Sverre Boström

Postoperative pseudoaneurysm of the superficial temporal artery (S.T.A.) treated with Thrombostat® (thrombin glue) injection

SummaryBackground. Pseudo-aneurysm is a rare complication of craniotomy. Blunt injury to the temporal artery region is the usual cause, but still a rare complication.Clinical presentation. A patient with subarachnoid hemorrhage was successfully treated by aneurysm clipping. The patient developed hydrocephalus, and was admitted for a shunt operation seventeen days later. The craniotomy had healed normally, but a palpable temporal lump was present in the skin incision.Intervention. The pulsating mass proved to be a postoperative aneurysm of the superficial temporal artery (S.T.A.) and was successfully occluded with 500 units Thrombostat® (thrombin glue) which was injected into the aneurysm sac using a 22-gauge needle guided by ultrasound.The permanency of the obliteration was verified by ultrasound examination.

Improved brain protection at decompressive craniectomy – a new method using Palacos ⌖ R-40 (methylmethacrylate)

SummaryA new method is described for protecting the brain after decompressive craniectomy in which a temporary methylmethacrylate flap is formed, somewhat larger than the original bone flap, thus gaining “extra” volume for the oedematous brain in which to expand.The present procedure was developed as a part of ordinary clinical practice particularly in response to demands from the NICU staff and our colleagues at other clinics who were responsible for the care of the patient in the post NICU period. They made us keenly aware that these patients frequently lack optimal co-ordination and balance and therefore run an increased risk of trauma to the unprotected brain when falling. This prompted us to develop a method for brain protection after decompressive craniectomy aiding in the care and rehabilitation until the final installation of the patient’s own bone flap can be performed.

Behςet’s disease, associated with subarachnoidal heamorrhage due to intracranial aneurysm

SummaryBehςet’s disease is an unusual medical condition in central Europe and North America, however more common in Turkey and Japan. It was originally described in Turkey, characterized by recurrent oral ulcers, genital ulcers and also uveitis. A variety of vascular lesions such as venous occlusions, arterial aneurysms and varices account for the high rate of morbidity and mortality with this disease. Arterial aneurysms most commonly occur in the abdominal aorta, femoral arteries and in the pulmonary arteries.To our knowledge there have been seventeen documented reports of patient’s with Behςet’s disease combined with aneurysms of cerebral arteries. We describe a patient with Behςet’s disease and subarachnoid haemorrhage due to a ruptured cerebral aneurysm.

A New Bone Dust Packer for Use in Neurosurgery

Summary A new tool for the packing of bone dust has been developed. The instrument compresses a mixture of bone dust and saline into suitable cylindrical plugs, fitting neatly into craniotomy burrholes. The skullbone at the craniotomy area will heal neatly also assuring the best healing possibilities for the overlying skin. The cosmetic results are excellent as no skin dents or cavities will be formed over the burrholes.

Low-grade infection complicating silastic dural substitute 32 years post-operatively

Background: A complication of a silastic dural substitute is described, which appeared after 32 years—by far the longest latency period reported in the literature. Methods: Case report and literature review. Results: In 1971, a 20-year old woman suffered from an acute subdural haematoma and a temporal cerebral contusion due to a motorbike accident. She underwent an operation with evacuation of these and the dura was mended with a silastic duraplasty. Thirty-two years later she deteriorated with increased memory problems and dysphasia. CT revealed an expanding haemorrhagic mass around the previous duraplasty, which demanded surgery with removal of the silastic dural implant and evacuation of the haemorrhagic mass. Although the haemorrhagic mass enveloped the silastic implant, a contribution of the acrylate flap cannot be ruled out. Bacteriological cultures revealed Acinetobacter spp. in the CSF. Adequate post-operative antibiotic treatment was administered. The patient slowly improved, but the complication represented a major setback in her long-term cognitive and communicative functions. Conclusions: This case widens the previously reported time-frame of late complications by 60%, from 20 to 32 years, and will hopefully serve to increase the awareness of late infections and haemorrhages induced by silastic dural implants, thereby improving diagnosis and treatment in future cases.

Leptomeningeal cyst due to vacuum extraction delivery in a twin infant

SummaryA rare case of a leptomeningeal cyst is reported in a twin male neonate delivered using a vacuum extractor, who presented a huge, non-pulsating, oedematous mass overlying the frontal fontanelle after birth. The mass was initially diagnosed as a cephalo haematoma. Ultrasonography indicated intracranial bleeding and a subsequent CT scan revealed an intraparenchymal bleeding above the left frontal horn, combined with a thin, left-sided, subdural haematoma and subarachnoid haemorrhage in the left Sylvian fissure. Apart from a bulging soft and round formation (2 × 2 × 3 cm) next to the anterior fontanel growing since birth, the neurological development of the infant was normal. MRI examination at the age of 7 months revealed that it consisted of a cystic mass (leptomeningeal cyst) connected to the left frontal horn, stretching right through the brain and also penetrating the dura mater. No signs of the perinatal haematomas were observed at this time.Surgical treatment, with fenestration of the cyst into the frontal horn and a watertight duraplasty with a periosteal flap and thrombin glue covered by small bone chips, was performed at 9 months of age. Due to a residual skull bone defect a second cranioplasty with autologous skull bone was performed three and half years later.During a follow-up period of 12 years the neurological and psychological development of the boy has been indistinguishable to that of his twin brother, indicating the satisfactory outcome of the treatment.

A new microsurgical instrument – a suction tube combined with a microdissector

A microsurgical suction tube with an attached ball probe has been developed. It functions as a microdissector when the ball probe is in its extended position, creating a larger working field than an ordinary sucker. When the ball probe is in the repose position, it does not interfere with the suction capacity, and the suction tube serves as a regular sucker. By adding the properties of the microdissector to the suction tube, dissection of exquisitely fine and subtle structures, including arachnoidal membranes, is facilitated. The ball probe is easily dismantled from the suction tube and the whole instrument conveniently cleaned.

A new scaled microgauge for use in neurosurgery

SummaryA new scaled microgauge is described for measuring anatomical structures during microsurgery. The instrument has a tip marked in millimetres, which can be positioned in any desired angle enabling measurement in confined areas.

The Dual-Tube Microsurgical Suction Instrument

Summary A dual-tube suction instrument intended for both macro- and microsurgery has been developed. A detachable air-tight inner tube is fitted into a conventional suction instrument; extending the ordinary sucking tube. The inner tube can easily be fitted, as well as removed from the other tube; a particular advantage in case the inner tube becomes obstructed. On removal of the inner tube the outer tube becomes cleaned and is at once, ready for re-use. Since the suction instrument does not have to be removed from the suction hose, valuable time is saved, enabling permanent sucking capacity.