Charles Taylon

Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique.

Study Design. Retrospective review of 110 patients undergoing spinal dural repair and regeneration using an onlay, suture-free, 3-dimensional-collagen matrix graft (DuraGen) over an 8-year period (1995–2003). Objectives. Technique appraisal of collagen matrix to repair spinal dura following incidental durotomy, spinal tumor surgery, and trauma. Summary of Background Data. Traditional methods of spinal dural repair following incidental durotomy involve tedious attempts at primary watertight suture with a 5% to 10% failure rate. Dural injury occurs after trauma, or dural excision may be required after tumor resection. Collagen matrix is a newer development in collagen sponge. Methods. The clinical and demographic data included diagnosis, type and site of surgery, infection risk, size of defect, use of lumbar drains, closed suction subfascial drains, and adverse events. The primary endpoints of graft failure were cerebrospinal fluid leak and pseudomeningocele formation. Neurosurgical wound infection rates were determined. Results. Collagen matrix was used (n = 110) in the following conditions: degenerative (69), pseudomeningocele formation repair (4), tumors (14), trauma (13), and congenital (5). There were 15 cervical (10 anterior), 21 thoracic (3 anterior), and 71 lumbar (all posterior) surgeries. Fibrin glue was used in 7.3%, subfascial drains in 82%, and lumbar drainage in 2.7%. Overall, cerebrospinal fluid leaks occurred in 2.7%. The 2 pseudomeningocele formations (3.2%) resolved at 3 months. There were 2 wound infections. In the subgroup with incidental durotomy (n = 69), failure of cerebrospinal fluid containment occurred in 4.3% [1 cerebrospinal fluid leak (1.4%), 2 pseudomeningocele formations (2.9%)]. Conclusions. Collagen matrix was successful in cerebrospinal fluid containment in > 95% of patients requiring dural repair following anterior and posterior spinal surgery. Subfascial drains were safe. Routine lumbar drains are not required but are recommended for repair of established pseudomeningocele formations.

Choroid Plexus Papilloma of the Third Ventricle: Case Report and Review of the Literature

Choroid plexus papilloma (CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricles of children and the 4th ventricle of adults. We describe the third reported case of a cystic CPP of the 3rd ventricle and review the pertinent literature. (Neurosurgery 12:217-220, 1983)

Role of routine emergency cervical radiography in head trauma

This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.

Caloric requirements in patients with severe head injuries

Indirect calorimetry was performed on 15 nonsteroid-treated, head-injured patients over 16 postinjury days. A search was made for a clinical marker that could be used to predict the caloric requirement in individual head-injured patients. Of all parameters reviewed, only motor activity correlated with the caloric needs of the patients (P less than 0.0001). Flaccid patients had a mean caloric expenditure of 108% of expected values, whereas patients with abnormal motor activity had a mean caloric expenditure of 191% of expected values.

Anticoagulation for prevention of cerebral infarcts following subarachnoid hemorrhage

BACKGROUND Late neurologic deterioration following subarachnoid hemorrhage is often due to vasospasm and rebleeding. Although the sudden onset of a focal neurologic deficit can actually be the result of thromboembolism, anticoagulation has rarely been used in such cases. METHODS We report a case of a 55-year-old woman who developed recurrent transient focal neurologic deficits 13 days after having a subarachnoid hemorrhage, with multiple cerebral infarcts by CT. Two cerebral angiograms showed no aneurysm. Her symptoms and clinical temporal profile were consistent with thromboembolic phenomenon. We elected to treat her with systemic anticoagulation. RESULTS The patient had no recurrent events after systemic anticoagulation, but had episodic sensory changes and a new infarct on MRI once the anticoagulation was discontinued. CONCLUSIONS Anticoagulant was safely administered after subarachnoid hemorrhage (SAH) in this patient and may have been effective in preventing further cerebral ischemic infarction following her SAH. Our patients clinical profile of sudden (rather than gradual) onset of a transient focal neurologic deficit and resolution of blood on CT indicates one setting in which the use of heparin may be considered.

Technical Application of Stereotactic Irradiation in Malignant Brain Tumors

This study reports the technical application of stereotactic interstitial brachytherapy for malignant gliomas in two groups of patients. Group I consisted of 2 patients who had undergone previous debulking brain surgery; group II were 3 patients who were not candidates for craniotomy because their tumors were surgically inaccessible. The stereotactic implantation technique in group I was somewhat complicated due to the irregular shape of the residual tumor masses. Sophisticated pre-implantation planning was necessary for adequate coverage of the entire tumor volume. In this series, inoperable tumors were also successfully implanted with excellent results.