1/20. Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.- - - - - - - - - - ranking = 1keywords = brain, trauma (Clic here for more details about this article) |
2/20. Traumatic cranial injury sustained from a fall on the rigid external distraction device.Distraction osteogenesis has become a popular treatment of congenital maxillocraniofacial anomalies. Many ingenious internal and external devices have been developed and used. The rigid external distraction system based on systems previously used in correction of maxillary retrusion offers postoperative adjustment in two dimensions. Figueroa and Polley reported the use of this device with minimal morbidity in children as young as 5 years of age. They reported no problems with infection, bleeding, pain, loosening of the intraoral splint, dental injury, or wear problems in a series of 14 consecutive cleft patients. Recent modification of the system, rigid external distraction II, has allowed it to be applied to more complex craniofacial deformities that require a LeFort III osteotomy. A review of the neurosurgery and orthopedic literature revealed that halo complications relate primarily to the skull pins. In most cases, these complications can be prevented if the device is carefully applied and monitored. Early recognition and prompt treatment of complications are important. After experience with this system for advancement at the LeFort III level, six patients with various syndromes involving the craniofacial skeleton have undergone LeFort III level distraction osteogenesis with the rigid external distraction device in combination with a planned and stabilized frontosupraorbital advancement. In one of these cases, a 7-year-old child fell on the device after discharge from the hospital and sustained a compound depressed skull fracture that required debridement and repair.- - - - - - - - - - ranking = 12.099174033396keywords = injury (Clic here for more details about this article) |
3/20. Fatal head trauma from tree related injuries.Two cases of death following tree related injuries are presented. Two females, an elderly woman and a child, suffered severe head trauma from falling objects from trees--a falling coconut and a falling branch respectively. Although this mode of injury has been previously documented, there have been no prior reports of in-hospital deaths in such patients. This uncommon cause of death is reviewed and recommendations made concerning its prevention.- - - - - - - - - - ranking = 2.8729175976541keywords = injury, trauma (Clic here for more details about this article) |
4/20. Traumatic basilar artery occlusion caused by a fracture of the clivus--case report.A 56-year-old man presented with a rare traumatic basilar artery occlusion caused by a fracture of the clivus. He fell from the height of 2 meters and immediately fell into a coma. head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty. head CT 8 hours 50 minutes after injury showed infarctions in the brain stem, cerebellum, and occipital lobes. cerebral angiography revealed occlusion of the basilar artery in the middle part of the clivus. The patient died after 3 days. autopsy revealed that the basilar artery was trapped in the clivus fracture site. Vertebrobasilar artery occlusion due to trapping in a clivus fracture has a very poor prognosis. diagnosis is difficult and generally only confirmed at autopsy. cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.- - - - - - - - - - ranking = 5.7490530551633keywords = injury, brain, trauma (Clic here for more details about this article) |
5/20. Cranioplasty for patients with severe depressed skull bone defect after cerebrospinal fluid shunting.Cranioplasty is indicated for patients with a skull bone defect. patients may achieve subjective and objective improvements after cranioplasty. Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus associated with severe brain bulging or even herniation via the skull bone defect. Consequently, these patients require a ventriculoperitoneal (V-P) shunt to relieve hydrocephalus. However, after shunting for hydrocephalus, they may develop severe sinking at the skull defect. Subsequently, when doing a cranioplasty for such a depressed defect, it may result in the dysfunction of the underlying brain, or even hematoma formation due to the large dead space. In this study, we advocate a temporary procedure to occlude the V-P shunt tube to allow the expansion of a depressed scalp flap to facilitate the subsequent cranioplasty. We report four patients with severe depression of the skull defect resulting from previous traumatic brain swelling followed by decompressive craniectomy and V-P shunting for communicating hydrocephalus. A simple subcutaneous clipping of the shunt tube was performed to allow the expansion of the depressed scalp to obliterate the dead space before the cranioplasty. All four patients obtained a satisfactory result without complications and achieved good functional recovery. A temporary occlusion of the shunt tube with an aneurysm clip before cranioplasty for patients with a severely depressed scalp flap is a simple and useful procedure. This procedure can safely and effectively eliminate the dead space between the skull plate and the dura to facilitate the cranioplasty, and thus prevent the potential complication of intracranial hematoma.- - - - - - - - - - ranking = 1.728150325415keywords = brain, trauma (Clic here for more details about this article) |
6/20. Acute isovolaemic haemodilution in two jehovah's witnesses presenting for major intracranial surgery.The jehovah's witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000 ml) were collected from each patient resulting in post donation PCV of 40% and 33%. The intraoperative blood loss was 300 ml and 2000 ml, respectively, and the units and crystalloid fluids were transfused for replacement. Postoperative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral haematinics. The two cases are discussed in the light of the experience gained.- - - - - - - - - - ranking = 0.18123311639keywords = trauma (Clic here for more details about this article) |
7/20. Punched with a fist: the etiology of a fatal depressed cranial fracture.We report a case in which a 33-year-old man was discovered unconscious following a fistfight with another man. Emergency neurosurgical efforts to repair a depressed temporoparietal skull fracture and associated brain injuries were unsuccessful. The forensic anthropologist and pathologist worked in tandem to sort out a complex combination of cranial evidence, including healed antemortem trauma, perimortem blunt force trauma, remote and recent neurosurgical intervention, and the craniotomy cut performed at autopsy. The victim had suffered head injuries and a right temporoparietal craniotomy ten years prior to death. The perimortem cranial fractures were centrally located within a surgically repaired roundel of bone involving portions of the right temporal and parietal bones. Reportedly, the victim was punched on the right side of his head as he was lying on the ground with the left side of his head against an asphalt surface. A primary question in the case was whether a blow with a fist could have produced the observed cranial injuries. To adequately answer that question, known data on the minimum amount of force required to fracture the temporoparietal region were compared to data on the amount of force generated by a blow with a fist. A biomechanics expert demonstrated that a single blow with a fist to the rigidly supported head of the victim could generate the required force to produce the observed fractures. The previous medical condition possibly predisposed the victim to the cranial fractures and contributed to the depressed nature of the fractures. Although depressed cranial fractures do not typically result from a blow with a fist, it was determined in this case that the fracture pattern was consistent with a punch to the head.- - - - - - - - - - ranking = 0.590616558195keywords = brain, trauma (Clic here for more details about this article) |
8/20. Transverse sinus air after cranial trauma.air in vascular compartments has been rarely reported. We report a case in whom air within transverse sinus and sinus confluence through ruptured superior sagittal sinus (SSS) due to fractures of parietal and frontal bones was disclosed by computed tomography (CT). Although air in transverse sinus has been reported rarely this could be the first case with air in transverse sinus through the SSS after cranial trauma.- - - - - - - - - - ranking = 0.453082790975keywords = trauma (Clic here for more details about this article) |
9/20. Reconstruction of post-traumatic frontal-bone depression using hydroxyapatite cement.The safety and efficacy of hydroxyapatite cement (Bone Source, Howmedica, Leibinger, Inc. Dallas, TX) use for the augmentation of post-traumatic frontal-bone depression was evaluated in a study of 20 consecutive oriental patients between June 1998 and July 2000 inclusively. The size of the depressed frontal bone ranged from 5 x 5 cm to 8 x 5 cm. The cement was placed in contact with the frontal sinus for 12 patients, none of whom revealed a history of paranasal sinus mucoperiosteal disease. Follow-up averaged 28 months for all 20 patients. Postimplantation evaluations included serial photographs, repeated physical examination, and 3-dimensional computed tomography for all patients. The cement paste allowed for precise and easy contouring of the bony depression's restoration. Meticulous hemostasis is essential to ensure a dry surgical field and successful application of the cement. No infection of the surgical site or extrusion of the cement was noted for any of our patients, and the contour of the reconstructed frontal bone was acceptable esthetically without any secondary depression noted during the follow-up period. Three-dimensional computed tomographic scans taken 2 years subsequent to implantation revealed good preservation of the cement restoration material. Small areas of cement loss due to cement absorption into the ambient fluid were noted for 2 patients, but such resorption did not appear to esthetically influence the final results. The results from this clinical study indicated that hydroxyapatite cement is a biocompatible, alloplastic material useful for augmentation of post-traumatic frontal-bone depression with stable volume maintenance over time. Judicious use of the hydroxyapatite cement offers an alternative to autogenous bone grafts or the use of methyl methacrylate for augmentation of the craniofacial skeleton among oriental patients.- - - - - - - - - - ranking = 0.54369934917001keywords = trauma (Clic here for more details about this article) |
10/20. Camel bite: an unusual type of head injury in an infant.Small children are predisposed for animal bite wounds in the craniofacial region, because the likelihood of sustaining trunk and extremity injuries increases with height. The clinical picture of animal bite wounds is highly variable. Depending on the dental anatomy of the biting animal, such wounds may range from sharp stitch wounds to extensive lacerations with or without tissue loss. The ears and nose are injured most often because of their exposed location. Nevertheless, depressed skull fractures with injury to the dura and to the brain parenchyma are extremely rare. This case presentation describes the rare case of a craniocerebral camel bite wound (Lackmann stage IV B) in a 3-year-old girl that required immediate neurosurgical management. The neurosurgical management, choice of antibiotic, postoperative treatment, and clinical course are discussed, and background information on camel bite injuries is given.- - - - - - - - - - ranking = 13.623065668187keywords = injury, laceration, brain (Clic here for more details about this article) |
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