ABSTRACT
Sterilization of allogeneic bone increases the availability of this tissue for supplanting skeletal defects and effecting fusions. The optimal sterilant destroys micro-organisms, preserves the physical and chemical integrity of bone and possibly even reduces immunogenicity. Cortical bone of skull heals slowly and is variably resorbed. Of 36 dogs, spontaneous regeneration in 72 paired 20 mm defects was constant but always incomplete, and restored only about one third of the cross-sectional area of the defect at six months. The repair in defects replaced with canine allogeneic bony disc, sterilized with ethylene oxide (n = 9), gamma irradiation (n = 7), or methanol/chloroform/iodoacetic acid (n = 7) and then lyophilizedd, was compared with repair in defects filled with aseptically procured lyophilized only (n = 23) discs from the same donor. Criteria for evaluation of implants at six months included volume of defect filled, radiodensity, extent of fusion around circumference, revascularization, and remodeling. Bony discs sterilized with methanol/chloroform/iodoacetic acid remodeled at a superior rate (p less than 0.01). Radiation sterilization resulted in diminished density and inferentially reduced protection of the brain (p less than 0.025). Ethylene oxide, lyophilized implants, and implants lyophilized only produced comparable repair. Whereas an acceptable cranioplasty was achieved in 86% of methanol/chloroform/iodoacetic acid, lyophilize implants, all other alloimplants served an osteoconductive function with a successful repair occurring in 56% to 58%.
Subject(s)
Bone Transplantation , Osteogenesis , Skull/surgery , Sterilization/methods , Animals , Bone and Bones/drug effects , Bone and Bones/radiation effects , Chloroform/pharmacology , Dogs , Ethylene Oxide/pharmacology , Freeze Drying , Iodoacetates/pharmacology , Methanol/pharmacologyABSTRACT
Every craniotomy requires immediate replacement of a fresh autograft of skull or, in the presence of cerebral swelling, delayed reimplantation of preserved autogenous skull. Resumption of osteogenesis, the index of viability, determines the effectiveness of these segments of calvaria in protecting the brain and restoring skull conformity. The cellular response in skull replaced either at the end of craniotomy or after frozen preservation was studied by light and fluorescence microscopy, skull roentgenograms, and radionuclide scintigraphy. In 5 patients eventual total remodeling of skull was found at the time of a second craniotomy performed from 1 to 19 years after the first. In 12 patients skull sections removed aseptically at craniotomy were frozen and stored for 1 to 35 months at -20 degrees C in bacitracin. This cytotoxic preservative method fixed the tissue, which appeared unchanged on light microscopy and was sterile on bacteriological and fungal cultures. In 53 patients who underwent autogenous cranioplasty with skull stored frozen for 3 weeks to 19 months, 48 operations were totally successful. Complications included infections in 2 patients, resorption in 2 infants, and incomplete restoration in 1 adult. In 10 patients the sequential dynamics of skull revitalization were found to be: revascularization, resorption, and accretion. The repair of membranous skull is similar to that of endochondral bone of the skeleton. Skull is metabolically intensely active after reimplantation and is the ideal material for cranioplasty.
Subject(s)
Freezing , Skull/transplantation , Tissue Preservation , Transplantation, Autologous , Adolescent , Adult , Age Factors , Aged , Bacitracin/pharmacology , Bone Resorption , Brain Edema/surgery , Child , Child, Preschool , Craniotomy/methods , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Osteoblasts , Osteogenesis , Radiography , Skull/blood supply , Skull/cytology , Skull/diagnostic imaging , Time FactorsABSTRACT
A recent experience with a chronic extradural hematoma found unexpectedly during an evaluation for an enlarged sella turcica is reported. This case, as well as pertinent literature, demonstrates the variability of the classical signs in the chronic lesion. Our experience suggests that the diagnosis of patients with persistent symptoms after head injury may be clarified by computerized tomographic scanning, which in the present case revealed chronic extradural hematoma.
Subject(s)
Hematoma, Epidural, Cranial/diagnostic imaging , Tomography, X-Ray Computed , Adult , Chronic Disease , Craniocerebral Trauma/complications , Female , Headache/etiology , Hematoma, Epidural, Cranial/complications , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/surgery , Humans , Time FactorsABSTRACT
A case is detailed of a patient who developed progressive neurological deficit above a fixed quadriplegic level at C-4 18 years after posterior cervical decompression for trauma. Diagnostic evaluation revealed a pseudomeningocele at the site of his previous surgery. Subsequent operative closure resulted in reversal of his neurological symptoms.
Subject(s)
Laminectomy/adverse effects , Meningocele/etiology , Quadriplegia/surgery , Spinal Cord Compression/surgery , Adult , Humans , Male , Meningocele/diagnosis , Meningocele/surgeryABSTRACT
The most widely used technique for treatment of a carotid-cavernous fistula involves embolization of the fistula with segmental occlusion of the internal carotid artery. An inflatable balloon capping a small flexible catheter becomes a controlled embolus when positioned within the internal carotid artery at the stoma of the fistula. A new double lumen catheter has been designed. Through one lumen the carotid circulation may be displayed, The second lumen allows inflation of the balloon through a self-sealing valve. In twelve patients, results were excellent in eight, fair in two, and poor in two patients intolerant of carotid occlusion.
