Neurosurgery
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Case Reports
Osteoma of the frontoethmoidal sinus with secondary brain abscess and intracranial mucocele: case report.
The authors report the case of a 17-year-old patient with an osteoma of the frontoethmoidal sinus who had a secondary abscess of the frontal lobe and an intracranial mucocele. Clinical, radiological, and surgical correlates of this triad are presented.
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Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. ⋯ For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.
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A simple technique for monitoring intracerebral temperature in humans via a ventricular catheter is described. This differs from a previously described method by enabling such measurements to be accomplished with a commercially available thermistor, a standard ventricular catheter, and common hospital supplies. In contrast to the earlier device, this system allows for the subcutaneous tunneling of the distal ventricular catheter. This is an easily assembled and cost-effective technique with which to conduct investigations on human intracerebral temperature.
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Ventriculoperitoneal shunt malfunction is most commonly caused by obstruction of the ventricular catheter by choroid plexus. Such ventricular catheter obstructions remain a major unsolved problem, despite improvements in materials, catheter design, new valves, and increased emphasis on precise techniques favoring optimal catheter placement. ⋯ Such revisions require a general anesthetic in addition to the operative procedure and are followed by a minimum hospitalization of 2 to 3 days. Our experience with hundreds of shunt revisions prompted novel ideas for the development of a new ventricular catheter to treat or prevent this common and previously unresolved difficulty effectively.