Surg Neurol
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Anterior screw fixation provides the best anatomical and functional results for odontoid process fracture (type II and "shallow" type III) with intact transverse ligament. The purpose of this study is to evaluate the clinical results of the 4.5-mm-diameter cannulated Herbert screw in the anterior odontoid fixation. ⋯ The Herbert screw is very useful in anterior fixation for types II and III odontoid process fractures. This series showed successful clinical results comparable with that of the 3.5-mm cannulated cancellous screw and distinct advantages over conventional screws in the aspect of biomechanical properties and less invasiveness.
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Access to tumors of the middle cranial base has traditionally required wide surgical exposures via open craniotomies. These open techniques often require the use of potentially disfiguring skin incisions and are often associated with a significant degree of brain retraction and potential morbidity. We report our experience with the use of a minimally invasive supraorbital endoscopic approach through the eyebrow for excision of middle cranial base tumors in 2 cases. ⋯ These cases demonstrate how the application of endoscopic techniques to surgery of the middle cranial base can eliminate the need for traditional open techniques without compromising surgical success.
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Case Reports
True hemicranial decompression for severe pediatric cranial trauma: a short series of 4 cases and literature review.
Traumatic acute SDH in pediatric patients is a life-threatening situation. There is a severe increase in ICP caused by acute SDH or diffuse brain swelling or secondary to ischemic brain damage. In certain situations, conventional measures may fail to control such a rapid increase in ICP. ⋯ In certain situations, pediatric patients with cranial trauma may be offered hemicranial decompression as a surgical option. These children may have a better long-term outcome despite massive infarcts.
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Surgery for meningiomas involving the cavernous sinus remains controversial. Interdural cavernous sinus is called the lateral dural wall in the cavernous sinus, which is composed of two layers, the outer dural layer and the inner membranous layer. We encountered two cases of dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension, which were successfully removed by surgical means. ⋯ Middle cranial fossa meningioma with interdural cavernous sinus extension can be removed more easily than other tumors with intracavernous sinus extension and, consequently, can be safely resected without any resulting cranial nerve deficit.
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Rupture of cerebral aneurysms results in subarachnoid hemorrhage. In many cases, bleeding from aneurysms spontaneously arrests. Although bleeding from cerebral aneurysms has been reported to arrest from outside, bleeding from some aneurysms can arrest in different ways. ⋯ The present preliminary study revealed that arrest of bleeding from a ruptured cerebral aneurysm does not always occur from outside the aneurysm. Unusual mechanisms of hemostasis are seen in approximately 12% of ruptured aneurysm. The outside-arrest-pattern aneurysm was more common for smaller aneurysms, and these patients tended to be of better grade. Further studies are necessary to explore the mechanism of hemostasis for ruptured cerebral aneurysms.