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Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression.
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http://dx.doi.org/10.4184/asj.2015.9.3.452 | DOI Listing |
J Neurosurg Case Lessons
September 2025
Division of Pediatric Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California.
Background: Intracranial hypotension (IH) is a secondary headache syndrome that can result from spontaneous or iatrogenic CSF leaks. Subdural hematomas (SDHs) are a particularly dangerous sequela of IH. Although epidural blood patch (EBP) is a recognized treatment for IH, its use in pediatric patients with SDH as a solitary intervention has not been reported.
View Article and Find Full Text PDFFront Neurol
August 2025
Department of Mini-invasive Spinal Surgery, The Third People's Hospital of Henan Province, Zhengzhou, Henan, China.
Background: This study aimed to develop and validate the first nomogram model for predicting postoperative complications in thoracic spinal stenosis (TSS) patients undergoing unilateral biportal endoscopy (UBE), integrating multidimensional risk factors to provide a quantitative basis for preoperative risk evaluation and individualized treatment planning.
Methods: Patients were divided into a retrospective training cohort ( = 375) and a prospective validation cohort ( = 100). Baseline clinical data [age, diabetes, preoperative Japanese Orthopaedic Association (JOA) score], radiographic parameters (Spinal cord/canal area (SC/ECA) ratio, intramedullary high signal, thoracic kyphosis (TK) angle), and surgical variables (intraoperative blood loss, number of lesion segments, dural adhesion, etc.
World Neurosurg
September 2025
Department of Neurosurgery, Independent Public Specialist Western Hospital John Paul II in Grodzisk Mazowiecki, Daleka 11, 05-825, Grodzisk Mazowiecki, PL. Electronic address:
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat herniated discs, degenerative disc disease, and nerve root compression in the cervical spine. This systematic literature review aims to analyze the available literature on the incidence, risk factors, clinical considerations, and available therapies for spinal epidural hematoma (SEH) following ACDF.
Methods: A systematic search was conducted in PubMed, Google Scholar, and Embase from database inception to June 18, 2025, following the PRISMA guidelines.
J Neurotrauma
September 2025
The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Cerebrovascular autoregulation (CA) is a protective mechanism against brain injury. We present an ultrasound-based volumetric blood flow indices to monitor CA. Swine were instrumented under general anesthesia to monitor mean arterial blood pressure (MAP), intracranial pressure (ICP), and blood flow in the internal carotid artery (ICA) and femoral artery (FA) and flow velocity and volumetric flow in the middle cerebral artery (MCA) using transcranial Doppler.
View Article and Find Full Text PDFEur Spine J
September 2025
Health Science University Istanbul Kanuni Sultan Süleyman Education and Training Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
Background: Opioid-free analgesia is critical in pediatric patients with complex comorbidities to avoid adverse effects, such as respiratory depression. Patients with tethered cord syndrome (TCS), often presenting with conditions like spina bifida, renal impairment, and musculoskeletal deformities, pose unique perioperative challenges that demand alternative pain management strategies.
Case: We present the case of an 11-year-old male with spina bifida and chronic kidney disease (CKD) undergoing tethered cord release surgery.