Ceslovas Vaicys

Failure of hydroxyapatite cement to set in repair of a cranial defect: case report.

OBJECTIVE AND IMPORTANCE Hydroxyapatite cement, a new biomaterial that is being marketed as a method for reconstructing cranial defects, offers many advantages. We document, herein, the complete dissolution and failure of this material to set in a surgically dry field, under optimal conditions, an occurrence that has not been previously reported. CLINICAL PRESENTATION Hydroxyapatite cement was used for reconstruction of a frontal bone defect secondary to a traumatic depressed cranial fracture in a 9-year-old male patient. At the time of suture removal on postoperative Day 6, we observed serous discharge from the wound, a reappearance of the cranial defect, and brain pulsations visible subcutaneously. INTERVENTION The patient was returned to the operating room, at which time we learned that the hydroxyapatite cement had migrated out of the defect; small concretions of the cement were scattered throughout the subgaleal space. The concretions of cement in the subgaleal space and the small amount of cement remaining in the defect were removed, and titanium mesh was used. An excellent cosmetic result was achieved. CONCLUSION Although offering many advantages, hydroxyapatite cement does carry a risk of failure to set, despite optimal technique. Causes for failure to set, as well as possible modifications in the use of material and technique, are discussed.

Failure of Hydroxyapatite Cement Set in Repair of a Cranial Defect: Case Report

OBJECTIVE AND IMPORTANCE: Hydroxyapatite cement, a new biomaterial that is being marketed as a method for reconstructing cranial defects, offers many advantages. We document, herein, the complete dissolution and failure of this material to set in a surgically dry field, under optimal conditions, an occurrence that has not been previously reported. CLINICAL PRESENTATION: Hydroxyapatite cement was used for reconstruction of a frontal bone defect secondary to a traumatic depressed cranial fracture in a 9-year-old male patient. At the time of suture removal on postoperative Day 6, we observed serous discharge from the wound, a reappearance of the cranial defect, and brain pulsations visible subcutaneously. INTERVENTION: The patient was returned to the operating room, at which time we learned that the hydroxyapatite cement had migrated out of the defect; small concretions of the cement were scattered throughout the subgaleal space. The concretions of cement in the subgaleal space and the small amount of cement remaining in the defect were removed, and titanium mesh was used. An excellent cosmetic result was achieved. CONCLUSION: Although offering many advantages, hydroxyapatite cement does carry a risk of failure to set, despite optimal technique. Causes for failure to set, as well as possible modifications in the use of material and technique, are discussed.

Ruptured intracranial aneurysm in an adolescent with Alport's syndrome--a new expression of type IV collagenopathy: case report.

BACKGROUND Aneurysmal subarachnoid hemorrhage is uncommon in the pediatric and adolescent age groups. Collagenopathies, particularly of collagen type III and IV, have been recognized in the pathogenesis of intracranial (i.c.) aneurysms in recent studies of cerebrovascular immunoreactivity and the molecular architecture of the walls of cerebral blood vessels. Alports syndrome is a genetic disease characterized by imperfect synthesis of type IV collagen leading to sensorineural hearing loss and hematuria. The hematuria results from an abnormal synthesis of the type IV collagen of the glomerular basement membrane. CASE DESCRIPTION After a motor vehicle accident, this 14-year-old male driver presented with diffuse subarachnoid hemorrhage confirmed by computerized tomography. Subsequent cerebral angiography revealed a left carotid artery bifurcation aneurysm. A retrospective review of the patients history disclosed renal biopsy-proven hereditary Alports syndrome. The patient underwent left pterional craniotomy and clipping of the aneurysm, which had clearly ruptured. CONCLUSIONS The authors present the first clinical observation of a ruptured cerebral aneurysm in an adolescent male with Alports syndrome. In this case the type IV collagenopathy of Alports syndrome may have contributed to the genesis of this adolescents aneurysm. Intracranial aneurysms may be more common in the population of collagenopathies than previously suspected and non-invasive screening may be appropriate.

Acute posttraumatic pituitary gland hemorrhage.

We report the first case of CT and MRI of acute posttraumatic hemorrhage into a normal pituitary gland. The patient, a 24-year-old man, was admitted to our institution following an assault. There was a brief loss of consciousness, and he complained of headaches and dizziness. The patient denied any pertinent medical history. Physical examination revealed a right frontal abrasion and periorbital ecchymosis. Neurological and neuroophthalmological evaluations were normal. The Glasgow Coma Scale score was 15. A CT scan at the time of admission revealed a hyperdensity in the pituitary gland consistent with an acute bleed (Fig. 1). There were no other abnormalities. An MR scan obtained within 24 h confirmed the presence of an acute hemorrhage in the pituitary gland. On the T1weighted images, the signal of the area of the bleed was isointense (Fig. 2) and on the T2-weighted MR images markedly hypointense as compared with the normal adenohypophysis (Fig. 3). The postcontrast (0.01 mmol/kg Gd-DTPA) MR image did not demonstrate the presence of a pituitary tumor. Follow-up endocrine profile, including prolactin, somatotropic (growth) hormone, thyroidstimulating hormone, T4, and adrenocorticotropic hormone, was within normal limits.