Bradycardia related to sudden decreases in intracranial pressure during craniotomy.
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One hundred fifteen burr hole defects were filled with sterilized human cadaver skull in 45 patients ranging in age between 10 and 88 years. One to 6 allogeneic skull discs per patient were placed in all areas of the calvaria. The length of postoperative observation ranges between 6 months and 5 years. No instances of infection, resorption, or rejection have occurred. Discs became incorporated and were osteoconductive, with new bone formed by "creeping substitution." In contrast to frozen autogeneic skull, these allogeneic discs were not resorbed. Allogeneic skull may be used safely and effectively to fill small discontinuity defects in the human calvaria.
There are various flaps for bifrontal exposure of the anterior fossa classically described in the neurosurgical literature. This article describes a bifrontal split osteoplastic flap that is characterized by removal of the anterior wall of the frontal sinus without the placement of burr holes on the external surface of the frontal bone. The procedure is safe and rapid, gives the same exposure as other techniques, and allows a superior cosmetic result.
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We describe two patients who underwent intracranial aneurysm surgery and developed postoperative subgaleal haematomas which, in the presence of an unfixed bone flap, resulted in significant extradural compression and a marked clinical deterioration. The application of a pressure dressing to tamponade a developing scalp haematoma is unwise unless the bone flap has been rigidly fixed in place.
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