World Neurosurg
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To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure. ⋯ Administration of prophylactic antibiotics was not associated with the incidence of intracranial infection secondary to PCGWs. Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection.
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Biography Historical Article
Iulius Casserius and the first anatomically correct depiction of the circulus arteriosus cerebri (of Willis).
The circulus arteriosus cerebri is the arterial anastomotic circle at the base of the brain, now better known as the circle or polygon of Willis. The British physician and anatomist Thomas Willis (1621-1675) was the first to demonstrate the physiologic function and observe the clinical significance of the circulus. It has been overlooked, however, that the first accurate depiction of the circulus was provided by the Paduan anatomist Giulio Cesare Casseri (Iulius Casserius) (1552-1616) in two engravings published posthumously in multiple formats, including the Tabulae anatomicae LXXIIX (1627). ⋯ Although previous authors have commented on Casserius's portrayal of the circulus arteriosus in Table 10 of Tabulae anatomicae LXXIIX, none have discussed Figure 2 of Table 9. This is important because whereas the anterior communicating artery complex is depicted clearly in one table, the accurate course of the posterior communicating arteries is shown in the other. Together, Tables 9 and 10 represent a sophisticated, sequential dissection, which deserves recognition as the first accurate portrayal of the arterial anastomosis at the base of the brain.
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Review Case Reports
Resolution of cystic deterioration of the C1-2 articulation with posterior fusion: treatment implications for asymptomatic patients.
The authors previously reported anterior decompression of C1-2 synovial cysts and subsequent posterior fusion in a large series. Although the surgical morbidity and mortality were acceptable, prior reports of stand-alone C1-2 fusion with resolution of cyst compression presumptively by correction of joint instability were intriguing and did not involve the morbidity associated with the transoral procedure. ⋯ In asymptomatic patients with a synovial cyst of the atlantoaxial junction, posterior fusion alone may lead to complete resolution of the cyst; however, in neurologically symptomatic patients with similar lesions, cyst decompression coupled with posterior fusion is recommended to ensure the highest chance of cyst resolution and clinical improvement.
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Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to C. immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome. ⋯ Our patient represents the only survivor of a C. immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.