World Neurosurg
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To demonstrate that anterior clinoidectomy is possible through the lateral supraorbital (LSO) approach, and that extent of the clinoidectomy is tailored according to the lesion. We reviewed our recent experience on patients with vascular and tumor who underwent anterior clinoidectomy through the LSO approach. ⋯ A tailored anterior clinoidectomy is useful and can be performed through the LSO approach. Intradural visualization of the internal carotid artery and optic nerve is mandatory for the exact anatomic orientation and safe anterior clinoidectomy. We recommend intradural anterior clinoidectomy for all vascular and most neoplastic lesions.
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Survival after a gunshot wound (GSW) to the head is becoming more common, with an accompanying increase in spontaneous migration of these intracranial bullet fragments. This phenomenon is well described in current literature and is a potentially life-threatening delayed complication of GSW to the head. ⋯ The potential for spontaneous migration exists with any penetrating brain injury involving a retained foreign body. When a retained intracranial foreign body is unable to be safely extracted during initial debridement, close clinical evaluation is essential and plain-film or computed tomographic imaging should be considered in order to enhance the early detection of delayed-onset life-threatening deterioration, such as meningitis and occlusion of cerebrospinal fluid drainage, because of spontaneous migration.