G. J. Vinayaka, M. Sharmad, A. Peethambaran, Raja K. Kutty, Indian J Neurotrauma
Abstract Background Posttraumatic hydrocephalus (PTH) is an important cause of morbidity after decompressive craniectomy (DC) following traumatic brain injury (TBI). Early diagnosis and treatment of PTH can prevent further neurological compromise in patients who are recovering from TBI. Objective The aim of this study was to assess the proportion of patients who develop hydrocephalus after undergoing DC and to identify the factors associated with PTH requiring surgical treatment in patients undergoing DC for TBI. Methods Data of patients undergoing DC for TBI in the Trauma Neurosurgery Unit, Medical College Hospital, Trivandrum, between June and December 2020 were collected prospectively. Results A total of 48 patients who underwent DC were studied. Six (12.5%) patients developed PTH. The patients were divided into two groups: PTH (patients who developed hydrocephalus) and non-PTH (patients who did not develop hydrocephalus). Age, sex, mode of injury, severity of injury, and preoperative radiological findings were not associated with the development of PTH. A distance of craniectomy margin from the midline of less than 2.5 cm was found to be statistically significant. No statistical difference was found in the outcome among the PTH and non-PTH groups. Conclusion Craniectomy with a superior limit too close to the midline can predispose patients undergoing DC to the development of hydrocephalus. We therefore suggest performing wide DCs with the superior limit greater than 25 mm from the midline.
摘要 背景 创伤后脑积水（PTH）是创伤性脑损伤（TBI）后减压开颅术（DC）后发病的一个重要原因。早期诊断和治疗 PTH 可防止创伤性脑损伤恢复期患者的神经功能进一步受损。目的 本研究旨在评估接受 DC 术后出现脑积水的患者比例，并确定因 TBI 而接受 DC 术的患者中与需要手术治疗的 PTH 相关的因素。方法 前瞻性收集特里凡得琅医学院附属医院创伤神经外科 2020 年 6 月至 12 月期间接受 DC 治疗的创伤性脑损伤患者的数据。结果 共研究了 48 名接受 DC 治疗的患者。六名患者（12.5%）出现了 PTH。患者分为两组：PTH组（出现脑积水的患者）和非PTH组（未出现脑积水的患者）。年龄、性别、损伤方式、损伤严重程度和术前放射学检查结果与 PTH 的发生无关。颅骨切除边缘与中线的距离小于 2.5 厘米具有统计学意义。PTH 组和非 PTH 组的结果无统计学差异。结论 颅骨切除上缘太靠近中线容易导致接受 DC 的患者发生脑积水。因此，我们建议进行上缘距中线大于 25 mm 的宽 DC。
{"title":"Posttraumatic Hydrocephalus Following Decompressive Craniectomy in Traumatic Brain Injury: Proportion and Risk Factors","authors":"G. J. Vinayaka, M. Sharmad, A. Peethambaran, Raja K. Kutty, Indian J Neurotrauma","doi":"10.1055/s-0044-1782608","DOIUrl":"https://doi.org/10.1055/s-0044-1782608","url":null,"abstract":"Abstract Background Posttraumatic hydrocephalus (PTH) is an important cause of morbidity after decompressive craniectomy (DC) following traumatic brain injury (TBI). Early diagnosis and treatment of PTH can prevent further neurological compromise in patients who are recovering from TBI. Objective The aim of this study was to assess the proportion of patients who develop hydrocephalus after undergoing DC and to identify the factors associated with PTH requiring surgical treatment in patients undergoing DC for TBI. Methods Data of patients undergoing DC for TBI in the Trauma Neurosurgery Unit, Medical College Hospital, Trivandrum, between June and December 2020 were collected prospectively. Results A total of 48 patients who underwent DC were studied. Six (12.5%) patients developed PTH. The patients were divided into two groups: PTH (patients who developed hydrocephalus) and non-PTH (patients who did not develop hydrocephalus). Age, sex, mode of injury, severity of injury, and preoperative radiological findings were not associated with the development of PTH. A distance of craniectomy margin from the midline of less than 2.5 cm was found to be statistically significant. No statistical difference was found in the outcome among the PTH and non-PTH groups. Conclusion Craniectomy with a superior limit too close to the midline can predispose patients undergoing DC to the development of hydrocephalus. We therefore suggest performing wide DCs with the superior limit greater than 25 mm from the midline.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"53 s185","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376375","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}
Muhammad Asif Shabbir, Shuja Ikram, Ahtesham Khizar, Inaam Elahi, Abdul Ghafoor, Muhammad Waqas Umer
Objective The aim of this study was to compare the outcome of anterior versus posterior fixation for traumatic subaxial cervical spine subluxation in terms of mean intraoperative blood loss, surgical time, and length of hospital stay. Materials and Methods A prospective observational study was conducted from August 25, 2022 to August 24, 2023 at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, including 60 patients (30 in each group) fulfilling the inclusion criteria. Group A had anterior cervical fixation, while group B underwent posterior cervical fixation. Patients were monitored for intraoperative blood loss, surgical time, and length of hospital stay. All the results were collected and recorded on a proforma. Results The mean age of the patients in group A was 45.40 ± 3.75 years and that in group B was 45.50 ± 4.13 years. In all, 48.8% (n = 21) were males and 52.9% (n = 9) were females in group A, while 51.2% (n = 22) were males and 47.1% (n = 8) were females in group B. The mean intraoperative blood loss was 71.60 ± 0.77 mL in group A and 101.76 ± 0.85 mL in group B. The mean surgical time was 72.73 ± 0.98 minutes in group A and 94.73 ± 0.58 minutes in group B. The mean length of hospital stay was 7.63 ± 0.55 days in group A and 12.80 ± 0.71 days in group B. Conclusion It was concluded that the anterior approach is better than the posterior approach for traumatic subaxial cervical subluxation spine in terms of low blood loss, less surgical time, and reduced hospital stay.
{"title":"Comparison of Anterior versus Posterior Fixation in Traumatic Subaxial Cervical Spine Subluxation in Terms of Intraoperative Blood Loss, Surgical Time, and Length of Hospital Stay: A Prospective Observational Study","authors":"Muhammad Asif Shabbir, Shuja Ikram, Ahtesham Khizar, Inaam Elahi, Abdul Ghafoor, Muhammad Waqas Umer","doi":"10.1055/s-0044-1786688","DOIUrl":"https://doi.org/10.1055/s-0044-1786688","url":null,"abstract":"\u0000 Objective The aim of this study was to compare the outcome of anterior versus posterior fixation for traumatic subaxial cervical spine subluxation in terms of mean intraoperative blood loss, surgical time, and length of hospital stay.\u0000 Materials and Methods A prospective observational study was conducted from August 25, 2022 to August 24, 2023 at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, including 60 patients (30 in each group) fulfilling the inclusion criteria. Group A had anterior cervical fixation, while group B underwent posterior cervical fixation. Patients were monitored for intraoperative blood loss, surgical time, and length of hospital stay. All the results were collected and recorded on a proforma.\u0000 Results The mean age of the patients in group A was 45.40 ± 3.75 years and that in group B was 45.50 ± 4.13 years. In all, 48.8% (n = 21) were males and 52.9% (n = 9) were females in group A, while 51.2% (n = 22) were males and 47.1% (n = 8) were females in group B. The mean intraoperative blood loss was 71.60 ± 0.77 mL in group A and 101.76 ± 0.85 mL in group B. The mean surgical time was 72.73 ± 0.98 minutes in group A and 94.73 ± 0.58 minutes in group B. The mean length of hospital stay was 7.63 ± 0.55 days in group A and 12.80 ± 0.71 days in group B.\u0000 Conclusion It was concluded that the anterior approach is better than the posterior approach for traumatic subaxial cervical subluxation spine in terms of low blood loss, less surgical time, and reduced hospital stay.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"90 17","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268068","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}
Posterior fossa epidural hematomas (EDHs) are much rarer entities than supratentorial EDHs which are reported only 4 to 7% in the literature. Due to the tight space and critical structures in posterior fossa, only a few cases can go with the conservative management but even then patients can deteriorate anytime with enlargement of hematoma and compression effects on brain stem and require urgent evacuation. This letter aims to provide a case of a young kid who presented initially with less-volume EDH and later required urgent evacuation because of hematoma expansion.
{"title":"Traumatic Delayed Posterior Cranial Fossa Epidural Hematoma: A Rare Entity","authors":"Abdur Rehman Baig, Ahtesham Khizar, Maryem Tanweer, Farooq Anwar","doi":"10.1055/s-0044-1787116","DOIUrl":"https://doi.org/10.1055/s-0044-1787116","url":null,"abstract":"Posterior fossa epidural hematomas (EDHs) are much rarer entities than supratentorial EDHs which are reported only 4 to 7% in the literature. Due to the tight space and critical structures in posterior fossa, only a few cases can go with the conservative management but even then patients can deteriorate anytime with enlargement of hematoma and compression effects on brain stem and require urgent evacuation. This letter aims to provide a case of a young kid who presented initially with less-volume EDH and later required urgent evacuation because of hematoma expansion.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"78 14","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268165","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}
Anil Chandra, B. Ojha, C. Srivastava, Somil Jaiswal, Aman Singh
Background Severe traumatic brain injury (STBI) continues to burden health care in developing countries. This study focuses on STBI patients undergoing surgical intervention to understand the factors affecting their outcomes in a constrained trauma center setup. Aim This aims to study the epidemiological and clinical factors to understand the long-term morbidity, mortality risks, and triaging among STBI patients requiring surgery. Methods A prospective observational study was conducted on 227 isolated STBI patients with Glasgow Coma Scale (GCS) ≤ 8 who underwent surgical evacuation of intracranial lesions. Patients were classified based on their neurological status and lesions on computed tomography head. Postoperative data on complications were collected. At 6-month follow-up, patients with Glasgow (Extended) scores of 7 to 8 were deemed good outcomes, and scores of 1 to 6 were deemed poor. Cox regression analysis was used to identify independent influencing factors, with p < 0.05 as statistically significant. Results The clinicoradiological factors including age (p = 0.02), asymmetric pupillary reaction (p = 0.002), low presenting pulse rate (p = 0.041), and low systolic and diastolic blood pressure (p = 0.016 and p < 0.0001, respectively), low GCS (p = 0.011), midline shift > 5 mm (p < 0.0001), and obliterated basal cisterns were significantly associated with poor outcome. Tracheostomy, respiratory tract infection, bedsore, meningitis, deep vein thrombosis, cerebrospinal fluid leak, and bone flap site infection were significantly associated with survival of the patients (p = 0.036). The most common cause of mortality during home care included respiratory tract infection and was associated with the care of the tracheostomized. GCS (p < 0.0001), age (p = 0.005), and alcohol use (p = 0.034) were independent predictors for the outcome of patients. Conclusion This study helps clinicians predict prognosis, postoperative recovery, manage challenges, counsel caregivers, and predict long-term patient outcomes.
{"title":"A Glimpse into the Prognostic Factors of Outcomes for Isolated, Operated Severe Traumatic Head Injury Patients in a Resource Constrained Trauma Center Setup","authors":"Anil Chandra, B. Ojha, C. Srivastava, Somil Jaiswal, Aman Singh","doi":"10.1055/s-0044-1782614","DOIUrl":"https://doi.org/10.1055/s-0044-1782614","url":null,"abstract":"\u0000 Background Severe traumatic brain injury (STBI) continues to burden health care in developing countries. This study focuses on STBI patients undergoing surgical intervention to understand the factors affecting their outcomes in a constrained trauma center setup.\u0000 Aim This aims to study the epidemiological and clinical factors to understand the long-term morbidity, mortality risks, and triaging among STBI patients requiring surgery.\u0000 Methods A prospective observational study was conducted on 227 isolated STBI patients with Glasgow Coma Scale (GCS) ≤ 8 who underwent surgical evacuation of intracranial lesions. Patients were classified based on their neurological status and lesions on computed tomography head. Postoperative data on complications were collected. At 6-month follow-up, patients with Glasgow (Extended) scores of 7 to 8 were deemed good outcomes, and scores of 1 to 6 were deemed poor. Cox regression analysis was used to identify independent influencing factors, with p < 0.05 as statistically significant.\u0000 Results The clinicoradiological factors including age (p = 0.02), asymmetric pupillary reaction (p = 0.002), low presenting pulse rate (p = 0.041), and low systolic and diastolic blood pressure (p = 0.016 and p < 0.0001, respectively), low GCS (p = 0.011), midline shift > 5 mm (p < 0.0001), and obliterated basal cisterns were significantly associated with poor outcome. Tracheostomy, respiratory tract infection, bedsore, meningitis, deep vein thrombosis, cerebrospinal fluid leak, and bone flap site infection were significantly associated with survival of the patients (p = 0.036). The most common cause of mortality during home care included respiratory tract infection and was associated with the care of the tracheostomized. GCS (p < 0.0001), age (p = 0.005), and alcohol use (p = 0.034) were independent predictors for the outcome of patients.\u0000 Conclusion This study helps clinicians predict prognosis, postoperative recovery, manage challenges, counsel caregivers, and predict long-term patient outcomes.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"80 4","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268435","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}
Acute subdural hematoma (SDH) constitutes one of the most common emergencies in neurosurgery and its spontaneous resolution is an uncommon phenomenon. Several theories have been described to explain this phenomenon including redistribution of subdural blood, dilution by cerebrospinal fluid, and brain atrophy. Rapid resolution of acute SDH related to thrombocytopenia is a rare phenomenon. We report a case of a patient who showed rapid resolution of acute SDH with thrombocytopenia and also discuss such a rare case with speculation of the thrombocytopenia as a factor to promote this phenomenon.
{"title":"Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Thrombocytopenia: A Blessing in Disguise","authors":"Guramritpal Singh, Pawan Kumar Verma","doi":"10.1055/s-0043-1777682","DOIUrl":"https://doi.org/10.1055/s-0043-1777682","url":null,"abstract":"Acute subdural hematoma (SDH) constitutes one of the most common emergencies in neurosurgery and its spontaneous resolution is an uncommon phenomenon. Several theories have been described to explain this phenomenon including redistribution of subdural blood, dilution by cerebrospinal fluid, and brain atrophy. Rapid resolution of acute SDH related to thrombocytopenia is a rare phenomenon. We report a case of a patient who showed rapid resolution of acute SDH with thrombocytopenia and also discuss such a rare case with speculation of the thrombocytopenia as a factor to promote this phenomenon.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"16 5","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266406","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}
Hany Elkholy, Hossam Elnoamany, Ahmed Shawky Ammar
Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons. Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay. Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p < 0.001). Delayed surgery > 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023). Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.
{"title":"Impact of Time from Injury to Surgery on Postoperative Functional Recovery in Large Volume Traumatic Extradural Hematomas","authors":"Hany Elkholy, Hossam Elnoamany, Ahmed Shawky Ammar","doi":"10.1055/s-0044-1787115","DOIUrl":"https://doi.org/10.1055/s-0044-1787115","url":null,"abstract":"\u0000 Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons.\u0000 Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay.\u0000 Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p < 0.001). Delayed surgery > 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023).\u0000 Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"18 6","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266720","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}
Background Tentorium cerebelli divide cranial cavity into supratentorial and infratentorial compartment. Tentorial notch is a gap in tentorium cerebelli located centrally and anteriorly, related to upper brainstem, first six cranial nerves, cerebrum, and cerebellum. The aim of this study was to analyze morphometric variation in tentorial notch anatomy in autopsy and computed tomography (CT) of head injury patients and to find out correlation between tentorial notch anatomy and uncal herniation and changes over brainstem surface in case of uncal herniation. Materials and Methods Autopsy examination of head injury patients was done between July 1, 2021, and Jan 31, 2023. Skull was opened in a standard manner and midbrain sectioned at the level of tentorial edge. Tentorial notch parameters (anterior notch width, maximum notch width, notch length, posterior tentorial length, apicotectal distance, interpedunculoclival distance) were measured using geometry compass and vernier caliper. These parameters were also measured on noncontrast computed tomography (NCCT) head of same patients. Evidence of uncal herniation was sought for in both NCCT head and autopsy examination. Impact of uncal herniation over brainstem in form of indentation over lateral surface of midbrain and macroscopic brainstem hemorrhage was noted. Results In 65 autopsy cases, there were 56 male and 9 female specimens; their mean age was 40.63 ± 16.78 years (range: 7–86 years). The most frequent type of tentorial notch observed in our study was typical type (32.30%). Relative frequency of uncal herniation was present predominantly (75%) in large type of tentorial notch and least (20%) in small type of tentorial notch. A significant correlation (p-value < 0.01) was found between uncal herniation and indentation over lateral surface of midbrain, while no significant correlation (p-value > 0.05) was found between uncal herniation and macroscopic brainstem hemorrhage in autopsy specimens. Conclusion The results of our study provide a baseline data about tentorial notch anatomy and it may facilitate neurosurgical decision making as well as help in deciding the best trajectory for lesions approaching in the vicinity of the tentorial notch
{"title":"Variations of Tentorial Notch Anatomy in Autopsy and NCCT of Head Injury Patients to Correlate Its Impact over Brainstem—An Observational Study","authors":"Anoop Kumar Singh, B.K. Ojha, Manish Jaiswal, Ankur Bajaj, Awdhesh Yadav","doi":"10.1055/s-0044-1778731","DOIUrl":"https://doi.org/10.1055/s-0044-1778731","url":null,"abstract":"\u0000 Background Tentorium cerebelli divide cranial cavity into supratentorial and infratentorial compartment. Tentorial notch is a gap in tentorium cerebelli located centrally and anteriorly, related to upper brainstem, first six cranial nerves, cerebrum, and cerebellum. The aim of this study was to analyze morphometric variation in tentorial notch anatomy in autopsy and computed tomography (CT) of head injury patients and to find out correlation between tentorial notch anatomy and uncal herniation and changes over brainstem surface in case of uncal herniation.\u0000 Materials and Methods Autopsy examination of head injury patients was done between July 1, 2021, and Jan 31, 2023. Skull was opened in a standard manner and midbrain sectioned at the level of tentorial edge. Tentorial notch parameters (anterior notch width, maximum notch width, notch length, posterior tentorial length, apicotectal distance, interpedunculoclival distance) were measured using geometry compass and vernier caliper. These parameters were also measured on noncontrast computed tomography (NCCT) head of same patients. Evidence of uncal herniation was sought for in both NCCT head and autopsy examination. Impact of uncal herniation over brainstem in form of indentation over lateral surface of midbrain and macroscopic brainstem hemorrhage was noted.\u0000 Results In 65 autopsy cases, there were 56 male and 9 female specimens; their mean age was 40.63 ± 16.78 years (range: 7–86 years). The most frequent type of tentorial notch observed in our study was typical type (32.30%). Relative frequency of uncal herniation was present predominantly (75%) in large type of tentorial notch and least (20%) in small type of tentorial notch. A significant correlation (p-value < 0.01) was found between uncal herniation and indentation over lateral surface of midbrain, while no significant correlation (p-value > 0.05) was found between uncal herniation and macroscopic brainstem hemorrhage in autopsy specimens.\u0000 Conclusion The results of our study provide a baseline data about tentorial notch anatomy and it may facilitate neurosurgical decision making as well as help in deciding the best trajectory for lesions approaching in the vicinity of the tentorial notch","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"6 4","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267523","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}
Decompressive craniectomy (DC) is a life-saving procedure to control refractory intracranial pressure after traumatic brain injury. Postdecompressive craniectomy hydrocephalus (PDCH) is debilitating complication following DCs. Lumbar drainage (LD) is a temporary measure that is helpful in the assessment of PDCH and its functioning can predict the risks and benefits of definitive cerebrospinal fluid (CSF) diversion procedures. LD is associated with multiple complications. Intracranial hemorrhage is a rare but devastating complication following LD. Here, the authors report a case in which LD was performed as a temporary measure to assess PDCH, resulting in brain stem hemorrhage (BSH). A 45-year-old male underwent DC for severe traumatic brain injury. Patient developed PDCH in postoperative period. LD was done as a bridging procedure for definitive CSF diversion procedure, which resulted in fatal BSH. Authors conclude that although a simple procedure, LD can be associated with fatal BSH. Since drainage of CSF after LD is unpredictable in patients of PDCH, a close monitoring of the functioning of the LD system is required to avoid overdrainage and brain herniations.
{"title":"Brain Stem Hemorrhage after Insertion of a Lumbar Drain: An Extremely Rare but Fatal Complication of a Routine Procedure","authors":"Vikrant Yadav, N. Pandey","doi":"10.1055/s-0044-1787113","DOIUrl":"https://doi.org/10.1055/s-0044-1787113","url":null,"abstract":"Decompressive craniectomy (DC) is a life-saving procedure to control refractory intracranial pressure after traumatic brain injury. Postdecompressive craniectomy hydrocephalus (PDCH) is debilitating complication following DCs. Lumbar drainage (LD) is a temporary measure that is helpful in the assessment of PDCH and its functioning can predict the risks and benefits of definitive cerebrospinal fluid (CSF) diversion procedures. LD is associated with multiple complications. Intracranial hemorrhage is a rare but devastating complication following LD. Here, the authors report a case in which LD was performed as a temporary measure to assess PDCH, resulting in brain stem hemorrhage (BSH). A 45-year-old male underwent DC for severe traumatic brain injury. Patient developed PDCH in postoperative period. LD was done as a bridging procedure for definitive CSF diversion procedure, which resulted in fatal BSH. Authors conclude that although a simple procedure, LD can be associated with fatal BSH. Since drainage of CSF after LD is unpredictable in patients of PDCH, a close monitoring of the functioning of the LD system is required to avoid overdrainage and brain herniations.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"77 2","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268168","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}
S. Raj, S. K. Thanneeru, Sukumar Mondithokha, Pradeep Chouksey, Tariq Janjua, Bharti Singh, L. Moscote-Salazar, Md Yunus, Amit Agrawal
Background Traumatic brain injury (TBI) is a significant public health concern. Standard care involves conservative management and pharmacological and surgical interventions. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment for TBI, with varied findings in the literature. Our systematic review aims to comprehensively assess the efficacy and safety of HBOT in TBI management, addressing existing knowledge gaps and providing insights for clinical practice and future research. Methods A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for the role of HBOT in TBI. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. Results After identifying 306 articles, we narrowed it to 8 for qualitative synthesis. The studies were categorized into subgroups: those on patients with an acute history of cerebral injury and those with a history of mild TBI. The combined RCTs involved 651 patients (326 in the first subgroup, 325 in the second). Despite a uniform HBOT session duration of 60 minutes, variations in compression, decompression phases, and pressure used (1.5ATA to 2.5ATA) hindered meta-analysis comparability. Outcome measures differed, complicating comparisons. Overall, HBOT appears beneficial in the first group and less so in the second. Complications are primarily pulmonary, which include dyspnea, cyanosis, hyperoxic pneumonia, and increased fraction of inspired oxygen requirement. Conclusion Our study encountered challenges in reaching definitive conclusions due to outcome variability among the included studies. Despite mixed results, HBOT shows potential benefits for acute TBI patients. Conversely, our findings suggest the limited efficacy of HBOT for chronic traumatic brain injury patients. Further research is crucial, particularly exploring diverse HBOT treatment protocols to establish optimal pressure levels and the required number of sessions for effective outcomes
{"title":"Role of Hyperbaric Oxygen Therapy in Traumatic Brain Injury: A Systematic Review of Randomized Controlled Trials","authors":"S. Raj, S. K. Thanneeru, Sukumar Mondithokha, Pradeep Chouksey, Tariq Janjua, Bharti Singh, L. Moscote-Salazar, Md Yunus, Amit Agrawal","doi":"10.1055/s-0044-1782609","DOIUrl":"https://doi.org/10.1055/s-0044-1782609","url":null,"abstract":"\u0000 Background Traumatic brain injury (TBI) is a significant public health concern. Standard care involves conservative management and pharmacological and surgical interventions. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment for TBI, with varied findings in the literature. Our systematic review aims to comprehensively assess the efficacy and safety of HBOT in TBI management, addressing existing knowledge gaps and providing insights for clinical practice and future research.\u0000 Methods A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for the role of HBOT in TBI. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded.\u0000 Results After identifying 306 articles, we narrowed it to 8 for qualitative synthesis. The studies were categorized into subgroups: those on patients with an acute history of cerebral injury and those with a history of mild TBI. The combined RCTs involved 651 patients (326 in the first subgroup, 325 in the second). Despite a uniform HBOT session duration of 60 minutes, variations in compression, decompression phases, and pressure used (1.5ATA to 2.5ATA) hindered meta-analysis comparability. Outcome measures differed, complicating comparisons. Overall, HBOT appears beneficial in the first group and less so in the second. Complications are primarily pulmonary, which include dyspnea, cyanosis, hyperoxic pneumonia, and increased fraction of inspired oxygen requirement.\u0000 Conclusion Our study encountered challenges in reaching definitive conclusions due to outcome variability among the included studies. Despite mixed results, HBOT shows potential benefits for acute TBI patients. Conversely, our findings suggest the limited efficacy of HBOT for chronic traumatic brain injury patients. Further research is crucial, particularly exploring diverse HBOT treatment protocols to establish optimal pressure levels and the required number of sessions for effective outcomes","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":"4 8","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267881","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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