Traumatic Aneurysm in an Infant: Case Report

We report a case of traumatic aneurysm in a 50-day old male infant arising from the peripheral portion of right middle cerebral artery. The infant had suffered a major head injury with an iron bar before coming to the hospital. On admission he presented with generalized tonic-clonic seizure 15 days after the head trauma. Computed tomography(CT) scan demonstrated a round, mixed-density hematoma in the right temporoparietal cortex. During operation, an aneurysm was found within the hematoma under the operating microscope, and the aneurysm was assumed to be of traumatic origin. The aneurysm arising from the peripheral right middle cerebral artery was ligated and cauterized, and the hematoma was evacuated. After the operation, the infant had no incidence of any seizure attack nor any focal neurologic deficit. The incidence pathogenesis, clinical diagnosis, and treatment of traumatic aneurysm is discussed together with a review of the literature.

Clinical Analysis of the Result of Halo Immobilization Versus Surgical Fusion in the Management of Traumatic Cerical Spine Injury

In the mamagement of cervical spine injuries, it is difficult to determine when to use halo immobilization alone, surgical fusion alone or a combination of the two. To investigate the appropriate condition and relative effectiveness of the treatment of cervical spine injuries, a 3-year retrospective analysis was conducted. During this study the authors reviewed the medical records and X-rays of 46 patients with cervical spine injuries treated with either halo immobilization or surgical fusion. Eighteen patients were treated with the initial surgical fusion, yielding a fusion failure rate of 22%. On the other hand, the remaining 28 patients were initially treated with the halo immobilization, yielding a fusion failure rate of 35%. The main fracture types in patients that require surgical fusion after failure with halo immobilization were hyperflexion anterior subluxation and locked facet injuries. From these findings, we concluded that halo immobilization of hyperflexion anterior subluxation injury and unilateral or bilateral locked facet results in relatively high failure rates and therefore treatment by initial surgical fusion should be the method of choice. Close monitoring is mandatory following halo vest with any type of fracture and level.