Abstract Type II odontoid fracture represents one of the most frequent and complex injuries of the upper cervical spine, posing a major challenge both in diagnosis and in surgical management. Despite advances in surgical fixation techniques, the choice of optimal treatment remains a matter of debate, especially in patients with low bone density or unfavorable anatomical characteristics. The aim of this study was to biomechanically analyze, through finite element numerical simulations (finite element model [FEM]), the different phases of surgical treatment of type II odontoid fracture, comparing the structural response of the C2 vertebra in three clinical scenarios: healthy vertebra, immediate postoperative phase following posterior C1–C2 fixation, and intermediate healing phase with partial bone fusion. For this purpose, precise three-dimensional models were developed from computed tomography scans of real patients, which were subjected to loading conditions representative of both physiological and high biomechanical stress situations. The simulations allowed identification of critical zones of stress and strain concentration, highlighting the vulnerability of the odontoid base in the early postoperative phases and the importance of callus evolution in load redistribution. Furthermore, the decisive influence of bone quality on the biomechanical integrity of the construct was demonstrated, with osteoporotic models being more susceptible to fixation failure and excessive deformation. The results obtained provide a valuable tool for personalized surgical planning, optimizing the choice of fixation type and immobilization protocol according to the individual characteristics of each patient. This work reinforces the usefulness of FEM simulation as a support tool in clinical decision-making.
Abstract Decompressive craniotomy (DC) is defined as the removal of a large area of skull with opening of dura to increase the volume of cranial cavity, facilitating a reduction in intracranial pressure. DC is a surgical option in the management of refractory intracranial hypertension when maximal medical treatment has failed to control it, especially in head injury, stroke, and postoperative edema after brain surgery. Autologous bone flap cranioplasty outcomes of in terms of cosmetic and function. A prospective and retrospective study from 2019 to 2023 of patients who presented to the Department of Neurosurgery NSCB Medical College, Jabalpur with previous history of craniotomy with bone in anterior abdominal wall and underwent cranioplasty in 1 year from the date of approval from the ethical committee were included in the study. This study was defined as early cranioplasty when the time interval between craniectomy and cranioplasty performed was within 3 months and late cranioplasty when cranioplasty waited for more than 3 months. Majority of the patients were in the age group 21 to 40 years. The mean age of the patients was 32.32 ± 10.68 years (range: 9 to 61 years). There were 14 (15.9%) females and 74 (84.1%) males. The male:female ratio was 5.3:1. Operated case of traumatic brain injury was seen in 86 (97.7%) patients, basal ganglia bleed in 1 (1.1%) patient, and arrow injury in 1 (1.1%) patient. Majority of the patients had an interval of more than or equal 12 weeks between craniectomy and cranioplasty. Complications are not affected by interval between craniectomy and cranioplasty. The difference was found to be statistically not significant (p = 0.532), showing a comparable mean hospital stay between the two intervals. Mortality was not seen in any of the patients. All the patients were discharged from the hospital. At 3 months follow-up, none of the patients experienced any adverse events or expired in both the interval groups. Cranioplasty ensures cosmesis and protection of underlying brain and may even improve postoperative neurological status. Reinsertion of the previously harvested autologous bone flap is the method of choice for most institution because of its low cost and excellent anatomical fit. Out of 88 patients 84 achieved satisfactory cosmetic reconstruction, while 4 cases required augmentation with titanium mesh to achieve cosmetic needs. Our study was for short term and in this study, we had limited amount of relevant data and time. Based on reviews of studies for standardization of better cranioplasty long studies and more material are required. There is hence need for future studies on how to reduce complications to improve clinical outcomes.
Abstract Orbital metastases are uncommon. They account for 1 to 13% of all orbital tumors and occur in roughly 2 to 5% of patients with systemic cancer. Often, they are the herald of disease. In 20 to 42% of cases, the orbital deposit is the first clinical sign of an occult or previously treated primary. The usual sources are breast, prostate, lung, and cutaneous melanoma. Gastric adenocarcinoma is rare. Here, we report a presentation of right axial proptosis and blurred vision with an intraconal mass that was diagnosed as gastric adenocarcinoma. A 73-year-old man presented with a history of progressive right-sided axial proptosis associated with blurred vision. Radiological imaging demonstrated an enhancing intraconal orbital mass causing displacement of the optic nerve. The patient underwent craniotomy with complete excision of the lesion. Histopathological examination revealed metastatic gastric adenocarcinoma. At the 3-month follow-up, the patient remained free of recurrence and continued under regular oncological surveillance. Solitary intraconal orbital metastasis from gastric adenocarcinoma is exceptionally rare and should be considered in any patient with a history of malignancy presenting with an intraconal orbital mass. Comprehensive metastatic evaluation, including whole-body positron emission tomography–computed tomography, and histopathological confirmation with immunohistochemistry are essential. In carefully selected patients with isolated disease, complete surgical excision may provide durable local control, supporting an individualized rather than uniformly palliative treatment approach.
The trigeminocardiac re fl ex (TCR) is a sudden parasympathetic response triggered by stimulation of peripheral or central trigeminal sensory branches, causing bradycardia, hypotension, apnea, or even asystole. 1 It is commonly observed during skull base and posterior fossa surgeries, but is rare during cranioplasty. 1 – 3 We describe an unusual case of abrupt intraoperative bradycardia and hypotension during cranioplasty that was highly suggestive of TCR. A
