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Complications of iliofemoral venous recanalization and stent placement
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
A potentially disastrous bleed could occur as a result of inadvertent passage of wire and or catheter into the epidural space via the epidural venous plexus. There is commonly a rich network of veins in and around the vertebral canal which are in direct communication with iliac veins and IVC. These connections are frequently used during diagnostic and therapeutic maneuvers for venous malformations of the spine and the cord. In an acute or chronic occlusion of the iliocaval segments, it is possible to inadvertently enter these collateral veins and puncture through into the epidural space. Awareness of this pitfall and frequent venography in orthogonal projections can avoid this rare but devastating complication that may lead to serious neurologic injury.
Pregnancy and neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Alexandra Kisilevsky, Alana M. Flexman
Although spinal surgery in the parturient in the lateral decubitus position is possible,41 the prone position may be preferred for optimal surgical access. As discussed previously, this position can be safely adopted in pregnancy by using a four-post frame (see Positioning section above). An additional consideration is the theoretical risk of increased bleeding during spine surgery due to engorgement of the epidural venous plexus during pregnancy. Despite this risk, successful spine surgery has been performed without significant blood loss.28,41
The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
The epidural venous plexus communicates with the lumbar veins of the inferior vena caval system as well as the azygous system, the basivertebral vein, and the intracranial venous sinuses, including the sigmoid, occipital, and basilar venous sinuses. The epidural venous plexus extends its reach to the iliac veins through the sacral venous plexus.
Technical note: Novel use of recombinant tissue plasminogen activator for the evacuation of an acute extensive spinal epidural haematoma in a patient with coagulopathy
Published in British Journal of Neurosurgery, 2023
Stavros Koustais, Kieron J. Sweeney, Ciaran Bolger
Spinal epidural haematoma is a rare entity, usually isolated to a few vertebral levels, which may potentially lead to long-term neurological disability.1 The estimated incidence is 1 per million patients2 and is most common in the fourth and fifth decades of life.3 The majority are associated with trauma, anticoagulation therapy and arteriovenous malformations.4 The exact pathogenesis of spontaneous spinal epidural haematoma remains unclear, however the epidural venous plexus has been thought to be the main source of haemorrhage by many authors. This valveless venous plexus is thought to be at risk of rupture and haemorrhage following activities that may result in increase in the intraluminal pressure, such as straining, coughing and voiding.5 Patients may present with back pain followed by symptoms and signs of neural compression. Neurological recovery has been reported in selected patients who had been managed conservatively, having exhibited early signs of improvement,6,7 however in patients without early neurological improvement or with deteriorating neurological function, the long term neurological outcome depends on the degree of initial neurological deficit and the timing of surgical intervention.1
Intraspinal hypotension syndrome presents as transient quadriplegia
Published in British Journal of Neurosurgery, 2018
Miki Katzir, Svetlana Tov, Ayelet Eran, Gill E. Sviri
The spinal epidural space contains a valveless, longitudinally oriented epidural venous plexus known as Batson’s venous plexus. Leakage of CSF is compensated by spinal venous engorgement.2 The craniocervical junction and upper cervical spine segments of the anterior internal venous plexus which anastomose with the vertebral arteriovenous plexus, anterior condylar vein and the suboccipital venous plexus are more prominently affected than the lower cervical segments.3 The CSF hypotension-related headache is caused by relative sinking of the brain in the skull leading to traction of suspending pain sensitive structures.
Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study
Published in Neurological Research, 2021
Chao Wu, Jiayan Deng, Bofang Zeng, Yuan Fang Zhu, Tao Li
In the operation of C1 pedicle screw implantation, attention should be paid to the following. First, to enhance the stability of the navigation template, the base of the template should contain the posterior tubercle of the C1. Second, great care was taken to avoid disrupting the large epidural venous plexus along the C1–C2 joint. Third, the K-wires should be inserted into the pedicle in a step-by-step fashion, even under the guidance of navigation templates. Fourth, the medial edge of the C1 pedicle was carefully separated by a nerve probe and was used to judge the safety of the entry point.