We present a case of severe head injury who developed contralateral extradural hematoma during evacuation of contused brain. The lesion was suspected due to sudden brain swelling at the site of surgery and was confirmed by computed tomography and was evacuated in emergency.
{"title":"Intraoperative contralateral extradural hematoma developing during evacuation of a traumatic contusion","authors":"Sushil Kumar, P. Pandey, P. Abbey, R. Ranjan","doi":"10.5580/b1b","DOIUrl":"https://doi.org/10.5580/b1b","url":null,"abstract":"We present a case of severe head injury who developed contralateral extradural hematoma during evacuation of contused brain. The lesion was suspected due to sudden brain swelling at the site of surgery and was confirmed by computed tomography and was evacuated in emergency.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125138136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Chrissicopoulos, S. Mourgela, A. Sakellaropoulos, K. Kirgiannis, K. Petritsis, T. Spanos
Management of brain abscesses is still an issue of debate. Large superficial abscesses should be totally extirpated through a craniotomy. We present a case of a 66-year old man with a brain pyogenic abscess, without neurological symptoms and signs, without positive cultures, larger than 4cm in size, located superficially who was treated successfully by two repeated aspirations without intracavitary application of antibiotics. We conclude that it is effective to treat a large superficial in capsular stage brain abscess with repeated elective aspirations, since the clinical picture of the patient is mild.
{"title":"Management of a large superficial brain abscess with repeated aspirations.","authors":"C. Chrissicopoulos, S. Mourgela, A. Sakellaropoulos, K. Kirgiannis, K. Petritsis, T. Spanos","doi":"10.5580/14c8","DOIUrl":"https://doi.org/10.5580/14c8","url":null,"abstract":"Management of brain abscesses is still an issue of debate. Large superficial abscesses should be totally extirpated through a craniotomy. We present a case of a 66-year old man with a brain pyogenic abscess, without neurological symptoms and signs, without positive cultures, larger than 4cm in size, located superficially who was treated successfully by two repeated aspirations without intracavitary application of antibiotics. We conclude that it is effective to treat a large superficial in capsular stage brain abscess with repeated elective aspirations, since the clinical picture of the patient is mild.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130835919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Wani, A. Ramzan, A. Kirmani, A. Sherwani, N. Malik, A. Bhatt, S. S. Chibber, M. A. Wani
Aim; To examine the outcome in patients with decerebration due to severe head injury.Method: All the patients of severe head injury were admitted to the hospital. Out of these patients, those who were having decerebration were included in the study (n=48). Various factors were analyzed to assess their effect on outcome.Outcome was assessed on basis of Glasgow outcome scale at three months following injury. Results: The patients who were normal or had minimal deficits were categorized as having good outcome while those with moderate or significant disability or death were categorized as having poor outcome. Patents in the pediatric group had lesser mortality as compared to adults (50% versus 81.6%). Age, eye opening, pupillary status, and surgical intervention were the factors having significant impact on outcome (p<.05). Those patients who had operable lesion had better survival than those with diffuse injuries. Over all good outcome was seen in 5 (10.4%) patients. Mortality in our series was 75 %( 36 patients).Conclusion: Patients who have decerebration after severe head injury have high mortality. However, some of these patients have functional recovery, hence they must be managed aggressively and every effort must be made to intervene in them before features of decerebration occur.
{"title":"Functional outcome following severe head injury in decerebrating patients","authors":"A. Wani, A. Ramzan, A. Kirmani, A. Sherwani, N. Malik, A. Bhatt, S. S. Chibber, M. A. Wani","doi":"10.5580/19a6","DOIUrl":"https://doi.org/10.5580/19a6","url":null,"abstract":"Aim; To examine the outcome in patients with decerebration due to severe head injury.Method: All the patients of severe head injury were admitted to the hospital. Out of these patients, those who were having decerebration were included in the study (n=48). Various factors were analyzed to assess their effect on outcome.Outcome was assessed on basis of Glasgow outcome scale at three months following injury. Results: The patients who were normal or had minimal deficits were categorized as having good outcome while those with moderate or significant disability or death were categorized as having poor outcome. Patents in the pediatric group had lesser mortality as compared to adults (50% versus 81.6%). Age, eye opening, pupillary status, and surgical intervention were the factors having significant impact on outcome (p<.05). Those patients who had operable lesion had better survival than those with diffuse injuries. Over all good outcome was seen in 5 (10.4%) patients. Mortality in our series was 75 %( 36 patients).Conclusion: Patients who have decerebration after severe head injury have high mortality. However, some of these patients have functional recovery, hence they must be managed aggressively and every effort must be made to intervene in them before features of decerebration occur.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133516484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abnormal migration of the ventricular end of a ventrculoperitoneal shunt used for treatment of hydrocephalous is a rare but a known complication. The migration can be in either direction and is most commonly associated with disconnection of ventricular end from its connector. The author here by reports a rare case of migration of shunt tip into pituitary fossa and discusses further course of management in such rare cases.
{"title":"Abnormal Migration Of The Ventricular End Of Shunt Tip Into The Pitutary Fossa","authors":"Vineet Saggar, A. Gandhi, R. Mittal","doi":"10.5580/1819","DOIUrl":"https://doi.org/10.5580/1819","url":null,"abstract":"Abnormal migration of the ventricular end of a ventrculoperitoneal shunt used for treatment of hydrocephalous is a rare but a known complication. The migration can be in either direction and is most commonly associated with disconnection of ventricular end from its connector. The author here by reports a rare case of migration of shunt tip into pituitary fossa and discusses further course of management in such rare cases.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129870711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The commonest treatment of hydrocephalus is VP shunt. The procedure has various acute and delayed complications like intracerebral hematoma, infection, shunt malfunction and intra abdominal complications. We report a case of chronic subdural hematoma in a case of right frontal oligodendroglioma who underwent postoperative VP shunting for hydrocephalus. The hematoma was evacuated and the shunt tied with no complications. Although rare, this complication must be thought of in all cases of VP shunt who present with deteriorating conscious level.
{"title":"Chronic Subdural Hematoma In A Case Of Ventriculoperitoneal Shunt","authors":"Y. Roka, G. Paudel, Bidur K.C, Sunil Munakomi","doi":"10.5580/6be","DOIUrl":"https://doi.org/10.5580/6be","url":null,"abstract":"The commonest treatment of hydrocephalus is VP shunt. The procedure has various acute and delayed complications like intracerebral hematoma, infection, shunt malfunction and intra abdominal complications. We report a case of chronic subdural hematoma in a case of right frontal oligodendroglioma who underwent postoperative VP shunting for hydrocephalus. The hematoma was evacuated and the shunt tied with no complications. Although rare, this complication must be thought of in all cases of VP shunt who present with deteriorating conscious level.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133782268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kunisawa, Mitsuteru Oikawa, Tamio Ito, A. Kurosawa, S. Hanada, Yuya Goto, H. Iwasaki
We performed anesthetic management for removal of a brain tumor, during which motor evoked potential (MEP) monitoring was performed. In addition to target-controlled infusion (TCI) of propofol, TCI of remifentanil, which was preinstalled in the Orchestra, was used for anesthetic induction and maintenance. Remifentanil was administered at the effect-site concentration of 10 μg/mL during surgery, and hemodynamics was stable and MEP was well elicited. Since TCI of remifentanil was easily performed by using Orchestra and it could provide stable hemodynamics and good conditions for MEP monitoring, Orchestra is thought to be suitable for MEP monitoring during craniotomy.
{"title":"Target-Controlled Infusion Of Remifentanil Using Orchestratm During Motor Evoked Potential Monitoring.","authors":"T. Kunisawa, Mitsuteru Oikawa, Tamio Ito, A. Kurosawa, S. Hanada, Yuya Goto, H. Iwasaki","doi":"10.5580/b04","DOIUrl":"https://doi.org/10.5580/b04","url":null,"abstract":"We performed anesthetic management for removal of a brain tumor, during which motor evoked potential (MEP) monitoring was performed. In addition to target-controlled infusion (TCI) of propofol, TCI of remifentanil, which was preinstalled in the Orchestra, was used for anesthetic induction and maintenance. Remifentanil was administered at the effect-site concentration of 10 μg/mL during surgery, and hemodynamics was stable and MEP was well elicited. Since TCI of remifentanil was easily performed by using Orchestra and it could provide stable hemodynamics and good conditions for MEP monitoring, Orchestra is thought to be suitable for MEP monitoring during craniotomy.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121080557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Solitary intraventricular metastasis is an extremely rare entity with poor outcome following surgery. A 26 years old male presented with features of raised intracranial pressure. An extensive intraventricular tumor was diagnosed as septal glioma on imaging. A gross total microsurgical excision of a vascular infiltrative tumour with subependymal infiltration resulted into marked pneumocephalus and progressive oedema of white matter. The patient died on 4th postoperative day the biopsy of tumor specimen revealed a metastatic papillary adenocarcioma. Venous infarct was thought to be the cause of an extensive white matter infarct. Literature is reviewed to explore the primary sites, clinical manifestations and causes of mortality in these cases.
{"title":"An unusual presentation of intracranial metastasis","authors":"Raj Kumar, A. Wani, S. Reddy, Rn Sahu","doi":"10.5580/2481","DOIUrl":"https://doi.org/10.5580/2481","url":null,"abstract":"Solitary intraventricular metastasis is an extremely rare entity with poor outcome following surgery. A 26 years old male presented with features of raised intracranial pressure. An extensive intraventricular tumor was diagnosed as septal glioma on imaging. A gross total microsurgical excision of a vascular infiltrative tumour with subependymal infiltration resulted into marked pneumocephalus and progressive oedema of white matter. The patient died on 4th postoperative day the biopsy of tumor specimen revealed a metastatic papillary adenocarcioma. Venous infarct was thought to be the cause of an extensive white matter infarct. Literature is reviewed to explore the primary sites, clinical manifestations and causes of mortality in these cases.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116025503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Spinal cord astrocytomas are considered diffuse infiltrating tumors. The optimal treatment of these lesions has been controversial. The conventional management with partial resection followed by radiotherapy remains. In order to evaluate this traditional and famous strategy, the authors retrospectively review a series of ten consecutive adult patients with spinal cord astrocytoma treated with conservative surgery and radiotherapy. Methods Results: A retrospective analysis of ten adult patients (4 men and 6 women) with spinal cord astorcytoma. The mean age was 33 years. Cervical cord was involved in 2 patients, cervicothoracic in 3, thoracic in 5. Seven patients had low grade astrocytoma and 3 high grade (2 anaplastic, 1 gliobastoma).Surgery was subtotal excision in 1 patient, partial excision in 3 and biopsy in 6 patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The follow-up period ranged from 7 to 48 months. Postradiotherapy, local tumor control was achieved in 7 cases ( 6 low gade, 1 high grade) despite incomplete or no resection. Three patients died, one paraplegic patient of pneumonia, and two patients with high grade astrocytoma from tumor progression or dissemination. Conclusion: There is no significant effect of the extent of resection on local relapse. We believe that conservative surgery and radiotherapy provide a balanced strategy in the treatment of adult spinal astrocytoma to maintain neurological outcome and prevent tumor recurrence.
{"title":"Conservative Surgery and Radiotherapy for Adult Spinal Astrocytoma: Balanced Strategy for Favorable Outcome","authors":"Yasser ElSawaf, Ali Eldeen, A. Shakal","doi":"10.5580/d51","DOIUrl":"https://doi.org/10.5580/d51","url":null,"abstract":"Objective: Spinal cord astrocytomas are considered diffuse infiltrating tumors. The optimal treatment of these lesions has been controversial. The conventional management with partial resection followed by radiotherapy remains. In order to evaluate this traditional and famous strategy, the authors retrospectively review a series of ten consecutive adult patients with spinal cord astrocytoma treated with conservative surgery and radiotherapy. Methods Results: A retrospective analysis of ten adult patients (4 men and 6 women) with spinal cord astorcytoma. The mean age was 33 years. Cervical cord was involved in 2 patients, cervicothoracic in 3, thoracic in 5. Seven patients had low grade astrocytoma and 3 high grade (2 anaplastic, 1 gliobastoma).Surgery was subtotal excision in 1 patient, partial excision in 3 and biopsy in 6 patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The follow-up period ranged from 7 to 48 months. Postradiotherapy, local tumor control was achieved in 7 cases ( 6 low gade, 1 high grade) despite incomplete or no resection. Three patients died, one paraplegic patient of pneumonia, and two patients with high grade astrocytoma from tumor progression or dissemination. Conclusion: There is no significant effect of the extent of resection on local relapse. We believe that conservative surgery and radiotherapy provide a balanced strategy in the treatment of adult spinal astrocytoma to maintain neurological outcome and prevent tumor recurrence.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122815784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kapapa, E. Rickels, B. Schmitz, E. Hans, D. Woischneck
A 29-year-old male made unsuccessful suicide by hanging. Instead he fell causing brain injury. After cranial surgery and rehabilitation the patient was re-admitted with vertical gaze paresis and unsteady gait. MRI revealed a cystic formation in the mesencephalon. Due to neurological deterioration, growing of the cystic formation within mesencephalon, and signs of posttraumatic hydrocephalus, a ventriculo-peritoneal shunt-system was implanted and a dilatation of the aqueduct was performed. Despite these measures there were ongoing neurological deterioration and increasing of the cystic formation.
{"title":"Laceration within the mesencephalon and pons after traumatic brain injury: a case report.","authors":"T. Kapapa, E. Rickels, B. Schmitz, E. Hans, D. Woischneck","doi":"10.5580/7b","DOIUrl":"https://doi.org/10.5580/7b","url":null,"abstract":"A 29-year-old male made unsuccessful suicide by hanging. Instead he fell causing brain injury. After cranial surgery and rehabilitation the patient was re-admitted with vertical gaze paresis and unsteady gait. MRI revealed a cystic formation in the mesencephalon. Due to neurological deterioration, growing of the cystic formation within mesencephalon, and signs of posttraumatic hydrocephalus, a ventriculo-peritoneal shunt-system was implanted and a dilatation of the aqueduct was performed. Despite these measures there were ongoing neurological deterioration and increasing of the cystic formation.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115034073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sushil Kumar, D. Jha, P. Abbey, V. Mishra, A. Handa
Traumatic basal ganglia hematoma (TBGH), seen rarely, has been associated with dismal prognosis. We evaluated ten patients (8 males, 2 females; average age 30 years) of TBGH and present their outcome. Average GCS at admission was 10 including 6 patients with severe head injury (GCS≤8). Brain lesions other than BGH were: diffuse axonal injury (DAI) (n=3), intraventricular bleed (n=1) and focal contusions in addition to BGH (n=4) in a total of 6 patients. Average volume of the BGH was 13.2 ml. None of the patients had a coagulation disorder. Surgical evacuation of focal hematoma other than BGH was done in 2 patients. Average GCS at discharge was 13. Average follow up was 30.4 months. Outcomes were excellent (GOS= 5) (n=3) or fair (GOS=4) (n=7) with no mortality. Outcome of TBGH appears favorable unless it is large and associated with coagulation disorders; however, DAI is an important factor governing the outcome in head injury including TBGH.
{"title":"Outcome Of Traumatic Basal Ganglia Hemorrhage","authors":"Sushil Kumar, D. Jha, P. Abbey, V. Mishra, A. Handa","doi":"10.5580/1b7b","DOIUrl":"https://doi.org/10.5580/1b7b","url":null,"abstract":"Traumatic basal ganglia hematoma (TBGH), seen rarely, has been associated with dismal prognosis. We evaluated ten patients (8 males, 2 females; average age 30 years) of TBGH and present their outcome. Average GCS at admission was 10 including 6 patients with severe head injury (GCS≤8). Brain lesions other than BGH were: diffuse axonal injury (DAI) (n=3), intraventricular bleed (n=1) and focal contusions in addition to BGH (n=4) in a total of 6 patients. Average volume of the BGH was 13.2 ml. None of the patients had a coagulation disorder. Surgical evacuation of focal hematoma other than BGH was done in 2 patients. Average GCS at discharge was 13. Average follow up was 30.4 months. Outcomes were excellent (GOS= 5) (n=3) or fair (GOS=4) (n=7) with no mortality. Outcome of TBGH appears favorable unless it is large and associated with coagulation disorders; however, DAI is an important factor governing the outcome in head injury including TBGH.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133484068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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