Cranioplasty for Skull Defects With Polypropylene Abdominal Wall Mesh.

OBJECTIVE: Cranioplasty is a well-established common surgery in the practice of neurosurgery and craniofacial surgery. In young patients, complete skull defect closure by bone splitting may be troublesome due to the difficulty to obtain enough bone area. In such cases, sometimes the authors need to use allografts, which may not be widely available in rural practice. In this study, the authors present the series of cranioplasty with polypropylene mesh, which is widely used in abdominal wall closure. PATIENTS AND METHODS: Nine patients with depressed compound skull fracture were treated by performing this technique. Selection criteria were: compound depressed skull fractures in which bones were fragmented in a way not able to be reconstructed with and leaving a skull defect, small-sized or relatively medium-sized skull defects, and skull defects not located on the sharp curvatures of the skull which needs firm bended meshes. All patients were male and their ages ranged between 8 months and 36 years.The skull bone defect was reconstructed with polypropylene abdominal wall mesh, which was sutured circumferentially with the galeal tissue. RESULTS: Skull defects were successfully treated in all patients. The follow-up period ranged from 4 to 13 months. One patient with a history of alcoholism and neglectance developed a wound infection after 3 weeks of surgery. This patient was treated successfully with intravenous antibiotics without the need to remove the mesh. There were no complications in the remaining 8 patients. CONCLUSIONS: Polypropylene mesh is a cheap and effective material for the reconstruction of small-sized or medium-sized skull defects. It can be a good alternative in rural practice and/or low economic communities, when other cranioplasty materials are not available.

Cranioplasty for Skull Defect With Polypropylene Abdominal Wall Mesh.

ABSTRACT: Cranioplasty is a routine procedure in the practice in neurosurgery and craniofacial surgery. For the closure of the cranial defect, it may be difficult or impossible to split the bone sufficiently to obtain enough bone for complete closure of the defect in younger children. Thus, sometimes there is the need to use allografts, which may not be widely available in rural practice. We present 2 cases of cranioplasty with widely available and used polypropylene abdominal wall mesh. To add rigidity to the construct, the mesh was organized in a multilayered fashion. Postoperative follow-up showed good functional and cosmetic results.

Primary Posterior Fossa Hydatid Cyst in a Child.

ABSTRACT: A 7-year-old boy referred to our emergency department complaining of headache, nausea, vomiting, dizziness, generalized fatigue, ataxia and diplopia. Neurological exam showed bilateral papilledema and ataxic gait. Routine blood test, plain chest x-ray and abdominal ultrasonography were normal. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed well-defined intra-axial unilocular cystic lesion in the left cerebellar hemisphere, causing mass effect on brain stem and fourth ventricle with associated tonsillar herniation and mild obstructive hydrocephalus. The authors started the treatment with Albendazole and the patient was operated with left sub-occipital craniotomy. Cyst was delivered with intact capsule. Postoperative period was uneventful and patient's symptoms improved totally after 1 week. Histopathologic examination confirmed the diagnosis of hydatid cyst.

Castleman Disease: An Unusual Cause of an Isolated Neck Mass.

ABSTRACT: A 15-year old female patient was complaining from swelling in the left side of the neck since 3 months. Physical examination showed palpable and mobile left supraclavicular neck mass in the carotid triangle, uvula deviation to the left side and normal vocal cords position and function. Neck imagings showed well-defined, well-encapsulated left neck mass in the left carotid sheath pushing the internal jugular vein anteriorly and the common carotid artery posteriorly. The mass was extending from the level of C4 superiorly and the supraclavicular region inferiorly. Patient was operated with left anterior approach and circumferential dissection and enucleation was performed. Post-operative period was uneventful and devoid of any complications or deficits. Histopathological examination revealed Castleman disease.

Extra-axial cerebellopontine angle cavernoma: A case report and review of literature.

BACKGROUND: Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location. CASE DESCRIPTION: A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma. CONCLUSION: Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.