Introduction: After reattachment of the temporalis muscle, atrophy of the temporalis muscle may occur, which is associated with difficulty in chewing function. To prevent this, numerous surgical modifications have been made to allow reattachment of the temporalis muscle with minimal damage. Methods: We describe the technical details of surgical modification for reattachment of the temporalis muscle in 12 cases treated surgically in our department. Results: We used a transosseous continuous suture along the superior temporal line as a base for reattachment of the muscle. The temporalis muscle was successfully reattached in all observed cases. No infections, dislocations, muscle tears, or significant temporal atrophy with depression occurred in any of the observed cases. In the author's technique, the temporalis muscle is reconstructed anatomically at the level of the superior temporal line. At follow-up after approximately 24 months, all patients were satisfied with the cosmetic result. Conclusions: The use of running sutures along the superior temporal line is a safe, simple, and successful alternative for reattachment of the temporal muscles in patients undergoing surgery for intracranial pathology. The surgery takes slightly longer but does not require additional costs. This technique minimizes the risk of atrophy of the temporal muscles. With this technique, muscle tension was maintained with good stabilization and the cosmetic result is also satisfactory.
{"title":"Temporalis muscle reattachment by using transosseus running suture along superior temporal line: technical note","authors":"D. Štimac, Dragana Jankovic","doi":"10.55005/v2i1.2","DOIUrl":"https://doi.org/10.55005/v2i1.2","url":null,"abstract":"\u0000\u0000\u0000\u0000Introduction: After reattachment of the temporalis muscle, atrophy of the temporalis muscle may occur, which is associated with difficulty in chewing function. To prevent this, numerous surgical modifications have been made to allow reattachment of the temporalis muscle with minimal damage.\u0000Methods: We describe the technical details of surgical modification for reattachment of the temporalis muscle in 12 cases treated surgically in our department.\u0000Results: We used a transosseous continuous suture along the superior temporal line as a base for reattachment of the muscle. The temporalis muscle was successfully reattached in all observed cases. No infections, dislocations, muscle tears, or significant temporal atrophy with depression occurred in any of the observed cases. In the author's technique, the temporalis muscle is reconstructed anatomically at the level of the superior temporal line. At follow-up after approximately 24 months, all patients were satisfied with the cosmetic result.\u0000Conclusions: The use of running sutures along the superior temporal line is a safe, simple, and successful alternative for reattachment of the temporal muscles in patients undergoing surgery for intracranial pathology. The surgery takes slightly longer but does not require additional costs. This technique minimizes the risk of atrophy of the temporal muscles. With this technique, muscle tension was maintained with good stabilization and the cosmetic result is also satisfactory.\u0000\u0000\u0000\u0000","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"235 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114416732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why another journal? Well, why not?","authors":"A. Demetriades","doi":"10.55005/v2i1.1","DOIUrl":"https://doi.org/10.55005/v2i1.1","url":null,"abstract":"","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130349267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaima Suzuki, M. Lepić, Hiroki Sato, Shinya Tabata, Tatsuki Kimura, Hiroki Kobayashi, Keiji Yoshida, Masayoshi Fukuoka, Nobuyuki Yahagi, T. Maeda, H. Ooigawa, H. Kurita
Introduction: Post-traumatic vasospasm is a rare but known ischemic damage after severe traumatic brain injury that independently predicts patients’ outcome. Although the pathogenesis and risk factors have not been elucidated, some reports describe relationship between the occurrence of vasospasm and traumatic subarachnoid haemorrhage. Here, we report a case of vasospasm in a patient with acute subdural hematoma in which traumatic subarachnoid haemorrhage was not recognized both surgically and radiologically.Case Report: A 60-year-old male was admitted for head trauma. Neurologically, he was somnolence and showed left hemiparesis. Computerized tomography (CT) revealed large acute subdural hematoma in the left side associated with midline-shift. He underwent urgent craniotomy and hematoma evacuation. Postoperatively, he recovered well with resolution of neurological symptoms. Follow-up CT revealed complete removal of hematoma. However, his level of consciousness deteriorated on the 5th day after surgery. CT showed no ischemic lesion, but 3D-CT angiography revealed diffuse vasospasm in the right middle cerebral artery. Subsequently, his neurological condition recovered gradually and he was discharged ambulatory on the 9th day after the surgery. Follow-up angiography showed the spasm had disappeared completely.Conclusion: Post-traumatic vasospasm without traumatic SAH was described. The etiology and pathogenesis of this fairly rare condition associated with head trauma is discussed.
{"title":"Delayed cerebral vasospasm following traumatic acute subdural hematoma: case report","authors":"Kaima Suzuki, M. Lepić, Hiroki Sato, Shinya Tabata, Tatsuki Kimura, Hiroki Kobayashi, Keiji Yoshida, Masayoshi Fukuoka, Nobuyuki Yahagi, T. Maeda, H. Ooigawa, H. Kurita","doi":"10.55005/v2i1.3","DOIUrl":"https://doi.org/10.55005/v2i1.3","url":null,"abstract":"Introduction: Post-traumatic vasospasm is a rare but known ischemic damage after severe traumatic brain injury that independently predicts patients’ outcome. Although the pathogenesis and risk factors have not been elucidated, some reports describe relationship between the occurrence of vasospasm and traumatic subarachnoid haemorrhage. Here, we report a case of vasospasm in a patient with acute subdural hematoma in which traumatic subarachnoid haemorrhage was not recognized both surgically and radiologically.Case Report: A 60-year-old male was admitted for head trauma. Neurologically, he was somnolence and showed left hemiparesis. Computerized tomography (CT) revealed large acute subdural hematoma in the left side associated with midline-shift. He underwent urgent craniotomy and hematoma evacuation. Postoperatively, he recovered well with resolution of neurological symptoms. Follow-up CT revealed complete removal of hematoma. However, his level of consciousness deteriorated on the 5th day after surgery. CT showed no ischemic lesion, but 3D-CT angiography revealed diffuse vasospasm in the right middle cerebral artery. Subsequently, his neurological condition recovered gradually and he was discharged ambulatory on the 9th day after the surgery. Follow-up angiography showed the spasm had disappeared completely.Conclusion: Post-traumatic vasospasm without traumatic SAH was described. The etiology and pathogenesis of this fairly rare condition associated with head trauma is discussed.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122631792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A worm Serbian welcome!","authors":"L. Rasulić","doi":"10.55005/sjns.v1i1.1","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.1","url":null,"abstract":"","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128014949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Central nervous system germinomas are the most frequent germ cell tumors, predominantly affecting adolescents and young adults. They are generally midline tumors primarily located in the pineal gland and suprasellar regions; however, basal ganglia germinomas (BGGs) are rare and generally unilateral, with only 16 histopathologically-confirmed bilateral BGGs reported to date. In this paper, we are presenting a rare case of bilateral BGG in a 14-year-old boy. The neuroradiological findings of bilateral BGGs are presented, and the strategy for their management is discussed along with previously reported cases. A 14-year-old suffering from involuntary jerky movements of the right shoulder and arm was referred to our department. An MRI scan revealed diffuse T2/FLAIR hyperintensity in the bilateral basal ganglia, and MR spectroscopy suggested a malignant disease. A stereotactic biopsy was conducted, and the histologic examination of the specimen revealed germinoma. Neoadjuvant chemotherapy followed by whole ventricular radiation therapy with a boost to the tumor was initiated. BGGs are mostly unilateral, but rarely bilateral entities may also be seen. Despite excellent survival rates, symptomatic outcomes may not be very favorable. Therefore, it is crucial to recognize the initial MRI findings and diagnose these tumors early for better outcomes and minimal disabilities.
{"title":"Bilateral Germinoma of the Basal Ganglia: A Case Report and Literature Review","authors":"F. Yavuz, Y. Samancı, I. Kulac, S. Peker","doi":"10.55005/sjns.v1i1.7","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.7","url":null,"abstract":"Central nervous system germinomas are the most frequent germ cell tumors, predominantly affecting adolescents and young adults. They are generally midline tumors primarily located in the pineal gland and suprasellar regions; however, basal ganglia germinomas (BGGs) are rare and generally unilateral, with only 16 histopathologically-confirmed bilateral BGGs reported to date. In this paper, we are presenting a rare case of bilateral BGG in a 14-year-old boy. The neuroradiological findings of bilateral BGGs are presented, and the strategy for their management is discussed along with previously reported cases. A 14-year-old suffering from involuntary jerky movements of the right shoulder and arm was referred to our department. An MRI scan revealed diffuse T2/FLAIR hyperintensity in the bilateral basal ganglia, and MR spectroscopy suggested a malignant disease. A stereotactic biopsy was conducted, and the histologic examination of the specimen revealed germinoma. Neoadjuvant chemotherapy followed by whole ventricular radiation therapy with a boost to the tumor was initiated. BGGs are mostly unilateral, but rarely bilateral entities may also be seen. Despite excellent survival rates, symptomatic outcomes may not be very favorable. Therefore, it is crucial to recognize the initial MRI findings and diagnose these tumors early for better outcomes and minimal disabilities.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129586354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Nerve transfers are the only surgical option in reconstruction of directly irreparable injuries of the brachial plexus. In the recent years there has been a trend toward the increased use of nerve transfers with introduction of many new methods and novel indications. Patients with total brachial plexus palsy generally have a poor outcome because of a very limited number of donor nerves. On the contrary, patients with partial injuries involving the C5, C6 and sometimes C7 spinal nerves have a remarquable outcome in a large majority of cases. In both situations , restoration of elbow flexion and shoulder functions are the main priorities. It should be emphasized, that in the cases with upper brachial plexus palsy this could be a complete functional recovery. The intention of this review article is a detailed survey on basics of nerve transfers with the comments concerning their advantages, problems and controversies. Analysis is documented with reported outcomes in the literature dealing with the most common methods of nerve transfer.Methods. PubMed/Medline databases were searched for English language basic articles concernig nerve transfers and series of adult patients who had nerve transfers for functional restoration of the upper arm nerves, performed within one year after injury and with minimum follow-up of one year. Finally, we selected 70 articles . Furthermore, literature search for outcome analysis was limited to the articles published after 1990 that included 45 systematic reviews and meta-analyses of the most common nerve transfers ( intercostal, spinal accessory, fascicular and collateral branches of the brachial plexus ). Analysis of clinical outcomes was based on Medical Research Council (MRC) grading system for muscle strenght, and grades M3 or more were considered as useful functional recovery.Results. Generally, intraplexal nerve transfers resulted with higher rate and better quality of recovery, comparing to the extraspinal transfers. Grades M3 or more were obtained in 72% of the intercostal and 73% of the spinal accessory nerve transfers for restoration of elbow flexion, and in 56% vs. 98% of transfers for restoration of shoulder function. Among intraplexal nerve transfers , elbow flexion was restored in 84% to 91% of the medial pectoral, 100% of the thoracodorsal and 94% to 100% of the single or double fascicular nerve transfers. Shoulder function was restored in 81,8% of the medial pectoral, 86% to 93% of the thoracodorsal and 100% of the triceps branch nerve transfers. Dual nerve transfers, meanning simultaneous reinnervation of the suprascapular and axillary nerves, resulted with 100% rate of recovery.Conclusion. Double fascicular transfer for restoration of elbow flexion and dual nerve transfer for restoration of shoulder function resulted with significantly better results than the other transfers, especially regarding the quality of recovery, meanning representation of grades M4 and M5 among recoveries. Med
{"title":"Motor nerve transfers for restoration of upper arm function in adult brachial plexus injuries","authors":"M. Samardžić, L. Rasulić, Lazar Stanković","doi":"10.55005/sjns.v1i1.6","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.6","url":null,"abstract":"Introduction. Nerve transfers are the only surgical option in reconstruction of directly irreparable injuries of the brachial plexus. In the recent years there has been a trend toward the increased use of nerve transfers with introduction of many new methods and novel indications. Patients with total brachial plexus palsy generally have a poor outcome because of a very limited number of donor nerves. On the contrary, patients with partial injuries involving the C5, C6 and sometimes C7 spinal nerves have a remarquable outcome in a large majority of cases. In both situations , restoration of elbow flexion and shoulder functions are the main priorities. It should be emphasized, that in the cases with upper brachial plexus palsy this could be a complete functional recovery. The intention of this review article is a detailed survey on basics of nerve transfers with the comments concerning their advantages, problems and controversies. Analysis is documented with reported outcomes in the literature dealing with the most common methods of nerve transfer.Methods. PubMed/Medline databases were searched for English language basic articles concernig nerve transfers and series of adult patients who had nerve transfers for functional restoration of the upper arm nerves, performed within one year after injury and with minimum follow-up of one year. Finally, we selected 70 articles . Furthermore, literature search for outcome analysis was limited to the articles published after 1990 that included 45 systematic reviews and meta-analyses of the most common nerve transfers ( intercostal, spinal accessory, fascicular and collateral branches of the brachial plexus ). Analysis of clinical outcomes was based on Medical Research Council (MRC) grading system for muscle strenght, and grades M3 or more were considered as useful functional recovery.Results. Generally, intraplexal nerve transfers resulted with higher rate and better quality of recovery, comparing to the extraspinal transfers. Grades M3 or more were obtained in 72% of the intercostal and 73% of the spinal accessory nerve transfers for restoration of elbow flexion, and in 56% vs. 98% of transfers for restoration of shoulder function. Among intraplexal nerve transfers , elbow flexion was restored in 84% to 91% of the medial pectoral, 100% of the thoracodorsal and 94% to 100% of the single or double fascicular nerve transfers. Shoulder function was restored in 81,8% of the medial pectoral, 86% to 93% of the thoracodorsal and 100% of the triceps branch nerve transfers. Dual nerve transfers, meanning simultaneous reinnervation of the suprascapular and axillary nerves, resulted with 100% rate of recovery.Conclusion. Double fascicular transfer for restoration of elbow flexion and dual nerve transfer for restoration of shoulder function resulted with significantly better results than the other transfers, especially regarding the quality of recovery, meanning representation of grades M4 and M5 among recoveries. Med","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133644025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traumatic intracranial pseudoaneurysms are rare complications of head injuries following traffic accidents, occurring in less than 1% of all cerebral aneurysms. Most cases are associated with fracture of the skull. Rupture of these traumatic aneurysms occur in up to 50% of all cases and are typically delayed from days to weeks following the initiating trauma. Traumatic pseudoaneurysms are often called a pulsating hematoma, which occurs when the arterial wall is ruptured by trauma and bleeding is confined only by the adventitia or surrounding tissues. Unlike the structure of a true aneurysm, that has all anatomical layers, the wall of a traumatic intracranial pseudoaneurysm is composed mainly of blood clot and a small amount of fibrous tissue. Difficult diagnosis, delayed presentation and poor outcomes contribute to overall prognosis of these traumatic intracranial aneurysms. We investigated the patients with traumatic intracranial aneurysms developed after traffic accidents and treated with endovascular embolization in our Institution, with a review of literature and discussion of management options. As traumatic intracranial aneurysms may present both diagnostic challenges and surgical difficulties, especially after polytrauma cases, rarely being appropriate for conservative treatment, early and precise diagnosis with cerebral angiography and prompt treatment are essential for good prognosis. Due to its nature to be fragile and prone to rupture, careful and precise endovascular embolization is thus a method of choice for treatment of these pseudoaneurysms.
{"title":"Traumatic intracranial aneurysms associated with traffic accidents and endovascular management options","authors":"F. Vitošević, Svetlana Milošević-Medenica","doi":"10.55005/sjns.v1i1.5","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.5","url":null,"abstract":"Traumatic intracranial pseudoaneurysms are rare complications of head injuries following traffic accidents, occurring in less than 1% of all cerebral aneurysms. Most cases are associated with fracture of the skull. Rupture of these traumatic aneurysms occur in up to 50% of all cases and are typically delayed from days to weeks following the initiating trauma. Traumatic pseudoaneurysms are often called a pulsating hematoma, which occurs when the arterial wall is ruptured by trauma and bleeding is confined only by the adventitia or surrounding tissues. Unlike the structure of a true aneurysm, that has all anatomical layers, the wall of a traumatic intracranial pseudoaneurysm is composed mainly of blood clot and a small amount of fibrous tissue. Difficult diagnosis, delayed presentation and poor outcomes contribute to overall prognosis of these traumatic intracranial aneurysms. \u0000We investigated the patients with traumatic intracranial aneurysms developed after traffic accidents and treated with endovascular embolization in our Institution, with a review of literature and discussion of management options. \u0000As traumatic intracranial aneurysms may present both diagnostic challenges and surgical difficulties, especially after polytrauma cases, rarely being appropriate for conservative treatment, early and precise diagnosis with cerebral angiography and prompt treatment are essential for good prognosis. Due to its nature to be fragile and prone to rupture, careful and precise endovascular embolization is thus a method of choice for treatment of these pseudoaneurysms.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122702582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reliable spatial orientation in neurosurgery is of utmost importance. Anatomical landmarks-based orientation or sulcal identification is insufficiently accurate for the requirements of modern times neurosurgery Intraoperative ultrasound (IoUS) is affordable and widely available, easy to use, does not require additional equipment nor installation, and does not use additional any expendable material. It is mainly used (but not limited) to localize, optimize approach and evaluate resection of expansions of all origins, but also in vascular neurosurgery, hydrocephalus and malformations. The paper reviews the possibilities of intraoperative ultrasound use in cranial neurosurgery, and also introduces the basic aspects of intraoperative use. The significance of IoUS in contemporary neurosurgery is improving with the technical development and advances within the field. The basic role in localization of the lesions is still not used to the extent it deserves, or should be used, while there are already numerous other possibilities providing exceptionally reliable intraoperative information regarding all aspects of surgical substrates and treatment.
{"title":"Intraoperative ultrasound use in cranial neurosurgery","authors":"M. Lepić","doi":"10.55005/sjns.v1i1.4","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.4","url":null,"abstract":"Reliable spatial orientation in neurosurgery is of utmost importance. Anatomical landmarks-based orientation or sulcal identification is insufficiently accurate for the requirements of modern times neurosurgery\u0000Intraoperative ultrasound (IoUS) is affordable and widely available, easy to use, does not require additional equipment nor installation, and does not use additional any expendable material. It is mainly used (but not limited) to localize, optimize approach and evaluate resection of expansions of all origins, but also in vascular neurosurgery, hydrocephalus and malformations.\u0000The paper reviews the possibilities of intraoperative ultrasound use in cranial neurosurgery, and also introduces the basic aspects of intraoperative use.\u0000The significance of IoUS in contemporary neurosurgery is improving with the technical development and advances within the field. The basic role in localization of the lesions is still not used to the extent it deserves, or should be used, while there are already numerous other possibilities providing exceptionally reliable intraoperative information regarding all aspects of surgical substrates and treatment.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124990256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction The prevalence of penetrating head injuries (PBI) has increased during the latest wars making up to 37,4% of all injuries (1,2) Microbiology of modern war wounds is unique for each military conflict depending on the climatic and geographical features of the theater of combat (3,4). Material and methods: 286 patients were operatively treated after penetrating combat injury in our institution between 1991-1999. Based on the inclusion criteria: combat-related cranial injury and absence of severe abdominal or chest combat injuries, as well as their ability to report for a follow-up exam led to the inclusion of 202 patients. Initial surgical treatment included removal of devitalized soft tissue and bone fragments with craniectomy, removal of devitalized brain tissue, easily accessible intracerebral bone and metal fragments and intracranial hemathoma. All patients received the same standardized postoperative care with triple antibiotics. Results Infection occurred in 36 patients (17,82%). In vast majority of the cases infection occurred in the form of brain abscess 31 (86.11%), in 4 cases as meningitis (11.1%) and in 1 case as osteomyelitis and epidural infection (2.78%). Retained metal and bone fragments and postoperative liquorrhea have significant influences on occurrence of postoperative infection. Conclusion Postoperative infection considerably increases long term functional outcome. Using advantages of minimally invasive surgical technique, neuronavigation or intraoperative imaging for removal of retained foreign bodies can reduce risk for postoperative infection with minimal risk of additional neurologic deficit. Autograft is preferable option for dural reconstruction in combat related head injuries.
{"title":"Risk factors for postoperative infection after combat related head injuries","authors":"G. Pavlićević","doi":"10.55005/sjns.v1i1.3","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.3","url":null,"abstract":"Introduction \u0000The prevalence of penetrating head injuries (PBI) has increased during the latest wars making up to 37,4% of all injuries (1,2) Microbiology of modern war wounds is unique for each military conflict depending on the climatic and geographical features of the theater of combat (3,4). \u0000Material and methods: \u0000286 patients were operatively treated after penetrating combat injury in our institution between 1991-1999. Based on the inclusion criteria: combat-related cranial injury and absence of severe abdominal or chest combat injuries, as well as their ability to report for a follow-up exam led to the inclusion of 202 patients. Initial surgical treatment included removal of devitalized soft tissue and bone fragments with craniectomy, removal of devitalized brain tissue, easily accessible intracerebral bone and metal fragments and intracranial hemathoma. All patients received the same standardized postoperative care with triple antibiotics. \u0000Results \u0000 \u0000Infection occurred in 36 patients (17,82%). In vast majority of the cases infection occurred in the form of brain abscess 31 (86.11%), in 4 cases as meningitis (11.1%) and in 1 case as osteomyelitis and epidural infection (2.78%). Retained metal and bone fragments and postoperative liquorrhea have significant influences on occurrence of postoperative infection. \u0000 \u0000Conclusion \u0000 \u0000Postoperative infection considerably increases long term functional outcome. Using advantages of minimally invasive surgical technique, neuronavigation or intraoperative imaging for removal of retained foreign bodies can reduce risk for postoperative infection with minimal risk of additional neurologic deficit. Autograft is preferable option for dural reconstruction in combat related head injuries.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124724218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dubovoy, E. Lekchnov, D. Galaktionov, K. Ovsyannikov, A. Bervitskiy, A. Sosnov, Jamil Rzaev
Introduction Management of complex aneurysms of the middle cerebral artery (MCA) is very challenging and require individualized treatment strategies. The aim of our review was to analyze experience with the treatment of complex MCA aneurysms using revascularization and artery sacrifice techniques. Methods We have reviewed 9 original articles on patients' treatment with complex MCA aneurysms. Depending on localization of complex aneurysm of MCA various methods of parent artery sacrifice, revascularization strategies, surgical results, outcomes and complications were reviewed. Results We have analyzed treatment of 244 patients with 246 complex MCA aneurysms in 9 different groups. From 67 to 100% of cases the aneurysms were occluded successfully. Bypass patency being a result of the performed revascularization methods was from 83.3 to 100%. The main complications included ischemic disorders related to occlusion of the bypass graft or perforators injury. Morbidity in some reviews varied from 2.4 to 6.9%. The majority of patients in late follow-up showed good outcomes 0-2 on modified Rankin scale and 4-5 on Glasgow Outcome Scale. Illustrative clinical cases of the patients with complex MCA aneurysms treated at the Federal Neurosurgical Center were presented. Conclusion Complex aneurysms of the MCA are very challenging lesions. The surgical strategy for treating complex MCA aneurysm should take into account vascular anatomy, complex aneurysm morphology, its localization and rupture status of each case
{"title":"Microsurgical management of complex middle cerebral artery aneurysms","authors":"A. Dubovoy, E. Lekchnov, D. Galaktionov, K. Ovsyannikov, A. Bervitskiy, A. Sosnov, Jamil Rzaev","doi":"10.55005/sjns.v1i1.2","DOIUrl":"https://doi.org/10.55005/sjns.v1i1.2","url":null,"abstract":"Introduction\u0000Management of complex aneurysms of the middle cerebral artery (MCA) is very challenging and require individualized treatment strategies. The aim of our review was to analyze experience with the treatment of complex MCA aneurysms using revascularization and artery sacrifice techniques.\u0000Methods\u0000We have reviewed 9 original articles on patients' treatment with complex MCA aneurysms. Depending on localization of complex aneurysm of MCA various methods of parent artery sacrifice, revascularization strategies, surgical results, outcomes and complications were reviewed.\u0000Results\u0000We have analyzed treatment of 244 patients with 246 complex MCA aneurysms in 9 different groups. From 67 to 100% of cases the aneurysms were occluded successfully. Bypass patency being a result of the performed revascularization methods was from 83.3 to 100%. The main complications included ischemic disorders related to occlusion of the bypass graft or perforators injury. Morbidity in some reviews varied from 2.4 to 6.9%. The majority of patients in late follow-up showed good outcomes 0-2 on modified Rankin scale and 4-5 on Glasgow Outcome Scale. Illustrative clinical cases of the patients with complex MCA aneurysms treated at the Federal Neurosurgical Center were presented.\u0000Conclusion\u0000Complex aneurysms of the MCA are very challenging lesions. The surgical strategy for treating complex MCA aneurysm should take into account vascular anatomy, complex aneurysm morphology, its localization and rupture status of each case","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128845850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：