Articles: treatment.
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It is important to be alert to the possibility of pneumocephalus in patients with head injury. Pneumocephalus is a potentially lethal complication in patients with craniofacial fractures following severe head trauma. ⋯ A time sequence of cerebral CT scans shows how the pneumocephalus developed and finally resolved without surgical intervention. The etiology, diagnosis, treatment and possible complications of this injury are discussed briefly.
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The International Subarachnoid Aneurysm Trial (ISAT) was designed as the first multi-central international prospective randomized trial aiming to compare the safety and efficacy of the 2 available treatments for ruptured intracranial aneurysms; endovascular coiling and surgical clipping. The initial results were published in the Lancet (2002), and it showed clearly a superiority of coiling over clipping in the treatment of ruptured intracranial aneurysms; 22.7% of coiled patients were dependent or dead compared with 30.6% in the surgical group with absolute risk reduction of 6.9%. ⋯ Despite criticisms, the study has made a significant impact on the treatment of aneurysmal subarachnoid hemorrhage, especially in the United Kingdom and Europe. Since their initial results, the ISAT group has published further papers and updates covering more interesting results regarding the risks of rebleeding, repeat procedures, epilepsy, and the cost effectiveness of both treatments.