The kleeblattschadel deformity: neurologic outcome with early treatment.

Despite its alarming appearance, the kleeblattschadel anomaly, when it occurs in the absence of a recognizable mental retardation syndrome, is not associated with primary abnormalities of the central nervous system. Early medical and surgical efforts may result in a satisfactory cosmetic and neurologic outcome.

Anterior cervical fusion using homologous bone grafts: a comparative study.

A comparative sutyd of homologous and autogenous bone grafts in Smith-Robinson type anterior cervical fusions reveals no significant difference between the two in clinical or radiographic results and no complications related to the use of the homologous grafts from the tissue bank.

Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap.

The latissimus dorsi myocutaneous flap is a remarkably durable and versatile flap. Flap necrosis did not occur in any of our patients. One can safely carry with it skin segments as narrow as 3 cm, or as wide as 30 cm. In addition to the 5 cases presented, we have used the flap to repair axillary burn contractures, for breast reconstruction after a transverse incision, and for coverage of the upper arm and shoulder. The applications of this flap challenge the creative imagination of the surgeon and allow a simplified reconstruction, compared to other good methods. The newly described posterior advancement of a latissimus dorsi myocutaneous flap is suggested as the preferred method to repair meningomyelocele defects.

Optic neuropathy from the use of intracranial muslin.

Following repair of an anterior communicating artery aneurysm with McFadden clips and muslin, a 32-year-old woman developed a steroid-responsive optic neuropathy. When she was explored, a sterile abscess with surrounding fibrotic tissue involving the muslin was found adjacent to the right optic nerve. The patient's vision improved following removal of the abscess.

Soft-tissue repair of myelomeningocele defects using bilateral latissimus dorsi and trapezius musculocutaneous flaps.

An urgent closure of myelomeningocele defects was carried out in 82 newborns using latissimus and/or trapezius musculocutaneous advancement flaps. A three-layer closure of skin, muscle, and fascia was achieved in a single stage without a flank skin graft. All of the wounds healed within a two-week period and no late breakdown of the wound occurred during the eight-year period of study. The urgent closure maximized the neurological salvage and facilitated early cerebrospinal fluid shunting by preventing both infection and neural desiccation. This report represents the largest number of sequentially treated myelomeningocele defects without a major wound healing problem or death. The advancement musculocutaneous flap closure is safe, simple, and effective and is recommended as the preferred method for closure of the myelomeningocele defect.

Surgical management of posthemorrhagic hydrocephalus in 22 low-birth-weight infants.

In order to assess the complication rates of cerebrospinal fluid diversion techniques used at our institution, a retrospective study of the surgical management of posthemorrhagic hydrocephalus was conducted from a population of 547 premature infants admitted to the neonatal intensive care unit from 1987 to 1989. The incidences of periventricular-intraventricular hemorrhage in the 3 years studied were 44%, 37%, and 27%, respectively. Thirty-nine of the infants developed posthemorrhagic hydrocephalus as determined by serial cranial ultrasonography; 22 required cerebrospinal fluid diversion. During the study period, we began using subcutaneous ventricular reservoirs and a low-pressure Neonatal Shunt (customized device) in infants weighing less than 1500 g at the time of instrumentation. This change in management was associated with a significant reduction (P < 0.005) in the morbidity and mortality compared to the use of external ventricular drainage devices. On the basis of these findings, the use of external ventricular drainage devices was discontinued.