Karl Janich

Management of Adult Traumatic Brain Injury: A Review

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the adult population. The management of traumatic brain injury depends on its severity. It must be recognized that almost all forms of treatment for TBI are geared towards the minimization of secondary injury, as it is assumed that primary injury is irreversible. The discussion here represents much of what is known up-to-date concerning TBI management, but its treatment continues to evolve once new mechanisms of injury are discovered and those that we know of now are refined. The treating staffs are encouraged to keep up with the current state of the literature to stay informed.

A rare remarkable recovery in a pediatric patient with the bi-hemispheric, transventricular trajectory craniocerebral gunshot wound.

The gunshot wound to the head (GSWH) is associated with a mortality rate of 20–90% in adults and 20–65% in the pediatric population. Due to the high rates of mortality and morbidity, the management of these patients has been a topic of high interest in the neurosurgical community. We present an 18-year-old male suffering a GSWH with the bullet following a transventricular trajectory and crossing the midsagittal plane, creating extensive intracranial injuries. Despite a calculated mortality rate of >97% from these devastating injuries, the patient survived the GSWH and made a remarkable recovery. The young adult brain still maintains a high potential for neurological plasticity. This may partially explain why the young adult population with a severe GSWH can have a better than expected recovery course. Bifrontal GSW injuries may have much better outcomes than more posterior injuries as has been demonstrated in this patient in this case.

A rare extra-axial midline tentorial adult medulloblastoma with dural-tail sign mimicking a meningioma

Medulloblastomas are categorized as the World Health Organization Grade IV neoplasms. Only 33 cases have been reported of extra-axial, mostly in the cerebellar pontine angle and lateral cerebellar hemisphere, medulloblastomas in the current literature. Our study showcases the first case of an extremely rare presentation of an extra-axial midline tentorial adult medulloblastoma with the dural-tail sign mimicking a meningioma. To achieve the best possible outcome, a high index of suspicion for medulloblastoma is critical especially in young patient with an atypical posterior fossa mass as treatment regimens drastically different between a medulloblastoma and a meningioma.

A novel application of the integra camino bolt for the drainage of chronic subdural hematoma: A technical note

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age and complicated by antiplatelet/anticoagulant therapies. With improving medical care in an aging population, the incidence of cSDH will likely increase over the next 25 years, placing a burden on health care costs. Aims: A simple and inexpensive treatment option for cSDH is desirable. Material and methods: We report a basic, but novel, technique to drain cSDH with an Integra Camino bolt. Results: This technique was employed in two patients, where the significant resolution of cSDH and associated clinical symptoms were observed without complications. Conclusions: Our technique is simple and effective. It incorporates readily available materials, which reduces costs. Such characteristics are necessary, given the increasing incidence of cSDH.

Intracranial subdural empyema mimicking a recurrent chronic subdural hematoma.

Intracranial subdural empyema (ISDE) is a life-threatening condition. The risk for ISDE increases in patients that have undergone prior intracranial procedures. The non-specificity in its clinical presentation often makes ISDE difficult to diagnose. Here, we present a rare case of ISDE mimicking a recurrent chronic subdural hematoma, emphasizing the significance of obtaining early magnetic resonance images of the brain for early diagnosis and treatment to achieve the optimal outcome.

Surgical Management of Chronic Subdural Hematoma: Short Communication

Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with prior traumatic brain injury (TBI) and older age that is often complicated by antiplatelet or anticoagulant therapies. cSDH often results from the liquefaction of a previous acute subdural hematoma that accompanies TBI. The incidence of cSDH will likely increase over the next 25 years, placing a burden on health care costs. As such, a simple, inexpensive treatment option is desirable. In this short communication, we describe recent data and different techniques that are available for treating cSDH.

Management of Pediatric Traumatic Brain Injury: A Mini-Review

Traumatic brain injury (TBI) is a significant source of concern in the pediatric population. It has been estimated that close to 500,000-700,000 pediatric TBI incidents occur within the United States alone, with majority occurring in early childhood ( 15 years). The management of TBI depends on its severity. It is the prevention of worsening of the secondary injury that is often targeted during the medical management. Given that TBI poses such a huge health risk, further understanding is required for adequate management of pediatric patients with TBI; especially due to the fact that their brain is still developing and has not completely matured.