Surgical neurology international
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The optimal timing of cranioplasty after decompressive craniectomy for trauma is unknown. The aim of this study was to determine if early cranioplasty after decompressive craniectomy for trauma reduces complications. ⋯ After decompressive craniectomy for trauma, early (<12 weeks) cranioplasty does not alter the incidence of complication rates. In patients <18 years of age, early (<12 weeks) cranioplasty increases the risk of bone resorption. Delaying cranioplasty (≥12 weeks) results in longer operative times and may increase costs.
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A better understanding of the etiologies of occipital neuralgia would help the clinician treat patients with this debilitating condition. Since few studies have examined the muscular course of the greater occipital nerve (GON), this study was performed. ⋯ Variations in the muscular course of the GON were common. Future studies correlating these findings with the anatomy in patients with occipital neuralgia may elucidate nerve courses vulnerable to nerve compression. This enhanced classification scheme describes the morphology in this region and allows more specific communications about GON variations.
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The presigmoid retrolabyrinthine space is characterized by a widely variable size. The main structure involved in this large variability is the sigmoid sinus. Few studies have attempted to establish a reliable classification of sigmoid sinus to predict the presigmoid retrolabyrinthine space. We used tomographic mapping of human cadaver temporal bones to classify the position of sigmoid sinus and performed a cadaveric study to assess the validity of a novel classification in predicting the presigmoid retrolabyrinthine space. ⋯ The tomographic classification proposed in this study predicts, in a cadaveric model, the presigmoid retrolabyrinthine space. It may help the surgeon select the best approach to reach the petroclival region and lead to safer neurological and otological surgeries.
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Tuberculous peritonitis (TBP) is a well-known complication of ventriculo-peritoneal (VP) shunt treatment for hydrocephalus resulting from tuberculous meningitis (TBM). However, a case of hydrocephalus unrelated to TBM resulting from VP shunt malfunction due to TBP has not been reported. ⋯ This case highlights the possibility of CSF shunt failure and concomitant neurological sequelae from TB infection even when the pathogen has not invaded the central nervous system, as in TBM. Moreover, TBP is rare in developed countries and therefore may be misdiagnosed because of nonspecific clinical features and low sensitivity of common TB screening methods.
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Patient-specific implants are used for cranioplastic skull reconstruction when large bone flaps must be replaced or where there are complex or critical contours, especially near the face. These implants have a low complication rate, with poor fit and postoperative infection being the most common complications. We report here a potentially serious hazard that may arise from the use of porous implants. ⋯ In this case, dural adhesion and ingrowth to the underside of the cranioplasty implant led to disastrous bleeding when the implant needed to be removed years after initial implantation.