The demonstration of the inferior sternal cleft using three-dimensional reconstruction: a case report.

Congenital sternal cleft is a rare disorder in which there is a gap in the midline of the anterior chest wall between the two halves of the sternum. Typically, the contour of the mediastinal structures can be seen beneath the skin. It is rare and the exact incidence is not known. It results from failure of fusion of the two lateral mesodermal sternal bars by 8 weeks of gestation. Most cases are diagnosed shortly after birth and are reported only rarely in adults. We report here one of the congenital major chest wall deformities; inferior sternal cleft is rarely seen, associated with sternal and costal variations in a 22-year young man.

Surgical treatment of chronic subdural haematoma under monitored anaesthesia care.

QUESTIONS UNDER STUDY: General and local uses of anaesthesia are the preferred common methods in the surgical treatment of chronic subdural haematoma (CSDH). The literature provides no information regarding monitored anaesthesia care during surgery of CSDH. In this report we evaluate the clinical results of surgical treatment for CSDH under monitored anaesthesia care. METHOD: Between 2001 and 2006 twenty consecutive patients with 24 CSDHs were surgically treated under monitored anaesthesia care at one institution. The clinical success of the procedure under monitored anaesthesia care, patient satisfaction, length of hospitalisation, anaesthesia-related complications and neurological outcome were analysed. RESULTS: Mean age was 60.9 years, with 15 patients aged over 60. ASA physical condition score was IV in 11 patients, III in 1, II in 4 and I in 4. In all patients CSDH was successfully drained by burr hole craniotomy under monitored anaesthesia care. There was no anaesthesia-related morbidity or mortality. Mean hospital stay was 4.5 days. CONCLUSION: Preliminary results indicate that surgery for CSDH under monitored anaesthesia care is safe and effective. Conscious sedation using monitored anaesthesia care, that is a middle ground between general anaesthesia and local anaesthesia, may facilitate patient comfort and surgical competence during surgery for CSDH.