1/12. Surgical treatment of penetrating orbito-cranial injuries. Case report.Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/12. Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/12. Double concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note.BACKGROUND: Craniocerebral penetrating injuries from nail-gun accidents are rare and usually are discovered immediately after the trauma. Several surgical procedures have been described to extract a foreign body that is infixed in the skull and has penetrated the surrounding structures; blind extraction, craniectomy, and craniotomy. CASE DESCRIPTION: We report the case of a 25-year-old ex-carpenter who presented with jacksonian seizure at the left limb. Plain radiography of the skull revealed the unexpected presence of a nail hammered in the right parietal bone, penetrating the underlying structures of the frontoparietal area up to a depth of 3 cm. The patient was operated on; a small craniotomy (1 x 1 cm) just around the head of the nail, and a concentric larger frontoparietal bone flap, involving the first craniotomy, were performed. The larger bone flap was elevated first, whereas the small bone flap with the nail infixed was carefully elevated along the axis of the nail, under direct vision of the nail tract. CONCLUSIONS: Double concentric craniotomy is the only technique that permits the removal of a foreign body that has penetrated both the skull and the brain, under direct vision, without transmitting any undue forces to the underlying structures. With this technique, control of bleeding can also be easily achieved.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
4/12. Unusual penetrating craniocerebral injuries. Report of three cases.Three cases of penetrating cranio-cerebral injuries are reported. Two were caused by steel hooks shot by rotating blades: in one of these, the foreign body penetrated the brain through the eye-ball and in the second case the main injury was caused by a careless of extraction. In the third case, the foreign body, a key, penetrated the left parasagittal rolandic area following an under-water injury. All three patients were submitted to surgery and had good neurological recovery without complications of infection or seizures.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
5/12. Penetrating orbital foreign body with intracranial involvement.A 19-year-old man presented with a penetrating orbital foreign body. Preoperative evaluation established involvement of the middle cranial fossa and right internal carotid artery. An extensive preoperative evaluation of penetrating orbital trauma and a combined ophthalmic neurosurgical approach is recommended to ensure complete removal of the foreign material and to minimize the morbidity of the surgical extraction.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
6/12. In-utero gunshot wound to the head. Use of intraoperative ultrasonography for localization of an intracerebral projectile.Approaching full gestational age, a 1700-g male fetus sustained a penetrating gunshot wound to the left parietal region of the head while in utero. The child was delivered by emergency caesarean section. Initially in profound fetal shock and with almost no neurological function, the child was eventually stabilized. A posttraumatic intracerebral porencephalic cyst developed, with the projectile moving freely within the confines of the cyst cavity. Six weeks after the initial injury, the patient underwent an operation for extraction of the projectile. The Neuro SectOR ATL ultrasound probe was used intraoperatively and was instrumental in determining the exact position of the intracerebral projectile.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
7/12. pulmonary embolism of cerebral tissue in a neonate. A case report.pulmonary embolism of cerebral tissue in a newborn infant, the first to be recorded following the use of vacuum extraction, is described.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
8/12. Unusual craniocerebral injuries from nailing.Three cases of unusual craniocerebral injuries caused by deliberate driving of nails into the head are reported. All injuries were on or near the midline in the parietal area and the nails measured about 10 cm. Two of the patients experienced little pain during the procedure and did not lose consciousness. The extraction of each nail was extremely easy. The only patient who died was admitted in a coma and had meningitis.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
9/12. MR of neurologically symptomatic newborns after vacuum extraction delivery.We present the MR findings in three neurologically symptomatic newborns after vacuum extraction delivery. The lesions included subdural hematomas, one tentorial hematoma, and one intracerebellar hemorrhage. One patient had hydrocephalus that required shunting. We propose that the visualized abnormalities are probably the result of vertical stress leading to laceration of bridging veins, venous sinuses, and/or venous hemorrhagic infarctions.- - - - - - - - - - ranking = 2.5keywords = extraction (Clic here for more details about this article) |
10/12. Cerebral extraction of oxygen, lactate production, and perfusion pressure in gunshot wound to the head: case report.A case of gunshot wound to the head is presented, in which the patient made a satisfactory recovery after a prolonged period of elevated intracranial pressure and increased cerebral extraction of oxygen. Even though cerebral extraction of oxygen was increased in the most acute phase, the arteriojugular lactate difference was never abnormally decreased (ischemic). This finding indicated that, in this patient, increased cerebral extraction of oxygen was not sufficient to result in global cerebral ischemia (increased cerebral lactate production). To our knowledge, this is the first report on frequent serial assessment of cerebral extraction of oxygen and lactate production in severe penetrating head injury.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
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