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

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

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.
Acellular Dermis ; Arachnoid ; Cerebrospinal Fluid ; Cerebrum ; Decompressive Craniectomy ; Dermis* ; Dura Mater ; Female ; Free Tissue Flaps* ; Humans* ; Intracranial Hemorrhages ; Methicillin Resistance ; Middle Aged ; Scalp* ; Staphylococcal Infections ; Superficial Back Muscles* ; Suppuration ; Temporal Arteries ; Wounds and Injuries

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

OBJECTIVETo analyze the reasons of intraoperative complications of microendoscopic disectomy (MED) and corresponding preventive measures.

METHODSFrom October 2001 to January 2012, the data of 851 patients with lumbar disc herniation underwent MED were retrospectively analyzed. There were 469 males and 382 females with an average age of 42.5 years ranging 16 to 75. Course of disease was from 1 to 18 months with an average of 3 months. The segments of herniated disc including L3,4 of 24 cases, L4,5 of 418 cases and L5S1 of 409 cases . Main symptoms included low back pain with lower extremity radial pain and numbness. Of them,unilateral lower extremity symptom was in 729 cases and bilateral symptom was in 122 cases. There were at least 2 abnormal signs in the four signs which including feeling anormaly, muscle strength anormaly,dysreflexia and muscle atrophy. Distraction test of nerve was positive. CT or MRI findings must coincide with the clinical symptoms and signs. No lumbar instability,spinal stenosis,the upper lumbar disc herniation or combined with cauda equina nerve syndrome were found in 851 patients. The intraoperative complications were recorded and analyzed for the reasons of the intraoperative complication and related prevention measures.

RESULTSAccording to the Macnab standard,424 cases obstained excellent results, 321 good,106 fair,with excellent and good rate of 87.5%. The result was similar to the traditional open operation. One cases transferred to open operation due to equipment breakdown, case died for myocardial infarction at 11 days after the operation, 2 cases occurred acute epidural hematoma in 1 hour after operation. Injury of dura mate of spinal cord occurred in 28 cases and incidence rate was 3.29%(28/851); traction injury of nerve root occurred in 38 cases and incidence rate was 4.46% (38/851). One case occurred in retroperitoneal hematoma, 2 cases in incomplete cauda equina injury and 2 cases in incomplete nerve root breakage.

CONCLUSIONSkilled endoscopic hemostasis techniques,careful and meticulous operation is very important for the prevention of intraoperative complications. Moreover,timely finding and treating the complications was effective measures to prevent the coniplications.

Adolescent ; Adult ; Aged ; Diskectomy ; adverse effects ; Dura Mater ; injuries ; Endoscopy ; Female ; Hematoma, Epidural, Spinal ; etiology ; Humans ; Intraoperative Complications ; etiology ; prevention & control ; Male ; Middle Aged ; Retrospective Studies ; Spinal Nerve Roots ; injuries

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.

Brain Injuries ; Contusions ; Dura Mater ; Endoscopy ; Humans ; Treatment Outcome

OBJECTIVETo investigate the management and outcome of cerebrospinal fluid leakage (CSFL) after cervical surgery.

METHODSMedical records of 642 patients who underwent cervical surgery between December 1999 and December 2005 at our hospital were retrospectively reviewed. Five patients complicated by CSFL after surgery were enrolled, of which 4 cases were complicated after ossified posterior longitudinal ligament or posterior vertebral osteophyte resection directly injuring the dura, and 1 case after posterior cervical double-door laminoplasty without observed dural injury during surgery. Of the 5 CSFL cases, 4 cases occurred at 1-3 days after operation and 1 case at 9 days after operation. All 5 postoperative CSFL cases were treated through wound drainage removal, wound sutures, prophylactic antibiotics, and continuous subarachnoid drainage in the elevated head position.

RESULTSAll 5 CSFL cases experienced leakage cessation within 1-3 days and wound healing within 4-8 days, and subarachnoid drainage lasted 11-16 days with an average volume of 320 mL (range, 150-410 mL). Four cases experienced headache, nausea and vomiting, 1 case suffered from somnolence and hyponatremia, and symptoms subsided after symptomatic treatment and intravenous fluid administration. All patients were followed up for an average of 32 months (range, 22-50 months). No occurrence of cerebrospinal fluid cyst or wound infection was observed. CSFL produced no significant negative effects upon neuromuscular function recovery.

CONCLUSIONContinuous subarachnoid cavity drainage in combination with elevated head position is a simple and safe non-surgical method in treatment of CSFL following cervical surgery.

Cerebrospinal Fluid ; metabolism ; Cervical Vertebrae ; surgery ; Dura Mater ; injuries ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Subdural Effusion ; etiology ; therapy

Marjolin's ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement.
Burns* ; Carcinoma, Squamous Cell* ; Consensus ; Dura Mater ; Female ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Rabeprazole ; Radiotherapy, Adjuvant ; Scalp* ; Skin ; Skull ; Superior Sagittal Sinus ; Ulcer ; Veins ; Wounds and Injuries*

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