World Neurosurg
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Review Case Reports
Surgical Treatment for Odontoid Fractures in Patients with Long-Standing Ankylosing Spondylitis: A Report of 3 Cases and Review of the Literature.
Ankylosing spondylitis (AS) is classified as a chronic inflammatory seronegative rheumatic arthritis. Patients with AS are more likely to sustain a fracture of the cervical spine compared with the general population. Most fractures occur in the lower cervical spine and manifest at the level of the intervertebral disc. There have been few reports about the surgical treatment for upper cervical spine fractures in patients with AS, especially odontoid fractures. We present 3 cases of odontoid fracture in patients with long-standing AS. ⋯ Odontoid fracture with atlantoaxial dislocation in patients with long-standing AS is uncommon. Clinicians must be cautious in assessing such patients with any episode of trauma. Computed tomography and magnetic resonance imaging can be helpful in demonstrating occult odontoid fractures. Posterior occipitocervical fusion with internal fixation may benefit these patients, although at the cost of sacrificing the last motion segment.
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The available surgical options to control increased intracranial pressure and to limit secondary brain damage in the setting of severe traumatic brain injury (TBI) include decompressive craniectomy, cisternostomy, and other methods to divert cerebrospinal fluid (CSF) such as placement of an external ventricular drain. ⋯ Further clinical studies need to be performed to validate the efficacy of this emerging surgical procedure for severe TBI.
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Review Historical Article
Review of Treatment of Gunshot Wounds to Head in Late 19th Century.
During the late 19th century, the seeds of modern neurosurgery were planted to bloom into what it is now known. Wars such as the American Civil War and Crimean War drove the need to find better ways of preventing mortality from gunshot wounds to the head. However, the mortality rate from all major surgical procedures to the head, neck, and face remained staggering. Herein, we describe the surgical treatments for head and neck injuries in order to improve our understanding of neurosurgical procedures performed during the late 19th century. ⋯ Because of improved understanding of infectious processes and technologic advances in surgical equipment, the late 19th century was a major milestone in creating modern day neurosurgery. The methodology behind today's treatments is no different from that of the late 19th century.
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It has been 125 years since the so-called initial use of bone wax (BW) by Sir Victor Horsley, and a review of this age-old hemostatic agent seems appropriate. The first use of BW for hemostasis occurred in the eighteenth century, when modeling or candle wax was used for hemostasis. Although the pioneers in the use of BW in craniofacial surgeries were Jean Louis Belloq, Khristian Khristianovich Salomon, and François Magendie, the first successful use in neurosurgery was demonstrated by Henri Ferdinand Dolbeau in 1864 after extirpation of a frontal osteoma. ⋯ The main action being mechanical tamponade, BW has found several other uses in neurosurgery, other than being a hemostatic agent. Although it is cost-effective, the use of BW is associated with several complications also, including ineffective bone healing and infection. Several alternatives are being developed, but none are yet a full replacement for "Horsley's wax."
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Review Case Reports
Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization.
Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Owing to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. In pediatric patients, the volume of total blood is less than in adults, and minimal intraoperative hemorrhage is desirable. ⋯ Successfully resection of primary intracranial rhabdomyosarcoma was achieved after preoperative embolization. Tumor vascularity was significantly reduced, and gross total removal was achieved safely with less hemorrhage.