Introduction: Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures.Material and Methods: A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done.Results: A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization.Discussion: The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization.Conclusion: Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.

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From 1.1. 1983 to 31.3. 1983 we used lyophilised allogenic costal cartilage as reconstruction material in middle ear surgery in 53 patients. Reconstructions of the posterior bony canal wall were performed in cholesteatoma surgery in 89% of the cases. Lyophilised cartilage was also used for the restoration of a traumatic defect in the posterior bony canal wall, for the reconstruction of an atretic ear and an old radical cavity, for closing of a bony defect in the roof of the mastoid, and shaping a cartilaginous columella, or modiolus. Lyophilised cartilage fulfills its function completely in 87% of the cases. 5 reconstructions of the posterior bony canal wall were moderately sunk in. The ears were however dry and free of an inflammation. Both the ear canal and the drum were easy to survey. In 2 cases of a recurrent cholesteatoma, the lyophilised cartilage was extensively destroyed. There were no problems, such as incompatibility, host-versus graft reaction, infection or distortion of the cartilage. With regard to our results, we recommend lyophilised allogenic costal cartilage as reconstruction material in circumscribed defects of the bony ear canal and in bony defects of the skull base of the ear, if larger and thicker pieces of cartilage, as can obtained from the patient's ear, are necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

INTRODUCTION Severe macrocephaly may occur due to untreated hydrocephalus and may persist even after treatment. Reductive cranioplasty intends to reduce the infant's head size to optimize motor development. Few surgical techniques of reductive cranioplasty have been reported. We present an innovative technique in which a 3D printed skull model was used to plan the surgery. METHODS A 21-mo-old male from Cape Verde was admitted to our center presenting untreated congenital hydrocephalus, severe macrocephaly and left posterior plagiocephaly. The patient had been initially treated with a right parietal ventriculo-peritoneal shunt placement that was not working for a long time. On admission, his head circumference was 64 cm and he was unable to lift the head up. The shunt was promptly revised but the severe macrocephaly persisted. A reductive cranioplasty was proposed for both functional and cosmetic reasons. The skull was reconstructed from a volumetric CT scan and a 3D volume was printed using a fused deposition modeling printer. This model was then used to simulate the cranioplasty using a total cranial vault remodeling technique. All the removed parts and augmenting cuts of the printed cranial vault were measured and transferred to the patients' skull to replicate the plan. RESULTS The surgical result was very similar to the planned one. One year later, the patient's head circumference was reduced to 59 cm and the cranial deformity had markedly improved. He had acquired head control and was able to sit without support. CONCLUSION Reductive cranioplasty is an off-standard and complex surgery. The authors consider that a preoperative simulation using a 3D computer assisted model may optimize the surgical results.

Primary breast sarcomas are rare high-grade tumors with a reported incidence of <1% of breast malignancies. Its dissemination to the CNS is exceptional and only one is found in the literature. The authors described the case of a 22-year-old female with history of a breast undifferentiated sarcoma that present with two large bilateral retrolenticular brain metastases. Both lesions were excised in the same procedure and she underwent adjuvant therapy. She died 24 months after surgery. Despite being aggressive lesions, aggressive treatment of primary breast sarcomas including brain metastases excision, should be considered in order to improve overall survival.