier mobilization, and shortenedhospital stay. Although uncommon, use of these devices can leadto a different spectrum of complications, as compared to manual compression. Ischemic symptoms following the use of these devices can have unexpectedclinical sequelae and can occur in a delayed fashion. Awarenessand recognition of such complications is important with the dramaticallyincreased use of these devices in recent years. We report on a case ofdelayed vascular complication manifesting as vascular claudication followinguse of the AngioSeal closure device.
Lee A Tan,Kiffon M. Keigher,Demetrius K. Lopes 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.2
Symptomatic Cerebral Air Embolism During Stent-assistedCoiling of an Unruptured Middle Cerebral Artery Aneurysm:Intraoperative Diagnosis and Management of a RareComplication
Treatment of a Ruptured Vertebrobasilar Fusiform Aneurysm Using Pipeline Embolization Device
Lee A Tan,Roham Moftakhar,Demetrius K. Lopes 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.1
Treatment options of ruptured vertebrobasilar fusiform aneurysms (VFA) are limited and often carry significant mortality and morbidity. We report the use of Pipeline Embolization Device (PED) to successfully treat a patient with a ruptured vertebrobasilar fusiform aneurysm (VFA) who presented with subarachnoid hemorrhage (SAH). A 73 year-old man with a history of cardiac stent placement seven days earlier presented with Hunt-Hess II SAH. He was taking aspirin and clopidogrel. Computed tomography angiogram revealed a large vertebrobasilar fusiform aneurysm. Microsurgical treatment options are technically challenging and carry high risk. He underwent endovascular treatment of the ruptured VFA using overlapping PEDs. Five PEDs were placed in a telescoping fashion to reconstruct the affected portions of the left vertebral and basilar arteries. An additional 2-mm blister aneurysm in the right vertebral artery was also discovered during the conventional cerebral angiography and was treated with one additional PED. The patient remained neurologically intact after the procedure. He was continued on aspirin and clopidogrel. Follow-up magnetic resonance imaging at three months demonstrated patency of the stents without any evidence of ischemic change. Follow-up conventional cerebral angiogram at six months demonstrated thrombosis of the VFA and reconstruction of the vertebrobasilar system. The patient remained clinically well. An endovascular approach using PEDs can be a safe and effective treatment option for ruptured VFA in selected cases.
Lee A Tan,Carter S. Gerard,Kiffon M. Keigher,Roham Moftakhar,Demetrius K. Lopes 대한뇌혈관외과학회 2015 Journal of Cerebrovascular and Endovascular Neuros Vol.17 No.1
Cerebral spinal fluid (CSF) diversion is frequently required in patients with aneurysmal subarachnoid hemorrhage who develop subsequent hydrocephalus. Procedures such as external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS) usually carry a very low rate of complications. However, as flow diverting stents such as Pipeline Embolization Device (PED) become more widely available, flow diverters are being used in treatment of some ruptured complex aneurysms. EVD and VPS placement in the setting of dual antiplatelet therapy (DAT) in these patients are associated with a significant risk of intracranial hemorrhage. We describe a management strategy and surgical technique that can minimize hemorrhagic complications associated with VPS in patients on DAT after treatment with flow diverting stents.