OBJECTIVETo investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery.

METHODSOver the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control.

RESULTSSeventeen cases (54.8%) in the unilateral operation group survived and were in good condition, 8 (25.8%) had moderate disability, 4 (12.9%) had severe disability, 1 (3.2%) was in vegetative state, and 1 (3.2%) died. Compared with the control group, the Glasgow Outcome Scale score was not significantly different in the unilateral operation group, but the operation time, blood transfusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group.

CONCLUSIONSEndoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dissymmetric bilateral frontal contusion. It can obviously diminish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation.

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Abducens Nerve Diseases* ; Abducens Nerve* ; Dura Mater ; Head ; Neck Injuries ; Paralysis ; Skull Fractures ; Spine

Epidural anesthesia was given to a 72-year-old female patient suffering from cholecystitis due to multiple gallstones, and chronic bronchial asthma. In the course of the procedure we inserted an epidural catheter (Deseret catheter with a plastic stylet) via a 17G Tuohy needle at the L1-2 intervertebral space. Since it was very difficult to insert the catheter through the Tuohy needle, we pushed it forward applying a considerable amount of force. Following the insertion of the catheter and prior to injection of a test dose of local anesthetic, it was found-that cerebrospinal fluid was flowing out through the catheter from a puncture of the dura. In a second attempt, we approached another intervertebral space, this time with a Portex catheter without a stylet, and succeeded in administering the anesthetic by means of a continuous epidural procedure.
Aged ; Anesthesia, Epidural/adverse effects* ; Catheterization/adverse effects* ; Dura Mater/injuries* ; Female ; Human ; Plastics

Dural arteriovenous fistulae (DAVF) is a rare intracranial vascular disease. It is pathologically characterized by direct shunting of the intracranial artery and vein, which results in cerebral ischemia, intracranial hemorrhage, neural deficit and intracranial murmur. The etiological mechanism of DAVF is not well known, but most researchers think it is associated with congenital abnormal development, especially abnormal development of dural blood vessels at the stage of embryogenesis. Recently, some researchers have found that DAVF is also associated with some acquired factors. This article reports a case who developed DAVF within 2 years after debridement of frontal bone fragmentation, depressed fracture, left frontal lobe contusion and superior sagittal sinus injury due to forehead knife-cut injury. The pathogenic mechanism was explored through a review of the related literatures.
Adult ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; etiology ; surgery ; Dura Mater ; injuries ; Forehead ; injuries ; Humans ; Male ; Wounds, Stab ; complications

The present study invetigates the effects of root planing only(control group) , DFDBA alone(test group 1) and combined use of DFDB and Dura mater(test group 2) in dehiscence defects in dogs. The results of 8weeks post-surgery by histological comparison between the three groups are as follows. 1. The contol group showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 2. The test group 1 showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 3. The test group 2 showed significant amount of the new cementum and new bone. 4. Both control and test groups healed without any observable root resorption and ankylosis. The above the results suggest that the use of resorbable Dura mater only does not improve the regeneration of new bone and periodontal ligament due to difficulties of space making, but the combined use with DFDB may be more effective.
Animals ; Ankylosis ; Connective Tissue ; Dental Cementum ; Dogs* ; Dura Mater* ; Periodontal Ligament ; Regeneration ; Root Planing ; Root Resorption ; Wound Healing* ; Wounds and Injuries*

One case of congenital cutis aplasia is presented. The defect involved includes full-thickness skin defect of scalp and cranium. The patient was treated with debridement of dirty necrosed crust which covered exposed dura mater and with double opposing rotation flap including pericranium for bone regeneration. The donor site was covered with skin graft from right thigh. During operation, the superficial temporal artery was found to be short and weak. And after operation, the margin of flap were congested and finally necrotized. The necrotic wound was treated with conservative management. The vascular impairment is thought to be main course of congenital cutis aplasia. So we conclude that the treatment of choice is conservative management or careful flap surgery for coverage of defect area.
Bone Regeneration ; Debridement ; Dura Mater ; Estrogens, Conjugated (USP) ; Humans ; Scalp ; Skin ; Skull ; Temporal Arteries ; Thigh ; Tissue Donors ; Transplants ; Wounds and Injuries

STUDY DESIGN: Cross sectional study. PURPOSE: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis. OVERVIEW OF LITERATURE: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia. METHODS: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively. RESULTS: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage. CONCLUSIONS: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.
Adult ; Asia, Southeastern ; Cerebrospinal Fluid* ; Constriction, Pathologic ; Dura Mater ; Humans ; Hypertension ; Incidence* ; Laminectomy* ; Life Expectancy ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Spinal Injuries ; Spinal Stenosis ; Wounds and Injuries

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.
Aneurysm, False* ; Athletic Injuries ; Brain ; Brain Edema ; Craniocerebral Trauma ; Dura Mater* ; Football* ; Hematoma, Subdural, Acute ; Humans ; Middle Cerebral Artery ; Rupture ; Seizures

Meningitis is the inflammation of the membranes of the brain and spinal cord. This disease is considered life threatening and classified as a medical and emergency. Here we report a case of delayed meningitis occurred in a patient with craniotomy for traumatic brain injury fifteen years ago. Meanwhile, he had been well, however he complained of headache for five days. A brain computed tomographic scan showed air density on the frontal lobe with frontal sinus defect and pansinusitis. His mental state was suddenly changed to stuporous, despite a day of empirical antibiotics. Therefore, a successful cranialization was performed and he was gradually improved. This is a rare case report. Our case shows that surgical intervention is to be considered in some cases of posttraumatic meningitis for effective and rapid control of infection.
Anti-Bacterial Agents ; Brain ; Brain Injuries ; Craniotomy ; Dura Mater* ; Emergencies ; Frontal Lobe ; Frontal Sinus* ; Headache ; Humans ; Inflammation ; Membranes ; Meningitis* ; Spinal Cord ; Stupor

Meningitis is the inflammation of the membranes of the brain and spinal cord. This disease is considered life threatening and classified as a medical and emergency. Here we report a case of delayed meningitis occurred in a patient with craniotomy for traumatic brain injury fifteen years ago. Meanwhile, he had been well, however he complained of headache for five days. A brain computed tomographic scan showed air density on the frontal lobe with frontal sinus defect and pansinusitis. His mental state was suddenly changed to stuporous, despite a day of empirical antibiotics. Therefore, a successful cranialization was performed and he was gradually improved. This is a rare case report. Our case shows that surgical intervention is to be considered in some cases of posttraumatic meningitis for effective and rapid control of infection.
Anti-Bacterial Agents ; Brain ; Brain Injuries ; Craniotomy ; Dura Mater* ; Emergencies ; Frontal Lobe ; Frontal Sinus* ; Headache ; Humans ; Inflammation ; Membranes ; Meningitis* ; Spinal Cord ; Stupor