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The article "What Sir William Battle Found: Observations Beyond his Sign" from the journal Neurocritical Care explores the contributions of William Henry Battle, a surgeon known for his work in traumatic brain injury (TBI). Battle's lectures highlighted key observations related to TBI, including the Battle sign, which indicates retroauricular ecchymosis from a basal skull fracture. His detailed examinations and findings on temperature changes as indicators of brain contusions remain relevant in modern neurointensive care. The article emphasizes the importance of recognizing Battle's comprehensive work beyond the eponyms associated with his name. [Extracted from the article]

Objective The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children. [ABSTRACT FROM AUTHOR]

To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children < 18 years old with Glasgow Coma Scale scores ≥ 14 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368/10,698 (3.4%) children < 2 years old, and in 676/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56/273 (20.5%) of younger children with palpable skull fractures and in 34/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6–24.2%), and in 30/486 (6.2%) vs 63/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5–7.8%). TBIs on CT were found in 73/273 (26.7%) and 189/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2–25.9), and in 61/486 (12.6%) vs 424/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1–12.0). Conclusions: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound. What is Known: • "Palpable skull fractures" are a high-risk predictor in the PECARN traumatic brain injury (TBI) rule for children younger than 2 years. • The reliability of physical exam findings suggestive of underlying skull fractures is unclear. What is New: • In children younger than 2 years of age, approximately one in five of those with "palpable skull fractures" will actually have a depressed skull fracture on CT, while 60% will have any skull fracture. • The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound. [ABSTRACT FROM AUTHOR]

Virtual surgical planning (VSP) stands as a novel advancement in craniofacial surgery. Since its inception, VSP has had the ability to improve accuracy and consistency in craniofacial surgery. The current case report describes the use of VSP in the context of a pediatric growing skull fracture and large calvarial defect requiring autologous reconstruction. Emphasis is placed on patient-specific osteotomy design and cutting guide design to decrease risk and optimize surgical outcomes. This case report illustrates a unique application of VSP in craniofacial surgery. [ABSTRACT FROM AUTHOR]

Fragment-induced penetrating injuries pose a significant threat in modern combat. Explosions from explosive devices generate metallic fragments that can lethally penetrate various body regions, with the head being particularly most vulnerable to fatality in terms of penetration. Hence, understanding the head's response to fragment impact is crucial. To this end, this study investigated the ballistic response of an anatomically accurate anthropometric head surrogate to fragment impact. The head surrogate comprised simulants for the three major layers of the head (skin, skull, and brain). Using a pneumatic gas gun, we impacted chisel-nosed fragment simulating projectiles (FSPs) of 1.10-g and 2.79-g on the head surrogate. We analyzed the ballistic response of the head surrogate in terms of ballistic limit velocities (V50), energy densities (E50/A), and failure mechanisms in each layer. The results indicated sensitivity to the FSP size. The 1.10-g FSP had a ∼41% higher V50 and a ∼63% higher E50/A compared to the 2.79-g FSP. Additionally, each head surrogate layer exhibited distinct failure mechanisms. The skin simulant failed due to a combination of shearing and elastic hole enlargement, forming a cavity smaller than the size of the FSP. The skull simulant fractured, creating a cavity at the entry point matching the FSP size. The brain simulant failure involved shearing of the cavity and penetration of fractured skull fragments. We also observed no significant difference in response when introducing a flexible neck attachment on which the head surrogate was mounted. Furthermore, comparisons of an anthropometric (close-shape) head surrogate with a simplified open-shaped head surrogate revealed the minimal influence of the head curvature on the response due to the localized nature of fragment penetration. These findings provide a comprehensive understanding of the head surrogate's mechanical response to fragment impact. The insights from this work hold significant value in the assessment of penetrating head injury, especially against small fragments. The results can be applied in modern warhead design and forensic investigations. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMaterials and methodsResultsConclusionGrowing skull fractures are a rare complication of paediatric skull fractures. Despite its rarity, a large proportion of resources go towards detecting this complication. This study aims to identify the factors associated with growing skull fracture development to determine which children require follow-up.This was a single-centre retrospective study examining the referral data from all patients under one years old referred with head trauma between 2013 and 2023 (n = 246). Of these patients 189 sustained skull fractures, with two requiring surgery for a growing skull fracture. Referral data for all head injuries between 2008 and 2013 was unavailable but surgical records were accessed for the only case of a child who developed a growing skull fracture in this time period. Each fracture was analysed using the commuted tomography (CT) head for its characteristics, including fracture splay distance and fracture elevation/depression.A total of 190 cases were reviewed, which showed a male to female ratio of 1.6:1. The majority of patients presented prior to one month of age and the most common mechanism of injury was a fall (80%). The most common fracture sustained was a linear fracture (87.4%). Of all fractures, the most common bone affected was the parietal bone (88.4%). Of those who developed a growing skull fracture, there was a significant difference in both the fracture splay distance (p < .05) and fracture elevation/depression distance (p < .05). All three patients who had growing skull fractures had a fracture splay distance above 5 mm at presentation and an elevation/depression of over 4 mm. 32% of children (n = 61) who had fractures had follow-up, with only nine having a fracture diastasis over 4mm.Resources and investigations should focus on children with fracture displacement over 4mm and/or elevation/depression distance of over 3mm, as they are at significantly greater risk of growing skull fracture development. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injuries are a major public health concern that contributes to youth morbidity and mortality in developing nations, including Ethiopia. Despite of this, little is known about head injury in the study area. The goal of the study was to identify the incidence, risk factors and outcomes for traumatic head injury among trauma patients who visited at the Yanet Trauma and Surgery Specialized Centre. Methods: This was a 5 year an institutional-based retrospective cohort study conducted among 1,029 patients who experienced trauma and admitted at the Yanet Trauma and Surgical Specialized Centre. The research was carried out between September 01/2023 to October 15/2023. The study units were selected by using simple random sampling techniques through computer-generated random numbers. The data were collected via a checklist designed on the Kobo toolbox with a smart smartphone. The collected data were exported to a statistical package for Social Science version 27. Then, descriptive statistical analysis was conducted to determine the mean, standard deviation, and median. Bivariate and multivariate logistic regression was subsequently conducted to determine the associations between head injury and the independent variables. Result: A total of 1,029 injured patients were followed for 2,302 person-days. Over all, incidence density rate of 14.03/100 person-days (323, 31.4%) [95% CI: 29.5–34%]. The third year of follow-up showed the greatest incidence compared to other years. The most common type of head injury observed during following up were brain contusion (38.1%), followed by epidural hematoma (33.1%), skull fracture (15.8%), and intracerebral hematoma (13.0%). In multivariate logistic model, rural residence [AOR = 1.6; 95% CI: 1.18–2.16], mechanism of injury namely road traffic accident [AOR = 5.5; 95% CI: 2.27–13.34], assault [AOR = 3.4; 95% CI: 1.35–8.37] and comorbidity of chronic disease [AOR = 2.2; 95% CI: 1.13–4.18] were the risk factors significantly associated with head injury. Discussions: The incidence density rate of 14.03/100 person-days. As the result, more has to be done by health professionals, traffic police officers and local government raise awareness and enforce the implementation of driving rules and regulations. [ABSTRACT FROM AUTHOR]

Aim: To determine the association of diabetes‐related characteristics with fractures at different sites in individuals with type 2 diabetes (T2D). Materials and Methods: We conducted a cohort study using the Clinical Practice Research Datalink (CPRD) GOLD. Patients aged over 30 years with T2D were identified within the CPRD. Patients were followed from the start of diabetes treatment until the end of data collection, death, or the occurrence of a fracture. Cox proportional hazards models were used to estimate the hazard ratios for the association of the individual characteristics (diabetes duration, glycated haemoglobin [HbA1c] level, and microvascular complications) with fracture risk, adjusted for demographics, comorbidities and comedication. Results: A diabetes duration of >10 years was associated with an increased risk of any fracture and major osteoporotic fractures (MOFs), while a diabetes duration of >8 years was associated with an increased hip fracture risk, compared to a duration <2 years. An HbA1c level <6% was associated with an increased fracture risk compared to HbA1c values of 6% to <7%. The presence of one or two microvascular complications was associated with an increased risk of any fracture and MOFs and the presence of two microvascular complications was associated with an increased hip fracture risk, compared to no microvascular complications. Conclusion: In conclusion, our study shows that a diabetes duration of 10 years or more, strict glycaemic control resulting in HbA1c levels below 6%, and/or the presence of at least one microvascular complication increased the risk of any fracture, hip fractures, MOFs, and humerus fractures, but not ankle, scapula or skull fractures. [ABSTRACT FROM AUTHOR]

Targeting single monitoring modalities such as intracranial pressure (ICP) or cerebral perfusion pressure alone has shown to be insufficient in improving outcome after traumatic brain injury (TBI). Multimodality monitoring (MMM) allows for a more complete description of brain function and for individualized management. Transcranial Doppler (TCD) represents the gold standard for continuous cerebral blood flow velocity assessment, but requires high levels skill and time. In TBI, the practical aspects of conducting extended TCD monitoring sessions have yet to be evaluated. Patients with acute moderate-to-severe TBI admitted to the neurocritical care unit between March 2022 and December 2023 receiving invasive ICP measurements were evaluated for inclusion. Exclusion criteria included trauma incompatible with TCD monitoring and if MMM was unwarranted. Daily MMM sessions (in addition to regular monitoring) were performed using TCD (Delica EMS 9D System or the DWL Doppler Box) for ≤5 d. Quantitative and qualitative feasibility, safety, and quality metrics were assessed. Of 74 patients, 36 (75% male; mean age, 44 ± 17 y) were included. Common reasons for exclusion were skull fractures (n = 12) and decompressive craniectomy (n = 9). We acquired 88 recordings (mean, 275 ± 88 min). Overall monitoring times increased, and set-up times decreased. Physiologic variables (including ICP/brain temperature) did not change with TCD application. A single adverse event (dislodging of a microdialysis catheter) occurred. Implementing extended TCD monitoring in MMM protocols is feasible and safe. Considering these results, inclusion of long-term TCD as part of the MMM is strongly encouraged to allow for in-depth description and direct evaluation of hemodynamic changes after TBI. [ABSTRACT FROM AUTHOR]

This prospective study aimed to compare ultra-high molecular weight polyethylene (UHMWPE) with polyetheretherketone (PEEK) in computer-designed patient-specific implants (PSIs) for cranial defect reconstruction, in terms of complications and aesthetic outcomes. Primary or secondary cranioplasty-eligible patients were included, while patients with active infection or hydrocephalus, or unfit for general anesthesia, were excluded from the study. All the implants were designed and fabricated by the same maxillofacial surgeon using CAD/CAM technology. UHMWPE PSIs were used in group 1 and PEEK PSIs in group 2. Technically, UHMWPE could be milled to a thinner margin thickness than PEEK, which resulted in better handling properties and a smoother end finish. All patients were evaluated over a period of 6 months in terms of overall complications or implant failure as the primary outcome, according to Clavien-Dindo (CVD) grading, and cosmetic satisfaction with the aesthetic results, using a Likert scale, as the secondary outcome. In total, 22 cranioplasty patients were included, with a mean age of 30.8 years (SD = 16.3). Across both groups, 17 patients (77.3%) did not develop postoperative complications. These occurred in three patients in group 1 (CVD grade I, II, and IIIb) (27.3%) and in two patients in group 2 (CVD grade II, IIIa, and IIIb) (18.2%), with no statistical difference (p = 0.6). None of the cases in both groups developed any clinical or radiographic signs of infection, or suffered implant failure. The mean satisfaction score was 4.8 in group 1 and 4.5 in group 2 (SD = 0.6). The difference in satisfaction scores between the two was not statistically significant (p = 0.23). Although UHMWPEE was comparable to PEEK in terms of overall complication rates and cosmesis after craniectomy, UHMWPEE as a material exhibited greater resiliency in technically challenging cases with large, complex/midline-crossing designs, previously fitted meshes, or single-stage resection-reconstruction, allowing better marginal adaptation. [ABSTRACT FROM AUTHOR]

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AbstractPurposeMethodsResultsConclusionsNational Institute of Clinical Excellence (NICE) guidelines advise that paediatric patients with linear skull fractures do not require admission in the absence of intracranial injury. Despite this, a period of inpatient neuro-observation has become the standard advice and practice in the UK for fear of deterioration. Our experience is that these children rarely deteriorate or require neurosurgical intervention. The primary aim of this study was to describe the incidence of neurological deterioration in patients referred to our paediatric neurosurgery unit with linear skull fractures.We identified all patients with a linear skull fracture referred to neurosurgery at a paediatric major trauma centre between 2018 and 2023. Patients with intracranial injury, skull base fracture or major trauma were excluded. Demographic and clinical data were collected. The primary outcome was deterioration which was defined as drop in Glasgow Coma Scale (GCS) score, unplanned repeat cranial imaging, neurosurgical intervention performed, or the patient died.Two hundred and ninety-four patients were identified in our referral database. Infants were the age group most commonly referred (44.2%) and falls from under 2 m in height the most common mechanism of injury (71.4%). Ninety-seven children had specific advice documented regarding neuro-observation; of these, the majority (n = 53) were advised 24 hours of inpatient observation. No patients experienced deterioration.This is the largest cohort of linear skull fractures in children described in the UK. None of our patients experienced neurological deterioration, mirroring findings from international studies and supporting current NICE guidance. In addition, at a cost of £360 per 24-hour admission, this has a cost implication for a resource-scarce NHS. We propose that UK trauma networks should devise protocols to support the safe discharge from ED of such patients without the need for discussion with a neurosurgical department. [ABSTRACT FROM AUTHOR]

The article explores the use of clinical decision rules (CDRs) in medical education and practice. It emphasizes the need for educators to understand the limitations of CDRs and teach them as a starting point rather than a definitive solution. The article also highlights the importance of developing diagnostic and management reasoning skills in residents, considering individual patient factors. It suggests that incorporating evidence-based practice and teaching critical appraisal skills are crucial for effective medical education. [Extracted from the article]

Background: Traumatic skull fractures have been traditionally classified into those that involve the base or vault with distinct entities linear or depressed. Compound elevated skull fracture is a newer entity with scanty reports in the literature. Objective: To describe the clinical presentation, neuro-radiology findings by development of a classification system, medical and surgical management, and complications of patients with compound elevated skull fractures at a tertiary referral neurosurgical department. Methods: Medical records of consecutive patients admitted from January 2005 to December 2018 with compound elevated skull fractures at the single neurosurgical referral hospital were retrospectively evaluated. Data was analyzed for demographics, clinical presentation, mechanisms of injury, neuro-radiology findings, management and outcomes. Results: Eighteen patients were included in this series with a median age of 28 years, median admission Glasgow Coma Scale was 12. Ten patients presented with focal neurological deficits which included hemiparesis [n = 8, 44%] and unilateral afferent pupil deficit [n = 2, 11%]. Intra-cerebral haematoma was the most common associated neuro-radiological finding [n = 10, 55%] followed by acute extradural haematoma [n = 4, 22%]. Three distinct neuro-radiological subtypes were identified: Type 1 – fractured segment with minimal loss of contact with rest of cranial vault, Type 2 – fractured segment with partial loss of contact with rest of cranial vault, Type 3 – fractured segment with complete loss of contact with rest of cranial vault. All patients underwent surgical debridement and of which 11 [61%] required duroplasty and 10[55%] re-placement of elevated bone flap. Septic complications included meningitis [n = 5, 27%], brain abscess [2, 11%] and surgical site infection [n = 1, 5%]. Seventeen patients had favourable outcomes at discharge (Glasgow Outcome Scale 4 or 5). Conclusion: Compound elevated skull fracture is an additional subtype of skull vault fracture. Prompt neurosurgical management with appropriate operative management of dura and elevated bone fragment reduces morbidity from septic complications. [ABSTRACT FROM AUTHOR]

Introduction: Depressed skull fractures occur when a portion of the skull is displaced inward towards the brain, leading to complications such as intracranial hematoma, brain contusion, and intracranial infection. Managing these fractures necessitates a multidisciplinary approach, with postoperative management and rehabilitation playing crucial roles in optimizing patient outcomes. This study aimed to assess the predictive factors and outcomes of patients who underwent surgical treatment for depressed skull fractures. Method: A comprehensive retrospective review was undertaken on the medical records of all patients who underwent surgery for depressed skull fractures at the University Comprehensive Specialized Hospital from January 1, 2021, to January 1, 2023 G.C. Patients with missile injuries were excluded from this study. The analysis incorporated a total of 163 patients. Results: A total of 163 patients (mean age 23.9; standard deviation 14.8; range 3–65) were studied, comprising 136 men (83.4%) and 27 women (16.6%). Among them, 153 (93.9%) were under 50 years old. Physical assault accounted for 102 (62.5%) of the injuries, with 62 (38%) involving a stone, 32 (19.6%) a stick, and 8 (5%) other objects (e.g., shovel, beer bottle). Using the Glasgow Coma Scale (GCS), minor head injuries were found in 123 individuals (75%). Fracture sites predominantly included frontal depressions (61 patients, 37.4%) and parietal depressions (53 patients, 32.5%). The associated injuries featured brain contusion (52 cases, 32%), epidural hematoma (26 cases, 16%), subdural hematoma (3 cases, 1.8%), and IVH/SAH (3 cases, 1.8%). Following surgery, full recovery occurred in 148 patients (91%), while sequelae—such as hemiparesis and aphasia—affected 15 patients (9%); unfortunately, three patients (1.8%) died due to critical head injuries prior to admission. Complications included meningitis (4 cases, 2.55%), brain abscesses (2 cases, 1.2%), surgical site infections (10 cases, 6.1%), hypocalcemia in one patient, post-traumatic stress disorder in two patients(1.6%), and osteomyelitis of the skull bone in two patients(1.2%). The multivariable logistic regression revealed that low GCS scores, compound fractures, hemiparesis, and the presence of an epidural hematoma were found to be substantially associated with a poorer outcome. Conclusion: The overall outcome of patients with depressed skull fracture was favorable. Factors associated with worse outcomes include compound fracture, low Glasgow Coma Scale at admission, presence of weakness, and presence of epidural hematoma. Complications associated with depressed skull fractures observed in our patients include wound infection, meningitis, brain abscess, osteomyelitis, PTSD, and hypocalcemia. [ABSTRACT FROM AUTHOR]

Objective To explore the surgical treatment of depressed fracture of skull in neonates. Methods and Results Eight neonates with depressed fracture of skull who underwent surgery in Children's Hospital Affiliated to Shandong University from January 2021 to December 2023 were included, and all of them underwent CT thin-slice scan + 3D reconstruction of skull before surgery. According to the location, extent and depth of the depression, the depressed edge was drilled and the depressed skull was reduced by bone pry (3 cases). The depressed skull collapsed again after the bone was pried up, the skin incision was extended to reveal the depressed area, and the shaped absorbable connector was fixed in the depressed area after prying up (2 cases). Blunt separation of the skull and dura mater at the lateral corner of the anterior fontanelle, and deep bone pry to pry up the depressed skull for reduction (one case). The skull and dura mater were bluntly separated from the coronal suture at the edge of the depression, and the depressed skull was pried up and reduced by deep bone pry (2 cases). On the first day after surgery, the re- examination of CT thin-slice scan + 3D reconstruction of skull showed that the depression reduction was satisfactory. Spontaneous fracture healing was happened in one case with linear fractures; hemorrhage resorption spontaneously was happened in one case with epidural hematoma. The average follow-up was 6.80 months, and the re-examination of CT thin-slice scan + 3D reconstruction of skull showed that the skull development was normal and there was no re-depression. Conclusions Immediate reduction of depressed fracture of skull can be achieved with surgery, and for fractures close to the anterior fontanelle or suture, the depression can be prying up through the lateral angle of the anterior fontanelle or the unclosed suture, which is more minimally invasive. [ABSTRACT FROM AUTHOR]

Head injury is an important cause of mortality worldwide. The present study was undertaken on 100 cases of vehicular accidents, which were autopsied at Thirunelveli Medical college over a period of one year from 2019-2020. Most of accidents has taken place during 8PM to 12 AM with a marked male preponderance of 83%. Vulnerable age group was found to be 21 to 40 years. Two wheeler occupants were commonly involved. Skull fractures were present in 65% of cases. Base of skull fractures found to be 23%, fracture of vault were found in 12%, linear fracture 50%. Among intra cranial hemorrhages, Subdural and sub arachnoid hemorrhage found to be 80.9%. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is a major medical and social concern in developing countries. TBI-related morbidity and mortality statistics in Egypt are lacking and do not reflect the actual magnitude of the problem. Objectives: To overview the incidence of moderate and severe head trauma in a heavily populated developing country and document the outcome of moderate and severe TBI associated with skull base fracture (SBF). Methodology: Data of patients admitted to our center with moderate and severe TBI associated with skull base fracture (SBF) were reviewed in the period between January 2019 and March 2023. Results: The most common type of trauma was road traffic accidents in 54.2% of the patients; 91.2% had Single SBF (middle cranial fossa fracture was predominant 58.5%). 25.5% had an initial GCS of ≤ 8. Periorbital ecchymosis was the most common presenting sign in 36.3%. The most frequent complication (37.3%) was pneumocephalus. The presence of skull base fracture inversely affected the Glasgow outcome scale extended GOSE (P = 0.001, r = 0.674). Higher initial GCS scores were positively correlated with good GOSE (GOSE) (P = 0.001, r =− 0.222). Conclusions: RTA represents a significant cause for moderate and severe TBI in young male population. SBF is associated with poor outcome in moderate and severe TBI. Higher initial GCS score was positively correlated with good GOSE. It is important to have an overview of different types of TBI in Egypt. [ABSTRACT FROM AUTHOR]

Background: Encephalocele refers to protrusion of the meninges and brain tissue through a skull bone defect. It results from congenital, traumatic, neoplastic, or spontaneous reasons. Traumatic encephalocele occurs because of the posttraumatic fracture of the skull bone or iatrogenic causes. The manifestations vary a lot, such as rhinorrhea, seizures, headaches, and focal neurological deficits. Case presentation: A 20-year-old Syrian male presented to our department with the complaint of clear cerebrospinal fluid drainage from his right nostril, which started 6 years ago after a head trauma, moderate headache, and episodes of tonic–clonic seizures without any response to medical treatment. Then, 2 months ago, the patient had meningoencephalitis, so he was admitted to the intensive care unit and treated for a month until he was cured. The patient underwent radiological investigations, which showed that he had a base fracture with an encephalocele in the nasal cavity. The brain tissues with the meninges herniated through the skull base fracture with a significant expansion of the subarachnoid spaces in the right hemisphere. He was advised to undergo surgical repair at that time, but he refused the surgery. During this visit, surgery was indicated. The surgery was done by a specialist who returned the herniated brain tissues to their normal location, repaired the meninges, and reconstructed the skull base with bone cement and bio-glue. The patient's recovery after the surgery was uneventful. Conclusion: Traumatic encephalocele is a rare and unexpected complication of trauma, but we should keep it in mind when the patient comes with head trauma because of its life-threatening consequences. This complication can happen after years of trauma if the patient refuses treatment, therefore, we must educate patients about the dangerous results of neglecting cerebrospinal fluid leakage and skull fractures. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) leak can occur immediately or several years after traumatic skull base injury which may present merely as a CSF leak or may even present with recurrent meningitis. Around 2% of all cases of head trauma, and 12%-30% of all basilar skull fractures may develop CSF leak. Posttraumatic CSF rhinorrhoea usually occurs within the first 48 hours, and the majority of them occur in the first 3 months, whereas delayed CSF leak beyond 3 months is rare. We encountered two such cases of delayed post-traumatic CSF rhinorrhoea about a decade after the head injury. We have reviewed and discussed previous studies on delayed post-traumatic CSF rhinorrhoea which have shown CSF leaks occur after months, years, or even after trauma. Such cases may help clinicians to be aware of the possibility of delayed CSF rhinorrhoea which may occur years after traumatic head injury. [ABSTRACT FROM AUTHOR]

This article discusses a study that examined the use of standardized algorithms to limit unnecessary neuroimaging in children with hemophilia who have sustained head trauma. The study analyzed data from 61 patients over a 15-year period and found that a low percentage of patients underwent head CT scans, with no adverse outcomes or surgical interventions. The study suggests that implementing guidelines can help reduce radiation exposure in this population. The study also explores the application of the PECARN head trauma criteria to pediatric patients with hemophilia, finding that it could potentially reduce the rate of neuroimaging by 13.5% without missing any cases of traumatic brain injury. The study recommends further validation of the PECARN criteria through prospective multi-centered studies. [Extracted from the article]

Background: Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults. Methods: We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split‐sample derivation cohort and then tested in an independent validation cohort. Results: Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) <15 (+20 points), GCS <14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total ≥25 had a sensitivity and specificity of 100.0% (95% CI: 96.0–100) and 12.3% (95% CI: 10.9–13.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention. Conclusions: The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice. [ABSTRACT FROM AUTHOR]

To assess the clinical significance of repeated head imaging in children with minor blunt force head trauma who underwent computed tomography (CT), limited to those who exclude with very low risk of important traumatic brain injury. We conducted a retrospective cohort study of children aged under 24 months with minor head trauma who underwent repeated head imaging and initial CT scans according to the Pediatric Emergency Care Applied Research Network (PECARN) rules. We enrolled 741 children and 110 with skull fracture (SF). Of the 96 patients with SF on initial CT who received head magnetic resonance imaging (MRI) a few days later, 36 (37.5%) patients' initial CT findings revealed intracranial injury in addition to SF. The number of children who exhibited new intracranial findings on follow-up MRI among those with isolated SF without intracranial damage and those with SF and intracranial injury on initial CT was 25/60 (40.7%) and 14/36 (38.9%), respectively. Subcutaneous hematoma on arrival and intersection with the coronal suture and lines of fracture were significantly associated with new intracranial findings. Four children with SF and intracranial injury on initial CT received neurosurgical intervention. No intervention was needed for those with isolated SF. We demonstrated that a proportion of children with head trauma had new findings on follow-up MRI, particularly in those without very low risk of clinically important traumatic brain injury. Patients who exhibit new intracranial MRI findings that satisfy the PECARN rules may not require neurosurgical intervention if their initial CT finding is isolated SF. [ABSTRACT FROM AUTHOR]

Background Between 3 and 15% of winter sports–related injuries are related to head injuries, which are the primary cause of mortality and disability among skiers. Despite the widespread adoption of helmets in winter sports, which has reduced the incidence of direct head injury, there is a paradoxical trend of an increasing number of individuals wearing helmets sustaining diffuse axonal injuries (DAI), which can result in severe neurologic sequelae. Methods We retrospectively reviewed 100 cases collected by the senior author of this work from 13 full winter seasons during the period from 1981 to 1993 and compared them with 17 patients admitted during the more shortened 2019 to 2020 ski season due to COVID-19. All data analyzed come from a single institution. Population characteristics, mechanism of injury, helmet use, need for surgical treatment, diagnosis, and outcome were collected. Descriptive statistics were used to compare the two databases. Results From February 1981 to January 2020, most skiers with head injuries were men (76% for the 1981–1993 and 85% for 2020). The proportion of patients aged over 50 increased from <20% in 1981 to 65% in 2020 (p < 0.01), with a median age of 60 years (range: 22–83 years). Low- to medium-velocity injuries were identified in 76% (13) of cases during the 2019 to 2020 season against 38% (28/74) during the 1981 to 1993 seasons (p < 0.01). All injured patients during the 2020 season wore a helmet, whereas none of the patients between 1981 and 1993 wore one (p < 0.01). DAI was observed in six cases (35%) for the 2019 to 2020 season against nine cases (9%) for the 1981 to 1993 season (p < 0.01). Thirty-four percent (34) of patients during the 1981 to 1993 seasons and 18% (3) of patients during the 2019 to 2020 season suffered skeletal fractures (p = 0.02). Among the 100 patients of the 1981 to 1993 seasons, 13 (13%) died against 1 (6%) from the recent season during care at the hospital (p = 0.15). Neurosurgical intervention was performed in 30 (30%) and 2 (12%) patients for the 1981 to 1993 and 2019 to 2020 seasons, respectively (p = 0.003). Neuropsychological sequelae were reported in 17% (7/42) of patients from the 1981 to 1993 seasons and cognitive evaluation before discharge detected significant impairments in 24% (4/17) of the patients from the 2019 to 2020 season (p = 0.29). Conclusion Helmet use among skiers sustaining head trauma has increased from none in the period from 1981 to 1993 to 100% during the 2019 to 2020 season, resulting in a reduction in the number of skull fractures and deaths. However, our observations suggest a marked shift in the type of intracranial injuries sustained, including a rise in the number of skiers experiencing DAI, sometimes with severe neurologic outcomes. The reasons for this paradoxical trend can only be speculated upon, leading to the question of whether the perceived benefits of helmet use in winter sports are actually misinterpreted. [ABSTRACT FROM AUTHOR]

Objective The clinical signs of base of skull fracture (BSF) are often ambiguous and difficult to identify, but are often used to make decisions on early medical interventions. This study aimed to assess the prevalence of the clinical signs of BSF, their dependency to diagnose this injury and to assess the correlation between the presence of these clinical signs and the severity of head injury and patient outcome. Materials and Methods A cross-sectional study was conducted in a tertiary care hospital in South India over a period of 3 years (2020–2023). Patients older than 18 years, with radiological or surgical evidence of BSF were monitored for developing the clinical signs including Battle's signs, raccoon's sign, otorrhea, and rhinorrhea. The presence of these clinical signs was correlated with demographical characteristics, patient presentation, complications, and their outcome. Results A total of 292 patients were included in the study. The mean age of the cohort was 36.27 ± 18.68 years. A total of 55 (18.8%) showed at least one of the four signs of BSF. Raccoon's sign was seen in 9.5% cases, Battle's sign in 5.5%, otorrhea in 5.5%, and rhinorrhea in 2.4% cases. Patients with frontal (p = 0.021) or ethmoid (0.049) fractures and ENT bleeding (p = 0.022) were significantly more likely to present with at least one sign of BSF. The patients who presented with clinical signs were more likely to have a complication during the course of the hospital stay (p = 0.024) than those without clinical signs, including cranial nerve palsy (p < 0.001) and cerebrospinal fluid leak (p < 0.001). The outcome of the patient did not change based on the presence of clinical signs (p = 0.926). Conclusion These study results indicate a limited diagnostic value of BSF clinical signs in the South Indian population. Thus, other modalities should be considered for the diagnosis when suspected. These results also discourage the use of the nasal route in all patients with suspected head injury and emphasize that during the nasal aspiration procedure, the use of a rigid device is fundamental to avoid false passage of the aspiration tube from the nasal to the intracranial region. [ABSTRACT FROM AUTHOR]

Leptomeningeal cyst (LMC) is a known complication of pediatric head injury but has not been described following a craniotomy other than for craniosynostosis. We present the case of a 20-month-old boy who underwent craniotomy for a traumatic epidural hematoma. There was an inadvertent tear of the dura which was repaired with a pericranial patch and dural sealant. The patient presented with a progressive surgical site swelling 5 months post-surgery and a CT scan revealed an LMC with elevation of the bone flap. He underwent re-exploration with watertight repair of the dural defect and rigid fixation of the bone flap. This iatrogenic LMC provides an opportunity to compare and confirm the pathogenesis vis a vis the more common spontaneous post-traumatic LMC. Our report highlights the importance of proper dural closure and bone fixation after craniotomy in children whose skulls are still growing. [ABSTRACT FROM AUTHOR]

Objectives: The carcinogenic risks of CT radiation in children and adolescents remain debated. We aimed to assess the carcinogenic risk of CTs performed in children and adolescents with minor head trauma. Methods: In this nationwide population-based cohort study, we included 2,411,715 patients of age 0–19 with minor head trauma from 2009 to 2017. We excluded patients with elevated cancer risks or substantial past medical radiation exposure. Patients were categorized into CT-exposed or CT-unexposed group according to claim codes for head CT. The primary outcome was development of hematologic malignant neoplasms. Secondary outcomes included development of malignant solid neoplasms and benign neoplasms in the brain. We measured the incidence rate ratio (IRR) and incidence rate difference (IRD) using G-computation with Poisson regression adjusting for age, sex, hospital setting, and the type of head trauma. Results: Hematologic malignant neoplasms developed in 100 of 216,826 patients during 1,303,680 person-years in the CT-exposed group and in 808 of 2,194,889 patients during 13,501,227 person-years in the CT-unexposed group. For hematologic malignant neoplasms, the IRR was 1.29 (95% CI, 1.03–1.60) and the IRD was 1.71 (95% CI, 0.04–3.37) per 100,000 person-years at risk. The majority of excess hematologic malignant neoplasms were leukemia (IRR, 1.40 [98.3% CI, 1.05–1.87]; IRD, 1.59 [98.3% CI, 0.02–3.16] per 100,000 person-years at risk). There were no between-group differences for secondary outcomes. Conclusions: Radiation exposure from head CTs in children and adolescents with minor head trauma was associated with an increased incidence of hematologic malignant neoplasms. Clinical relevance statement: Our study provides a quantitative grasp of the risk conferred by CT examinations in children and adolescents, thereby providing the basis for cost–benefit analyses and evidence-driven guidelines for patient triaging in head trauma. Key Points: • This nationwide population-based cohort study showed that radiation exposure from head CTs in children and adolescents was associated with a higher incidence of hematologic malignant neoplasms. • The incidence rate of hematologic malignant neoplasms in the CT-exposed group was 29% higher than that in the CT-unexposed group (IRR, 1.29 [95% CI, 1.03–1.60]), and there were approximately 1.7 excess neoplasms per 100,000 person-years at risk in the CT-exposed group (IRD, 1.71 [0.04–3.37]). • Our study provides a quantified grasp of the risk conferred by CT examinations in children and adolescents, while controlling for biases observed in previous studies via specifying CT indication and excluding patients with predisposing conditions for cancer development. [ABSTRACT FROM AUTHOR]

Characterizing the suture morphological variation is a crucial step to investigate the influence of sutures on infant head biomechanics. This study aimed to establish a comprehensive quantitative framework for accurately capturing the cranial suture and fontanelle morphologies in infants. A total of 69 CT scans of 2–4 month‐old infant heads were segmented to identify semilandmarks at the borders of cranial sutures and fontanelles. Morphological characteristics, including length, width, sinuosity index (SI), and surface area, were measured. For this, an automatic method was developed to determine the junction points between sutures and fontanelles, and thin‐plate‐spline (TPS) was utilized for area calculation. Different dimensionality reduction methods were compared, including nonlinear and linear principal component analysis (PCA), as well as deep‐learning‐based variational autoencoder (VAE). Finally, the significance of various covariates was analyzed, and regression analysis was performed to establish a statistical model relating morphological parameters with global parameters. This study successfully developed a quantitative morphological framework and demonstrate its application in quantifying morphologies of infant sutures and fontanelles, which were shown to significantly relate to global parameters of cranial size, suture SI, and surface area for infants aged 2–4 months. The developed framework proved to be reliable and applicable in extracting infant suture morphology features from CT scans. The demonstrated application highlighted its potential to provide valuable insights into the morphologies of infant cranial sutures and fontanelles, aiding in the diagnosis of suture‐related skull fractures. Infant suture, Infant fontanelle, Morphological variation, Morphology analysis framework, Statistical model. [ABSTRACT FROM AUTHOR]

Background and Aims: A ping pong fracture is a rare depressed skull fracture (DSF) observed in infants. It occurs due to the inward buckling of the calvarium, creating a cup‐like shape. Trauma during childbirth, particularly from instrumental delivery or the application of pressure by physicians or midwives during challenging deliveries, is the primary cause. This study aimed to investigate the epidemiologic characteristics associated with DSF in newborns and to identify the main factors related to its incidence and the type of hematoma involved. Methods: This is a retrospective case‐control analysis of all newborns delivered with DSF at King Abdulla University Hospital in Jordan between January 2008 and December 2020. The medical records were reviewed, and clinical data were collected and analyzed. Results: Out of 42,955 live births delivered at King Abdulla University Hospital, 13 cases of DSF were observed, giving an incidence of 3.0 in 10,000 live births. All cases were delivered at full term. Of the 13 cases, nine cases were associated with the use of instrumental delivery. Seven of those nine cases were delivered vaginally, while the other two cases required cesarean section following unsuccessful instrumental delivery. Four cases were spontaneous, with no history of trauma or instrument use, and delivered by cesarean section. Only 3 of the 13 cases required neurosurgical elevation of DSF. The outcome was excellent in all cases, both cosmetically and neurologically. Conclusion: Ping‐pong skull fractures are seen in newborns infrequently in the Jordanian population, with an incidence of 0.03%. Most of the cases have resulted from difficult deliveries though spontaneous fractures can be encountered rarely. The treatment is usually conservative with spontaneous resolution. The overall prognosis is excellent both neurologically and cosmically. [ABSTRACT FROM AUTHOR]

Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST. [ABSTRACT FROM AUTHOR]

Background: Skull base fracture management depends on location, severity, and can range from observation to surgical intervention. A comparison between the different locations of skull base fractures, namely anterior versus lateral, with regards to hospital length of stay (LOS), need for intensive care, and surgery has not been studied. Methods: Patients with skull base fractures between 2012 and 2019 were reviewed. Demographics and inpatient events were collected. Multivariate logistic and linear regressions evaluated the association between fracture location, multiple traumas, loss of consciousness, and mechanism of injury with hospital course and sequalae. Results: There were 134 patients (74.6% male) with skull base fractures (67 anterior and 67 lateral), with an average age of 44.2 years. The mechanism of injury was more likely to be MVCs in anterior fractures and falls in lateral fractures (MVC: 56.7% vs 34.3%; falls: 28.4% vs 44.8%, P =.03). Patients with anterior fractures were more likely to undergo any surgery (P <.002), and surgeries for facial fractures (P <.005), but less likely to need ICU care (P =.01). When admitted, patients with anterior skull base fractures had longer ICU stays (P =.03). They were also more likely to experience vision difficulties whereas patients with lateral fractures were more likely to experience hearing loss (P =.02). Conclusion: Patients with lateral skull base fractures are more likely to require an ICU admission compared to anterior fractures, but anterior fractures are more likely to need surgery and have longer ICU stays when admitted. A better understanding of the expected hospital course for patients based on skull base fracture location can improve care-coordination, hospital resource management and patient counseling. [ABSTRACT FROM AUTHOR]

Microwave (MW) sensing is regarded as a promising technique for various medical monitoring and diagnostic applications due to its numerous advantages and the potential to be developed into a portable device for use outside hospital settings. The detection of skull fractures and the monitoring of their healing process would greatly benefit from a rapidly and frequently usable application that can be employed outside the hospital. This paper presents a simulation- and experiment-based study on skull fracture detection with the MW technique using realistic models for the first time. It also presents assessments on the most promising frequency ranges for skull fracture detection within the Industrial, Scientific and Medical (ISM) and ultrawideband (UWB) ranges. Evaluations are carried out with electromagnetic simulations using different head tissue layer models corresponding to different locations in the human head, as well as an anatomically realistic human head simulation model. The measurements are conducted with a real human skull combined with tissue phantoms developed in our laboratory. The comprehensive evaluations show that fractures cause clear differences in antenna and channel parameters (S11 and S21). The difference in S11 is 0.1–20 dB and in S21 is 0.1–30 dB, depending on the fracture width and location. Skull fractures with a less than 1 mm width can be detected with microwaves at different fracture locations. The detectability is frequency dependent. Power flow representations illustrate how fractures impact on the signal propagation at different frequencies. MW-based detection of skull fractures provides the possibility to (1) detect fractures using a safe and low-cost portable device, (2) monitor the healing-process of fractures, and (3) bring essential information for emerging portable MW-based diagnostic applications that can detect, e.g., strokes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to offer a real-world clinical result. Materials and Methods: Our institute presented a clinical retrospective, single-institute research study of 150 pediatric TBI cases that were diagnosed and underwent emergency surgical treatment from 2010 to 2019. Results: The incidence of radiological findings is detailed as follows: brain edema (30%, 45/150), followed by acute subdural hematoma (27.3%, 41/150), epidural hematoma (21.3%, 32/150), chronic subdural hemorrhage (10%, 15/150), skull fracture (6.7%, 10/150), and traumatic subarachnoid hemorrhage (4.7%, 7/150). Surgical intervention data revealed that decompressive craniectomy was still the main effective surgical method. The results showed longer hospital stays and higher morbidity rates in the brain edema, acute subdural hematoma, and chronic subdural hemorrhage groups, which were viewed as poor surgical outcome groups. Epidural hematoma, skull fracture and traumatic subarachnoid hemorrhage were categorized into good surgical outcome groups. Notably, the data revealed gross improvement in Glasgow Coma Scale/Score (GCS) evolution after surgical interventions, and the time to cranioplasty was a significant factor in the development of post-traumatic hydrocephalus (PTH). Conclusions: Our study provided real-world data for the distribution of etiology in pTBI and also categorized it into six groups, indicating disease-orientated treatment. In addition, our data supported that decompressive craniectomy (DC) remains a mainstay surgical treatment in pTBI and early cranioplasty could decrease the incidence of PTH. [ABSTRACT FROM AUTHOR]

The human head can sometimes experience impact loads that result in skull fractures or other injuries, leading to the need for a craniectomy. Cranioplasty is a procedure that involves replacing the removed portion with either autologous bone or alloplastic material. While titanium has traditionally been the preferred material for cranial implants due to its excellent properties and biocompatibility, its limitations have prompted the search for alternative materials. This research aimed to explore alternative materials to titanium for cranial implants in order to address the limitations of titanium implants and improve the performance of the cranioplasty process. A 3D model of a defective skull was reconstructed with a cranial implant, and the implant was simulated using various stiff and soft materials (such as alumina, zirconia, hydroxyapatite, zirconia-reinforced PMMA, and PMMA) as alternatives to titanium under 2000N impact forces. Alumina and zirconia implants were found to reduce stresses and strains on the skull and brain compared to titanium implants. However, PMMA implants showed potential for causing skull damage under current loading conditions. Additionally, PMMA and hydroxyapatite implants were prone to fracture. Despite these findings, none of the implants exceeded the limits for tensile and compressive stresses and strains on the brain. Zirconia-reinforced PMMA implants were also shown to reduce stresses and strains on the skull and brain compared to PMMA implants. Alumina and zirconia show promise as alternatives to titanium for the production of cranial implants. The use of alternative implant materials to titanium has the potential to enhance the success of cranial reconstruction by overcoming the limitations associated with titanium implants. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma. Materials and Methods: In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student's t and chi-squared tests and logistic regression analysis. Results: Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients. Conclusion: TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors. [ABSTRACT FROM AUTHOR]

Purpose: To determine the obstetric factors affecting the development of depressed skull fracture in neonates. Materials and methods: This was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed. Results: There were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography. Conclusions: There was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases. [ABSTRACT FROM AUTHOR]

Objective: To quantitatively study the measurement data related to the bony posterior cranial fossa and explore the correlation between bony posterior cranial fossa morphology and the occurrence of hemifacial spasm. Methods: A total of 50 patients with hemifacial spasm who attended the Department of Neurosurgery of China-Japan Friendship Hospital from October 2021 to February 2022 were included, and 60 patients with minor head trauma excluding skull fracture and intracranial abnormalities were included as controls. Cranial multilayer spiral CTs (MSCTs) were performed in both groups, and multiplanar reconstruction (MPR) was used as a postprocessing method to measure data related to the posterior cranial fossa in both groups. Results: Compared with the control group, the anteroposterior diameter (labeled AB) and the height (labeled BE) of the bony posterior cranial fossa, the anteroposterior diameter of the foramen magnum (labeled BC), the length of the clivus (labeled AB), and the length of the posterior occipital (labeled CD) in the HFS group were all reduced, and the differences were statistically significant. BE is positively correlated with AB and CD, with a stronger correlation observed between BE and AB (r = 0.487, p < 0.01). AB is negatively correlated with AD (r = -0.473, p < 0.01). The remaining correlations between the data were not statistically significant. There was no overlap in the 95% confidence interval for any of the measurements between the hemifacial spasm group and the control group. Conclusion: There is a correlation between the posterior cranial fossa and hemifacial spasm. [ABSTRACT FROM AUTHOR]

Introduction: Penttinen premature aging syndrome is caused by mutations in the PDGFRB gene. We describe the case of a 10-year-old girl with a de novo c.1994T>C variant in PDGFRB who developed multiple cranial, intracranial, and spinal manifestations, including macrocephaly, enlarged convexity subarachnoid spaces crossed by numerous vascularized arachnoid trabecule, hydrocephalus, spinal epidural lipomatosis, a low conus medullaris, calvarial thinning with large anterior fontanelle, and a skull fracture with bilateral epidural hematomas. Vascularized arachnoid granulations, spinal epidural lipomatosis, and low conus medullaris have not been previously described in Penttinen syndrome. Case Presentation: A female with Penttinen syndrome diagnosed at 9 years of age initially presented as an infant with cutaneous hemangiomas and macrocephaly; imaging showed enlarged convexity subarachnoid spaces. Her convexity subarachnoid spaces continued to expand, leading to subdural shunt placement. At surgery, her enlarged subarachnoid spaces were found to contain numerous abnormally thick, vascularized arachnoid trabecule. Eventually, her subdural shunt failed and her ventricles enlarged, leading to ventricular shunt placement. A large, sunken anterior fontanelle which did not diminish in size led to cranioplasty with a custom implant. She later developed chronic back pain and imaging revealed spinal epidural lipomatosis, a low conus medullaris, and mild scoliosis. At 10 years of age, a fall from a chair resulted in a depressed skull fracture and bilateral parietal epidural hematomas. Emergency left parietal craniotomy was performed for evacuation of the left hematoma, and the patient recovered without complications. Intraoperatively, it was noted that her skull was extremely thin. Conclusion: This case report highlights the clinical presentation and multifaceted neurosurgical management of a patient with Penttinen syndrome. The patient exhibited characteristic features including hypertrophic skin lesions, macrocephaly, and skeletal abnormalities. Our patient's vascularized arachnoid trabecule, spinal epidural lipomatosis, and low conus medullaris have not previously been reported in Penttinen syndrome. Her thin skull potentially contributed to the extent of her depressed skull fracture after her backwards fall and predisposed her toward developing epidural hematomas. Patients with Penttinen syndrome can have multiple cranial, intracranial, and spinal manifestations which may need the attention of a neurosurgeon. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) with skull fractures parallel to or crossing venous sinuses is a recognized risk factor for traumatic cerebral venous sinus thrombosis (tCVST). Despite the recognition of this traumatic pathology in the literature, no consensus regarding management has been achieved. This study aimed to evaluate the impact of tCVST on TBI outcomes and related complications. Patients within a prospective registry at a level I trauma center from 2014 to 2023 were reviewed to identify tCVST cases. The impact of tCVST presence on Glasgow Outcome Scale scores at 6 months, 30-day mortality, and hospital length of stay were evaluated in multivariable-adjusted analyses. Among 607 patients with TBI, 61 patients were identified with skull fractures extending to the vicinity of venous sinuses with dedicated venography. Twenty-eight of these 61 patients (44.3%) had tCVST. The majority (96.4%) of tCVST were located in a unilateral transverse or sigmoid sinus. Complete recanalization was observed in 28% of patients on follow-up imaging (7/25 with follow-up imaging). None of the 28 patients suffered attributable venous infarcts or thrombus propagation. In the adjusted analysis, there was no difference in the 30-day mortality or Glasgow Outcome Scale at 6 months between patients with and without tCVST. Unilateral tCVST follows a benign clinical course without associated increased mortality or morbidity. The management of tCVST should be distinct as compared to spontaneous CVST, likely without the need for anticoagulation. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the role of the foramen of Vesalius (FV) in the pathogenesis of skull base meningioma by analyzing data from various multi-image modalities. For this single-center retrospective study, 39 consecutive patients with skull base meningioma who underwent tumor resection between January 2020 and March 2023 were enrolled. The anatomical and pathological characteristics of the FV were evaluated using computed tomography and 3-dimensional digital subtraction angiography. The clinical significance of the FV in tumor hemodynamics and treatment, such as preoperative tumor embolization, was investigated using the 3-dimensional digital subtraction angiography/computed tomography fusion images. We identified FV in 52% (17/27) of the finally included patients. In 10 (30%) patients, the FV was found bilaterally with no significant variation in appearance between the healthy and tumor-affected sides (P = 0.786). The mean FV diameter was significantly larger on the tumor-affected side (P = 0.010). No significant anatomical differences, like duplication and partial assimilation with the foramen ovale, were observed between the 2 sides. The FV was involved in venous skull base perfusion around the tumor in 9 cases. In 4 cases where it was the pathway for tumor feeders, preoperative tumor embolization via the FV resulted in disappearance of the tumor stain. No complications associated with endovascular treatment were observed. This study elucidated the anatomical asymmetry of the FV and its role in the hemodynamics of skull base meningioma. Our findings highlight the significance of performing anatomical and pathological evaluations of the FV in determining treatment strategies, including preoperative embolization, for skull base lesions. [ABSTRACT FROM AUTHOR]

Carotid-cavernous fistula (CCF) is a rare condition. However, it should be suspected when there are traumatic facial fractures, because if not diagnosed, it can lead to permanent damage such as blindness. Traumatic CCF often presents delayed symptoms, and delayed diagnosis without prompt treatment can lead to permanent injuries in optic and cranial nerves III, IV, V, and VI as well as intracranial hemorrhage. The routine initial modality for patients with suspected facial bone fractures is noncontrast computed tomography (CT) to identify any fracture lines and check for intracranial hemorrhage. We report a post-traumatic CCF case with a 4-day symptom delay, where left superior ophthalmic vein (SOV) enlargement was observed on the routine noncontrast facial CT with ipsilateral orbital wall fracture. When the patient first presented to the emergency room (ER), we did not detect vein enlargement on CT. Afterwards, the patient developed delayed symptoms of CCF and was readmitted to the ER. When we reanalyzed the first CT scan, an enlarged SOV was confirmed. The diagnosis was confirmed via magnetic resonance imaging angiography, and the patient was successfully treated with embolization of the fistula. Thus, we recommend reviewing ophthalmic vein enlargement that is readily identifiable through noncontrast CT for patients injured by craniofacial trauma to suspect the presence of delayed CCF at their initial presentation. [ABSTRACT FROM AUTHOR]

Post-mortem computed tomography (PMCT) enables the creation of subject-specific 3D head models suitable for quantitative analysis such as finite element analysis (FEA). FEA of proposed traumatic events is an objective and repeatable numerical method for assessing whether an event could cause a skull fracture such as seen at autopsy. FEA of blunt force skull fracture in adults with subject-specific 3D models in forensic pathology remains uninvestigated. This study aimed to assess the feasibility of FEA for skull fracture analysis in routine forensic pathology. Five cases with blunt force skull fracture and sufficient information on the kinematics of the traumatic event to enable numerical reconstruction were chosen. Subject-specific finite element (FE) head models were constructed by mesh morphing based on PMCT 3D models and A Detailed and Personalizable Head Model with Axons for Injury Prediction (ADAPT) FE model. Morphing was successful in maintaining subject-specific 3D geometry and quality of the FE mesh in all cases. In three cases, the simulated fracture patterns were comparable in location and pattern to the fractures seen at autopsy/PMCT. In one case, the simulated fracture was in the parietal bone whereas the fracture seen at autopsy/PMCT was in the occipital bone. In another case, the simulated fracture was a spider-web fracture in the frontal bone, whereas a much smaller fracture was seen at autopsy/PMCT; however, the fracture in the early time steps of the simulation was comparable to autopsy/PMCT. FEA might be feasible in forensic pathology in cases with a single blunt force impact and well-described event circumstances. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a method of cranial bone reconstruction for cranial burst fractures and early-stage growing skull fractures, named bone flap binding and transposition. Methods: Cranial burst fractures, severe head injuries predominantly observed in infants, are characterized by widely diastatic skull fractures coupled with acute extracranial cerebral herniation beneath an intact scalp through ruptured dura mater. These injuries can develop into growing skull fractures. This study included two cases to illustrate the procedure, with a particular focus on the bone steps in managing these conditions. The medical history, clinical presentation, surgical procedures, and postoperative follow-up were retrospectively studied. The details of the surgical procedure were described. Results: The method of bone reconstruction, named bone flap binding and transposition, was applied after the lacerated dural repair. Two bone pieces were combined to eliminate the diastatic bone defect and then fixed by an absorbable cranial fixation clip and bound by sutures. The combined bone flap was repositioned into the bone window, completely covering the area of the original dural laceration. Subsequently, the bone defect was transferred to the area of normal dura. The postoperative courses for the two infants were uneventful. Follow-up CT scans revealed new bone formation at the previous bone defect and no progressive growing skull fracture. The major cranial defects had disappeared, leaving only small residual defects at the corners of the skull bone window, which required further recovery and did not affect the solidity of the skull. Conclusion: Bone flap binding and transposition provide a straightforward, cost-effective, and reliable method for cranial bone reconstruction of cranial burst fractures and early-stage growing skull fractures. This method has taken full advantage of the small infant's dura osteogenic potential without the need for artificial or metallic bone repair materials. The effectiveness of the method needs further validation with more cases in the future. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Advanced skull base malignancies are a heterogenous subset of head and neck cancers, and management is often complex. In recent times, there has been a paradigm shift in surgical technique and the advent of novel systemic options. Our goal was to analyse the long‐term outcomes of a single quaternary head and neck and skull base service.A retrospective review of 127 patients with advanced anterior skull base malignancies that were treated at our institution between 1999 and 2015 was performed. Multiple variables were investigated to assess their significance on 5 and 10‐year outcomes.The mean age was 60.9 (± 12.6 SD). Sixty‐four percent were males and 36% were females. Ninety percent of patients had T4 disease. Median survival time was 133 months. The 5‐year overall survival (OS) was 66.2%, disease‐specific survival (DSS) was 74.7%, and recurrence‐free survival (RFS) was 65.0%. The 10‐year OS was 55.1%, DSS was 72.1%, and RFS was 53.4%. Histological type and margin status significantly affected OS & DSS.Surgical management of advanced skull base tumours has evolved over the last few decades at our institution with acceptable survival outcomes and complication rates. Histological diagnosis and margin status are the main predictors of survival. The addition of neoadjuvant systemic agents in current trials may improve outcomes. [ABSTRACT FROM AUTHOR]

Falls commonly occur in hospitals, particularly among older adults. Fractures in the older population can cause major morbidity, which can result in long hospital admissions and increased care costs. This study aimed to characterise the demographics of patients aged 65 years and over who fell in hospital and to determine the type of fractures they sustained. A descriptive study was undertaken to examine hospital data of older inpatients who had a fall during admission in two regional Queensland hospitals in Australia over a 2.5-year period. The prevalence of inpatient falls was 1.28%. Most falls were unwitnessed (77.34%) and they had an average of seven medical comorbidities. The mean age was 80.4 years and 63% were male. Women who fell were significantly older than men (p = 0.004). The mean length of stay of in-hospital fallers was 22.77 days and same admission mortality was 9.3%. Thirty-three fall events (3.8%) resulted in fractures, some with multiple injuries. The most common fracture was neck of femur, followed by rib, femur, and facial fractures. In conclusion, this study identifies the incidence of falls increased with age, most falls were unwitnessed, as well as provides evidence that patients with falls had multiple comorbidities and long hospital admissions. The data could be used to optimise fall prevention strategies and to refine post-fall assessment pathways. [ABSTRACT FROM AUTHOR]

Cerebral contusion, a form of traumatic brain injury (TBI), is a significant cause of morbidity and mortality in pediatric populations. This article explores recent innovations in the neurosurgical treatment of pediatric cerebral contusions, highlighting advancements that have improved clinical outcomes and provided new avenues for intervention. The article discusses the pathophysiology and clinical presentation of pediatric cerebral contusion, advances in imaging and monitoring techniques, recent innovations in neurosurgical treatment, and the importance of neuroprotection and long-term care. The management of pediatric cerebral contusion has benefited from significant neurosurgical and technological advancements, leading to improved diagnostic accuracy, more precise surgical interventions, and better overall outcomes. However, challenges remain in addressing long-term neurodevelopmental outcomes and ensuring access to specialized care in all regions. [Extracted from the article]