Neurosurgeon, Ph.D. Sergey Tikhomirov 

Patient B., 39 years old, was taken by an ambulance from Rodnikovskaya Central District Hospital to Kineshemskaya Central District Hospital. The injury was caused by hitting his head on a metal sheet.

He underwent an X-ray examination and then a CT scan of the brain. A depressed penetrating fracture of the frontal bone was detected.

MSCT of the brain performed upon admission.

Cranioplasty is the surgical repair of defects in the cranial vault
(the dome-shaped part of the skull). It sounds complicated, but in
reality, it is an operation that closes the “hole” in the head
caused by trauma or disease. Why is this necessary? First, the brain
needs to be protected from mechanical damage. Second, an intact skull
helps fluids circulate properly around the brain. Third, it is
important for the patient's appearance and psychological comfort.

When is cranioplasty
necessary?

Skull defects can
occur in several ways:

After severe head
injuries. In cases of serious fractures, when the bone is shattered,
surgeons have to remove the damaged fragments to prevent them from
entering the brain.

In cases of critical
brain edema. When the brain swells sharply due to a stroke,
hemorrhage, or severe trauma, doctors perform a decompressive
craniectomy — removing part of the bone to give the brain room to
expand and save the patient's life. Later, when the swelling
subsides, this bone must be put back in place.

Due to infection.
Sometimes an infection of the bone tissue (osteomyelitis) develops in
the area of the operation, and the infected area of the bone has to
be removed.

For tumors. If a
tumor affects the skull bone, surgeons remove that area along with
the tumor and then restore the brain's protection.

Trepanation
syndrome: when the defect affects life

After removing part
of the skull, patients often develop an unpleasant condition that
doctors call trepanation syndrome. Imagine: a hollow forms in the
head, and the skin above it sinks inward. Atmospheric pressure
literally presses on the brain through this hollow.

How it feels:

-- Headache —
often worse when standing or sitting. The pain is less severe when
lying down because atmospheric pressure is less intense.

-- Dizziness and
fatigue — patients feel exhausted and have difficulty
concentrating.

-- Memory and
thinking problems — the person has trouble remembering information,
finds it difficult to plan, and becomes distracted.

MRI of the patient's cervical spine after atezolizumab therapy. MRI scans show signs of myelitis.

MRI of the patient's cervical spine after atezolizumab therapy. MRI scans show signs of myelitis.

Kimmerli's anomaly, also known as ponticulus posticus, is an anatomical variant involving the ossification of the posterior atlanto-occipital membrane over the groove of the vertebral artery, leading to the formation of an arcuate foramen or ridge (). This anomaly can result in extravasal compression of the vertebral artery, which can sometimes cause cerebrovascular symptoms.

A complete Kimmerli anomaly on the right and an incomplete one on the left.

Patient C., 16 years old, applied. According to the patient's words, the previous day he accidentally shot himself in the head from a pneumatic weapon. On visual examination, an entrance hole with a diameter of 2-3 mm was seen in the right frontal region.

The patient underwent MSCT of the brain. A foreign body is seen in the soft tissues of the frontal region. Due to metal artifacts it is not possible to make an unambiguous conclusion about the presence or absence of damage to the frontal bone.

A patient came to the consultation complaining of pain in the lumbar region radiating along the posterior surface of the right lower limb. An X-ray report on an MRI examination of the lumbar spine by a radiologist described a left-sided herniated disc. Visual examination of the MRI scans shows that the herniation originates from the left segment of the intervertebral disc, and then spreads obliquely down and to the right with moderate compression of the right S1 root.