Cranio-cervical bone hyperpneumatization: An overview and illustrative case

The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized;Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.

Preoperative embolization of skull-base tumors: Indications, utility, and concerns

Skull-base tumors are generally difficult to access compared with many other cranial lesions. Usually surgery remains the gold standard treatment for the majority of these tumors. However, in many cases, surgical resection is a challenge because the disease usually is already in the advanced stage by the time of diagnosis. Additionally, there are hypervascular lesions which cause excessive loss of blood, then results in multiple blood transfusions and prolonged operative time, increases the risk of neural injury and prevents complete excision. In order to reduce blood loss intraoperatively, many alternatives were available with the neurosurgical armamentarium, such as head elevation, intravenous use of tranexamic acid, total intravenous anesthesia and even preoperative embolization of tumors. However, preoperative embolization carries variable results, potentially aggravating edema and increasing tumor size. To ascertain the current status and the up-to-date indications, an evaluation of the therapeutic role of preoperative embolization was performed in the current study.

Cardiovascular complications associated with spinal cord injury

Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature.

Intracranial ricocheted-bullet injuries: An overview and illustrative case

The impact of a bullet by firearm is a mortal entity that in recent years has been on the rise due to the increase in crime,confrontations,among other acts of violence.Brain injuries by firearm account for 33.3% of all fatal injuries from this type of weapon.This resulted in a significant number of disabilities with its burden cost at a global level.The types of bullet injuries to the head include:penetrating (inlet without outlet),perforating (through and through),tangential (not enter the skull,causing coupe injury),ricochet (intracranial bouncing of bullet) and careening (rare.enter skull but not brain,runs in the subdural space).There are several situations that can occur once the bullet enters the body or into the intracranial cavity.Unmatched association of the bullet trajectory with the final position of the bullet within the body raise the suspicion for additional phenomena involvement,this can be explained by either internal bullet ricochet or internal bullet migration.The former usually represents an active movement and the latter is a passive movement.Intracranial ricocheting of bullets forms up to 25% of all penetrating bullet injuries to the skull.Such bullets types are commonly tumbling and have an unpredictable trajectory.The surgical management for intracranial bullet injury developed over decades from the time of Harvey Cushing and the World War I till the present.Now,the accepted intervention ranges from simple wound care to a proper surgery that includes hematoma evacuation,removal of only accessible bone fragments and foreign bodies,dural repair and wound debridement with or without decompressive craniectomy.Also.intracranial pressure monitoring is generally indicated.We reported a thirty-three years old male.victim of homicidal bullet injury to the head.presented with Glasgow Coma Scale score of 8 (best eye response:2.best motor response:4,best verbal response:2),upon examination a right parietal (near vertex) inlet without outlet was found.The poor prognostic factors in this patient included bi-hemispheric involvement,associated acute subdural hematoma with interhemispheric extension,ricochet type of injury and effacement of sulci.Intracranial ricocheted-bullet injury is a special entity of bullet injury to the head with its particular ballistics and management that deserve highlighting by the trauma team to gain fluent treatment and better outcome.

Pharmacological potential of acetazolamide in traumatic intracranial hypertension

Traumatic brain injuries are an important cause of morbidity and mortality around the world. These types of lesions are often associated with increased intracranial pressure and cerebral edema, proper management of this can reduce tissue damage of the brain and improve brain perfusion. The use of acetazolamide is not indicated in guidelines for the management of intracranial hypertension, which is used to a great extent for the management of idiopathic intracranial hypertension. However, it is not yet known in the management of traumatic intracranial hypertension.

The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review

Simulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety.Several models have been used for simulation purposes.Non-living animal models offer a range of benefits,including affordability,availability,biological texture,and a comparable similarity to human anatomy.In this paper,we review the available literature on the use of non-living animals in neurosurgical simulation training.We aim to answer the following questions:(1)what animals have been used so far,(2)what neurosurgical approaches have been simulated,(3)what were the trainee tasks,and(4)what was the experience of the authors with these models.A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020.Our initial search yielded a total of 70 results.After careful screening,we included 22 articles for qualitative analysis.We compared the reports in terms of the(1)animal used,(2)type of surgery,and(3)trainee tasks.All articles were published between 2003 and 2019.These simulations were performed on three types of animals,namely sheep,cow,and swine.All authors designed specific,task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches.Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training.Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training.These models enable the acquisition and refinement of surgical skills,with the added benefits of accessibility and cost-effectiveness.To date,16 different microneurosurgical cranial approaches have been replicated on three non-living animal models,including sheep,cows,and swine.This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training,with particular attention to the set of tasks that could be performed on them.