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Edit article Share article View revision history Report problem with Article. URL of Article. Article information. System: Central Nervous System. Cases and figures. Case 1 Case 1, Radiohelium Hit - Cerebral Turbulency - Forces Closing Down (Cassette. Case 3 Case 3. Our clinics remain open and we will continue to see our patients for all appointment types. We stay committed to keeping our families safe, please visit our social media to learn more about our safety protocols or click here for a memo from our CEO, Debbie James.
A valuable resource to help with your decision are other parents who have already gone through the process. My son just got his band Wednesday and I assumed there would be a transition period but he hardly notices it! The staff and doctors are so accommodating and appointments are easy to make. Cranial CTA and digital subtraction angiography DSA was performed immediately and it showed a high-density shadow in the initial part of the right middle cerebral artery Fig.
The right anterior and right posterior cerebral artery compensated for the blood supply of the right middle cerebral artery. However, a CT scan showed large areas of low-density shadows in the right parietal lobe and right temporal lobe with midline shifting to the left side 2 days later.
Physical examination of the nervous system showed a myodynamia degree 0 of his left upper limb, degree I of the proximal part of his left lower limb and degree II of Album) distal part of his left lower limb. The patient presented with somnolence and dysphoria. He could still speak logically. The patient could not talk logically and appeared irritable in the afternoon.
The patient was diagnosed as having an acute cerebral infarction. Acute cerebral infarction is a contradiction for cranial artery by-pass operations. It has been reported that DC surgery can lower intracranial pressure but there is little evidence to show that this surgery can help improve the blood supply. In terms of the dangerous and urgent situation of this patient, he was taken into the operating room.
A DC and dura turning-over surgery was conducted to help him from becoming worse under general anesthesia. We removed a part of the skull in the area of the frontal bone, temporal bone and parietal bone Fig. We made an incision in his dura mater to release the intracranial hypertension and covered his brain tissue with turning-over of his dura mater onto the brain with the outside surface Fig.
The incision was closed with a relaxation suture. Treatments after the surgery included hemostasis, antibiotics, analgesia, diuretics and neurotrophic drugs. CT scan showed decreased low-density areas with the midline-line moving back 24h after the surgery Fig.
Three steps of the surgery procedure. Five days after the surgery, the patient started to speak logically but was still in lethargy. Medical examination of the nervous system showed myodynamia degree I of his left upper limb, degree II of the proximal part of his left lower limb and degree II of the distal part of his left lower limb. Nine days after the surgery, the myodynamia degree of his left upper limb rose to Album) II. Twelve days after the surgery, the patient turned became conscious without somnolence.
Posterior-anterior picture of the patient 2 weeks after the surgery showed a decreased difference between two sides of the face Fig. Fifteen days after the surgery, Album) myodynamia degree of his left lower limb rose to degree IV. Eighteen days after the surgery, medical examination of the nervous system showed myodynamia degree IV of his left upper limb, degree V of the proximal part of his left lower limb and degree V of the distal part of his left lower limb Fig.
We advised him to take more exercise to help functional recovery of his muscle and ankles. Twenty-three days after the surgery, the patient was conscious and spoke logically.
Craniocerebral penetrating gunshot injuries have a high potential to kill as wounds in action, even when treated aggressively and timely in the battlefield. The projectile will transmit the kinetic energy to the skull, fragmenting and fracturing bones, severing the brain parenchyma and generating secondary missiles that damage brain structures further [ 567 ].
DC is widely used for wounds in wartime. It has been reported that patients who undergo DC had worse injuries than those receiving craniotomy and, while not achieving the same outcomes as those with a lesser injury, they did improve with time.
Hemicraniectomy is recommended for damage control to protect patients from the effects of brain swelling during the long overseas transport to their definitive care [ 34 ].
Warfare-related DC defects can be safely reconstructed using custom alloplastic implants. The patient in our case suffered from gunshot-induced cerebral vascular injury. The feature of our case exists in the innovative pattern of surgery by the combination of dura turning-over surgery with DC surgery. Patients with craniocerebral gunshot injury should be given consideration regarding gunshot-induced vascular injury. We need to take craniocerebral vascular injury into consideration when patients fall into unconsciousness and limb dysfunction that cannot be explained by simple trauma independently.
A CT scan in time is very necessary, because it can detect foreign bodies inside cranial tissue and the secondary injury condition. CTA has remarkable superiority in regard to the battlefield condition because it can reveal the position relationship between bullets and vessels and whether the continuity of the vessel has been blocked. However, DSA is irreplaceable in the assessment of the compensatory state of the blood supply of craniocerebral vessels in the ischemic tissue.
Acute cerebral infarction is a contradiction for cranial artery by-pass operation. DC is effective in lowering intracranial pressure but there is not enough evidence to demonstrate that the surgery can improve blood supply for the ischemic tissue. There is no evidence to support the routine use of secondary DC to reduce unfavorable outcomes in adults with severe traumatic brain injury TBI and refractory high intracranial pressure ICP. To date, there are no results from randomized trials to confirm or refute the effectiveness of DC in adults.
However, the results of non-randomized trials and controlled trials with historical controls involving adults suggest that DC may be a useful option when maximal medical treatment has failed to control ICP [ 89 ]. Their results support the conclusion that early aggressive treatment of refractory ICP can lead to a favorable clinical status and function [ 1011 ].
There are abundant vessels on the surface of the dura mater. Thus, we used a new way of surgery by turning over the dura mater above the ischemic brain tissue to increase the attachment of vessels to the cerebral cortex, which often lack blood supply in a brain infarction [ 31213 ]. Dura turning-over surgery introduced in our case can increase the blood supply and improve the ischemic state of the cerebral cortex by the growth of new vessels. Compared with an artery by-pass operation, dura turning-over surgery can be less harmful to brain tissue, which is a great advantage in protecting brain tissue from secondary injury.
This new pattern of surgery is also more accurate and can improve the brain blood supply more precisely for certain brain areas. In this particular case, we successfully helped the patient recover from the edge of death. Prompt treatments and surgery all contributed to reducing neurological loss of the wounded.
A follow-up survey carried out later showed that this new pattern of surgery is effective in improving the blood supply and relieving symptoms and signs of damage to certain brain tissue. Combining dura turning-over surgery with DC can not only lower ICP, Radiohelium Hit - Cerebral Turbulency - Forces Closing Down (Cassette can increase the blood supply for hypertension-induced vessel stenosis but also help vessels outside the dura mater to grow into ischemic areas of the cerebral cortex [ 3141516 ].
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