New guidelines for the initial management of head injury.

The majority of patients presenting with mild head trauma will have no intracranial pathology and can be safely discharged home. It is estimated that 10% to 15% of these patients will have clinically significant findings on computed tomography imaging and up to 1% may require neurosurgical intervention. The revised Scandinavian Head Trauma Guidelines provide an evidence- and consensus-based algorithm to assist physicians in determining which patients presenting with minimal, mild or moderate blunt head injury are at higher risk for intracranial pathology and thus require neuroimaging and hospital admission. Striking a balance between health care costs and risk of morbidity remains an ongoing challenge and we will present our concerns with this useful, but conservative management algorithm.

Case Report: Free Latissimus Dorsi Flap in Combination With Subdural Space Reduction for the Prevention of Recurrent Hemorrhage Following Hemispherectomy.

BACKGROUND AND IMPORTANCE: Extensive cerebral resections for the treatment of epilepsy may result in a large intracranial dead space that is prone to recurrent hemorrhage, either due to mechanical dislodgement or the development of extensive subdural membranes. Several techniques have been proposed to decrease the risk of hemorrhage by either reducing or filling the remaining intracranial dead space. CLINICAL PRESENTATION: We present a case of persistent hemorrhage following functional hemispherectomy in a patient with a large porencephalic cyst. A treatment strategy involving both subdural space reduction and cranial vault filling with a vascularized free latissimus dorsi flap is discussed. CONCLUSION: Subdural space reduction and cranial vault filling with a vascularized free latissimus dorsi flap is a viable treatment alternative in patients with large areas of intracranial dead space.

Operative Nuances of Stereotactic Leksell Frame-Based Depth Electrode Implantation.

Background: For intracranial electroencephalographic monitoring, stereotactically implanted depth electrodes are increasingly used at epilepsy centers around the world. Objective: To identify pearls and pitfalls from our experience with stereotactic Leksell (Elekta AB, Stockhom, Sweden) frame-based depth electrode implantation. Methods: An intraoperative video of the implantation technique was recorded. Results: A detailed description and a video on how to implant depth electrodes using the stereotactic Leksell frame is provided. Conclusion: Neurosurgeons implanting depth electrodes for intracranial electroencephalographic monitoring might find the technical nuances and caveats described in this technical note useful for their practice.

Traumatic encephalopathy.

Traumatic brain injury is the leading cause of death and disability among young adults. Clinical evaluation is of limited value in the assessment of patients with traumatic brain injury and is often inaccurate in determining the extent of brain damage. Neurophysiological techniques and neuroimaging can provide valuable prognostic information and are useful in monitoring for seizures and other causes of secondary brain damage and in tracking the effects of therapy. More recently, cognitive electrophysiology and functional magnetic resonance imaging have shown that many patients clinically deemed to be in vegetative or in minimally conscious states are, in fact, aware. This opens new frontiers for further research into establishing communication with otherwise unresponsive patients.