Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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There is much interest in the use of decompressive craniectomy for intracranial hypertension. Whilst technically straightforward, the procedure is not without significant complications. A retrospective analysis was undertaken of 41 patients who had had a decompressive craniectomy for severe head injury in the years 2006 and 2007 at the two major hospitals in Western Australia, Sir Charles Gairdner Hospital and Royal Perth Hospital. ⋯ Syndrome of the trephined occurred in three (7%) of those patients whose bone flap had significantly resorbed. Two deaths (5.5%) occurred as a direct complication of the craniectomy or cranioplasty procedure. I attempted to define what may be regarded as a complication of the decompressive procedure rather than what may be a consequence of the primary pathological process of traumatic brain injury.
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A spectrum of surgical techniques has been used in the management of chronic subdural hematomas. Single burr hole and double burr hole drainage are among the commonest techniques. ⋯ Thus, the number of burr holes does not affect the post-operative recurrence rate of chronic subdural hematomas. Both techniques are equally effective treatments.
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The endovascular approach has become the standard treatment for ruptured aneurysms during the vasospasm risk period following subarachnoid hemorrhage; however, it may be disadvantageous under certain conditions. We report a patient with a ruptured middle cerebral artery aneurysm with severe vasospasm and thrombosis within the aneurysm immediately after angiography. Emergent operative open thrombectomy of the intra-aneurysmal thrombus restored blood flow to the ischemic penumbra territory demonstrated by single photon emission CT scan and diffusion-weighted MRI.
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Case Reports
Catastrophic delayed rupture of a traumatic aneurysm of the distal superior cerebellar artery in a child.
Traumatic aneurysms of the superior cerebellar artery are rare, especially in children. We report a 3-year-old boy who had a catastrophic delayed rupture of a traumatic aneurysm arising from the superior vermian branch of the left superior cerebellar artery. ⋯ The aneurysm and the superior vermian artery were successfully embolised endovascularly, but the child never recovered and died 3 days later. The pathogenesis, natural history and treatment options of these aneurysms are discussed.
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Autologous bone grafts from cervical vertebral bodies (Williams-Isu method) are used for anterior fusion of the cervical spine. When adequate amounts of bone cannot be harvested from the vertebral body, hydroxyapatite (a ceramic) is placed between the bone grafts (the sandwich method). ⋯ In both groups the position of the anterior edge of the graft and the loss in the angle of the fused segment were significantly correlated (p<0.05). We found that the sandwich method not only reinforced the graft, but also yielded better results with respect to the angle and height of the fused segment.