There is a dearth of evidence-based practice regarding the differential diagnosis, natural history, and management of post-craniotomy headache. The etiology of post-craniotomy headache is typically multifactorial, with patients' medical history, type of craniotomy, and perioperative management all playing a role. Post-craniotomy headaches are often undertreated, yet available evidence supports a multimodal approach for both prophylaxis and management. Many therapeutic techniques that aim to treat or prevent post-craniotomy headache require more robust validation than clinical evidence currently imparts. Pre- and intraoperative locoregional anesthesia should be the mainstay of prophylaxis; the role of opiates co-administered with analgesics, corticosteroids, and antiepileptic therapy in the acute perioperative phase is of paramount importance. Treatment of chronic PCH is less well-defined but should involve trials of analgesic, antineuropathic, and antiepileptic medications before enlisting experimental treatments. Comorbid psychiatric, musculoskeletal, or seizure disorders should be managed distinctly from post-craniotomy headaches. In patients failing all extant therapies, experimental approaches should be considered. These include subanesthetic ketamine infusion or surgical site injection with local anesthetics, corticosteroids, or botulinum toxin. Post-craniotomy headache is a complex phenomenon with many underutilized treatment options available, and many more under investigation. Nonetheless, further research is required to differentiate the efficacy of contemporary treatment strategies and to elucidate the applicability of novel therapies.
Axillary artery injury is a rare complication of blunt upper extremity trauma and is reported in the literature
on only a few cases. The usual treatment is an open operation with the exclusion of the aneurysm and
interposition grafting. Vascular injury in the elderly population after trauma is especially “dangerous” owing
to a large cohort of these patients being on anticoagulation. For this reason, any hematoma after blunt trauma
must be fully “evaluated” and a careful vascular exam must be undertaken. When the vascular injury is
acute as a result of trauma, the typical interventions include an open repair either with an interposition graft
or reverse saphenous vein graft. We report a case of a delayed traumatic axillary artery dissection with
resultant pseudoaneurysm treated with endovascular stent-grafting.
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