British journal of neurosurgery
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Infection of intracranial catheters is a common complication of ICP monitoring. The introduction of a simple technique of ensheathing the entire length of the external segment of the catheter in a sterile plastic sheath resulted in a decreased infection rate. In the study year, one of 78 patients developed catheter-induced meningitis, compared with seven of 64 patients in the year prior to the introduction of the protective plastic sheath. The use of a plastic sheath resulted in a low rate of infection.
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Review Case Reports
Pneumocephalus associated with fracture of thoracic spine: case report.
A 53-year-old man presented with pneumocephalus following a thoracic vertebral fracture. Computed tomography (CT) myelography revealed a leakage of contrast medium from the thecal sac in the vicinity of the vertebral fracture and was used to confirm the origin of a subarachnoid-pleural fistula.
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For effective management of patients with unruptured intracranial aneurysms, prognostic criteria for rupture are needed, of which aneurysm size is a key factor. However, the critical size at which an aneurysm becomes hazardous is not known. During the last 5 years, 1558 aneurysm patients have been operated on in our centre. ⋯ The remaining 57 patients with unruptured aneurysms harboured multiple aneurysms totalling 116 aneurysms; 50% of them were small in size. Our of 160 patients with multiple aneurysms presenting with subarachnoid haemorrhage, 34 patients had small aneurysm(s) accompanied with medium or large sized aneurysm(s); in nine (26.5%) of these 34 patients the small aneurysm was the ruptured one. These data suggest that small aneurysms < 6 mm in diameter are not innocuous and hazardous, and surgical treatment should be considered for small unruptured aneurysms even if they are less than 6 mm in diameter.
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A new surgical method for the treatment of chronic subdural haematoma is presented. A small craniostomy is made on the superior lateral angle of the forehead just beneath the hair line without hair removal using a high-speed drill. ⋯ The surgical wound was negligible. Because of its simplicity, and the lack of a need for hair removal, the procedure appears to be acceptable as an optional therapeutic modality.
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We report our experience with five lesions exclusively involving the entire cavernous sinus in which an essentially extradural surgical approach was used. There were two cases of cavernous haemangioma, two cases of meningioma and one case of fungal granuloma. The dural cover of the superior orbital fissure, and mandibular and maxillary divisions of the fifth nerve was dissected along with the dura of the lateral wall of the cavernous sinus. ⋯ The contents of the cavernous sinus were exposed from an anterolateral, lateral and inferior approach. Through the corridor available between the splayed out cranial nerves, a radical resection of the tumour was accomplished in each case. The technical advantages of this approach are discussed in light of the anatomy of the dural configuration of the lateral wall of the cavernous sinus.