Thirty-five relevant studies involving in total 682 patients with 709 different types of injuries were evaluated in a review to determine the outcomes after immobilisation in a halo vest for various injuries to the upper cervical spine between 1962 and 1998. Studies were analysed according to the type of injury pattern and in terms of the treatment outcomes following primary treatment with a halo vest. The following types of injuries were evaluated: odontoid fractures (n = 420), hangman's fractures (n = 172), other axis fractures (n = 75), Jefferson fractures (n = 26), C1 arch fractures (n = 9), atlantooccipital (n = 2) and atlantoaxial dislocations (n = 5). The ligamentary atlantooccipital dislocations never healed. All isolated Cl ring fractures healed completely. The isolated C1 arch fractures healed in 83% of the cases. The ligamentary atlantoaxial dislocations had a 60% rate of healing. Healing was noted in all isolated odontoid type I fractures, 85% of the isolated odontoid type II fractures, and 67% of the odontoid type II fractures with combined injuries. The isolated odontoid type III fractures had a 97% healing rate. The non-classifiable odontoid fractures had a healing rate of 85%. The stable C2 arch fractures (hangman's fracture) healed consistently in 99%, and 90% success was found for other C2 fractures. A halo vest can be recommended for patients with isolated Jefferson fractures, hangman's fractures, odontoid type III and type II fractures, with a low dislocation rate. The results of treatment with a halo vest were unsatisfactory with regard to combined injuries with an odontoid type II fracture. An overall healing rate of 86%, however, allows one to conclude that this treatment continues to be a good alternative to operative stabilisation of bone injuries to the upper cervical spine.
Background-The surgical management of petroclival meningiomas is, despite the invaluable technical achievements in the past decade, still burdened by a high operative morbidity. It seems doubtful whether radical surgical removal should always be the primary goal in those lesions as advocated until very recently. Methods-A series was critically analysed and the literature discussed to elucidate criteria for a different attitude. Between 1990 and 1995 a total of 19 patients harbouring petroclival meningiomas were operated on. The following approaches were used: petrosal (n = 13), retrosigmoidal (n = 5), and subtemporal (n = 1). Thirteen lesions were removed completely and six incompletely as assessed by postoperative MRI. Results-No recurrence or regrowth could be detected on MRI after a mean follow up of 18 months. Surgical mortality occurred in one patient (5%) and there was early postoperative dysfunction in 56%. At the time of follow up major permanent operative morbidity was present in two patients (11%). Conclusions-In accord with recent literature subtotal resection of petroclival meningiomas should be contemplated in a subset of patients (with invasion of brain stem or cavernous sinus) to reduce the incidence of disabling deficits. Surgery should not be delayed in younger patients because surgical morbidity relates positively with tumour size.
The construction constraints of a spinal fixator make it prone to corrosion. New spinal implants should be examined not only in vitro but also in vivo to ascertain whether corrosion and adjacent tissue reaction occur. Corrosion is one reason to explant the internal fixation system after fusion of the spinal fracture.
During a five-year-period (January 1990 to December 1994) a total of 67 patients were operated on for frontobasal skull fractures. The indication for surgical treatment was based on the evidence of fractures encroaching paranasal sinuses or the cribriform plate on high-resolution axial or coronal CT scans. The following clinical signs indicating frontobasal trauma were observed: 25 patients (37%) showed rhinoliquorrhea, 14 (21%) had raccoon's eyes, and 2 (3%) had meningitis. Distinct dura laceration was observed intraoperatively in 64 of 67 patients (96%). In our experience, high resolution CT has proven to be a sensitive diagnostic tool for frontobasal skull fractures. With respect to the high coincidence of fractures and dura lacerations, the indication for surgical treatment based on CT findings seems to be justified.
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