World Neurosurg
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Basilar invagination (BI) is a developmental anomaly and commonly presents with neurologic findings. The incidence of BI associated with other osseous anomalies of the craniovertebral junction is high, including incomplete ring of C1 with spreading of the lateral masses, atlanto-occipital assimilation, hypoplasia of the atlas, basiocciput hypoplasia, and occipital condylar hypoplasia. However, BI combined with C1 prolapsing into the foramen magnum (FM) is an extremely rare condition. ⋯ We present 2 rare cases of BI combined with C1 prolapsing into the FM. We adopted different surgical strategies with satisfying outcome for these patients. We deem that the treatment of unique BI should be individualized according to the different image characteristics. The image-based modern rapid prototyping and 3D printed techniques can provide invaluable information in presurgical planning for complex craniovertebral junction anomalies.
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Severe factor V deficiency is an extremely rare coagulation disorder. Patients with factor V activity <5% usually become symptomatic in early childhood. ⋯ We conclude that in this rare bleeding disorder, intracranial surgery was successfully managed because of a thoroughly planned perioperative therapeutic strategy. However, if there is time prior to surgery, a full checkup of the bleeding disorder is advisable.
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We compared the efficacy of a closed suction irrigation system (CSIS) and negative pressure wound therapy (NPWT) for deep surgical site infection (SSI) after lumbar surgery with instrumentation. ⋯ Our results have shown that both NPWT and CSIS are efficient techniques for the management of deep SSI after lumbar surgery with instrumentation. CSIS was more economical and the NPWT system was portable and easier for postoperative nursing care.
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Case Reports
Spontaneous bone regeneration following a large craniectomy in a pediatric patient: a case report.
In children, decompressive craniectomy is commonly performed in cases of increased intracranial pressure that is not medically managed. Currently, it is standard practice to perform cranioplasty after decompressive craniectomy, although optimal timing for the procedure remains controversial. To date, few studies have reported spontaneous cranial bone regeneration in children without intervention. ⋯ This case report shows that cranial bone regeneration is possible in children older than 6 years old, bypassing the need for cranioplasty after decompressive craniectomy. On the basis of this observation, we recommend that more studies should be performed to identify the factors involved in spontaneous skull bone regeneration in the pediatric population.
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The superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis (STA-MCA bypass) currently is performed to prevent atherosclerotic occlusive cerebrovascular disease. However, the benefits of the bypass surgery remain controversial. To ensure consistent surgical benefits, understanding the mechanisms of perioperative cerebral infarction (CI) is required. Moreover, appropriate patient selection procedures must be determined to decrease the rate of perioperative stroke. We retrospectively investigated patients who underwent bypass surgery at our institution and determined that the patients who presented with cortical venous reddening after anastomosis during the surgery developed perioperative CI. ⋯ We determined that patients presenting with cortical venous reddening after anastomosis developed perioperative CI. Cortical venous reddening may be an important predictor for the occurrence of CI after STA-MCA bypass surgery for patients with atherosclerotic occlusive cerebrovascular disease.