Mini titanium plates; hearkening the end of nonrigid cranial bone flap fixation

Background and Objective: Craniotomy bone flaps should be replaced for both cosmetic and protective purposes. Different methods are available commercially. The aim of this study was to assess outcome of bone flap fixation using mini titanium plates and screws

Methods: Between March 2011 and March 2014, 71 patients underwent cranial bone flap fixation with mini titanium plates and screws after craniotomy and excision of supratentorial lesions at Combined Military Hospital, Peshawar. There were 42 males and 30 females with a mean age of 40.07. All patients had supratentorial lesions. Intracranial lesion size ranged from 3 cm by 2 cm to 7 cm by 5 cm. The changes of local incision and general condition were observed

Results: Subcutaneous effusion occurred in two patients. One patient developed a mild postoperative wound infection. CT scan showed good repositioning of the flap and edge to edge apposition at two weeks after operation. All the patients were followed up for 12 months post operatively. Skull had good appearance without any discharge and, local deformity or effusion. Repeat CT/MRl showed no subsidence or displacement of cranial flap or artifacts

Conclusion: Mini titanium plate and screw fixation of cranial flaps is a simple, cost effective and safe option for repositioning and immediate stability as compared to traditional sutures

Subdural hematomas following intracranial aneurysm rupture: a rare phenomenon

Acute Subdural Hematoma [aSDH] due to aneurysm rupture and no subarachnoid bleeding are very rare with only 29 cases reported in literature. A 56-year female presented with headache and drowsiness and a previous history of loss of consciousness. Clinical examination revealed a GCS of 14 and a right sided hemiparesis. Workup revealed a pure subdural hematoma due to a middle cerebral artery aneurysm rupture with no subarachnoid hemorrhage. Laboratory workup was otherwise normal and she had no history of falls or head trauma consistent with the usual etiology of an aSDH. She underwent evacuation of the hematoma with clipping of the aneurysm. She had an uneventful recovery with good outcome and no residual neurological deficits at one-year follow-up