Neurosurgery
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To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. ⋯ PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.
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The purpose of this study was to clarify the risk of rupture of unruptured intracranial aneurysms among large groups of patients with various underlying diseases or conditions. ⋯ The risk of rupture of unruptured aneurysms is high, especially for multiple aneurysms, but there are no significant differences in the risk of rupture according to the underlying disease or the aneurysm location. Radical treatment should be considered for patients with unruptured intracranial aneurysms.
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The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries. ⋯ Brachial plexus injuries afflict slightly more than 1% of multitrauma victims. Motorcycle and snowmobile accidents carry especially high risks, with the incidence of injury approaching 5%. Head injuries, thoracic injuries, and fractures and dislocations affecting the shoulder girdle and cervical spine are particularly common associated injuries. Supraclavicular injuries are more common, are of more severe grade, more often require surgery, and are associated with worse prognosis, compared with infraclavicular injuries.
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Basilar cranial fractures have been associated with injury to the carotid artery. We sought to determine whether fracture through the carotid canal was a significant risk factor for carotid injury. ⋯ Vascular complications are more frequently observed after basilar cranial fractures when there is involvement of the carotid canal. The lacerum-cavernous junction, which is partly formed by the spheno-occipital suture, is the most frequently fractured segment of the carotid canal. Fracture through the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury. Fracture through the carotid canal may serve as an index of injury severity, because patients with these fractures suffered more severe head injuries.