Cranioplasty: Indications, Techniques, and Results by Dragoslav Stula M.D. (auth.)

By Dragoslav Stula M.D. (auth.)

This monograph provides a accomplished assessment of the medical adventure in surgical fix of cranial defects which the writer has received in the course of a interval of over ten years. specific difficulties of sufferers present process cranioplasty, akin to neurological impairments, EEG adjustments, diversifications of intracranial strain, and sinking pores and skin flap syndrome are defined and mentioned. the writer offers convincing proof of the significance of cranioplasty in bettering the standard of lifetime of sufferers with huge and disfiguring cranial defects. regrettably, cranioplasty nonetheless ameliorates in basic terms to a minimum volume the final situation in sufferers discomfort of significant cerebral lesions. i'm confident that this quantity will serve the aim it used to be designed for : that it'll be a so much useful advent into the issues on the topic of reconstructive surgical procedure. Basel, August 1984 Otmar Gratzl Contents advent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. background of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . three B. medical features of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. starting place of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. received Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . nine three. Demographic and different features of sufferers . . . . . . . . . . . . . . . . . nine II. Neurological and Psychic alterations sooner than and After Cranioplasty . . . . . . . eleven 1. category of Neurological Deficits and of the outside Flap forms . . . . . thirteen 2. The "Sinking epidermis Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixteen three. The impression of Cranioplasty Upon Neurological and Psychic adjustments 17 III. Electroencephalographic (EEG) adjustments in sufferers with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. assessment of EEG alterations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in sufferers with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. effects and dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Extra info for Cranioplasty: Indications, Techniques, and Results

Sample text

4 months after the operation a POS and a left-sided hemisyndrome developed Fig. 37b. The computer tomography shows a large cranial defect with a massive compression of the right brain hemisphere Fig. 38 a, b. The same patient as in Fig. 37 a three weeks after cranioplasty with Palacos® R: the hemiparesis had completely regressed, the POS symptoms showed a tendency of disappearing as well. The computer tomography of the skull shows a complete expansion of the brain 52 Surgical Procedures and Techniques of Cranial Repair skull.

Case No 2: In November 1976, a 64-year-old lady was involved in a car accident. 39b Fig. 39a. The patient's own bone implanted 3 years before, markedly hollowed and absorbed to a large extent, visible compression on the left hemisphere Fig. 39b. After cranioplasty with acrylate (Palacos® R with Gentamycin) . Normalization of the intracranial situation Fig. 37a. A 51-year-old patient after several operations for a chronic subdural haematoma with following wound infection. 4 months after the operation a POS and a left-sided hemisyndrome developed Fig.

Stula, Cranioplasty 58 Surgical Procedures and Techniques of Cranial Repair 1. Raised Intracranial Pressure and Brain Prolapse A decompressive craniotomy must be attempted as ultimate possibility [96], especially when a severe postcontusional ("malignant") brain oedema with brain mass displacement does not respond to the conventional osmo- or, the newer, barbiturate therapy [181]. This may happen after removal of an acute subdural or intracerebral haematoma with progressive brain stem compression.

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