Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates.

Background: Cryopreservation of bone flaps after decompressive craniectomies is a common practice. A frequent complication after bone flap reimplantation is postoperative infection, so culturing of frozen craniectomy bone flaps is a crucial practice that can prevent patient morbidity and mortality. Although many studies report on infection rates after cranioplasty, no study reports on the results of bone flaps stored in a cryopreservation freezer, reimplanted or otherwise.

Removing Craniofacial Titanium Screws: Technical Note.

Craniotomy, cranioplasty, and craniofacial procedures may involve reoperation for additional treatment of the primary pathological condition or treatment of complications, requiring removal of previously placed hardware. During removal of the titanium hardware, there is a risk of losing, dropping, or misplacing the titanium screws because of their small size. There are also instances of difficulty disengaging the screw from the screwdriver.

Community-funded integrated care outreach clinics as a capacity building strategy to expand access to health care in remote areas of Uganda.

Most Ugandans live in rural, medically underserved communities where geography and poverty lead to reduced access to healthcare. We present a novel low-cost approach for supplemental primary care financing through 1) pooling community wealth to cover overhead costs for outreach clinic activities and 2) issuing microfinance loans to motorcycle taxi entrepreneurs to overcome gaps in access to transportation. The intervention described here, which leverages community participation as a means to extend the reach of government health service delivery, was developed and implemented by Health Access Connect (HAC), a non-governmental organization based in Uganda.

Normal Pressure Hydrocephalus with Primary Presentation of Psychiatric Disturbance: Case Report.

Background And Objective:  Progressive impairment of cognitive function is a common feature seen in patients with normal pressure hydrocephalus (NPH). Along with cognitive decline, many of the other classic symptoms of NPH are chronic and rarely present with overwhelming anxiety. We report the case of a 63-year-old man who presented with recent primary psychiatric manifestation of severe disabling anxiety and otherwise a minimal change in gait and no urinary disturbance.

Conjugative and replicative biology of the Staphylococcus aureus antimicrobial resistance plasmid, pC02.

Genetic transfer among bacteria propels rapid resistance to antibiotics and decreased susceptibility to antiseptics. Staphylococcus aureus is a common culprit of hospital and community acquired infections, and S. aureus plasmids have been shown to carry a multitude of antimicrobial resistance genes.

Cervical Kyphotic Deformity Worsening After Extensor Cervical Muscle Paralysis from Botulinum Toxin Injection.

Background: Botulinum toxin (Botox) has long been used therapeutically to treat a variety of diseases, including migraine headaches, cervical spine dystonia, and chronic cervical spine pain, among many others. Although quite useful, Botox has been reported to cause adverse events, some of which may lead to devastating morbidity.

Case Description: An elderly woman presented with severe neck pain after a motor vehicle collision.

Mandatory Change From Surgical Skull Caps to Bouffant Caps Among Operating Room Personnel Does Not Reduce Surgical Site Infections in Class I Surgical Cases: A Single-Center Experience With More Than 15 000 Patients.

Background: Surgical site infections (SSIs) are noteworthy and costly complications. New recommendations from a national organization have urged the elimination of traditional surgeon's caps (surgical skull caps) and mandated the use of bouffant caps to prevent SSIs.

Objective: To report SSI rates for >15 000 class I (clean) surgical procedures 13 mo before and 13 mo after surgical skull caps were banned at a single site with 25 operating rooms.

Anthropological contributions to historical ecology: 50 questions, infinite prospects.

This paper presents the results of a consensus-driven process identifying 50 priority research questions for historical ecology obtained through crowdsourcing, literature reviews, and in-person workshopping. A deliberative approach was designed to maximize discussion and debate with defined outcomes. Two in-person workshops (in Sweden and Canada) over the course of two years and online discussions were peer facilitated to define specific key questions for historical ecology from anthropological and archaeological perspectives.

Large, spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section: Conservative management with excellent outcome.

Background: Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively.

Acute ischemic stroke and infections.

We present an overview of multiple infections in relation to acute ischemic stroke and the therapeutic options available. Conditions that are a direct cause of stroke (infectious endocarditis, meningoencephalitides, and human immunodeficiency virus infection), the pathophysiologic mechanism responsible for stroke, and treatment dilemmas are presented. Independently or in conjunction with conventional risk factors, chronic and acute infections can trigger an acute ischemic stroke through an accelerated process of atherosclerosis and immunohematologic alterations.

CT perfusion cerebral blood flow imaging in neurological critical care.

Computed tomography (CT) perfusion imaging is a technique for the measurement of cerebral blood flow, cerebral blood volume, and time-to-peak or mean transit time. The technique involves the administration of a single-bolus dose of iodinated contrast material, followed by spiral CT imaging during the passage of the contrast bolus through the cerebral vasculature. CT perfusion is a fast and inexpensive brain imaging modality for use in the management of patients with various neurological disorders, ranging from acute stroke to subarachnoid hemorrhage.

Submaximal angioplasty and staged stenting for severe posterior circulation intracranial stenosis: a technique in evolution.

Introduction: Severe medically refractory intracranial stenosis portends a grave prognosis. Recent advances in stent technology have enabled clinicians to treat these lesions. Evidence in the coronary literature suggests that stenting without predilation angioplasty is as safe and effective as stenting immediately preceded by predilation angioplasty for the treatment of severely stenotic lesions.

Hypotensive endovascular test occlusion of the carotid artery in head and neck cancer.

Object: To evaluate the reliability of balloon test occlusion with hypotensive challenge (BTO and HC) as a predictor of neurological complications before internal carotid artery (ICA) sacrifice in patients with advanced head and neck cancer, the authors retrospectively reviewed the medical records of patients presenting to their institutions between 1992 and 1997 in whom this preoperative assessment was performed.

Methods: Eleven patents who were candidates for extended comprehensive neck dissection (ECND) and potential ICA sacrifice were included in the study. Eight patients tolerated the test and underwent endovascular occlusion or surgical ligation of the ICA before ECND (four patients), preservation of the ICA at the time of surgery (three patients), or palliative therapy (one patient).

The integration of neurosurgical techniques in current head and neck skull base surgery.

The recent advances in neurosurgery, applied to the growing field of skull base surgery, provide surgeons with new techniques to avoid the devastating complication of CSF leak, to improve patient selection by reducing the risk of stroke while expanding the operative options available to patients with head and neck malignancies, and to aid operative care through improved surgical planning and intraoperative localization.

Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery.

Object: Medically refractory, symptomatic atherosclerotic disease of the basilar artery (BA) portends a poor prognosis. Studies have shown morbidity rates following placement of stents in these lesions to be quite variable, ranging from 0 to 30%. The authors review their experience with BA stent placement for severe atherosclerotic disease to determine whether an increase in neurological morbidity is associated with direct stent placement (that performed without predilation angioplasty) compared with conventional stent placement (that performed immediately after predilation angioplasty) or staged stent placement (angioplasty followed > or = 1 month later by stent placement with or without repeated angioplasty).

Resection followed by radiosurgery for advanced juvenile nasopharyngeal angiofibroma: report of two cases.

Objective And Importance: Experience with the management of juvenile nasopharyngeal angiofibroma (JNA) by gamma knife radiosurgery is limited. We report control of the disease in two patients with advanced-stage JNA treated with primary resection followed by gamma knife stereotactic radiosurgery of residual disease.

Clinical Presentation: An 18-year-old man presented with chronic sinusitis, worsening headaches, diplopia, and left-sided facial numbness.