Although cranioplasty seems to be a simple procedure, fatal complication of development of diffuse severe cerebral edema following cranioplasty although unusual have been reported in a few cases. The mechanism for this occurrence is still speculative. A 38-year-old male patient presented with a history of having undergone left decompressive hemicraniectomy following a road traffic accident with traumatic left intracranial internal carotid artery dissection leading to anterior cerebral artery and middle cerebral artery territory infarct and endovascular embolization of traumatic type 1 left caroticocavernous fistula. The preoperative computed tomography scan of the brain revealed left frontotemperoparietal craniectomy defect with sunken flap and diffuse encephalomalacia with gliosis of the entire left cerebral hemisphere. Immediately following an uneventful cranioplasty surgery with titanium mesh, the patient developed severe hypotension and dilated fixed pupils. Postoperative imaging revealed diffuse severe cerebral edema in bilateral hemispheres with a significant midline shift toward the ipsilateral (left) side, that is, toward the side of cranioplasty. The patient immediately underwent removal of the titanium mesh, and despite all efforts, the patient had a fatal outcome on postoperative day 5. Although this type of fatal complication of diffuse severe cerebral edema is rare in postcranioplasty patients, neurosurgeons must be aware of this complication and close monitoring postprocedure is important, especially in patients with a large craniectomy defect and sunken skin flap.
{"title":"The Silent Threat: Unraveling the Rare Catastrophic Complication after Elective Cranioplasty","authors":"Arvind Kr, Joy Varghese, Senthilnath M.","doi":"10.1055/s-0044-1788255","DOIUrl":"https://doi.org/10.1055/s-0044-1788255","url":null,"abstract":"Although cranioplasty seems to be a simple procedure, fatal complication of development of diffuse severe cerebral edema following cranioplasty although unusual have been reported in a few cases. The mechanism for this occurrence is still speculative. A 38-year-old male patient presented with a history of having undergone left decompressive hemicraniectomy following a road traffic accident with traumatic left intracranial internal carotid artery dissection leading to anterior cerebral artery and middle cerebral artery territory infarct and endovascular embolization of traumatic type 1 left caroticocavernous fistula. The preoperative computed tomography scan of the brain revealed left frontotemperoparietal craniectomy defect with sunken flap and diffuse encephalomalacia with gliosis of the entire left cerebral hemisphere. Immediately following an uneventful cranioplasty surgery with titanium mesh, the patient developed severe hypotension and dilated fixed pupils. Postoperative imaging revealed diffuse severe cerebral edema in bilateral hemispheres with a significant midline shift toward the ipsilateral (left) side, that is, toward the side of cranioplasty. The patient immediately underwent removal of the titanium mesh, and despite all efforts, the patient had a fatal outcome on postoperative day 5. Although this type of fatal complication of diffuse severe cerebral edema is rare in postcranioplasty patients, neurosurgeons must be aware of this complication and close monitoring postprocedure is important, especially in patients with a large craniectomy defect and sunken skin flap.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667943","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}
Zahier Ebrahim, Armin Gretschel, Alex van der Horst, A. J. Vlok
Abstract Background Spinal arachnoid cysts are rare entities occurring mainly in the cervical and thoracic spine. The majority of these lesions are treated through posterior approaches with laminectomy or laminotomy. We present trans-disc and trans-vertebral aspiration of anterior cervical arachnoid cysts as an alternative therapeutic approach. Methods We present three cases and four procedures where anterior cervical arachnoid cysts were treated through an anterior trans-discal or trans-vertebral approach. A standard Smith–Robertson approach was used to expose the appropriate level in the cervical spine. A 22-gauge spinal needle is passed through the intervertebral disc or a 3-mm channel created in the midline of the vertebral body. This is performed under fluoroscopic guidance. Results Three out of the four procedures resulted in complete clinical resolution at a 6-month follow-up. One patient required a repeat aspiration for a recurrent cyst at a level lower than the previous procedure. One patient had an initial improvement post-procedure followed by a functional decline within the first 5 postoperative days. Our assessment was that the cyst was re-filled and this was confirmed on magnetic resonance imaging (MRI). A standard posterior approach was used to excise the cyst with a good clinical result. Overall, no morbidity was suffered from the anterior approach. Conclusion We believe this approach is a safe alternative to posterior intradural approaches. MRI scanning is advised at 6 months or earlier if clinical improvement is not demonstrated.
{"title":"Trans-Disc Aspiration of Anterior Cervical Cysts","authors":"Zahier Ebrahim, Armin Gretschel, Alex van der Horst, A. J. Vlok","doi":"10.1055/s-0042-1744248","DOIUrl":"https://doi.org/10.1055/s-0042-1744248","url":null,"abstract":"Abstract Background Spinal arachnoid cysts are rare entities occurring mainly in the cervical and thoracic spine. The majority of these lesions are treated through posterior approaches with laminectomy or laminotomy. We present trans-disc and trans-vertebral aspiration of anterior cervical arachnoid cysts as an alternative therapeutic approach. Methods We present three cases and four procedures where anterior cervical arachnoid cysts were treated through an anterior trans-discal or trans-vertebral approach. A standard Smith–Robertson approach was used to expose the appropriate level in the cervical spine. A 22-gauge spinal needle is passed through the intervertebral disc or a 3-mm channel created in the midline of the vertebral body. This is performed under fluoroscopic guidance. Results Three out of the four procedures resulted in complete clinical resolution at a 6-month follow-up. One patient required a repeat aspiration for a recurrent cyst at a level lower than the previous procedure. One patient had an initial improvement post-procedure followed by a functional decline within the first 5 postoperative days. Our assessment was that the cyst was re-filled and this was confirmed on magnetic resonance imaging (MRI). A standard posterior approach was used to excise the cyst with a good clinical result. Overall, no morbidity was suffered from the anterior approach. Conclusion We believe this approach is a safe alternative to posterior intradural approaches. MRI scanning is advised at 6 months or earlier if clinical improvement is not demonstrated.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141682135","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}
Anshu Warade, Alay V. Khandhar, C. Sankhla, Ketan I. Desai
Abstract Venous sinus thrombosis is a common neurovascular problem with multifactorial etiology, infection being one of the common causes. Cerebral abscess causing thrombophlebitis and venous sinus occlusion is a known entity. In contrast, venous hemorrhagic infarct leading to abscess formation is extremely uncommon. We report a rare case of such delayed abscess formation in a venous hemorrhagic infarct secondary to superior sagittal sinus occlusion.
{"title":"Venous Hemorrhagic Infarct Leading to Delayed Brain Abscess Formation: A Case Report","authors":"Anshu Warade, Alay V. Khandhar, C. Sankhla, Ketan I. Desai","doi":"10.1055/s-0043-1774816","DOIUrl":"https://doi.org/10.1055/s-0043-1774816","url":null,"abstract":"Abstract Venous sinus thrombosis is a common neurovascular problem with multifactorial etiology, infection being one of the common causes. Cerebral abscess causing thrombophlebitis and venous sinus occlusion is a known entity. In contrast, venous hemorrhagic infarct leading to abscess formation is extremely uncommon. We report a rare case of such delayed abscess formation in a venous hemorrhagic infarct secondary to superior sagittal sinus occlusion.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141681087","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 To analyze the differential proteomic profile of gliomas in patients from South India and to identify novel protein glioma biomarkers and possible therapeutic targets to tailor the treatment to individual patients. Material and Methods We have prospectively analyzed the differential proteomic profile of 34 patients with glioma imaging characteristics and compared them with that of normal brain tissue. This research was conducted at the Institute of Neurosurgery, Madras Medical College, in technical collaboration with the Indian Institute of Technology, Madras, over 1 year. Statistical Analysis Biological variate analysis (I-ANALYSIS OF VARIANCE (ANOVA)) was used, with p-value less than 0.05 being significant. Results Twenty proteins (10 upregulated and 10 downregulated) were differentially expressed in tumor tissue. The expression of three pro-apoptotic proteins was downregulated and the expression of three anti-apoptotic proteins was upregulated with statistical significance. The cellular functions of the 20 differentially regulated proteins were subjected to pathway analysis revealing significant alterations in heme biosynthesis, deoxyribonucleic acid (DNA) replication, fibroblast growth factor (FGF) signaling, and epidermal growth factor (EGF0 receptor signaling in glioma. Conclusion KRT18, PRS4, and EF1A2 are anti-apoptotic proteins and are significantly upregulated in gliomas. EARS2, COX5A, and LSM3 are pro-apoptotic proteins, and are significantly downregulated in gliomas. This subverts the apoptotic pathways resulting in prolonged cell survival. This study's statistically significant dysregulation of these six proteins was unique, suggesting that they might be considered population-specific biomarkers and possible therapeutic targets for patients from South India. Abnormalities of heme biosynthesis at the proteomic level were identified in this study, which has not been very well studied previously.
{"title":"Identification of Population-Specific Novel Protein Biomarkers and Possible Therapeutic Targets in Gliomas by Proteomics Approach","authors":"S. Devanand Senthil Kumar, Anbazhagan Periyasamy","doi":"10.1055/s-0044-1786983","DOIUrl":"https://doi.org/10.1055/s-0044-1786983","url":null,"abstract":"\u0000 Objective To analyze the differential proteomic profile of gliomas in patients from South India and to identify novel protein glioma biomarkers and possible therapeutic targets to tailor the treatment to individual patients.\u0000 Material and Methods We have prospectively analyzed the differential proteomic profile of 34 patients with glioma imaging characteristics and compared them with that of normal brain tissue. This research was conducted at the Institute of Neurosurgery, Madras Medical College, in technical collaboration with the Indian Institute of Technology, Madras, over 1 year.\u0000 Statistical Analysis Biological variate analysis (I-ANALYSIS OF VARIANCE (ANOVA)) was used, with p-value less than 0.05 being significant.\u0000 Results Twenty proteins (10 upregulated and 10 downregulated) were differentially expressed in tumor tissue. The expression of three pro-apoptotic proteins was downregulated and the expression of three anti-apoptotic proteins was upregulated with statistical significance. The cellular functions of the 20 differentially regulated proteins were subjected to pathway analysis revealing significant alterations in heme biosynthesis, deoxyribonucleic acid (DNA) replication, fibroblast growth factor (FGF) signaling, and epidermal growth factor (EGF0 receptor signaling in glioma.\u0000 Conclusion KRT18, PRS4, and EF1A2 are anti-apoptotic proteins and are significantly upregulated in gliomas. EARS2, COX5A, and LSM3 are pro-apoptotic proteins, and are significantly downregulated in gliomas. This subverts the apoptotic pathways resulting in prolonged cell survival. This study's statistically significant dysregulation of these six proteins was unique, suggesting that they might be considered population-specific biomarkers and possible therapeutic targets for patients from South India. Abnormalities of heme biosynthesis at the proteomic level were identified in this study, which has not been very well studied previously.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140964510","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}
M.S. Sridhar, Arti Sarin, H.S. Bhatoe, H. C. Pathak, Manish Sharma, Maneet Gill, Saurabh K. Verma, Raj Ratan, Nilotpal Chakravarty, M. Semwal
Purpose We present the profile of first 1,000 cases of intracranial radiosurgery (IRS) treated with Gamma Knife system at a government-funded tertiary care hospital in India. In addition to the information on the indications treated, this study provides an idea of the relevance of the Gamma Knife Radiosurgery (GKRS) for IRS in the fast-changing technological scenario. This study also shows the disease indications for which GKRS was the primary treatment preference. Materials and Methods Leksell Gamma Knife model 4C was used for GKRS. Leksell G-frame-based stereotactic localization was used for all patients. Axial magnetic resonance imaging scans were used for treatment planning with additional two-dimensional angiography images for patients treated for arteriovenus malformations (AVM). The patient population treated with GKRS at our center mainly comprised of patients referred from across the country. Results Acoustic schwannoma formed the largest group of patients (27%) followed by meningioma (21%), AVM (18%), pituitary adenoma (16%), brain metastasis (5.3%), trigeminal neuralgia (3%), cavernoma (2.4%), glomus jugulare (1.8%), craniopharyngioma (1.1%) and “others” (5%). Conclusion The case mix at our center is similar to the overall Indian case mix. However, it is different from the Asian data of 2018 but interestingly similar to the data from Middle East and Africa for 2018. Among the various categories of cranial disorders treated by us, pituitary adenoma tumors had minimum (14/161) and cavernoma tumors had maximum (24/24) proportion of cases managed with GKRS as primary treatment modality.
{"title":"First Thousand Cases of Intracranial Radiosurgery Treated with Gamma Knife at a Tertiary Care Hospital in India","authors":"M.S. Sridhar, Arti Sarin, H.S. Bhatoe, H. C. Pathak, Manish Sharma, Maneet Gill, Saurabh K. Verma, Raj Ratan, Nilotpal Chakravarty, M. Semwal","doi":"10.1055/s-0044-1782666","DOIUrl":"https://doi.org/10.1055/s-0044-1782666","url":null,"abstract":"\u0000 Purpose We present the profile of first 1,000 cases of intracranial radiosurgery (IRS) treated with Gamma Knife system at a government-funded tertiary care hospital in India. In addition to the information on the indications treated, this study provides an idea of the relevance of the Gamma Knife Radiosurgery (GKRS) for IRS in the fast-changing technological scenario. This study also shows the disease indications for which GKRS was the primary treatment preference.\u0000 Materials and Methods Leksell Gamma Knife model 4C was used for GKRS. Leksell G-frame-based stereotactic localization was used for all patients. Axial magnetic resonance imaging scans were used for treatment planning with additional two-dimensional angiography images for patients treated for arteriovenus malformations (AVM). The patient population treated with GKRS at our center mainly comprised of patients referred from across the country.\u0000 Results Acoustic schwannoma formed the largest group of patients (27%) followed by meningioma (21%), AVM (18%), pituitary adenoma (16%), brain metastasis (5.3%), trigeminal neuralgia (3%), cavernoma (2.4%), glomus jugulare (1.8%), craniopharyngioma (1.1%) and “others” (5%).\u0000 Conclusion The case mix at our center is similar to the overall Indian case mix. However, it is different from the Asian data of 2018 but interestingly similar to the data from Middle East and Africa for 2018. Among the various categories of cranial disorders treated by us, pituitary adenoma tumors had minimum (14/161) and cavernoma tumors had maximum (24/24) proportion of cases managed with GKRS as primary treatment modality.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140968753","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}
An elderly diabetic gentleman developed epidural abscess several days after traumatic esophageal perforation secondary to flexion-extension injury of the cervical spine in a road traffic accident. The patient underwent high-resolution ultrasonography of the neck along with noncontrast computed tomography and magnetic resonance imaging of the cervical spine, which showed collection in soft tissue of the neck region along with epidural abscesses and osteophytes at multiple levels. However, due to the rarity of cervical esophageal perforation due to vertebral osteophytes, esophageal perforation was missed and was only diagnosed during the second admission of the patient, about 1 month later, when he presented with progressive quadriparesis. We present an extremely rare case of cervical esophageal perforation due to a flexion-extension injury.
{"title":"Quadriparesis Following Intrinsic Traumatic Esophageal Perforation: Report of a Rare Case","authors":"Anchal Awasthi, Sunil Kumar Singh, Ahemadullah Shaikh, Saurabh Kumar Verma, Shuchi Singh","doi":"10.1055/s-0044-1786975","DOIUrl":"https://doi.org/10.1055/s-0044-1786975","url":null,"abstract":"An elderly diabetic gentleman developed epidural abscess several days after traumatic esophageal perforation secondary to flexion-extension injury of the cervical spine in a road traffic accident. The patient underwent high-resolution ultrasonography of the neck along with noncontrast computed tomography and magnetic resonance imaging of the cervical spine, which showed collection in soft tissue of the neck region along with epidural abscesses and osteophytes at multiple levels. However, due to the rarity of cervical esophageal perforation due to vertebral osteophytes, esophageal perforation was missed and was only diagnosed during the second admission of the patient, about 1 month later, when he presented with progressive quadriparesis. We present an extremely rare case of cervical esophageal perforation due to a flexion-extension injury.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980113","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}
Abhijit Acharya, A. Mahapatra, S. Tripathy, Souvagya Panigrahi, R. Deo, S. Senapati
{"title":"Postoperative Contralateral Spontaneous Epidural Hematoma","authors":"Abhijit Acharya, A. Mahapatra, S. Tripathy, Souvagya Panigrahi, R. Deo, S. Senapati","doi":"10.1055/s-0044-1786974","DOIUrl":"https://doi.org/10.1055/s-0044-1786974","url":null,"abstract":"","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981143","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}
Chirag Jain, I. Bhagavatula, D. Bhat, Dhaval Shukla, Subhas K Konar
Hinge craniotomy has been described as an alternative to decompressive craniectomy for the control of intracranial pressure in traumatic brain injury and stroke. In this study, the authors highlight critical steps in performing a hinge craniotomy and present a clinical case of a patient with traumatic brain injury.
{"title":"Hinge Craniotomy for Traumatic Brain Injury: Surgical Technique","authors":"Chirag Jain, I. Bhagavatula, D. Bhat, Dhaval Shukla, Subhas K Konar","doi":"10.1055/s-0044-1782690","DOIUrl":"https://doi.org/10.1055/s-0044-1782690","url":null,"abstract":"Hinge craniotomy has been described as an alternative to decompressive craniectomy for the control of intracranial pressure in traumatic brain injury and stroke. In this study, the authors highlight critical steps in performing a hinge craniotomy and present a clinical case of a patient with traumatic brain injury.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141015140","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}
M. Kumawat, Amanpreet Singh, Prashant Kumar, S. Johar, Ishwar Singh
Introduction Phenytoin, although commonly used for postoperative seizure prophylaxis, exhibits variable results in mitigating seizure frequency following craniotomy. These discrepancies may be linked to a reduction in plasma phenytoin levels subsequent to the surgical intervention. Aims This prospective study aims to characterize changes in plasma phenytoin levels after craniotomy and their relationship with intraoperative blood loss. Methods Fifty consecutive patients were enrolled in this study after obtaining written informed consent. These patients had either been on oral phenytoin for at least 7 days or had received an intravenous loading dose before undergoing craniotomy. Serum phenytoin levels were measured 24 hours preoperatively, immediately before craniotomy (prior to skin incision), postcraniotomy (after skin closure), and 24 hours postcraniotomy. Additionally, intraoperative blood loss was calculated using a modified Gross formula. Results Immediately following craniotomy, there was a statistically significant mean decline of 28.16% in serum phenytoin levels. Furthermore, the analysis revealed a robust positive correlation between the decrease in phenytoin concentration level and several factors, including blood loss during surgery, the duration of the surgical procedure, intravenous fluids administered during surgery, and the occurrence of postoperative seizures. Conclusion This study underscores the potential utility of routinely measuring perioperative serum phenytoin levels in high-risk patients to prevent postcraniotomy seizures. Moreover, it suggests that patients with substantial intraoperative blood loss may benefit from an additional bolus dose of phenytoin toward the end of the surgical procedure.
{"title":"To Study Perioperative Changes in Plasma Phenytoin Levels in Patients with Brain Tumor Undergoing Craniotomy and Its Correlation with Postoperative Seizures","authors":"M. Kumawat, Amanpreet Singh, Prashant Kumar, S. Johar, Ishwar Singh","doi":"10.1055/s-0044-1785527","DOIUrl":"https://doi.org/10.1055/s-0044-1785527","url":null,"abstract":"\u0000 Introduction Phenytoin, although commonly used for postoperative seizure prophylaxis, exhibits variable results in mitigating seizure frequency following craniotomy. These discrepancies may be linked to a reduction in plasma phenytoin levels subsequent to the surgical intervention.\u0000 Aims This prospective study aims to characterize changes in plasma phenytoin levels after craniotomy and their relationship with intraoperative blood loss.\u0000 Methods Fifty consecutive patients were enrolled in this study after obtaining written informed consent. These patients had either been on oral phenytoin for at least 7 days or had received an intravenous loading dose before undergoing craniotomy. Serum phenytoin levels were measured 24 hours preoperatively, immediately before craniotomy (prior to skin incision), postcraniotomy (after skin closure), and 24 hours postcraniotomy. Additionally, intraoperative blood loss was calculated using a modified Gross formula.\u0000 Results Immediately following craniotomy, there was a statistically significant mean decline of 28.16% in serum phenytoin levels. Furthermore, the analysis revealed a robust positive correlation between the decrease in phenytoin concentration level and several factors, including blood loss during surgery, the duration of the surgical procedure, intravenous fluids administered during surgery, and the occurrence of postoperative seizures.\u0000 Conclusion This study underscores the potential utility of routinely measuring perioperative serum phenytoin levels in high-risk patients to prevent postcraniotomy seizures. Moreover, it suggests that patients with substantial intraoperative blood loss may benefit from an additional bolus dose of phenytoin toward the end of the surgical procedure.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141016495","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}
H. Beniwal, N. P. K., Prakash Rao G., K. Srinivas, Krishnamurthy Talari, U. Nookathota
Introduction Tethered cord syndrome (TCS) is a stretch-induced functional disorder associated with tethering of caudal spinal cord to dura mater with inelastic tissue, limiting its movement. It not only manifests in childhood but also noted in adults. Here, we studied the role of detethering on delayed presentation of TCS. Material and Methods All patients of symptomatic TCS from January 2011 to December 2019 were included. Preoperative evaluation was done through X-ray; ultrasonography kidney, ureter, urinary bladder; magnetic resonance imaging spine and brain; and urodynamic studies. Detethering was done and associated pathology was excised. Preoperative and postoperative comparison was done through Necker functional score using chi-squared system. Results Age range was 8 to 30 years with mean age of 13.8 years. Most common presentation was urological manifestations in ∼61.1% of cases followed by pain in 41.6%, sensory deficits in 38.8%, asymmetric weakness in 30.5%, orthopaedic and trophic ulcers in 22.2% each, and bowel abnormalities in 13.8% of cases. Mean duration of symptoms was 5.52 years. Improvement in urological manifestations was in 71.4% patients, pain in 80%, sensory dysfunctions in 71.4%, bowel dysfunctions in 80%, motor weakness in 90.9%, and trophic ulcer in 100% patients. On comparison, chi-squared value was 25.9993 and p-value was 0.000032, which was significant (<0.05). Conclusion Detethering in early ages is already proven with good results. In our study, detethering showed statistically significant improvement even in delayed presentation. So, authors recommend to surgically interfere by detethering, even if tethering is detected late with significant deficits.
{"title":"A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome","authors":"H. Beniwal, N. P. K., Prakash Rao G., K. Srinivas, Krishnamurthy Talari, U. Nookathota","doi":"10.1055/s-0044-1782689","DOIUrl":"https://doi.org/10.1055/s-0044-1782689","url":null,"abstract":"\u0000 Introduction Tethered cord syndrome (TCS) is a stretch-induced functional disorder associated with tethering of caudal spinal cord to dura mater with inelastic tissue, limiting its movement. It not only manifests in childhood but also noted in adults. Here, we studied the role of detethering on delayed presentation of TCS.\u0000 Material and Methods All patients of symptomatic TCS from January 2011 to December 2019 were included. Preoperative evaluation was done through X-ray; ultrasonography kidney, ureter, urinary bladder; magnetic resonance imaging spine and brain; and urodynamic studies. Detethering was done and associated pathology was excised. Preoperative and postoperative comparison was done through Necker functional score using chi-squared system.\u0000 Results Age range was 8 to 30 years with mean age of 13.8 years. Most common presentation was urological manifestations in ∼61.1% of cases followed by pain in 41.6%, sensory deficits in 38.8%, asymmetric weakness in 30.5%, orthopaedic and trophic ulcers in 22.2% each, and bowel abnormalities in 13.8% of cases. Mean duration of symptoms was 5.52 years. Improvement in urological manifestations was in 71.4% patients, pain in 80%, sensory dysfunctions in 71.4%, bowel dysfunctions in 80%, motor weakness in 90.9%, and trophic ulcer in 100% patients. On comparison, chi-squared value was 25.9993 and p-value was 0.000032, which was significant (<0.05).\u0000 Conclusion Detethering in early ages is already proven with good results. In our study, detethering showed statistically significant improvement even in delayed presentation. So, authors recommend to surgically interfere by detethering, even if tethering is detected late with significant deficits.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141016745","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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