British journal of neurosurgery
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Dural cavernous haemangiomas are rare, and they do not display a classical ring of haemosiderin on MRI as parenchymal cavernous haemangiomas. Sometimes, they are misinterpreted as meningiomas with a dural tail sign. In this short report, a 37-year-old woman was diagnosed with a convexity cavernous haemangioma, and the tumour was totally resected.
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Hereditary haemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu disease is a rare autosomal dominant condition causing vascular dysplasia. Cerebral abscess formation, secondary to paradoxical septic emboli via HHT-derived pulmonary arteriovenous malformations (pAVMs) in this context is well documented. Herein, we present the first case of subdural empyema with this aetiology.
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Observational Study
Cranioplasty outcomes and associated complications: A single-centre observational study.
The resurgence of decompressive craniectomy has led to recent published reviews of the safety of cranioplasties. To date there is a wide range of reported mortality and morbidity. This observational study reports the outcomes of the cranioplasty operations from a single centre and evaluates the factors involved in their management. ⋯ Some potentially preventable complications have been addressed with a resulting rate of complications lower than other published reports. We use two standard adjuncts: the presence of a senior surgeon and strict antimicrobial regimens. We believe that our results could be transferrable to other units by following similar guidelines.
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In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). ⋯ An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.
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Randomized Controlled Trial Comparative Study
A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation during elective supratentorial craniotomy.
Hyperosmolar solutions have been used in neurosurgery to reduce brain volume and facilitate surgical exposure. The purpose of this study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation, intensive care unit (ICU) and hospital stay, postoperative outcomes and incidence of side-effects in patients undergoing elective supratentorial craniotomy. ⋯ Single doses of 3 ml/kg of 20% mannitol and 3% HS are safe and effective for intraoperative brain debulking during elective supratentorial craniotomy, but less effective in patients with pre-existing mass effect and midline shift.