British journal of neurosurgery
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Review Case Reports
Multiple postoperative intracerebral haematomas remote from the site of craniotomy.
A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.
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The psychosurgical treatment of psychiatric illnesses, using stereotactic subcaudate tractotomy (SST), has been carried out at the Geoffrey Knight Unit since 1961. Recently, the procedure has had to be modified. This paper describes the manner in which this has been achieved and the clinical implications of this change.
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Comparative Study
A clinical evaluation of the Codman MicroSensor for intracranial pressure monitoring.
The strain-gauge Codman MicroSensor intracranial pressure (ICP) transducer has shown consistently good laboratory performance. To assess the practical performance of the system in patients following acute brain injury, 10 patients were fitted with a MicroSensor and a second ICP monitor. In five cases this was a fibre-optic transducer and in five cases an intraventricular fluid-filled device. ⋯ Comparison traces of ICP in individual patients show high agreement in timing and size of changes. The unexplained constant offset leads to uncertainty about the true ICP. Treatment decisions are often based upon absolute levels of ICP and patient care may therefore differ depending upon the monitor used.
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Osteoid osteoma is a benign bone tumour which rarely occurs in the skull. A case of such a tumour in the posterior ethmoid region bulging into the anterior cranial fossa is reported in a 42-year-old woman who presented with intense frontal headaches. Excision of the tumour was performed through a subfrontal approach.
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Shaving the scalp prior to surgery is a very common practice. Out of 105 cases operated upon without skin shave at the Royal London Hospital, only one became infected (0.95%). A search into the history of aseptic surgery shows that there are no scientific grounds for the practice of shaving. An examination of contemporary practices worldwide shows that there is a greater realization that preoperative skin shaving does not confer any benefit against postoperative wound infection and that, paradoxically, it may lead to higher rates of wound infection due to the epidermal injury that it inflicts.