British journal of neurosurgery
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In order to determine the factors influencing outcome following craniotomy for trauma in patients over the age of 65 and to establish criteria for surgical intervention, the authors carried out a retrospective analysis of the hospital and general practice records of all head injury patients over the age of 65 who underwent a craniotomy for evacuation of a post-traumatic haematoma within 7 days of injury at Frenchay Hospital during a 10-year period (1980-89). Outcome was measured using the Glasgow Outcome Scale and patients were allotted to a good outcome group (good recovery or moderate disability but independent) or a poor outcome group (severe disability, vegetative state of death). There were 35 men and 31 women with a mean age of 72.5 years (range 65-85 years). ⋯ Outcome was significantly worse in the older patients (75-85 years) compared with the younger patients (65-74 years) and in those patients requiring craniotomy within 24 hours of injury, but the mechanism of injury (fall or road traffic accident), the presence or absence of skull fractures and limb fractures and the pre-operative CT scan appearances did not influence outcome. This study confirms the high probability of poor outcome following surgical evacuation of traumatic intracranial haematomas for elderly head-injured patients with pupillary dilatation or extensor motor responses. Craniotomy under these circumstances is not justified.
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Case Reports
Giant cell reparative granuloma of the craniofacial complex: case report and review of the literature.
Giant cell reparative granuloma (GCRG) is an infrequent non-tumoural lesion affecting particularly the maxillary and mandibular bones and only rarely the cranial bones. The pathogenesis is still controversial and the differential diagnosis, especially from giant cell tumours of bone, is difficult. A case of GCRG of the sphenoid masquerading as an intracranial tumour is reported here. The relevant literature is reviewed.
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Retrospective and epidemiological studies have suggested that smoking increases the risk of developing aneurysmal subarachnoid haemorrhage (SAH). During 1990, 217 patients presenting to the Mersey Regional Neurosurgical unit with spontaneous SAH were prospectively studied. ⋯ Management outcome at 6 months following aneurysmal SAH was similar for smokers and non-smokers (p = 0.43) but smokers had more postoperative pulmonary complications requiring ventilation. Significance was tested with chi-square tests.
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Case Reports
The role of the perforated segment of the ventricular catheter in cerebrospinal fluid leakage into the brain.
Two cases of gross post-operative cerebrospinal fluid (CSF) leakage along an indwelling ventricular catheter are reported. The CSF appeared to leak through the perforations of the ventricular catheter, as well as at the site of penetration of the ventricular wall. A small or slit ventricle with high intraventricular pressure may thus be a predisposing factor for this localized CSF collection.
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The effects of high velocity missiles are described. A series of cases of craniocerebral tangential gunshot wounds over a 6 year period is presented with unsuspected cerebral contusion shown by CT. ⋯ The short- and long-term sequelae and the extent of cerebral damage belie the innocent appearance of the scalp wound. This influences the management of this unusual type of head injury.