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Neurosurgery Without TearsNeuroimaging is very essential in the diagnosis of a brain abscess. Radiographs may show depressed skull fractures, intracranial foreign bodies or fluid in the paranasal sinuses when these are present but is otherwise not useful for diagnosis.
The introduction of computed tomography brought about the most important single advancement in the management of intracranial infections especially [...]
Pyogenic inflammation of the brain leading to cerebral abscess may result from:
direct spread from an adjacent focus of infection such as sinusitis, otitis or dental infections. The infection usually involve the adjacent part of the brain. As such, frontal sinusitis affects the frontal lobe while otitis spread to the temporal lobe. They are usually [...]
The histogenesis of cerebral abscess was defined by defined by Britts and associates (1985).
The following stages are recognized in the development of brain abscess:
• Stage 1: Early cerebritis
o Days 1-3
o local inflammatory response surrounding the adventitia of blood vessels
o development of oedema
o beginning of a central necrotic region
• Stage 2: Late cerebritis
o Days 4-9
o Most important pathological changes occur
o Oedema reaches its maximum
o Increase in [...]
A quick and concise history is essential in the care of the patient with head injury. Necessary details include:
• Age
• Type of accident that caused the head injury and the events surrounding it
• Time of occurrence
• Details of rescue/transportation to the hospital
• Occurrence and details of
o Vomiting: may indicate raised ICP
o Convulsions (early/late post traumatic seizures)
o Bleeding (craniofacial orifices and others)
o CSF leaks
o Fever
o Loss of [...]
Resuscitation of the injured patient is often an Herculean task for the untrained health workers. Similarly, some students find it difficult answering questions on the initial care of the acutely injured patient. In this entry I have tried to summarise, in simple language, the essential components of resuscitation, specifically for use in head injury, but [...]
The initial management of head injury is very important to reduce the morbidity and mortality associated with the condition. The initial care impacts significantly on the eventual outcome and if not properly done, it may make nonsense of any eventual specialist neurosurgical care.
The key aspects in the management of patients following head injury [...]
Clinical presentation of hydrocephalus depends on the age of the affected individual and the rate of CSF accumulation. In infants, the most striking feature is the abnormal increase in the size of the head whereas in adults, it commonly presents with features of raised intracranial pressure.
In young children, hydrocephalus could present with any combination of [...]
The conditions causing hydrocephalus include the following:
• Excessive CSF production by the choroid plexuses
o Choroid plexus papilloma
• Blockage in the CSF circulation, either within the ventricle, or on the outside of them
o Aqueductal stenosis
o Tumours
o Chiari malformation especially types I and II
o Dandy-Walker malformation
o Intraventricular haemorrhage
o Meningitis
o Spinal tumour
o Myelomeningocoele
• Impairment of CSF absorption by the arachnoid villi.
o Meningitis
o Subarachnoid haemorrhage
The causes enumerated above could also be classified into [...]
There are several ways of classifying hydrocephalus. A simplified method of classification is as follows:
1. Based on time of acquisition
a. Congenital (cause present before birth), e.g
i. Aqueductal stenosis
[...]
This is perhaps the best known, and most widely performed neurosurgical procedure. It is sometimes done as a life-saving procedure. Most neurosurgical residents ‘cut their teeth’ with burr holes.
Simply put, burr hole is a hole made in the skull (cranium) so as to gain access into the intracranial compartment. The procedure could be done [...]
