World Neurosurg
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Patients with central nervous system (CNS) hemorrhage who receive anticoagulation (AC) therapy are at high risk for progressive or recurrent hemorrhagic and thromboembolic (TE) events. The authors conducted a survey at the 2010 American Association of Neurological Surgeons (AANS) annual meeting to determine how these patients are currently being managed by neurosurgeons. ⋯ This study is the first to describe how patients with CNS hemorrhage who receive AC therapy are currently being managed by clinicians. An apparent neurosurgical preference to avoid hemorrhagic complications is at odds with a suggested early risk for TE. These data suggest that the neurosurgical management of patients with CNS hemorrhage who receive AC therapy is an area that could benefit from consensus-based practice guidelines and an organized effort at knowledge translation and mobilization.
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Case Reports
Successful repair of a gunshot wound to the head with retained bullet in the torcular herophili.
Nonlethal missile injuries to the dural venous sinus system are rare. To date successful repair of isolated penetrating injury to the torcular herophili has not been reported without significant associated morbidity. We report the case of a gunshot wound injury to the occipital region with retained bullet fragment in the confluence of the sinuses causing traumatic sinus venous thrombosis. ⋯ Gunshot wounds with retained bullet fragments in the torcula can be successfully repaired with preservation of neurological function after retrieval of metallic foreign body and restoration of venous sinus patency.
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To review the microsurgical anatomy of Meckel's cave, a detailed knowledge of which is a prerequisite to devising an appropriate surgical strategy and performing successful surgery. ⋯ Detailed and sound knowledge of the microsurgical anatomy of Meckel's cave, which borders on surgically important structures, such as the internal carotid artery and cavernous sinus, is essential to performing precise microneurosurgery in this region. This study describes the complex anatomy of Meckel's cave and surrounding structures to provide the knowledge needed to devise a more complete surgical strategy and establish accurate orientation during the surgical procedure.
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Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation.
Hyponatremia is common in patients with traumatic brain injury (TBI). This study aims at ascertaining the incidence of hyponatremia in TBI with its etiologic diagnosis, biochemical confirmation, and severity correlation with initial Glasgow Coma Scale (GCS) score and computed tomography (CT) abnormality. ⋯ Hyponatremia due to SIADH is more common in TBI. FEUA measurement is not consistent enough to make a distinction between SIADH and CSWS. CT scoring of severity is more predictive of hyponatremia than initial GCS.