Pineal apoplexy: is it a facilitator for the development of pineal cysts?

BACKGROUND: The radiographic identification of pineal cysts has increased dramatically within the last two decades due to the advent of magnetic resonance imaging. Pineal cysts are often found incidentally with only a minority of these lesions ever becoming symptomatic and requiring treatment. Many theories attempting to explain the pathogenesis of these cysts exist. METHODS: We describe a case of a 12-year-old girl who presents with a pineal hemorrhage of unknown etiology with associated hydrocephalus. RESULTS: Her hydrocephalus was initially treated with an external ventricular drain followed by a third ventriculostomy. She had no evidence of elevated beta human chorionic gonadotropin or alpha-fetoprotein within the serum or cerebrospinal fluid. Follow-up imaging at seven weeks revealed resolution of her hemorrhage, however, there was development of a progressive cystic lesion within the pineal region. In order to make a definitive tissue diagnosis, a supracerebellar infratentorial surgical approach with complete resection was performed. During the resection, brownish fluid was aspirated from the cyst and the cyst wall was removed. The pathological diagnosis was a pineal cyst. CONCLUSIONS: Although cases have been described of pineal apoplexy with an underlying cyst, this case describes the development of a progressive pineal cyst secondary to a hemorrhage. This case demonstrates that pineal hemorrhage may be a promotor for the development or progression of pineal cysts.

Light-guided tracheal puncture for percutaneous tracheostomy.

PURPOSE: To determine the effectiveness of lightwand-guided tracheal puncture for percutaneous tracheostomy. METHODS: The desired puncture site was marked on the skin of the anterior neck. A lightwand (Trachlight) was inserted into the patient's endotracheal tube (ETT), so that the number indicator on the lightwand matched the number indicator of the ETT of the patient. At this position, the light bulb of the lightwand was exactly placed at the tip of the endotracheal tube. With the lightwand turned on, the lightwand together with the endotracheal tube (ETT-LW) was slowly withdrawn from the trachea until a bright glow in the anterior neck could be seen 1 cm above the marked puncture site. At this position, the tip of the ETT was 1 cm above the puncture site. RESULTS: Percutaneous tracheostomy via a light-guided tracheal puncture was performed on 11 neurosurgical patients. The withdrawal of the endotracheal tube to a location above the puncture was accomplished easily with the lightwand. All percutaneous tracheostomies performed were successful, with ease and without any complications. The procedure time was 17.8 +/- 5.3 min. Mechanical ventilation was not interrupted during the whole procedure. CONCLUSION: The lightwand guided intratracheal puncture for percutaneous tracheostomy is a simple, effective, and safe procedure. This technique can avoid the risk of puncturing the endotracheal tube and/or cuff, thus allowing adequate ventilation and oxygenation during the percutaneous tracheostomy. Furthermore, this technique is inexpensive and minimizes the risk of damaging equipment like the fibreoptic bronchoscope.

Closing wedges: a technique for repair of midline craniosynostosis.

Description of a surgical technique for sagittal and metopic synostosis utilizing closing skull wedges. The technique and results are outlined. The technique has proven effective when done by 4 months of age.

Craniosynostosis: an assessment of blood loss and transfusion practices.

Assessment and accurate replacement of blood loss during primary craniosynostosis repair is difficult due to patient size and surgical technique. Eighty-five charts of all patients undergoing primary craniosynostosis repair over a 15-year period were reviewed to determine blood loss and to assess blood transfusion practices both intraoperatively and postoperatively. Blood loss was calculated on the basis of estimated red cell mass (ERCM). Blood transfusion management was considered appropriate if the postoperative or posttransfusion ERCM was within 15 per cent of the preoperative value. Isolated sagittal craniectomy was the most common operation performed (60 per cent). Mean blood loss for sagittal craniectomies was 24 per cent of estimated blood volume (EBV) or approximately 20 ml.kg-1 and for metopic craniectomies 42 per cent of EBV (P less than 0.05). Intraoperatively, 70 per cent of all patients were appropriately managed with respect to blood transfusion. Postoperatively only 29 per cent of patients receiving transfusions were transfused appropriately. At our institution, intraoperative blood transfusion practices are appropriate, but postoperative transfusions are frequently unnecessary.

Spontaneous intracerebral haemorrhage: an analysis of factors affecting prognosis.

A retrospective study of 100 patients with spontaneous intracerebral haemorrhage was carried out, to identify clinical factors which have a predictive value for outcome. Numerical equivalents for the admission level of consciousness (the Glasgow Coma Scale), ventricular rupture, partial pressure of oxygen in the blood, the electrocardiogram, clot location, and clot size were combined into equations predicting outcome. The best single parameter for prediction was the Glasgow Coma Scale.

Ankylosis of the temporo-mandibular joint after temporal craniotomy: a cause of difficult intubation.

It is not generally appreciated that surgery in the region of the temporal fossa commonly produces, within a few weeks, a contracture of the temporalis muscle with "pseudo" ankylosis of the jaw. This usually, but not always, resolves within six months. The aetiological possibilities include, singly or in combination: Postincisional scar formation within the muscle. A Volkman's contracture due to devascularization of the muscle. Organization of haematoma. It is recommended that active and passive jaw exercises be started early after surgery in the temporal fossa and that such postcraniectomy patients be carefully assessed for jaw ankylosis prior to undertaking anaesthesia.

Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method.

An alternative method of cervical fixation utilizing a stainless steel clamp is described. The clamp is applied to the adjoining laminae of involved vertebrae in those cervical dislocations and subluxations with posterior instability. The long term results of this method have been most satisfactory, as indicated by our follow-up of 51 patients treated during the last decade.