Lifesaving decompressive craniectomy in 'malignant' cerebral venous infarction.
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Biomedical subjects
Publications and source records attributed to J Maarrawi.
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OBJECTIVE: Establish the risk factors for infection following missile head injuries (MHI). METHODS: Between 1975 and 1990, 500 cases of MHI were admitted, with only 272 responding to inclusion criteria. After initial evaluation including CT scan for 177 patients, all underwent craniectomy with debridement and duroplasty. A retrospective study was undertaken in order to identify the risk factors that increase the infection rate. RESULTS: The global infection rate was 11.39%. Among the studied factors, those increasing the infection rate were: coma on admission (17.6% vs 7.6%), penetrating wounds (12.93% vs 7% for tangential wounds), intracerebral trajectory length over 6 cm (18.42% vs 6.32%), air sinuses effraction (25.8% vs 9.54%), a surgical delay over 72 hours (41.6% vs 10.6%), inadequate duroplasty (28% vs 7.33%), cerebrospinal fluid (CSF) fistulae (58.62% vs 5.76%). The presence of postoperative bone fragments did not increase the infection rate (11.4% vs 11.2%). DISCUSSION AND CONCLUSION: Adequate duroplasty and aggressive treatment of CSF fistulae decrease the infection rate. There is no need to reoperate on residual bone fragments after adequate debridment. A delay of 24 to 48 hours should be considered, to facilitate the procedure without increasing the infection risk.
The authors report a case of intraspinal neurenteric cyst in a 22-month-old child, who presented with acute paraplegia following a vesicourethrogram. Despite 8 days' delay in surgical decompression, he made a complete neurological recovery. Neurenteric cysts are rare congenital lesions of the spinal canal lined with an epithelium of endodermal origin. They are usually located at the cervicothoracic junction and present with progressive mild to moderate signs of myelopathy. This is a unique case in regard both to its clinical presentation and to the excellent outcome after 8 days of complete paraplegia.
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We report a case of growing fracture of the orbital roof in a 5-year-old child. The presenting sign was a pulsatile orbital mass. This child had a history of a minor head injury with orbital impact 2 years ago. Cerebral CT scan revealed a diastatic fracture of the right orbital roof. On MRI a leptomeningeal cyst extending in the orbital cavity was shown. Frontal craniotomy with direct repair of the dural and bone defects was performed. The outcome was excellent. In the literature the exact pathophysiology of the growing fractures is still debated but a dural laceration along the fracture line is noted in all the cases. They are mostly located in the cranial convexity, and rarely affect the skull base. Only 5 similar cases were found in the relevant literature. Growing fracture of the orbital roof should be suspected if ocular symptoms appears in childs who have sustained a head injury several months or years ago.