Surg Neurol
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In an attempt to evaluate the predictive factors of morbidity and mortality in patients who suffered from civilian gunshot wounds to the head, we reviewed a series of 319 patients admitted to the Hospital Santa Marcelina, São Paulo, Brazil, between 1994 and 2000. ⋯ We conclude that low GCS scores at admission, unilateral dilated pupil or medium fixed pupil, transventricular or bihemispheric central type trajectory, and bilobar or multilobar wounds noted through CT scan are predictive factors of high morbidity and mortality in patients with gunshot wounds to the head, in our clinical experience. We also conclude that surgical treatment is not recommended for patients with penetrating wounds and GCS score of 3 to 5 in the absence of hematoma causing a mass effect.
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During military conflicts, surviving victims traditionally underwent large enough craniectomy or craniotomy to achieve extensive debridement of the in-driven bone, shell fragments, and debris. Meanwhile, the completely as well as the partially devitalized adjacent brain tissue would also be debrided. This might have led to additional neurologic deficit or lesser degree of recovery of functions. ⋯ This study seems to indicate that not only is reoperation for retained bone or shell fragments unnecessary, but surgeons having modern neuroradiological instruments available to detect the proper explanation for changes in GCS of the patients may decide not to proceed with any surgical intervention in a good number of patients. As a result of the "no surgical treatment protocol," one can preserve cerebral tissue without exposing the patient to undue risk of seizures, infection, or death by leaving behind some or all the in-driven bone and shell fragments.
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The purpose of this study is to find out how different compression time affects the results of percutaneous trigeminal ganglion compression for treatment of trigeminal neuralgia. ⋯ With accurate monitoring of the balloon pressure during the percutaneous trigeminal ganglion compression, it was found that the shorter duration of compression had less side effect. At one year follow-up, the incidence of recurrrence rate was slightly higher in the patients who received 60-second compressions than in those who received 180-second compressions, but there was no significant statistical difference. Whether patients with first or second branch of trigeminal neuralgia require longer compression duration needs further study.
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Dorsal foraminotomy is a standard operative procedure for lateral cervical disc herniation. Factors associated with surgical complications and clinical outcome in dorsal foraminotomy of cervical disc herniation were evaluated in a retrospective cohort study. ⋯ In lateral cervical disc herniation, associated spondylosis or medial disc protrusion poses a significant risk of surgical failure and complications of dorsal foraminotomy. Reducing the radicular failure rate by enlarging the bony decompression may lead to local failure. In well-selected patients with a lateral cervical free disc fragment, dorsolateral foraminotomy is successful and safe.
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A variety of complications can occur following ventriculoperitoneal shunt. We report a case of extrusion of the catheter tip through the old scar of the percutaneous endoscopic gastrostomy (PEG) wound. ⋯ The catheter end of VP shunt can extrude through the weak point of an old PEG scar. This kind of complication should be brought to mind while performing abdominal surgery in patients with VP shunts.