Hemonta Kr. Dutta, Mauchumi Baruah, Mridusmita Dutta
Abstract Objective Children with hydrocephalus need regular monitoring following shunt surgery. A parent-completed assessment tool was used successfully in follow-up of postshunt hydrocephalus children in the recent pandemic. Methods The Ages & and Stages Questionnaires (ASQ) was sent via WhatsApp to parents of 40 postventriculoperitoneal (post-VP) shunt hydrocephalus children (7–57 months). Assessment was done by the parents/guardians in five domains over a period of 3 months. The completed questionnaires were analyzed and children with below the cutoff scores were called to the hospital for further evaluations and intervention if necessary. Result Questionnaires of 25 children were found completed and analyzed. There were 16 males and 18 children had aqueductal stenosis and 11 had meningomyelocele. Eighteen children with failed/borderline (11/7) ASQ scores were called for further evaluation and in all but one the scores obtained by the parents and clinical psychologists were found comparable. Two children needed hospital admissions for shunt revision and adjustment of anticonvulsant medicines. Conclusion The ASQ could be a useful tool, as parents can conduct the test at home and attend clinics in case of failed or borderline scores for further developmental assessment and/or intervention. This can be used as a routine monitoring tool in other clinical situations as well.
{"title":"Ages and Stages Questionnaires: Feasibility of Online Survey for Postshunt Hydrocephalus Follow-Up","authors":"Hemonta Kr. Dutta, Mauchumi Baruah, Mridusmita Dutta","doi":"10.1055/s-0043-1775972","DOIUrl":"https://doi.org/10.1055/s-0043-1775972","url":null,"abstract":"Abstract Objective Children with hydrocephalus need regular monitoring following shunt surgery. A parent-completed assessment tool was used successfully in follow-up of postshunt hydrocephalus children in the recent pandemic. Methods The Ages & and Stages Questionnaires (ASQ) was sent via WhatsApp to parents of 40 postventriculoperitoneal (post-VP) shunt hydrocephalus children (7–57 months). Assessment was done by the parents/guardians in five domains over a period of 3 months. The completed questionnaires were analyzed and children with below the cutoff scores were called to the hospital for further evaluations and intervention if necessary. Result Questionnaires of 25 children were found completed and analyzed. There were 16 males and 18 children had aqueductal stenosis and 11 had meningomyelocele. Eighteen children with failed/borderline (11/7) ASQ scores were called for further evaluation and in all but one the scores obtained by the parents and clinical psychologists were found comparable. Two children needed hospital admissions for shunt revision and adjustment of anticonvulsant medicines. Conclusion The ASQ could be a useful tool, as parents can conduct the test at home and attend clinics in case of failed or borderline scores for further developmental assessment and/or intervention. This can be used as a routine monitoring tool in other clinical situations as well.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"93 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870946","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}
Abstract Neuroglial cysts are very rare benign lesions of the brain, accounting for up to 1% of all intracranial cysts. Various intracranial locations such as parenchyma, ventricles, subarachnoid spaces, and rarely the spinal cord have been reported. The clinical features vary according to the site of the cyst ranging from being asymptomatic to having headache, seizures, and hemiparesis. It is most commonly seen in infants and children but can be seen in adults too. This rare case is of a middle-aged woman presenting with complaints of headache and left-sided hemiparesis. We report a rare case of a right-sided neuroglial cyst for which a contralateral endoscopic approach was taken for the surgery. Endoscopic cyst fenestration is an ideal modality to treat neuroglial cyst. The contralateral endoscopic approach to treat neuroglial cyst is a better option with the advantage of minimal invasiveness along with better visualization of ventricles and easy maneuverability of the endoscope within the ventricles and surrounding anatomy.
{"title":"Contralateral Endoscopic Approach for a Rare Case of Neuroglial Cyst","authors":"Deepak Kumar Singh, Kshitij Sinha, Rakesh Kumar Singh, Vipin Kumar Chand, Neha Singh, Arun Kumar Singh, Krishan Kumar","doi":"10.1055/s-0043-1775747","DOIUrl":"https://doi.org/10.1055/s-0043-1775747","url":null,"abstract":"Abstract Neuroglial cysts are very rare benign lesions of the brain, accounting for up to 1% of all intracranial cysts. Various intracranial locations such as parenchyma, ventricles, subarachnoid spaces, and rarely the spinal cord have been reported. The clinical features vary according to the site of the cyst ranging from being asymptomatic to having headache, seizures, and hemiparesis. It is most commonly seen in infants and children but can be seen in adults too. This rare case is of a middle-aged woman presenting with complaints of headache and left-sided hemiparesis. We report a rare case of a right-sided neuroglial cyst for which a contralateral endoscopic approach was taken for the surgery. Endoscopic cyst fenestration is an ideal modality to treat neuroglial cyst. The contralateral endoscopic approach to treat neuroglial cyst is a better option with the advantage of minimal invasiveness along with better visualization of ventricles and easy maneuverability of the endoscope within the ventricles and surrounding anatomy.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870419","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}
Igor Vadimovich Basankin, Vladimir Alekseevich Porkhanov, Abram Akopovich Giulzatyan, Pavel Borisovich Nesterenko, Eduard Romanovich Khurshudyan, Marina Igorevna Tomina, Ivan Evgenievich Gritsaev, Karapet Karapetovich Takhmazyan, Sergey Borisovich Malakhov
Abstract Screw loosening, avulsion, fracture, and rod migration are mechanical complications associated with dorsal fixation of the cervical spine. These usually occur in the late postoperative period and range from 2 to 5%. In this article, we describe a rare case of rod migration into the posterior cranial fossa 4 years after C1–C2–C3–C4 screw fixation in a patient with traumatic fracture of the C2 and C3 vertebrae.
{"title":"Rod Migration into the Posterior Cranial Fossa after C1–C2–C3–C4 Screw Fixation: Case Report and Review of the Literature","authors":"Igor Vadimovich Basankin, Vladimir Alekseevich Porkhanov, Abram Akopovich Giulzatyan, Pavel Borisovich Nesterenko, Eduard Romanovich Khurshudyan, Marina Igorevna Tomina, Ivan Evgenievich Gritsaev, Karapet Karapetovich Takhmazyan, Sergey Borisovich Malakhov","doi":"10.1055/s-0043-1775735","DOIUrl":"https://doi.org/10.1055/s-0043-1775735","url":null,"abstract":"Abstract Screw loosening, avulsion, fracture, and rod migration are mechanical complications associated with dorsal fixation of the cervical spine. These usually occur in the late postoperative period and range from 2 to 5%. In this article, we describe a rare case of rod migration into the posterior cranial fossa 4 years after C1–C2–C3–C4 screw fixation in a patient with traumatic fracture of the C2 and C3 vertebrae.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"42 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872494","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}
Abstract Background Ring-enhancing lesion is one of the most common radiological findings in a spectrum of diseases affecting the central nervous system (CNS) including infectious, inflammatory, demyelinating, and neoplastic pathologies. Objective The aim of this study was to analyze the clinical and radiological parameters of pathologies presenting as ring-enhancing lesions in the brain, especially tuberculoma and neurocysticercosis. Materials and Methods In this study, 58 patients with ring-enhancing lesions on brain magnetic resonance imaging (MRI) were recruited. Cases were studied for different clinical and radiological variables. Data were analyzed using SPSS 20 version. Results Tuberculoma is the most common pathology accounting for ring-enhancing lesions in the brain, followed by neurocysticercosis. Seizures were present in the majority of cases, with focal onset seizures being more common than generalized seizures. Multiple ring-enhancing lesions were present in the majority of cases, with the cerebral cortex being the most frequently involved site. On T2 fluid-attenuated inversion recovery (FLAIR) sequence, 2/3rds of the neurocysticercosis cases showed full suppression, whereas only 1/10th of tuberculoma cases showed full suppression. On diffusion-weighted imaging (DWI), a minority of neurocysticercosis cases showed diffusion restriction, while more than one-fifth of tuberculoma cases showed diffusion restriction. MR spectroscopy (MRS) results showed that a normal lipid lactate peak was observed in the majority of neurocysticercosis cases, whereas more than half of tuberculoma cases had a high lipid lactate peak. The choline-to-creatine ratio (Chol/Cre ratio) was less than 1.2 in one-third of neurocysticercosis cases and between 1.2 and 2.0 in two-thirds of the cases. In contrast, more than half of tuberculoma cases showed a Chol/Cre ratio between 1.2 and 2.0. Conclusion Tuberculoma and NCC are the two most common causes of ring-enhancing lesions in developing world. Radiological characteristics like FLAIR suppression and diffusion restriction on MRI and Chol/Cre ratio and lipid peak on MRS can substantiate the clinical parameters in distinguishing the two pathologies to a good extent.
{"title":"Utility of Clinical and Radiological Markers in Diagnosing Cerebral Tuberculoma and Neurocysticercosis","authors":"Chandrakanta Patra, Shabeer Ahmad Paul, Gouranga Prosad Mondal, Ramesh Bhattacharyya, Kartik Chandra Ghosh","doi":"10.1055/s-0043-1774815","DOIUrl":"https://doi.org/10.1055/s-0043-1774815","url":null,"abstract":"Abstract Background Ring-enhancing lesion is one of the most common radiological findings in a spectrum of diseases affecting the central nervous system (CNS) including infectious, inflammatory, demyelinating, and neoplastic pathologies. Objective The aim of this study was to analyze the clinical and radiological parameters of pathologies presenting as ring-enhancing lesions in the brain, especially tuberculoma and neurocysticercosis. Materials and Methods In this study, 58 patients with ring-enhancing lesions on brain magnetic resonance imaging (MRI) were recruited. Cases were studied for different clinical and radiological variables. Data were analyzed using SPSS 20 version. Results Tuberculoma is the most common pathology accounting for ring-enhancing lesions in the brain, followed by neurocysticercosis. Seizures were present in the majority of cases, with focal onset seizures being more common than generalized seizures. Multiple ring-enhancing lesions were present in the majority of cases, with the cerebral cortex being the most frequently involved site. On T2 fluid-attenuated inversion recovery (FLAIR) sequence, 2/3rds of the neurocysticercosis cases showed full suppression, whereas only 1/10th of tuberculoma cases showed full suppression. On diffusion-weighted imaging (DWI), a minority of neurocysticercosis cases showed diffusion restriction, while more than one-fifth of tuberculoma cases showed diffusion restriction. MR spectroscopy (MRS) results showed that a normal lipid lactate peak was observed in the majority of neurocysticercosis cases, whereas more than half of tuberculoma cases had a high lipid lactate peak. The choline-to-creatine ratio (Chol/Cre ratio) was less than 1.2 in one-third of neurocysticercosis cases and between 1.2 and 2.0 in two-thirds of the cases. In contrast, more than half of tuberculoma cases showed a Chol/Cre ratio between 1.2 and 2.0. Conclusion Tuberculoma and NCC are the two most common causes of ring-enhancing lesions in developing world. Radiological characteristics like FLAIR suppression and diffusion restriction on MRI and Chol/Cre ratio and lipid peak on MRS can substantiate the clinical parameters in distinguishing the two pathologies to a good extent.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135869988","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}
Abstract Collet-Sicard syndrome (CSS) is a rare condition associated with the involvement of cranial nerve (CN) IX to XII due to lesions involving the jugular foramen and hypoglossal canal. The most common causes are found to be tumors (primary or metastatic), trauma, vascular lesions, inflammatory processes, and iatrogenic complications. Primary intracranial tumors are an extremely rare cause of CSS. However, CSS associated with both CN VII and VIII palsy has been not yet described in English literature. We are presenting a rare case of a 32-year-old man who met with a road traffic accident while riding a bike that resulted in traumatic left-sided involvement of CNs from VII, VIII, IX, X, XI, and XII. The syndromes associated with CSS are mostly jugular foramen syndromes that have been tabulated. The association of CSS with facial palsy is quite rare. So much CN involvement in a traumatic case has so far not been reported in the Medical literature yet and thus, this becomes one of the first cases reported worldwide.
{"title":"Traumatic Collet-Sicard Syndrome with Associated VIIth and VIIIth Cranial Nerve Palsy: Time for a New Nomenclature","authors":"Abhijit Acharya, Satya Bhusan Senapati, Souvagya Panigrahi, Rama Chandra Deo, AK Mahapatra","doi":"10.1055/s-0043-1776022","DOIUrl":"https://doi.org/10.1055/s-0043-1776022","url":null,"abstract":"Abstract Collet-Sicard syndrome (CSS) is a rare condition associated with the involvement of cranial nerve (CN) IX to XII due to lesions involving the jugular foramen and hypoglossal canal. The most common causes are found to be tumors (primary or metastatic), trauma, vascular lesions, inflammatory processes, and iatrogenic complications. Primary intracranial tumors are an extremely rare cause of CSS. However, CSS associated with both CN VII and VIII palsy has been not yet described in English literature. We are presenting a rare case of a 32-year-old man who met with a road traffic accident while riding a bike that resulted in traumatic left-sided involvement of CNs from VII, VIII, IX, X, XI, and XII. The syndromes associated with CSS are mostly jugular foramen syndromes that have been tabulated. The association of CSS with facial palsy is quite rare. So much CN involvement in a traumatic case has so far not been reported in the Medical literature yet and thus, this becomes one of the first cases reported worldwide.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870581","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}
Darpanarayan Hazra, Gina Maryann Chandy, Amit Ghosh
Abstract This report presents a compelling case of remote site hemorrhage (RSH), a rare but severe complication associated with neurosurgery. RSH involves cerebral bleeding away from the surgical site and was first documented in 1937 by Van Gehuchten. Despite its rarity, RSH remains challenging, affecting less than 1% of cases, with an unclear cause. The case involves a 67-year-old male who developed severe symptoms within 24 hours post-surgery. The initial computed tomography scan showed an acute subdural hematoma. Surgical evacuation was followed by rapid deterioration, leading to multiple RSH and brain stem infarctions. Unfortunately, the patient did not survive. RSH poses significant morbidity and mortality risks. Potential factors include volume loss, dural opening, and blood pressure fluctuations. Management ranges from conservative approaches to surgery, with poor prognosis post-RSH intervention. This case highlights the need for thorough preoperative assessment and careful intraoperative management. It emphasizes the complexities of neurosurgery and underscores the importance of ongoing research for managing rare complications like RSH, ultimately improving patient outcomes.
{"title":"Remote Site Hemorrhage following Evacuation of Left Fronto-Temporo-Parietal Subdural Hematoma: A Rare Case Report and Comprehensive Literature Review","authors":"Darpanarayan Hazra, Gina Maryann Chandy, Amit Ghosh","doi":"10.1055/s-0043-1776018","DOIUrl":"https://doi.org/10.1055/s-0043-1776018","url":null,"abstract":"Abstract This report presents a compelling case of remote site hemorrhage (RSH), a rare but severe complication associated with neurosurgery. RSH involves cerebral bleeding away from the surgical site and was first documented in 1937 by Van Gehuchten. Despite its rarity, RSH remains challenging, affecting less than 1% of cases, with an unclear cause. The case involves a 67-year-old male who developed severe symptoms within 24 hours post-surgery. The initial computed tomography scan showed an acute subdural hematoma. Surgical evacuation was followed by rapid deterioration, leading to multiple RSH and brain stem infarctions. Unfortunately, the patient did not survive. RSH poses significant morbidity and mortality risks. Potential factors include volume loss, dural opening, and blood pressure fluctuations. Management ranges from conservative approaches to surgery, with poor prognosis post-RSH intervention. This case highlights the need for thorough preoperative assessment and careful intraoperative management. It emphasizes the complexities of neurosurgery and underscores the importance of ongoing research for managing rare complications like RSH, ultimately improving patient outcomes.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993156","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}
Abstract Treatment of giant basilar aneurysm presents a major treatment challenge, especially in the pediatric population. Morbidity and mortality approach 80 and 30%, respectively. Both reconstructive and deconstructive techniques are associated with high rates of complete occlusion and good neurological outcomes. We report a 14-year-old male with a giant basilar trunk aneurysm treated with an endovascular approach. Clinical symptoms began following an ischemic stroke 2 weeks prior to admission. Endovascular treatment was performed through a reconstructive technique by single flow diverter device (FDD) in the basilar artery; however, this technique failed. At 1-year follow-up, without additional endovascular treatment, the mid-basilar artery and aneurysm were occluded, with vertebrobasilar flow maintained through collaterals from the right posterior communicating artery. We present a challenging management of giant basilar aneurysm in a pediatric patient experiencing a failure of FDD deployment; however, we highlight the importance of collateral flow development in progressive occlusions.
{"title":"Failure of Reconstructive Technique to Repair a Giant Intracranial Fusiform Aneurysm of the Basilar Artery: Case Report and Literature Review in the Pediatric Population","authors":"Frank G. Solis, Mauro Toledo, Rosa L. Ecos","doi":"10.1055/s-0043-1776020","DOIUrl":"https://doi.org/10.1055/s-0043-1776020","url":null,"abstract":"Abstract Treatment of giant basilar aneurysm presents a major treatment challenge, especially in the pediatric population. Morbidity and mortality approach 80 and 30%, respectively. Both reconstructive and deconstructive techniques are associated with high rates of complete occlusion and good neurological outcomes. We report a 14-year-old male with a giant basilar trunk aneurysm treated with an endovascular approach. Clinical symptoms began following an ischemic stroke 2 weeks prior to admission. Endovascular treatment was performed through a reconstructive technique by single flow diverter device (FDD) in the basilar artery; however, this technique failed. At 1-year follow-up, without additional endovascular treatment, the mid-basilar artery and aneurysm were occluded, with vertebrobasilar flow maintained through collaterals from the right posterior communicating artery. We present a challenging management of giant basilar aneurysm in a pediatric patient experiencing a failure of FDD deployment; however, we highlight the importance of collateral flow development in progressive occlusions.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135992998","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}
Praveen M. Ganigi, Arijit Chakraborty, K.M. Bopanna, Sathwik R. Shetty
Abstract Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon tumors that rarely occur in the orbit. Malignant orbital tumors are always a challenge to remove completely. We present the case of a 42-year man with painful movement of the left eye and restriction of adduction of the left eye causing double vision. Magnetic resonance imaging (MRI) of the brain/orbit revealed intraconal tumor located inferomedial to the optic nerve. The imaging features were suggestive of schwannoma or cavernoma. Gross total resection of the tumor was done with an endoscopic endonasal intraconal approach. The histopathology revealed an MPNST. The patient received adjuvant radiotherapy and chemotherapy. His left eye adduction recovered completely and he had no local recurrence or systemic metastasis on follow-up evaluation.
{"title":"Endoscopic Endonasal Approach to Orbital Malignant Peripheral Nerve Sheath Tumor: A Minimally Invasive Method for Rare Orbital Tumor—Case Report and Review of Literature","authors":"Praveen M. Ganigi, Arijit Chakraborty, K.M. Bopanna, Sathwik R. Shetty","doi":"10.1055/s-0043-1775973","DOIUrl":"https://doi.org/10.1055/s-0043-1775973","url":null,"abstract":"Abstract Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon tumors that rarely occur in the orbit. Malignant orbital tumors are always a challenge to remove completely. We present the case of a 42-year man with painful movement of the left eye and restriction of adduction of the left eye causing double vision. Magnetic resonance imaging (MRI) of the brain/orbit revealed intraconal tumor located inferomedial to the optic nerve. The imaging features were suggestive of schwannoma or cavernoma. Gross total resection of the tumor was done with an endoscopic endonasal intraconal approach. The histopathology revealed an MPNST. The patient received adjuvant radiotherapy and chemotherapy. His left eye adduction recovered completely and he had no local recurrence or systemic metastasis on follow-up evaluation.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135992997","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}
Manoranjitha Kumari M, T.P. Jeyaselva Senthilkumar, Yamunadevi Ravi
Abstract Aim The aim of this study was to evaluate various prognostic factors and their impact on the outcome of patients with bifrontal brain contusions and to define the critical volume of bifrontal brain contusions and to advice early surgery Materials and Methods This is a prospective study performed with 250 patients admitted in a tertiary care hospital in Chennai. Observations and Results In this study, we have studied the various findings in computed tomography (CT) scan brain that haves influence over the outcome. These are: Bilateral squashing of frontal horn, Posterior shift of genu, The deformation of third ventricle, The complete obliteration of basal cisterns, 5. Development of delayed intracranial hemorrhage (ICH). All these factors are associated with worst outcome and in patients those developed delayed increase in contusion volume, the median volume of contusion at the admission time ranged from 22 to 32 mL and the mean being 27 mL, we recommend prophylactic surgery in this subset of patients to prevent them from developing rapid deterioration in Glasgow coma scale (GCS) due to delayed ICH. Conclusion Critical volume of bilateral frontal contusion that warrants prophylactic surgical intervention irrespective of the admission GCS is 27 mL. Younger age and good admission GCS are independent predictors for better outcome. Patients with volume of contusion more than 50 mL are always associated with unfavorable outcome. Bilateral frontal horn squashing, anteroposterior shift of genu of corpus callosum, deformation of third ventricle, and obliteration of basal cisterns are CT predictors for poor outcome in bifrontal brain contusions.
{"title":"A Study to Evaluate Prognostic Factors and Define a Critical Volume for Early Surgery in Patients with Bifrontal Brain Contusions","authors":"Manoranjitha Kumari M, T.P. Jeyaselva Senthilkumar, Yamunadevi Ravi","doi":"10.1055/s-0043-1774813","DOIUrl":"https://doi.org/10.1055/s-0043-1774813","url":null,"abstract":"Abstract Aim The aim of this study was to evaluate various prognostic factors and their impact on the outcome of patients with bifrontal brain contusions and to define the critical volume of bifrontal brain contusions and to advice early surgery Materials and Methods This is a prospective study performed with 250 patients admitted in a tertiary care hospital in Chennai. Observations and Results In this study, we have studied the various findings in computed tomography (CT) scan brain that haves influence over the outcome. These are: Bilateral squashing of frontal horn, Posterior shift of genu, The deformation of third ventricle, The complete obliteration of basal cisterns, 5. Development of delayed intracranial hemorrhage (ICH). All these factors are associated with worst outcome and in patients those developed delayed increase in contusion volume, the median volume of contusion at the admission time ranged from 22 to 32 mL and the mean being 27 mL, we recommend prophylactic surgery in this subset of patients to prevent them from developing rapid deterioration in Glasgow coma scale (GCS) due to delayed ICH. Conclusion Critical volume of bilateral frontal contusion that warrants prophylactic surgical intervention irrespective of the admission GCS is 27 mL. Younger age and good admission GCS are independent predictors for better outcome. Patients with volume of contusion more than 50 mL are always associated with unfavorable outcome. Bilateral frontal horn squashing, anteroposterior shift of genu of corpus callosum, deformation of third ventricle, and obliteration of basal cisterns are CT predictors for poor outcome in bifrontal brain contusions.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135967793","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}
Abstract There is an urgent need to develop a national program and allocation of resources to improve stroke care in India. Management of stroke requires a multidisciplinary approach and close collaboration not only among physicians from different specialties but also among paramedical personnel and patient transport services. Here we propose a healthcare model of providing acute stroke therapies to patients in central India to minimize the wide supply mismatch we face in providing adequate care to our patients. Observations and the proposed model presented below were based on personal experience and a review of the literature on stroke care available in central India.
{"title":"Proposed Model to Improve Acute Stroke Care in Central India","authors":"Pankaj Sharma","doi":"10.1055/s-0043-1771495","DOIUrl":"https://doi.org/10.1055/s-0043-1771495","url":null,"abstract":"Abstract There is an urgent need to develop a national program and allocation of resources to improve stroke care in India. Management of stroke requires a multidisciplinary approach and close collaboration not only among physicians from different specialties but also among paramedical personnel and patient transport services. Here we propose a healthcare model of providing acute stroke therapies to patients in central India to minimize the wide supply mismatch we face in providing adequate care to our patients. Observations and the proposed model presented below were based on personal experience and a review of the literature on stroke care available in central India.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86195575","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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