Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience.

Background And Objectives: Temporalis muscle management remains one of the most challenging aspects of cranioplasty, which accounts for considerable rates of dissection-related complications. Since 2019, the senior author has developed and consistently used a methodical, two-stage anatomic dissection technique to separate the scalp and temporalis muscle from the underlying brain. This technique is believed to facilitate dissection and minimize the risk of brain injury, while optimizing cosmetic outcomes.

Emergency decompressive surgery in patients with transtentorial brain herniation and pupillary abnormalities: the importance of improved pupillary response after osmotherapy and surgery.

Objective: The predictors of survival and functional recovery following emergency decompressive surgery in patients with transtentorial brain herniation, particularly those with pupillary abnormalities, have not been established. In this study, the authors aimed to assess the outcome of patients with intracranial mass lesions, transtentorial brain herniation, and nonreactive mydriasis, following emergency surgical decompression.

Methods: A retrospective chart review was performed of all patients with transtentorial herniation and pupillary abnormalities who underwent craniotomy or craniectomy at two trauma and stroke centers between 2016 and 2022.

Gunshot Wound to the Posterior Fossa With a Transcerebellar Retromesencepahlic Bullet Path, Transient Mutism, and Unexpected Functional Recovery: The Pivotal, Energy-Absorbing Function of the Petrous Bone and Tentorial Leaflet.

Given the abundance of vital neurovascular structures, gunshot wounds (GSWs) to the posterior fossa are generally fatal. We present a unique such case where a bullet entered the petrous bone, traversed the cerebellar hemisphere and overlying tentorial leaflet, and reached the dorsal aspect of the midbrain, resulting in transient cerebellar mutism with an unexpectedly favorable functional recovery. A 17-year-old boy sustained a GSW to the left mastoid region with no exit wound and presented with agitation and confusion, ultimately leading to a coma.

Skull Reconstruction Using a Custom-Made, Three-Dimensional-Printed, Hydroxyapatite-Titanium Cranioplasty Implant: Largest Single-Center U.S. Experience.

Objective: Although several material options, both natural and synthetic, are available for cranioplasty, the rate of implant-related complications has remained high. A relatively novel, synthetic hydroxyapatite-titanium implant, which combines biocompatibility with biomechanical resilience, has been reported to reduce tissue inflammation, infection, and explantation rates, while delivering superior cosmetic results. However, despite such promising preliminary reports, clinical data supporting its use have remained scarce.

Bilaterally Fixed and Dilated Pupils Are Not the Kiss of Death in Patients with Transtentorial Herniation: A Single Surgeon's Experience.

Background: Bilaterally fixed and dilated pupils in the setting of transtentorial herniation have traditionally been considered a sign of futility. Such patients are often denied life-saving surgery based on the premise that meaningful functional recovery would be extremely unlikely. We sought to determine the survival and functional outcome in a cohort of patients who underwent aggressive medical and surgical management.

Dural-Based Posterior Fossa Medulloblastoma Mimicking a Petrous Meningioma in Late Adulthood.

Medulloblastoma of the posterior fossa is commonly encountered in pediatric populations but rarely reported in adults. Adult cases of medulloblastoma typically occur in younger patients, tend to arise intra-axially within the cerebellar hemisphere, and usually exhibit classic histopathologic features. A 54-year-old male presented with headaches, dizziness, gait instability, and frequent falls that had worsened during the prior 3 months.

Sinking bullet syndrome: A unique case of transhemispheric migration.

Background: Spontaneous migration of retained intracranial bullet fragments is an increasingly recognized phenomenon. However, such migration is usually limited in extent, since it occurs along the bullet tract or cerebrospinal fluid (CSF) spaces. Transhemispheric migration through an intact cerebral hemisphere has not been previously reported.

Minimally Invasive Microsurgical Technique for Evacuation of Deep Intracerebral Hematomas.

Despite the lack of conclusive outcome data, surgical evacuation of large, symptomatic intracerebral hematomas (ICH) may be offered to patients on a case-by-case basis, aiming to prevent brain herniation, control intracranial pressure, relieve symptoms, and possibly facilitate or accelerate recovery. For deep ICH, minimally invasive techniques, which limit operative damage to healthy brain tissue, are generally preferred. Although new tube and endoscope-based techniques are currently being studied, those elaborate techniques are not widely available and often require special equipment and/or expensive disposable material.

Uterus didelphys and longitudinal vaginal septum coincident with an obstructive transverse vaginal septum.

A wide variety of Müllerian anomalies has been described in the literature. Various combinations of anomalies may coexist in a single subject. Precise identification of the various components of the anomaly is paramount in choosing and planning the appropriate conservative and surgical treatment.