Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 93
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Craniofac Surg ; 30(7): 2239-2244, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503116

RESUMO

BACKGROUND: A skull fracture widely occurs in patients with traumatic brain injury, leading to intracranial hematoma, brain contusion, and intracranial infection. It also influences the prognosis and death of patients. This study aimed to discuss cases of patients with comminuted skull fractures. METHODS: From October 2015 to December 2018, 38 patients with comminuted skull fractures were admitted to the hospital. All patients underwent three-dimensional reconstruction of computed tomography scan images. Digital subtraction angiography or magnetic resonance venography was performed to find out the venous sinus. The clinical findings of the patients were significant regarding gender, age, injury mechanism, location, admission Glasgow Coma Scale (GCS), combined epidural, subdural, cerebral contusion, intracranial pneumatosis, maximum depth of depression, admission to surgery, dural tear, post-operative cerebrospinal fluid leakage, post-operative infection, and Glasgow Outcome Scale (GOS) 3 months after surgery. RESULTS: The incidence of traffic accidents, fall from a height, railway accidents, fall of an object, and chop injury was 60.5%, 18.4%, 13.2%, 5.3%, and 2.6%, respectively. Intra-operative dural trar negatively correlated with epidural hematoma, cerebral contusion, and subdural hematoma. Also, post-operative infection negatively correlated with intracranial pneumatosis, depth of fracture depression, and pre-operative cerebrospinal fluid leakage. No correlation was found between contusion, subdural hematoma, intracranial pneumatosis, depth of fracture depression, and post-operative infection. The GOS score positively correlated with age, pre-operative cerebrospinal fluid leakage, and admission GCS score. CONCLUSIONS: A perfect pre-operative examination is a key to successful surgery. Further studies should be conducted to find out more effective treatments for traumatic comminuted skull fractures.


Assuntos
Fratura do Crânio com Afundamento/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Contusões , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/complicações , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
2.
Pediatr Neurosurg ; 54(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673675

RESUMO

OBJECTIVE: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. METHODS: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients' own bone flaps were used to repair depressed skull fractures in all of them. RESULTS: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidu-ral empyema or abscess. None of the patients required reoperation and removal of the bone. CONCLUSION: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.


Assuntos
Transplante Ósseo/métodos , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Adolescente , Transplante Ósseo/tendências , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
World Neurosurg ; 121: 186-192, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30326316

RESUMO

Surgery for depressed skull fractures has developed over centuries to attain the consensus approaches currently used. This review outlines the last 200 years of development of surgical approaches to closed and open depressed skull fractures, fractures involving dural venous sinuses and ping-pong fractures involving infants. Early reports often dealt with only closed and open depressed skull fractures. However, experience has shown that each fracture category merits its own management strategies. Accepted approaches are based on observation only; there is little to no scientific evidence to support treatment for any fracture type.


Assuntos
Fratura do Crânio com Afundamento/cirurgia , Humanos
4.
J Craniofac Surg ; 29(5): 1358-1362, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29521750

RESUMO

The aim of this study was to elucidate the precise location of the maxillary ostium using computed tomography for the reduction of depressed nasomaxillary fractures.Computed tomography images (61 males, 42 females; age range, 3-97 years) were analyzed. Coronal sections were cut every 3 mm.The primary maxillary ostium (PMO) was located 24.7% ±â€Š3.9% of bizygomatic distance (BZD) lateral to septum. The horizontal distance of the PMO significantly increased with age (P = 0.032). The PMO was located 53.3% ±â€Š8.0% of nasal length (NL) above superior surface of the palatal bone (SP). The vertical-to-horizontal ratio of the PMO decreased with age (P = 0.013). The PMO was located 30.3 ±â€Š4.3 mm posterior to the tip of nasal bone. The PMO was located 24.6 ±â€Š4.8 mm posterior to the anterior nasal spine (ANS). The ANS-PMO distance significantly increased with age (P = 0.027). The hiatus semilunaris (HS) was located 11.9% ±â€Š3.2% of BZD lateral to septum. The HS was located 62.4% ±â€Š10.3% of NL above SP. The vertical distance of the HS significantly decreased with age (P = 0.019). The accessory maxillary ostium (AMO) was located 14.9% ±â€Š2.8% of BZD lateral to septum. The horizontal distance of the AMO significantly increased with age (P = 0.027). The AMO was located 44.8% ±â€Š6.9% of NL above SP. The vertical distance of the AMO significantly decreased with age (P < 0.001). The vertical-to-horizontal ratio of the AMO decreased with age (P < 0.001).The distances of the ostium from surgical landmarks measured in this study might be helpful when inserting a small curved elevator into the maxillary ostium in the reduction of medial maxillary fractures.


Assuntos
Fixação de Fratura/métodos , Fraturas Maxilares/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/lesões , Osso Nasal/diagnóstico por imagem , Osso Nasal/lesões , Fratura do Crânio com Afundamento/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fraturas Maxilares/cirurgia , Pessoa de Meia-Idade , Osso Nasal/cirurgia , Valores de Referência , Estudos Retrospectivos , Fratura do Crânio com Afundamento/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
World Neurosurg ; 114: e833-e839, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29588245

RESUMO

BACKGROUND: Compound depressed skull fracture (DSF) is a neurosurgical emergency. Preoperative knowledge of dural status is indispensable for treatment decision making. This study aimed to determine predictors of dural tear from clinical and imaging characteristics in patients with compound DSF. METHODS: This prospective, multicenter correlational study in neurosurgical hospitals in Addis Ababa, Ethiopia, included 128 patients operated on from January 1, 2016, to October 31, 2016. Clinical, imaging, and intraoperative findings were evaluated. Univariate and multivariate analyses were used to establish predictors of dural tear. A logistic regression model was developed to predict probability of dural tear. Model validation was done using the receiver operating characteristic curve. RESULTS: Dural tear was seen in 55.5% of 128 patients. Demographics, injury mechanism, clinical presentation, and site of DSF had no significant correlation with dural tear. In univariate and multivariate analyses, depth of fracture depression (odds ratio 1.3, P < 0.001), pneumocephalus (odds ratio 2.8, P = 0.005), and brain contusions/intracerebral hematoma (odds ratio 5.5, P < 0.001) were significantly correlated with dural tear. We developed a logistic regression model (diagnostic test) to calculate probability of dural tear. Using the receiver operating characteristic curve, we determined the cutoff value for a positive test giving the highest accuracy to be 30% with a corresponding sensitivity of 93.0% and specificity of 43.9%. CONCLUSIONS: Dural tear in compound DSF can be predicted with 93.0% sensitivity using preoperative findings and may guide treatment decision making in resource-limited settings where risk of extensive cranial surgery outweighs the benefit.


Assuntos
Hematoma/cirurgia , Meningite/cirurgia , Fratura do Crânio com Afundamento/cirurgia , Adulto , Idoso , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lágrimas
6.
J Craniofac Surg ; 29(4): 976-979, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29438209

RESUMO

Bone wax is a commonly used hemostatic agent with minimal complications. Some of the known complications include inflammation, granuloma formation, infection, and impaired osteogenesis. Several clinical reports of bone wax migration have also been reported. In this paper, the authors present a rare patient of bone wax migration intracranially in a 6-year-old patient who initially underwent craniotomy for the evacuation of subdural hematoma and repair of depressed skull fracture. The patient then underwent craniotomy scalp scar revision several months later. Postoperatively he developed short-term memory loss, apraxia, and word finding difficulties. The imaging findings were consistent with the presence of a foreign body centered in the posterior aspect of the left middle temporal gyrus, which was surgically removed and found to be bone wax. The patient recovered well with complete improvement of his neurologic symptoms.


Assuntos
Craniotomia , Hemostáticos/efeitos adversos , Palmitatos/efeitos adversos , Reoperação , Ceras/efeitos adversos , Apraxias/etiologia , Criança , Craniotomia/efeitos adversos , Craniotomia/métodos , Corpos Estranhos/cirurgia , Hemostáticos/uso terapêutico , Humanos , Masculino , Transtornos da Memória/etiologia , Palmitatos/uso terapêutico , Fratura do Crânio com Afundamento/cirurgia , Lobo Temporal/cirurgia , Ceras/uso terapêutico
7.
Can Vet J ; 59(1): 31-35, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29302099

RESUMO

A 5-month-old spayed female mixed breed dog was attacked by another dog causing multiple fractures of the left calvarium with a fragment penetrating through the gray matter of the parietal lobe. Surgery was performed to remove the bone fragment. A 6-month follow-up showed dramatic improvement in neurologic status.


Assuntos
Mordeduras e Picadas/veterinária , Lesões Encefálicas Traumáticas/veterinária , Doenças do Cão/cirurgia , Cães/lesões , Tecido Parenquimatoso/lesões , Fratura do Crânio com Afundamento/veterinária , Animais , Mordeduras e Picadas/complicações , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/cirurgia , Cães/cirurgia , Feminino , Tecido Parenquimatoso/cirurgia , Fratura do Crânio com Afundamento/cirurgia
8.
World Neurosurg ; 110: 256-262, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29051109

RESUMO

BACKGROUND: Spontaneous intrauterine depressed skull fractures (IDSFs) are rare fractures that often require neurosurgical evaluation and therapy. Most of the reported congenital depressions are secondary to maternal abdominal trauma or instrumentation during delivery. Spontaneous IDSFs occur in the setting of uneventful normal spontaneous vaginal delivery or cesarean section, without obvious predisposing risk factors. The etiology and optimal management of spontaneous IDSFs remain controversial. CASE DESCRIPTION: We describe 2 cases of spontaneous IDSF who underwent cranioplasty at our institution using an absorbable mesh, as well as review the current state of knowledge regarding the diagnosis and management of spontaneous IDSF. The 2 neonates, 1 male and 1 female, presented at Lucile Packard Children's Hospital with spontaneous IDSF after uneventful normal spontaneous vaginal deliveries. The fractures were located in the left frontal and right parietotemporal calvarium, respectively. Both patients underwent open craniotomy and elevation of their IDSFs with mesh cranioplasty. At last follow-up, both patients were normocephalic and neurologically intact. CONCLUSIONS: Neurosurgery consultation is necessary for initial evaluation of spontaneous IDSF. Surgical intervention is indicated for larger defects and/or intracranial involvement. Expectant management and negative-pressure elevation have also been shown to be effective.


Assuntos
Traumatismos do Nascimento/cirurgia , Procedimentos Neurocirúrgicos/métodos , Fratura do Crânio com Afundamento/cirurgia , Traumatismos do Nascimento/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
World J Surg ; 42(5): 1248-1253, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29022129

RESUMO

INTRODUCTION: Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. METHOD: This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia. RESULTS: A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits. CONCLUSION: Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.


Assuntos
Anestesia Local , Países em Desenvolvimento , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Abscesso Encefálico/cirurgia , Criança , Descompressão Cirúrgica , Feminino , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Intracraniano/cirurgia , Humanos , Lactente , Malaui , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fratura do Crânio com Afundamento/cirurgia , Adulto Jovem
10.
Childs Nerv Syst ; 33(9): 1609-1611, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28643041

RESUMO

BACKGROUND: The popularity of unmanned aerial vehicles, or drones, raises safety concerns as they become increasingly common for commercial, personal, and recreational use. Collisions between drones and people may result in serious injuries. CASE REPORT: A 13-year-old male presented with a comminuted depressed skull fracture causing effacement of the superior sagittal sinus secondary to a racing drone impact. The patient experienced a brief loss of consciousness and reported lower extremity numbness and weakness after the accident. Imaging studies revealed bone fragments crossing the superior sagittal sinus with a short, focal segment of blood flow interruption. Neurosurgical intervention was deferred given the patient's improving neurological deficits, and the patient was treated conservatively. He was discharged home in stable condition. CONCLUSION: Drones may represent a hazard when operated inappropriately due to their capacity to fly at high speeds and altitudes. Impacts from drones can carry enough force to cause skull fractures and significant head injuries. The rising popularity of drones likely translates to an increased incidence of drone-related injuries. Thus, clinicians should be aware of this growing trend.


Assuntos
Aeronaves , Fratura do Crânio com Afundamento/etiologia , Adolescente , Humanos , Masculino , Fratura do Crânio com Afundamento/patologia , Fratura do Crânio com Afundamento/cirurgia , Seio Sagital Superior/patologia
11.
Medicine (Baltimore) ; 96(22): e7055, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28562569

RESUMO

RATIONALE: The superior sagittal sinus (SSS) is the major dural sinuses that receive a considerable amount of venous drainage. Interruption of its posterior third has been suggested to cause intracranial hypertension and lead to potentially fatal consequences. PATIENT CONCERNS: We presented a 22-year-old man with a severe headache and scalp bleeding after a head chop wound. Physical examination identified a 20-cm straight laceration in his parietooccipital scalp. Computed tomography (CT) demonstrated a depressed cranial fracture (DCF) in the left parietooccipital bone, a fracture line across the midline to the right side, and penetrations of bone fragments into the brain parenchyma. DIAGNOSES: Traumatic open DCF in left parietooccipital bone. INTERVENTIONS: An emergent left parietooccipital craniotomy, followed by cranioplasty to restore the depressed bone flap, was delivered to the patient. Postoperative CT confirmed successful elevation of the DCF and removal of intracerebral bone fragments. However, postoperative CT angiography (CTA) demonstrated an absence of venous flow distal to the fracture, suggesting occlusion of the posterior third of SSS. MRV revealed a persistent absence of venous flow in the posterior third of SSS with dilated cortical venous drainage. Anticoagulation treatment was initiated 3 days after surgery, and follow-up CTA and digital subtraction angiography showed gradually improved patency in the anterior and middle two-thirds of SSS. OUTCOMES: Despite occlusion of the posterior third of SSS, patient's symptoms resolved after the operation and he was discharged without complications. LESSONS: The favorable clinical outcome after complete occlusion of the posterior third of the SSS has rarely been reported and it might be explained by our timely surgical intervention and development of compensatory cerebral collateral circulation.


Assuntos
Fraturas Expostas/complicações , Fratura do Crânio com Afundamento/complicações , Seio Sagital Superior/lesões , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Seio Sagital Superior/diagnóstico por imagem , Seio Sagital Superior/cirurgia , Adulto Jovem
12.
Br J Neurosurg ; 31(5): 624-625, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27340736

RESUMO

Depressed skull fractures sustained from golf balls are quite rare. We report such a case in a 16-year old, and demonstrate its appearance in a 3D CT reconstruction.


Assuntos
Golfe/lesões , Fratura do Crânio com Afundamento/cirurgia , Criança , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Acta Neurochir (Wien) ; 158(12): 2341-2345, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27704214

RESUMO

BACKGROUND: There is no settled standard of care or even a consensus between neurosurgeons on the replacement of bone fragments in compound depressed skull fractures (CDSF). MATERIALS AND METHODS: This cohort study retrospectively reviewed the patients with nonmissile CDSF who were admitted to our university hospitals from January 2010 to January 2015. Patients who were managed nonoperatively, polytrauma, comatose patients, and CDSF over the air sinuses were excluded from this study. RESULTS: This study includes 87 consecutive patients with nonmissile CDSF who were surgically treated from January 2010 to January 2015. Follow-up varied from 12 to 36 months. All of the 87 patients presented within 1 week after injury; 76 patients (87.35 %) had surgery within the first 72 h of trauma, and these patients had primary bone fragment replacement (after decontamination) with or without miniplates and minimesh. The patients who presented after 72 h of trauma with no wound discharge had their bone fragments autoclaved then replaced. The patients who presented after 72 h of trauma and had pus or serous discharge from the wound had their bone fragments discarded and scheduled for delayed cranioplasty. The long-term infection rate in all patients who had a primary bone fragment replacement in this study is 0 %. CONCLUSIONS: Primary bone fragment replacement (after decontamination) is a safe option in the management of nonmissile CDSF within 72 h of trauma in selected patients.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Fratura do Crânio com Afundamento/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Padrão de Cuidado
15.
Artigo em Inglês | MEDLINE | ID: mdl-27722022

RESUMO

Depression is predicted to be the most common cause of disability in the coming decade. Self-inflicted hammer blow to the cranium is a rare phenomenon seen in patients with a history of attempted suicide. The resulting comminuted depressed skull fracture of the midline vertex is life threatening. Rapid interdisciplinary communication and intervention are essential to reduce morbidity and mortality. We present a case of self-inflicted hammer blows to the head, review the relevant literature on this topic, and discuss neurosurgical and psychiatric implications.


Assuntos
Fraturas Cominutivas/etiologia , Fraturas Cominutivas/cirurgia , Transtornos Mentais/complicações , Comportamento Autodestrutivo/terapia , Fratura do Crânio com Afundamento/etiologia , Fratura do Crânio com Afundamento/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/patologia , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/patologia , Tentativa de Suicídio
16.
J Plast Reconstr Aesthet Surg ; 69(8): 1037-45, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27345471

RESUMO

Anterior table frontal sinus fractures can result in aesthetically displeasing contour deformities. Acute anterior table frontal sinus fractures that are depressed may be reduced with an open, closed, or endoscope-assisted approach. Delayed contour deformity camouflage can be achieved using bone grafts, titanium meshes, methyl methacrylate, hydroxyapatite cement, and polyether ether ketone implants. The selection of surgical approach to repair a frontal sinus contour deformity depends on the fracture severity, chronicity, complexity, patient comorbidities, and surgeon preference and experience. Advancement in endoscopic technology and expertise has created a paradigm shift toward a less invasive approach to the frontal region, with considerably less morbidity than conventional open techniques.


Assuntos
Fixação de Fratura , Seio Frontal/lesões , Procedimentos Cirúrgicos Reconstrutivos , Fratura do Crânio com Afundamento/cirurgia , Humanos , Fratura do Crânio com Afundamento/diagnóstico por imagem
17.
Rev Stomatol Chir Maxillofac Chir Orale ; 116(5): 308-11, 2015 Nov.
Artigo em Francês | MEDLINE | ID: mdl-26432648

RESUMO

INTRODUCTION: Reconstruction of the anterior wall of the frontal sinus usually requires a coronal incision. This extended approach may lead to paresthesia, unsightly scars, bruises and cicatricial alopecia. These complications encouraged several authors to endoscopic management of this kind of fractures. We present a delayed technique of reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling. TECHNICAL NOTE: Two incisions were performed behind the hair line. Subperiosteal dissection using a periosteal elevator was performed. A 30° angled endoscope was used to visualize the depression. The latter was filled by Hydroset® (Stryker, USA) as a bone substitute. DISCUSSION: In the absence of contra-indication, the reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling has many advantages including uneventful outcome, reduction of the hospital stay and a fast learning curve.


Assuntos
Endoscopia/métodos , Seio Frontal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Substitutos Ósseos/uso terapêutico , Endoscopia/educação , Seio Frontal/patologia , Hematoma/complicações , Hematoma/cirurgia , Humanos , Hidroxiapatitas/uso terapêutico , Curva de Aprendizado , Tempo de Internação , Procedimentos Cirúrgicos Reconstrutivos/educação , Fratura do Crânio com Afundamento/complicações , Fratura do Crânio com Afundamento/cirurgia
18.
Forensic Sci Int ; 255: 106-11, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26232886

RESUMO

We report a craniocerebral trauma case in which a man sustained severe skull fractures and cerebral contusions and it demanded elucidating the injury mechanism of being formed by strike or tumble. However, the initial features of skull fractures were mostly lost when the forensic pathologists involved in the case 5 months later because of injury healing and craniocerebral surgery. Therefore, we aimed to reconstruct the original skull fracture features by utilizing the digital reconstruction technologies in terms of CT (computed tomography) scanning, 3D (3-dimentional) reconstruction, and virtual surgical tools. The original fracture skull was assembled by using Mimics 13.0 based on the CT slices of postoperative head and the removed craniotomy skull flaps, which revealed fracture features of focal and overall skull deformation. Based on the assembly skull model and the contrecoup cerebral contusions, we conclude that the man suffered a tumble after being drunk and the serious craniocerebral trauma occurred. The case demonstrated that the digital reconstruction technologies can serve as effective approaches for forensic investigation in case of survived craniocerebral trauma patients without direct evidences interpreting the original trauma patterns, which could potentially be helpful in exploring the injury mechanisms.


Assuntos
Medicina Legal/métodos , Imagem Tridimensional , Tomografia Computadorizada Multidetectores , Fratura do Crânio com Afundamento/diagnóstico por imagem , Acidentes por Quedas , Adulto , Intoxicação Alcoólica/complicações , Lesões Encefálicas/etiologia , Craniotomia , Humanos , Masculino , Fratura do Crânio com Afundamento/etiologia , Fratura do Crânio com Afundamento/cirurgia
20.
Acta Neurochir (Wien) ; 157(2): 305-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25510645

RESUMO

BACKGROUND: Compound depressed fractures have conventionally been managed surgically with elevation and debridement to avoid infection, especially when there is dural penetration, nonetheless with little evidence. This study was to prospectively compare outcomes after simple suturing and elevation debridement in patients with compound depressed fractures. METHODS: Patients of compound depressed fracture with GCS of five or more, no serious systemic injury, and no significant mass effect were prospectively studied for various factors in relation to infection, hospital stay, survival, and late post-traumatic seizures. Univariate and multivariate analyses were performed using SPSS21. RESULTS: Of the total 232 patients with complete clinico-radiological and follow-up data, 183 underwent simple cleansing and suturing, and 49 underwent surgical elevation debridement. The surgical group at baseline had significantly lower GCS, greater dural violation, and brain matter herniation compared to the conservative arm. Univariate analysis showed simple suturing group to have significantly shorter hospital stay (2.4 vs. 10.3 days) (p < 0.001), lesser infection among survivors (4 vs. 21 %) (p = 0.001), and greater 'survival with no infection' (85 vs. 69 %) (p = 0.01). Multivariate analysis adjusting for age, sex, GCS, dural penetration, and surgical intervention confirmed significantly shorter hospital stay (p < 0.001) and lesser infection among survivors (p = 0.02) in the simple suturing group. Overall, there was no benefit offered by surgical debridement. Simple suturing had a better outcome in most subgroups, except in those with brain matter herniation and GCS 5-8, which showed non-significant benefit with surgical intervention. CONCLUSIONS: Simple suturing seems to be an equally good option in patients with compound depressed fracture with no significant mass effect or brain matter herniation.


Assuntos
Desbridamento/métodos , Fratura do Crânio com Afundamento/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desbridamento/efeitos adversos , Dura-Máter/lesões , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Técnicas de Sutura/efeitos adversos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA