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.

Mortality in traumatic brain injury (TBI) is thought to be pathology in the heart-brain axis but its effect on the prognosis of traumatic brain injury remains unclear. Our study aimed to investigate the relationship between cardiac troponin I (cTnI) level and prognosis in TBI patients. Between January 2017 and May 2021, 480 patients diagnosed with TBI, who applied to the emergency department, were retrospectively included in this multicentric study. The databases of the hospitals were examined comprehensively and the demographic, clinical, laboratory, radiological, and therapeutic data and results of the patients were obtained. The severity of trauma and clinical status was evaluated with AIS, Injury Severity Score (ISS), ASA physical status, and Glasgow Coma Scale (GCS). The severity of the trauma was evaluated with the ISS. The modified Rankin Scale (mRS) and the Glasgow Outcome Scale (GOS) at discharge were used to evaluate in-hospital clinical outcomes. cTnI levels were classified into three categories: normal (< 0.05 ng/ml), mildly elevated (0.05–0.99 ng/ml), and severely elevated (≥ 1 ng/ml). The mean age of the patients was 41.7 and 75.4% of them were men. It was observed that mortality among patients over 65 years (13.9%) increased. High cTnI was detected in 284 (59.1%) patients. Although it was not statistically significant regarding the elevation of cTnI in patients under 65 years of age (P = 0.62), the difference was significant for cTnI in patients over 65 years of age (P < 0.001). The relationship between cTnI elevation was found to be statistically significant (P < 0.001) as the severity of the trauma increased and when severe additional traumas (thoracic, abdominal, or pelvic) occurred. A high cTnI level is associated with poor prognosis in TBI patients. cTnI measurement is a useful tool for early risk stratification and accelerated care; however, further prospective studies are needed.

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.

DerlemeS urgical access to the paraclinoid segment of the internal carotid artery is important to know for surgical treatment of aneurysms of the paraclinoid, carotid-ophthalmic and/or anterior cavernous segments of the inter- 1-8, 2014 doi:10.5222/sscd.2014.001 Surgical access to the paraclinoid segment of the internal carotid artery is important for safe surgical clipping of paraclinoid carotid aneurysms such as carotid-ophthalmic aneurysms and for the surgical treatment of tumors of the anterior clinoid process (ACP), anterior part of cavernous sinus and the wall of the orbital apex. Anterior clinoidectomy is useful during the surgical access to the paraclinoid segment of the internal carotid artery (ICA). The extensive surgical field gained after anterior clinoidectomy allows lesser brain retraction and increases mobilization of the intracranial ICA and optic nerve. In this report, the authors describe the anatomy of the internal carotid artery and its various segments. Anatomy of the anterior clinoid process and its relation to the internal carotid artery are reviewed. The basic principles of anterior clinoidectomy, the risks and possible complications are also discussed. Paraklinoid karotid anevrizmaların (karotid-oftalmik anerizma gibi) güvenli kliplenebilmesi, anterior klinoid çıkıntı (AKÇ), anterior kavernöz sinüs ve orbital apeks duvarı tümörlerinin cerrahi tedavilerinin yapılabilmesi için, internal karotid arterin paraklinoid segmentine cerrahi yaklaşım çok önemlidir. Anterior klinoidektomi internal karotid arterin (İKA) paraklinoid segmentine cerrahi yaklaşımda çok faydalıdır. Anterior klinoidektomi yapıldıktan sonra kazanılan geniş cerrahi alan, daha az beyin retraksiyonu yapılmasına izin verir, intrakranial İKA'nın ve optik sinirin mobilizasyonunu arttırır. Bu yazıda, yazarlar internal karotid arterin anatomisini ve değişik segmentlerini anlatıyor. Anterior klinoid çıkıntının anatomisi ve internal karotid arter ile ilişkisi gözden geçiriliyor. Anterior klinoidektominin temel prensipleri, riskleri ve komplikasyonları tartışılıyor.