Autoclaved and autogenous bone grafts and PMMA have a significantly higher rate of graft infection. Titanium mesh has the significantly lowest rate of graft infection.

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To minimize sternal ischemia, skeletonized internal mammary artery (IMA) harvesting has been performed in the last few years. The benefits of skeletonization in high risk patients, such as diabetic patients undergoing bilateral IMA grafting, are unknown. A total of 99 patients underwent isolated coronary artery bypass grafting (CABG) using a pedicled bilateral IMA between 6/1/1997 and 5/31/2000 (group P), and 115 patients receiving a skeletonized IMA between 6/1/2001 and 3/31/2002 (group S). An ultrasonic scalpel was used for skeletonization. The perioperative and early angiographic results of CABG using these two techniques were collected prospectively and compared. There were two (1.7%) perioperative myocardial infarctions in group S and one (1.0%) in group P (P=NS), none of which were related to the IMA graft. The incidence of mediastinitis was one (0.9%) in group S and three (3.0%) in group P, P=NS, however, minor chest wound complications were observed in four (3.5%) in group S, which was significantly less frequent than the 12 (12.1%) in group P (P<0.05). Angiographic control was obtained in 87 patients in group S and 36 in group P, revealing no IMA occlusions in either group. Bilateral skeletonized IMA grafting for diabetic patients is safe and may decrease wound complications.

The authors report on their technique for preserving the lesser occipital nerve (LON) during lateral suboccipital craniotomy. In their technique, the LON, which runs along the surface of or just beneath the sternocleidomastoid muscle, is identified and preserved. Lesser occipital nerve preservation using their technique was attempted in 25 patients who underwent microvascular decompression for hemifacial spasm. The LON was successfully preserved in 16 of these patients, was impossible to preserve in two patients, and could not be identified in seven patients. Among the patients in whom LON preservation was successful, 87.5% were free of sensory disturbance 6 months after surgery, whereas both patients in whom the LON could not be preserved complained of sensory disturbances in the occipital area and the posterior part of the auricula. Fifty-seven percent of the patients whose LON could not be identified complained of sensory disturbance. Thus, this technique for preserving the LON reduces the incidence of sensory disturbance in the occipital region after suboccipital craniotomy for microvascular decompression for hemifacial spasm.

In 1994, we started cisternal washing therapy (CWT) using urokinase combined with head-shaking method in order to prevent cerebral vasospasm. In this paper, we showed the surgical procedure for CWT and reported the effect of this therapy in preventing vasospasm following SAH. A total of 332 consecutive cases with Fisher group 3 SAH since 1988 were analyzed. Of these patients, 118 cases (56 cases before 1994 and 62 cases after 1994) had not CWT, and, 214 cases after 1994 had this therapy. All of these patients had clipping surgery within 3 days following SAH, and had postoperative management both with normovolemia and normal to mild hypertension. In these two groups, the incidence of symptomatic vasospasm (transiently symptomatic vasospasm without infarction), cerebral infarction due to vasospasm on CT, and mortality and morbidity (M&M) due to vasospasm were analyzed. In the group without CWT, the incidences of symptomatic vasospasm, cerebral infarction on CT, and M&M due to vasospasm were 4.2%, 28.8%, and 17.8%, respectively. On the other hand, in the group with CWT, they were 3.7%, 6.5%, and 2.8%, respectively. In the patients with CWT, the incidence of cerebral infarction on CT due to vasospasm and M&M due to vasospasm were significantly (p < 0.05) decreased. CWT was effective in preventing cerebral vasospasm.

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Once considered an exceedingly rare disorder, intracranial hypotension has recently been found to be an important cause of persistent headaches. However, the nature of intracranial hypotension remains largely unknown. Spinal cerebrospinal fluid (CSF) leaks may be related to intracranial hypotension. Orthostatic headache is among the most common signs and symptoms in patients suspected of having intracranial hypotension, because CSF is readily absorbed into the spinal epidural space and causes the downward displacement of the brain. [1][2][3][4][5] In addition, nausea, vomiting, photophobia, diplopia, ABSTRACT: Background: Spinal cerebrospinal fluid (CSF) leaks, which are considered a cause of intracranial hypotension, generally do not cause any local symptoms. Although symptoms are key elements for further evaluation, few studies have examined symptom predictors of intracranial hypotension. The aim of this study was to determine what symptoms are predictors of CSF leaks in patients suspected of intracranial hypotension. Methods: We performed radionuclide cisternography in 207 consecutive patients suspected of intracranial hypotension. Intracranial hypotension was suspected when a patient had a history of minor trauma and complained about uncontrolled headache, cranial nerve dysfunction, autonomic dysfunction, or higher brain dysfunction. The leakage of CSF was defined as direct signs of tracer leak into the spinal epidural space or early accumulation of the tracer in the urinary bladder. We obtained information on 16 symptoms commonly reported in previous studies. Results: CSF leaks were observed in 154 cases (74%). Back pain, limb pain, and limb numbness were inversely associated with CSF leaks (p = 0.042, p = 0.045, and p = 0.006, respectively). In logistic regression analysis, diplopia was a positive predictor of CSF leaks (odds ratio [OR], 6.53; 95% confidence interval [CI], 1.49 to 28.51), whereas limb numbness was a negative predictor (OR, 0.38; 95% CI, 0.17 to 0.84). Of the 21 patients in whom diplopia was present and limb numbness was absent, 20 had CSF leaks (specificity, 98%; positive predictive value, 95%). Conclusion: Some symptoms may be helpful in the diagnosis of CSF leaks in patients suspected of intracranial hypotension.RÉSUMÉ: Symptômes prédictifs de fuites du liquide céphalorachidien. Contexte : Les fuites spinales de liquide céphalorachidien (LCR), une cause d'hypotension intracrânienne, ne provoquent généralement pas de symptômes locaux. Bien que les symptômes soient l'élément le plus important motivant une évaluation plus poussée, peu d'études ont examiné les symptômes prédictifs de l'hypotension intracrânienne. Le but de cette étude était de déterminer quels symptômes prédisent les fuites de LCR chez les patients chez qui on soupçonne une hypotension intracrânienne. Méthodes : Nous avons effectué une cisternographie isotopique chez 207 patients consécutifs chez qui on soupçonnait la présence d'une hypotension intracrânienne. On soupçonnait une hypotension intracrânienne quand un patient av...