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Decompressive craniectomy is an effective therapy to relieve intractable intracranial hypertension following acute brain injury. However, little is known about the optimal timing for cranioplasties in the sub-acute phase. The objective of the present study was to analyse the effect of cranioplasty timing on neurological outcomes.Single-centre observational study.One hundred and forty-seven consecutive patients with decompressive craniectomy and cranioplasty during the course of inpatient neurorehabilitation were identified by means of a retrospective hospital database search. This database contains the following prospectively-entered weekly scores: Barthel-Index (BI), Functional Independence Measure (FIM) and Coma Remission Scale (CRS). Additional clinical data were taken retrospectively from patient charts. Regression analysis was used to identify factors that influenced the end-of-rehabilitation outcome.Patients with shorter delays to cranioplasty (86 days) had a better functional outcome than patients with longer delays of85 days (60 ± 29.5 versus 25 ± 24.1 BI points; p 0.01, respectively). Age, pre-operative BI and CRS scores were additional independent outcome factors. Complication rates were not different between early and late cranioplasty groups.Patients with decompressive craniectomy for management of intracranial hypertension may benefit from early cranioplasty.

The primary objective of the study was to test whether there is a general downward trend in the number of head injuries in Europe. The research design of the study was a retrospective, explorative orientating analysis. A comparison of 27 European countries is presented. They have been sourced from the World Health Organization. The mean percentage of all hospital admissions for intracranial trauma in Europe is 0.855 % (±SD 0.550; range 0.03 to 2.82 %). The highest rates of treatments due to intracranial injuries are found in the Czech Republic, Latvia and Lithuania, whereas in the new member states of the European Union, such rates have been falling since entry, and there has been an increase in countries such as Germany, Finland and Cyprus. The mean length of in-hospital stay due to intracranial trauma in Europe is 6.79 days (±SD 2.95). There is no general decrease in the number of treated patients due to head injuries. There are serious regional differences and there is a need for preventive and informative action throughout Europe.

Primary objective The number of head injuries is not generally falling, but rather rising in some European countries. We want to certify the age and sex proportion in the number of head injuries in Europe.

Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function.Patients and Methods. The platelet function was analysed in 10 patients who had received single (N=4) or multiple (N=6) doses of acetylsalicylic acid and 3 patients (control group) who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance ofP≤0.05.Results. (1) Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2) The platelet function worsened again after three hours. (3) There were no complications related to electrolytes or fluid balance.Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients.

Background Anatomical variants of the aortic arch and its branching patterns often appear as an incidental finding during routine computed tomography (CT) scanning. These variations can be of relevance when performing angiography or endovascular interventions and may cause symptoms such as dysphagia. Purpose To analyze common anatomical variations found within the arteries originating from the aortic arch in patients using contrast CT imaging techniques. Material and Methods A total of 2033 contrast CT scans were analyzed. To obtain a truly representative sample, cases were chosen from different hospital departments without previous knowledge of the patient history. Results The total percentage of variations within the analyzed patients was 13.3%. In 8.0% a truncus bicaroticus was found. 4.2% of the patients showed a left vertebral artery originating directly from the aortic arch, mostly proximal, and in 1 case distal to the left subclavian artery. In 1.0% we found an aberrant right subclavian artery. We also found a single case of a right descending aortic arch. Conclusion Variations of the aortic arch and its branching are frequently found, mostly as an incidental finding during routine diagnostic scanning. A contrast-enhanced CT scan is a good method with which to study the aortic arch and its associated branching pattern.