Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Wakeboarding is a popular water sport but has significant potential for trauma due to the high velocities, rotational maneuvers, acceleratory forces, water obstacles, and general lack of protective equipment used. Head or neck trauma is a concern, which may be even more common with wakeboarding than other water sports, but the true trauma incidence is unknown and probably underreported. While traumatic brain injury has been reported to occur during wakeboarding we present an unusual mechanism of central nervous system injury in which a young adult male developed a carotid artery dissection and stroke shortly following a wakeboarding accident.
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Exophytic ependymomas of the spinal cord are very rare outside the filum or conus region. We present a patient with a thoracic spinal cord intradural extramedullary and intramedullary, World Health Organization grade II ependymoma. Gross total resection of the extramedullary component with subtotal resection of the intramedullary tumor was achieved, since there was no clear distinction between cord and tumor. The patient received postoperative external beam radiotherapy for residual tumor, and at a 2-year follow-up he is ambulatory without evidence of tumor recurrence.
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The objective of our study was to compare the incidences of cardiovascular disturbance during venous air embolism (VAE) episodes detected using transesophageal echocardiography (TEE) and end tidal carbon dioxide (ETCO(2)) tension monitoring. We retrospectively analyzed the anesthesia records of patients who underwent posterior fossa surgery while in the sitting position and who were simultaneously monitored using both TEE and ETCO(2) tension monitoring. Data on the occurrence of VAE and the cardiovascular changes associated with it were recorded. ⋯ No instances of cardiovascular disturbance were detected in the ETCO(2)-negative group, whereas the incidences of tachycardia and hypotension were 20% and 30%, respectively, in the ETCO(2)-positive group. None of the episodes of VAE detected by TEE (without a fall in ETCO(2)) were clinically significant. We conclude that ETCO(2) monitoring is sensitive enough to detect hemodynamically significant VAE episodes.
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Although decompressive hemicraniectomy with dural expansion and bone flap removal is a potentially life-saving procedure, concerns remain regarding the morbidity associated with this approach. We and others have noted the high rate of wound complications resulting from this technique, often associated with cerebrospinal fluid (CSF) absorption problems. Here, we present our experience with an improved technique for wound closure after unilateral decompressive hemicraniectomy with a wide cruciate durotomy. ⋯ Over a 1year period, we dramatically reduced the rate of wound complications in patients undergoing hemicraniectomy at our hospital using this new (Monocryl technique, 0% (n=29) compared to other techniques, 35% (n=98), chi-squared [χ(2)] p<0.001). Patients closed using our new technique experienced markedly reduced rates of wound infection (p<0.01), and CSF leak (p<0.05), compared to other, more standard, techniques. Thus, attention to closure of hemicraniectomy wounds can markedly reduce the rate of wound complications, thus improving the risk-to-benefit ratio of this procedure.
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Malignant middle cerebral artery (MCA) infarction (MMI) is associated with a mortality rate of 80%. Decompressive craniectomy is considered a life-saving procedure for patients with this devastating condition. ⋯ This article reviews the pathophysiology of MMI, and the experimental and clinical evidence supporting this procedure. We consider some of the controversies surrounding patient selection for this procedure and discuss the role of intracranial pressure monitoring in MMI.