One-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base / 中华实用儿科临床杂志

Objective To explore the surgical techniques and effects of one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base.Methods The clinical data of 13 pediatric cases with one-stage reconstruction surgery for comminuted and depressed fractures of the frontal bone and anterior skull base were reviewed retrospectively,including 8 male and 5 female,aged from 4 to 14 years,with a mean age of 8 years.Admission Glasgow Coma Scale (GCS) was as follows:3 to 8 scores in 2 cases,9 to 11 scores in 4 cases,and 12 to 15 scores in 7 cases.The intraoperative one-stage osseous and vascular pedicle membranous reconstruction of frontal bone and anterior skull base had been performed in all patients.The periosteum-bone fragments-periosteum had been used in 4 cases whose bony defect diameter of anterior cranial fossa was over 1 cm,multimodality therapy were carried out postoperatively.The follow-ups were regularly executed after discharge.Results GCS at discharge was as follows:3 to 8 scores in 1 case,9 to 11 scores in 2 cases,and 12 to 15 scores in 10 cases.No significant difference was found in GCS between those on admission and at discharge(χ2=3.02,P>0.05).Eleven cases had a phenomenon of nasal hemorrhage and the duration was not exceeding 48 hours.No intracranial infection and cerebrospinal fluid leakage occurred in all patients.All patients received an acceptable appearance without obvious frontal depre-ssion or proptosis.Postoperative computed tomography image showed normal cranial volume,well reset of fracture pieces,no fracture pieces existing in intracerebral tissue,satisfactory hematoma evacuation,and orbital contents without compression.The complications like cerebrospinal fluid leakage,poor incision healing,brain abscess or mucous cyst had not been found in all patients from 3 months to 6 years follow-up period.Conclusions The one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base suggests a better prognosis,effectively less complications,which helps to avoid secondary surgery,but regular follow-ups are absolutely necessary.This procedure is worth applying and spreading to pediatric patients and medical institutions if necessary.

Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery / 대한신경손상학회지

We report an unusual case of skull perforation and depressed fracture with epidural hematoma in a 61-year-old woman who has been undertaken a skeletal fixation for stereotactic evacuation of intracerebral hematoma. Most neurosurgeons secure the patient's head in a skeletal fixation device with a three- or four-pronged pin-type headrest for stereotactic procedure or microsurgery. Although a variety of complications have been reported secondary to the use of head fixation devices, these potential complications of skull fixation have been infrequently described in the medical literatures. Consideration of calvarial thickness, tightening force, and adequate location of skull fixation may reduce the risk of skull perforation and depressed fracture.

Elevation of Depressed Skull Fracture with a Cup of Breast Pump and a Suction Generator: A Case Report in Technical Aspects

Surgical elevation of the depressed bone is known to be the conventional treatment usually recommended for a simple depressed skull fracture in the adult or pediatric age. The authors introduce, however, a case of depressed skull fracture in an infant which was elevated by means of a cup of breast pump and a suction generator without surgical elevation. In our case, without surgery, a 'cup-shaped' depressed skull fracture in an infant was safely elevated with no neurological signs. This method is considered a simple, effective, safe, and alternative procedure in an infant with simple depressed skull fracture.

Application on Ni-Ti form memory alloy cramp in fixing the skull with depressed fracture / 临床神经病学杂志

Objective To explore a surgical therapy on close depressed fracture of the skull.Methods Ni-Ti form memory-alloy cramps were fixed on between the depressed bone and the normal surrounding skull in 16 patients with close depressed fracture of the skull.Results The follow up was 5～54 months(average 26 months).It indicated that there was no displacement and depressing of the fixed bone, no subcutaneous collection of fluid, no reject reaction and inflammation, and no erosion. The fixed bone and skull density showed normal by X ray and the fixed cramp did not disturb CT and MR scaning. All patients declared no mental burden and felt safe.Conclusion The Ni-Ti form memory-alloy cramp has a good mechanical restoration force and a good plastic effect,but no complication,it can increase the ability to resist external force in fracture region, and the surgical procedure is very simple, therefore it is ideal to treat the depressed fracture of skull.