Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections. (25/76)

CASE REPORT: Two cases are presented in which the complication of dural puncture is documented in the context of a lumbar transforaminal epidural steroid injection. The hazard of dural puncture during transforaminal epidural injections, the anatomy of the dural and thecal sac, the potential for subdural injections, and relevant literature are reviewed. DESIGN: Report of two cases. BACKGROUND: Lumbar transforaminal epidural steroid injections are a commonly employed procedure for the treatment of lumbar radiculopathy. The optimal target point lies at the "6 o' clock" position of the pedicle. Contrast is injected to confirm proper placement of the needle and correct flow of the medication through the epidural space. Despite apparent proper placement of the needle, a potential complication exists of puncturing the dura while performing this procedure. Spinal injectionists should recognize the subsequent contrast patterns associated with this complication. CONCLUSION: Subdural and intrathecal spread of contrast is rarely seen with transforaminal injections and thus can be easily overlooked. Becoming familiar with the images presented in these cases may help alert the interventionalist of a dural puncture, and thus avoid injection of medications into the intrathecal and subdural spaces.  (+info)

Phase I trial: safety and feasibility of intracranial electroencephalography using hybrid subdural electrodes containing macro- and microelectrode arrays. (26/76)

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Subdural intrathecal catheter placement: experience with two cases. (27/76)

BACKGROUND: Subdural migration of epidural catheters is well known and documented. Subdural placement of intrathecal catheters has not been recognized. Two cases of sudural placement of intrathecal catheters are presented. OBJECTIVE: The possibility of subdural migration of epidural catheters and its manifestations has been well documented. The following 2 cases demonstrate that intrathecal catheters can enter the subdural space upon placement. CASE REPORTS: The first case is a 52-year-old male with multiple sclerosis receiving a pump for intrathecal baclofen. It worked well for 10 years, but after 2 months of inadequate relief despite a 2-fold increase in baclofen, the catheter was imaged. The catheter pierced the arachnoid in the lower thoracic spine and tunneled subdural. It then pierced the arachnoid again, re-entering the cerebrospinal fluid (CSF) in the cephalad portion of the thoracic spine. Over time, the tip became covered with tissue, preventing direct CSF communication and causing subdural drug sequestration. The second case is a 54-year-old male with chronic bilateral lower extremity pain having a pump placed for pain control. Because of inadequate relief after implantation, the catheter was imaged. It pierced the arachnoid at L4-L5 but became subdural at T12-L1. At the time of surgical revision, the catheter was pulled back to L2. Repeat imaging showed it to be entirely subarachnoid, and analgesia was restored. CONCLUSIONS: These cases differ from others in the literature because the catheter was apparently subdural at the time of initial implantation. As these 2 cases demonstrate, this placement may manifest immediately, but it may remain undetected for a prolonged period. Initial subdural placement should be considered along with catheter migration into the subdural space in the differential of a malfunctioning pump.  (+info)

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients. (28/76)

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Association of subdural hematoma with increased mortality in lobar intracerebral hemorrhage. (29/76)

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Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery. (30/76)

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Bilateral acute subdural hematomas with intracerebral hemorrhage without subarachnoid hemorrhage, caused by rupture of an internal carotid artery dorsal wall aneurysm. Case report. (31/76)

A 45-year-old man presented with bilateral acute subdural hematomas (ASDHs) without subarachnoid hemorrhage (SAH). He was found comatose in a parked car. Computed tomography showed left frontal intracerebral hemorrhage (ICH) and bilateral ASDHs but no signs of SAH. Magnetic resonance angiography demonstrated an internal carotid artery dorsal wall aneurysm. Emergent surgical intervention was performed. However, he died of cerebral herniation 6 days later. We inferred that massive intracranial bleeding might have ruptured through the cortex and lacerated the arachnoid membrane. Aneurysm rupture generally results in unilateral SDH, whereas trauma is the usual cause of bilateral ASDHs with ICH. Our case suggests that ruptured aneurysm should be considered in patients with non-traumatic bilateral ASDHs without SAH.  (+info)

Decoding movement-related cortical potentials from electrocorticography. (32/76)

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