Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old

Background  

Decompressive craniectomy is an effective treatment option in case of refractory intracranial hypertension after severe head injury. The incidence of complications following cranial repair after decompressive craniectomy for traumatic brain injury is not negligible, particularly in infants and young toddlers. However, only a few dedicated papers can be found in the literature.     

Traumatic brain injury and subsequent brain tumor development: a systematic review of the literature

The role of prior head trauma in stimulating brain tumor development has been previously described in the literature but continues to be debated. The goal of this study was to conduct a systematic review interrogating the contemporary literature to delineate any possible relationship between traumatic brain injury and brain tumor development. A systematic review exploring development of post-TBI brain tumor was conducted by searching electronic databases. Abstracts from articles were read and selected for full-text review according to criteria previously established in the scientific literature. Relevant full-text articles were divided into case reports and single-arm studies and epidemiological studies. Of 1070 resultant articles, 18 case reports and single-arm studies (level of evidence of IV and V) with 45 patients were included. The most common cause of TBI was traffic accidents. The average period between TBI and subsequent tumor diagnosis was 12.8 years. Meningiomas represented the largest share of tumors, followed by gliomas. Most post-TBI brain tumors developed in the frontal and temporal lobes. Fifteen epidemiological studies were also interrogated from a variety of countries (level of evidence of III). Case–control studies were more common than cohort studies. There were 9 of 15 studies proposed a possible relationship between history of head trauma and development of brain tumor. The relationship between head trauma and neoplastic growth continues to be heavily debated. There are certainly case reports and epidemiological studies in the literature that suggest a correlational relationship between the two. However, there is no concrete evidence of a causal relationship between TBI and brain tumors. More research is needed to definitively delineate the extent of any such relationship.

     

Desmoplastic fibroma of the skull in an infant

Desmoplastic fibromas are uncommon osseous tumors that seldom involve the skull. These tumors are histologically benign but locally aggressive with a propensity for recurrence if resection is partial. To our knowledge, only 16 cases have been reported in the literature, seven of which concerned children. We report a further case of a desmoplastic fibroma of the skull in a 3-year-old boy who presented with a right parietal mass. The CT scan showed a lytic mass with brain compression and cortical destruction. The patient underwent a craniectomy and complete mass resection. Histological diagnosis was desmoplastic fibroma. Postoperative progress was normal without recurrence 6 months later.     

Hydrocéphalie unilatérale secondaire à un abcès temporal traitée par septotomie endoscopique : à propos d’un cas

Hydrocephalus is a rare complication of brain abscess, due to either the mass effect on the ventricular system or to the rupture of the abscess in the ventricles. We report here the case of 44-year-old man who was operated on for a temporal lobe abscess of pulmonary origin who presented 6 weeks later with obstructive hydrocephalus secondary to a likely choroid plexus thrombophlebitis. This patient was treated successfully with an endoscopic septotomy. In light of the pertinent literature, we discuss the pathophysiological and management aspects of this unusual entity.     

A report of a desmoplastic non-infantile ganglioglioma in a 6-year-old boy with review of the literature

Desmoplastic infantile gangliogliomas (DIG) are uncommon supratentorial brain tumors with a usually good prognosis despite an aggressive radiological appearance that typically occurs in infants below the age of 24 months. DIGs are exclusively supratentorial, generally have a voluminous size, and are partially cystic. Total surgical removal is sufficient for the treatment of these tumors, and no chemotherapy or radiotherapy is indicated if complete resection is achieved. Except for age difference, DIG and desmoplastic non-infantile gangliogliomas are radiologically and histologically similar. Non-infantile variants of this biologically benign intracranial neoplasm are rare; only 15 cases of non-infantile DIGs have been reported in the literature. As far as we know, this case is the 16th in literature. We reported the magnetic resonance imaging and histological findings of desmoplastic ganglioglioma in a 6-year-old boy.     

Renal Cell Carcinoma Metastatic to the Duodenum: Treatment by Classic Pancreaticoduodenectomy and Review of the Literature

Renal cell cancer (RCC) most commonly metastasizes to the lungs, bones, liver, renal fossa, and brain, although metastases can occur elsewhere. RCC metastatic to the duodenum is especially rare, with only a small number of cases reported in the literature. Herein, we describe a case of an 86-year-old woman with a history of RCC treated by radical nephrectomy 13 years previously. The patient presented with duodenal obstruction and anemia from a solitary duodenal mass invading into the pancreas and was treated via classic pancreaticoduodenectomy. Preoperative imaging and intra-operative assessment showed no evidence of other disease. Pathology confirmed metastatic RCC without lymph node involvement. Our case report and review of the English language literature underscore the rarity of this entity and support aggressive surgical treatment in such patients. Presented as a poster at the 41st Annual Meeting of the Pancreas Club, May 20th, 2007, Washington DC.     

De novo arteriovenous malformations: case report and review of the literature

Intracerebral arteriovenous malformations (AVMs) are traditionally recognized as congenital lesions. However, with the advent of frequent, noninvasive imaging of the brain, that notion has been challenged. We describe another patient with a de novo cerebral arteriovenous malformation and evaluate the reported literature for trends in the development of these lesions. Cases were selected from the English literature using the PUBMED database using the search term “acquired or de novo cerebrovascular arteriovenous malformations”. A total of seven patients (including the one reported in this study) with de novo arteriovenous malformations are reported. Majority of patients were female, and mostly diagnosed as children. Their mean age at diagnosis was 18 years (6–32), and the mean time from the initial intracranial study to the diagnosis of an AVM was 8 years (3–17). De novo formation of AVMs is being increasingly reported, especially in young females. We present only the seventh such case reported in the literature and challenge the traditional view that all arteriovenous malformations are congenital in nature.     

Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books

Background  

The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern.     

Abcès cérébral à Clostridium perfringens après chirurgie d’exérèse d’un glioblastome : à propos d’un cas et revue de la littérature

Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patient's death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.     

Co-existing ipsilateral subcapital and subtrochanteric fracture of the proximal femur

Background  Co-existing subcapital and subtrochanteric fracture on the same side of the hip is rare. We are not aware of a similar case reported in the literature. Case study  We present a rare case of co-existing ipsilateral subcapital and subtrochanteric fracture in a 67-year-old woman. The mechanism of injury was low energy. Therapeutic implication  The outcome of internal fixation using a Proximal Femoral Nail was satisfactory. This work was carried out in the Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, UK.     

Intracerebral tension pneumocephalus complicating endoscopic sinus surgery: case report

Background  Various forms of intracranial air have been described in the literature. Aim  This report aims to present clinical, radiological and intraoperative findings of a rare intracranial air entrapment case after endoscopic sinus surgery.     

Brain abscess caused by Cladosporium trichoides.

Brain abscess caused by the fungus Cladosporium trichoides is rare. Only 20 cases of brain abscess caused by this fungus are reported in the literature. We report a case of brain abscess caused by Cladosporium trichoides in a healthy adult male. The relevant literature on this subject is reviewed.     

Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation

Maternal brain death during pregnancy remains an exceedingly complex situation that requires not only a well-considered medical management plan, but also careful decision-making in a legally and ethically delicate situation. Management of brain dead pregnant patients needs to adhere to special strategies that support the mother in a way that she can deliver a viable and healthy child. Brain death in pregnant women is very rare, with only a few published cases. We present a case of a pregnant woman with previously diagnosed multiple brain cavernomas that led to intracranial hemorrhage and brain stem death during the 21st week of pregnancy. The condition that can be proven unequivocally, using tests that do not endanger viability of the fetus, is brain stem death, diagnosed through absence of cranial reflexes. The patient was successfully treated until delivery of a healthy female child at 29 weeks of gestation. The patient received continuous hormone substitution therapy, fetal monitoring and extrinsic regulation of maternal homeostasis over 64 days. After delivery, the final diagnosis of brain death was established through multi-slice computerized tomography pan-angiography. This challenging case discusses ethical and medical circumstances arising from a diagnosis of maternal brain death, while showing that prolongation of somatic life support in a multidisciplinary setting can result in a successful pregnancy outcome.     

Long-term oncologic outcomes of laparoscopic radical nephrectomy for kidney cancer resection: Dundee cohort and metaanalysis of observational studies

Background  

The long-term oncologic outcome of laparoscopic radical nephrectomy compared with that of open radical nephrectomy remains unclear. A few case series with follow-up periods longer than 5 years are reported in the literature. The existing literature is focused primarily on early and intermediate outcomes of laparoscopic radical nephrectomy. This study aimed to assess the outcome of laparoscopic radical nephrectomy for localized disease compared with open surgery.     

Neuroma of the Bile Duct: A Late Complication After Cholecystectomy

Introduction  Extrahepatic biliary obstruction with a mass in the common bile duct and elevated CA 19-9 level is often due to cholangiocarcinoma. Case Report  We present a case of a 71 year-old woman who presented with an extrahepatic biliary obstruction and a mass in the common bile duct 45 years after cholecystectomy. Pathologic analysis revealed a bile duct neuroma. We present the preoperative imaging, operative management, pathologic diagnosis, and literature review of this rare condition. Meetings presented at: None     

Complex Pediatric Elbow Injury: An Uncommon Case

Background  

There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow.     

General anaesthesia for deep brain stimulator electrode insertion in Parkinson's disease

Background  

This paper compares the use of general and local anaesthetic in patients having deep brain stimulator (DBS) surgery. It is a retrospective case note study of 46 patients treated consecutively with subthalamic nucleus stimulation for Parkinson’s disease as practise changed in a Neurosurgical unit.     

Long-Term Results of Modified Green Method in Sprengel’s Deformity

Aim  

Congenital undescended scapula (Sprengel deformity) is a rare deformity that is reported in the literature mostly as small case series with short- or medium-term follow-up periods. Here, we aimed to present the long-term results of this deformity treated with modified Green procedure.