Herein, we report the case of a 32-year-old man who experienced spontaneous migration of a bullet within the brain following a gunshot injury. Emergent computed tomography revealed the bullet located in the posterosuperior side of mesencephalon. During follow-up after 10 days, the neurological status of the patient had worsened. Computed tomography revealed that the bullet had migrated posteriorly and lodged in the occipital lobe. Although a few studies have reported on the spontaneous migration of a bullet within the brain, the present case is unique as the patient examination changed with migration. We recommend serial imaging and surgery in cases of bullet migration in the brain.

Background: Postoperative headache is a major complaint after RS surgery. PH affected the patient’s quality of life. The role of craniotomy in the prevention of such headaches. We aimed to evaluate the role of craniectomy versus craniotomy via the retrosigmoid approach in reducing the incidence of postoperative headaches. Materials and methods: Patients who underwent surgery between January 2012 and December 2018 were retrospectively assessed and were classified into the craniectomy and craniotomy groups. Clinical data, such as those on age, sex, type of surgery, surgical repair technique, development of infection, postoperative cerebrospinal fluid leak, postoperative meningitis, size of the bone flap, and wound infection, were collected. The severity of headache in all patients was clinically assessed using the Catalano grading system. Results: Overall, 95 patients underwent microsurgery via the retrosigmoid approach. Of these, 48 were men and 47 were women. In total, 34 patients underwent craniectomy, and 61 patients underwent craniotomy. On discharge, postoperative headache was observed in 47% (16/34) and 21% (13/61) of patients who underwent craniectomy and craniotomy, respectively ( P =.01). The incidence of headache decreased at follow-up. At 12 months after surgery, 15% of patients in the craniectomy group (5/34) and 2% of patients in the craniotomy group (2/61) experienced headache ( P =.01). Of the 61 patients in the craniotomy group, 2 (2%) had less severe headache at 12 months of follow-up. Conclusion: The severity of headache after surgery and upon discharge significantly decreased in patients who underwent craniotomy than in those who underwent craniectomy.

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Background The aim of the present study was to evaluate long term C1-C2 fusion rates and functional outcomes in patients with type II odontoid fractures treated with posterior fixation with polyaxial C1 lateral mass and C2 pars screws. Methods A total of 32 patients were retrospectively evaluated. Study parameters included Japanese Orthopaedic Association (JOA) score and visual analog scale score for neck pain. All patients had computerized tomography (CT) scans preoperatively and at six months postoperatively; X-rays preoperatively and at three months and 12 months after operation Results Among the etiological factors, first (59.4%) fall from high and second (40.6%) traffic accidents have been observed. The duration of follow-up was 28.4 ± 8.5 months. A total of 25 patients had improvement on mean VAS score. A total of 12 patients had improvement at modified JOA score. No vascular injury occurred in our series. One patient (3.1%) developed hospital pneumonia, and the patient died at postoperative 6 th week. One patient (3.1%) had nonunion, but no neurological deficit was observed, and revision surgery was not needed 30 patients (93.8%) had fracture healing and fusion after posterior C1-C2 fixation. Conclusions In our opinion, posterior C1-C2 fixation and fusion is the treatment of choice in type II odontoid fractures with good fusion results. We achieved good results and low complication and mortality rates.