Surg Neurol
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A case of extradural hematoma of the vertex presenting 4 days after injury, which was diagnosed using magnetic resonance imaging, is reported. The relevant literature is also reviewed.
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A review of 146 medical malpractice cases involving surgery of the lumbar spine disclosed that unintended "incidental" durotomy (23 cases) was the second most frequently named occurrence. In each instance there was an associated alleged complication or sequelae. There appears to be a subset of patients in whom an unintended "incidental" durotomy is associated with perioperative morbidity and long-term sequelae. Considering the frequency with which a dural tear is listed as one of the complaints in medical malpractice cases involving surgery of the lumbar spine, it cannot be considered an entirely "benign event."
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Transcranial cerebral oximetry based on the principle of near-infrared spectroscopy has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. The non-invasive technique of cerebral oximetry provides valuable information about brain oxygenation in patients with cerebral ischemia (due to occlusion or stenosis of the internal carotid artery). It is also used in intraoperative monitoring of carotid endarterectomy and surgical procedures performed under deep hypothermia and circulatory arrest, during neuroendovascular procedures, and in critical care settings (in patients with arterial vasospasm and during the terminal period). This article describes our preliminary clinical experience with the use of this new technique and summarizes the current literature on clinical and experimental use of transcranial cerebral oximetry.
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Hypothermia is of proven benefit in cerebral ischemia, and may be of benefit in blunt head injury. Peritoneal dialysis is a fast, effective method of inducing generalized hypothermia. ⋯ Hypothermia was associated with prompt control of temperature and intracranial pressure. Peritoneal dialysis is a useful method for inducing hypothermia in the blunt head-injured patient.