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Giorgio Di Ricco, Carlo Marini, Maurizio Rindi, Vitale Ravelli, Lodovico Lutzemberger, Giorgio Tusini and Carlo Giuntini

T he mortality rate from pulmonary embolism (PE) is still high. In the United States some 142,000 fatal cases a year are reported in hospitalized patients. 15 Little is known about PE in neurosurgical patients. In four series totaling over 1200 patients, the incidence of fatal pulmonary emboli in cases with acute paraplegia was 2%. 8 It has been reported that most neurosurgical patients die “within minutes of the onset of symptoms” without any possibility of treatment. 13 This work was designed to investigate the presence of signs and/or symptoms helpful

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Wong Wai Kwan, Ng King Kwi and Lim Eng Chye

V enous intravasation of Pantopaque with pulmonary embolism is a rare complication of myelography. Of 13 cases of venous intravasation during myelography reported in the English literature, 2–4, 6, 7, 9–13 only six had radiographic demonstration of pulmonary embolism. 4, 7, 10–13 Case Report A 13-year-old girl presented with a 1-year history of pain in the right hip radiating to the right foot. Clinical examination suggested involvement of the right L-5, S-1, and S-2 nerve roots. At myelography, a lumbar puncture at the L4–5 level was traumatic, it was

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Karl W. Swann, Peter McL. Black and Mary F. Baker

N eurosurgical patients are often at risk for the development of deep vein thrombosis (DVT) of the lower extremity and/or pulmonary embolism (PE) due to prolonged surgery, immobilization, paralysis, advanced age, and malignancy. 7, 23 Deep vein thrombosis is reported to occur in 29% to 43% of neurosurgical patients. 14, 25 While the incidence of PE has not recently been analyzed in neurosurgical patients, Wetzel, et al. , 28 have implicated this event in 3% of neurosurgical deaths. Management of DVT and PE in neurosurgical patients can be problematic

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Ahmad Khaldi, Naseem Helo, Michael J. Schneck and Thomas C. Origitano

hemorrhage rate between the control group (no subcutaneous heparin) and the treatment group (subcutaneous heparin at 24 or 48 hours after surgery). Pulmonary Embolism Between January 2006 and December 2008 we identified 94 (4%) of 2638 patients who exhibited possible clinical manifestations of PE leading to a diagnostic radiological study. Twenty-two (0.8%) of these 2638 patients had a positive radiological study. We did find a positive correlation between the duration of surgery and the risk of developing PE, which was independent of heparin use (p < 0.05; Fig. 5

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James C. Dickerson, Katherine L. Harriel, Robert J. Dambrino IV, Lorne I. Taylor, Jordan A. Rimes, Ryan W. Chapman, Andrew S. Desrosiers, Jason E. Tullis and Chad W. Washington

Neurological Surgeons Annual Scientific Meeting, New Orleans, LA, April 28–May 2, 2018. References 1 Agnelli G , Piovella F , Buoncristiani P , Severi P , Pini M , D’Angelo A , : Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery . N Engl J Med 339 : 80 – 85 , 1998 2 Aito S , Pieri A , D’Andrea M , Marcelli F , Cominelli E : Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients . Spinal

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Timothy J. Crimmins, Gaylan L. Rockswold and Douglas H. Yock Jr.

torcula. To our knowledge, this is the first report of a possible pulmonary embolus from thrombus in a dural sinus. The association in our case of well documented sinus thrombosis, proven angiographically, and pulmonary embolism remains circumstantial, but the negative leg venography suggests the possible intracranial source. Treatment of superior sagittal sinus thrombosis is controversial. Surgical thrombectomy with survival has been reported. 12, 14 Gettelfinger and Kokmen 8 used anticonvulsant and anti-edema agents successfully, and recommended avoiding

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Victor Volovici, Ruben Dammers and Lotte M. E. Berghauser Pont

TO THE EDITOR: It is with great interest that we have read the clinical article by Rolston et al. 10 (Rolston JD, Han SJ, Bloch O, et al: What clinical factors predict the incidence of deep venous thrombosis and pulmonary embolism in neurosurgical patients? J Neurosurg 121: 908–918, October 2014). They have investigated risk factors for venous thromboembolisms (VTEs) in neurosurgical patients using a large data set acquired from the American College of Surgeons' National Surgical Quality Improvement Program database over a 5-year period. 10 In 1.7% of

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Nicholas Wetzel, Marion C. Anderson and Thomas W. Shields

these died of a fatal pulmonary embolism. The general surgeon has concerned himself with this problem for years. However, thromboembolism has been considered a rarity in the neurosurgical patient. A recent review by two of the authors 2 of 22 autopsy-proven cases of fatal postoperative pulmonary embolism from a series of 943 consecutive autopsies on adults over a 10-year period revealed that 9 (41 per cent) of these occurred in neurosurgical patients. Since that time, several more deaths have occurred on the neurosurgical service from this cause. To determine, if

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John D. Rolston, Seunggu J. Han, Orin Bloch and Andrew T. Parsa

vena cava ligation, or anticoagulation therapy. Pulmonary embolisms must occur within 30 days of an operation and must be confirmed with a highprobability ventilation-perfusion (VQ) scan, CT scan, or pulmonary arteriogram. Database files were acquired in delimited text format and parsed using both SPSS version 20 (IBM Corp.) and MATLAB R2012a (MathWorks Inc.). Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery” and further classified as “spine” or “cranial” depending on the current procedural

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Chad W. Washington

TO THE READERSHIP: An error appeared in the article by Dickerson et al. ( Dickerson JC, Harriel KL, Dambrino RJ IV, et al: Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality. J Neurosurg [epub ahead of print April 26, 2019; DOI: 10.3171/2018.12.JNS182800] ). A clarification is needed in the first sentence of the Results section. The phrase “Of the 2532 reviewed patients” should be “Of the 2532 reviewed admissions.” The corrected sentence appears below. Of the 2532