Rational design of secondary operation for penetrating head injury: A case report.

Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well.

A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma.

BACKGROUND: Burr hole craniostomy is a widely used method for the evacuation of CSDH. However it is not clear whether the irrigation during operation improves the prognosis or gives rise to additional complications instead. This retrospective cohort study was conducted to determine this issue. METHODS: Patients attending two medical centers in China who underwent burr hole drainage with irrigation (BHDI) or burr hole drainage without irrigation (BHD) for unilateral CSDH during January 2013 to December 2016 were included in this study. The patients' clinical information and follow-up data were retrospectively reviewed, and the radiologic findings were processed using the 3D Slicer software. The differences in outcomes were identified using t-test, chi-square test, or Fisher's exact test. RESULTS: A total of 151 patients comprising 63 patients in the BHD group and 88 patients in the BHDI group were included. Patients in the BHDI group had a higher volume of pneumocrania on the first postoperative day than that of patients in the BHD group (p < 0.05). No significant differences were observed between the two approaches in rates of rebleeding, recurrence and other complications (p > 0.05). CONCLUSIONS: Irrigation had no improvement in the long-term curative effect on CSDH, but it increased the risk of short-term complication in terms of pneumocrania. Therefore, this study suggests that irrigation is not an obligatory procedure during burr hole drainage.

Characteristics of circadian rhythm in patients with intracerebral hemorrhage before death.

OBJECTIVE: To investigate characteristics of circadian rhythm in intracerebral hemorrhage before death. METHODS: This retrospective study was carried out from September 2002 to February 2009. One hundred and twenty-two dead cases with intracerebral hemorrhage(ICH) were collected. The study was carried out in the Department of Neurosurgery in The Second Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China. Blood pressure (BP) and heart rate (HR) were recorded every half-hour during the 72 hours before death. Data of BP and HR before deaths were divided into 3 time periods, namely, period A (72-48 hours to death), period B (48-24 hours to death), and period C (24 hours to death). Data from the 3 periods were analyzed using the Cosinor method to determine whether circadian rhythm was present or absent. The cases were divided into a present and absent group after Cosinor analysis. Prognostic factors in the 2 groups were analyzed by Student`s t-test and Pearson`s chi-squared test. RESULTS: Significant differences in prognostic factors between the 2 groups were not found. When circadian midline-estimating statistic of rhythms over the 3 periods were compared, there were no significant differences. However, when circadian amplitudes over the 3 periods were compared, the amplitudes during period C were significantly lower than period A or B (p<0.001). The percentage of cases in the absent and present groups was significantly different (p<0.001) over the 3 periods. CONCLUSION: As an independent factor, circadian variation could predict death in patients with ICH.

[Influence of heart rate's circadian rhythm in postoperation of intracerebral hemorrhage with different surgery].

OBJECTIVE: To study the influence of different surgery on heart rate's circadian rhythm in postoperation of intracerebral hemorrhage. METHODS: One hundren cases of hypertensive intracerebral hemorrhage at basal ganglia had been collected. According to methods of operation, cases were divided into two groups. Forty-three cases and 57 cases were treated respectively by standard craniotomy (Craniotomy group) and microinvasion of puncturation (Microinvasion group) to remove hematoma. Value of heart rate (HR) was recorded by monitor every 1 hour for 9 days. Circadian rhythm of every day was analyzed by single cosinor and population mean-cosinor. RESULTS: Circadian rhythm of postoperative HR appeared (P < 0.001) in microinvasion group after operation. Circadian rhythm of postoperative HR had not been appearing (P < 0.001) in craniotomy group until to the 8th day. All amplitudes in microinvasion group are higher than that in craniotomy group. Both of amplitudes in two groups begin to be low during 4-7 d after operation and recover the level till the 8th day. CONCLUSION: Influence of circadian rhythm in craniotomy was more severe than microinvasion puncturation. There would be a intimate relationship between encephaledema and recovery of circadian rhythm after neurosurgery.

No association between hypertension and risk for Alzheimer's disease: a meta-analysis of longitudinal studies.

This study examined the association between hypertension and AD by using a quantitative meta-analysis of longitudinal studies. EMBASE and MEDLINE were searched for articles published up to February 2011. All studies that examined the association of hypertension or antihypertensive medication use with the onset of AD were included. Pooled relative risks (RR) were calculated using fixed and random effects models. Twelve studies met our inclusion criteria for this meta-analysis. All subjects were without dementia at baseline. Among them, 9 studies compared the incidence of AD between subjects with (7,270) and without (8,022) hypertension. The quantitative meta-analysis showed that there was no significant difference in incidence of AD (RR: 1.02, 95% confidence interval (CI): 0.91-1.14) between subjects with and without hypertension. Seven studies compared the incidence of AD between subjects with (8,703) and without (13,041) antihypertensive medication use. The quantitative meta-analysis showed that there was no significant difference in incidence of AD (RR: 0.90, 95% CI: 0.79-1.03) between subjects with and without antihypertensive medication use. The quantitative meta-analysis showed that neither hypertension nor antihypertensive medication use was associated with risk for incident AD.