Giancarlo Piazza

Skull fracture as a factor of increased risk in minor head injuries ☆: Indication for a broader use of cerebral computed tomography scanning

Two series of patients with a minor head injury (for a total of 182 cases), differing only in the presence and absence of a linear skull fracture, were admitted to a nonspecialized hospital and prospectively examined by computed tomography scanning. The presence of a fracture line proved to be significant, inasmuch as it was accompanied by approximately 38% of intracranial abnormalities versus 6% in the nonfracture cases. Early detection of any intracranial pathology that was still asymptomatic allowed prompt transfer of patients to the neurosurgical center, where operative treatment was carried out, when indicated, without mortality or morbidity. All operations (11 cases) were performed on patients with a fracture (105 cases) whereas none of the nonfracture patients (77 cases) required surgery. It is proposed that adult patients with minor head injuries with a skull fracture be submitted to computed tomography scanning in order that intracranial lesions may be detected, and treated, before the onset of clinical deterioration.

Stereotaxic biopsy and radioactive implantation for interstitial therapy of tumors of the pineal region

Stereotaxic biopsy was performed in 10 patients with tumors of the pineal region. On the basis of intraoperative tissue diagnosis, low-energy radioactive sources (125I) were implanted in seven patients for interstitial irradiation during the same stereotaxic procedure. Results were good in five cases. This therapeutic modality appears to be indicated in cases of proven low-grade malignancy, inasmuch as the implantation of radioactive sources in a highly malignant lesion carries the risk of severe, often irreversible, damage to the surrounding brain, because of possible seed migration.

Rapid spontaneous disappearance of an acute extradural hematoma: case report.

The authors report the case of a patient presenting with an acute extradural hematoma and diffuse axonal injury. Control CT scan performed 4 hours later showed the complete resolution of the extradural collection together with increased evidence of shearing injuries. The mechanism of the hematoma resolution may probably be related to the concomitant acute brain swelling.

Asymptomatic Acute Bilateral Epidural Hematoma: Results of Broader Indications for Computed Tomographic Scanning of Patients with Minor Head Injuries

The authors report the case of a patient with an apparently minor head injury in whom broader indications for computed tomographic (CT) scanning allowed the early detection and treatment of an acute bilateral extradural hematoma. CT scanning of adult patients with linear skull fractures should be done whenever possible.

Craniopagus twins. An unsuccessful separation and a clinical review of the entity.

Craniopagus twinning is an extremely uncommon birth defect with an estimated incidence of 4–6 every 10 million births. The most complex and challenging issue is the feasibility of surgical separation, which involves not only technical but also socioethical problems and requires strict multidisciplinary cooperation between pediatricians, neuroradiologists, anesthesiologists, and plastic and neurological surgeons. The authors report a case in which separation was followed by the death of both twins and stress the importance, from the surgical and prognostic viewpoints, of the degree of vascular connections between the major dural sinuses, We propose a classification into three types according to severity.

Intracranial Cavernous Angiomas: a Simple Method for Their Surgical Approach

Stereotactically aimed small craniotomies have been performed in 14 cases of cavernous angiomas that were either deep seated or located in highly functional areas. The method has been without risk both quoad vitam and quoad valetudinem. Epilepsy was the main presenting symptom of the patients and was cured in 21.4% of the cases. Seizures were reduced in 57.1% of the patients and were unchanged in the remaining 21.4%.