Association between cervical spine and skull-base fractures and blunt cerebrovascular injury.

INTRODUCTION: Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. MATERIALS AND METHODS: With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. RESULTS: Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6%). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87%, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2%, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). CONCLUSION: BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. KEY POINTS: • CTA screening is important to identify patients with underlying BCVI • Cervical spine and/or skullbase fractures were significantly associated with BCVI • BCVI may occur in up to 11% of patients with blunt trauma injuries.

Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair.

OBJECT: The authors prospectively evaluated the safety and efficacy of a novel polyethylene glycol (PEG) hydrogel sealant in patients undergoing elective cranial surgery with documented cerebrospinal fluid (CSF) leakage after sutured dural repair. METHODS: The PEG hydrogel sealant was used at 11 different study sites in 111 patients with documented intraoperative CSF leakage after neurosurgical dural repair for a variety of conditions. Intraoperative CSF leakage was either spontaneous or induced by a Valsalva maneuver. Patients were monitored for 3 months postoperatively with physical examinations, clinical laboratory analyses, and diagnostic imaging. The PEG hydrogel sealant was 100% effective in stopping CSF leakage in all patients. There were no sealant-related adverse events and all clinical outcomes were consistent with expectations for seriously ill patients undergoing prolonged neurosurgical procedures. CONCLUSIONS: The PEG hydrogel sealant provides a safe and effective watertight closure when used as an adjunct to sutured dural repair during cranial surgery.