Abstract Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH). Background IPH in the presence or absence of intraventricular hemorrhage has severe morbidity and has almost 50% mortality whether the patient is managed surgically or medically. Development of minimally invasive surgical techniques offers better outcomes but requires the use of special instruments and a unique skill set that is costly and requires special training. Method We inserted infant feeding tube within the hematoma via the left Kocher's burr hole. We instilled 40,000 IU of urokinase serially at an 8 hours interval for 3 days to evacuate the left gangliocapsular hematoma. Result We have treated a 50 years old hypertensive male patient with left gangliocapsular IPH and right hemiparesis (power: ⅖ on admission). After a month, on follow-up, the patient was conscious and oriented with improved right hemiparesis (power: ⅘). Conclusion This technique of evacuating hematoma is instrumental in peripheral centers in developing as well as under-developed countries where there are limited resources and a better outcome is expected with minimal morbidity.
{"title":"Minimally Invasive Technique for Spontaneous Intraparenchymal Hemorrhage","authors":"Himanshu Raval, Kalpesh Shah, Mona Bhatt","doi":"10.1055/s-0043-1761427","DOIUrl":"https://doi.org/10.1055/s-0043-1761427","url":null,"abstract":"Abstract Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH). Background IPH in the presence or absence of intraventricular hemorrhage has severe morbidity and has almost 50% mortality whether the patient is managed surgically or medically. Development of minimally invasive surgical techniques offers better outcomes but requires the use of special instruments and a unique skill set that is costly and requires special training. Method We inserted infant feeding tube within the hematoma via the left Kocher's burr hole. We instilled 40,000 IU of urokinase serially at an 8 hours interval for 3 days to evacuate the left gangliocapsular hematoma. Result We have treated a 50 years old hypertensive male patient with left gangliocapsular IPH and right hemiparesis (power: ⅖ on admission). After a month, on follow-up, the patient was conscious and oriented with improved right hemiparesis (power: ⅘). Conclusion This technique of evacuating hematoma is instrumental in peripheral centers in developing as well as under-developed countries where there are limited resources and a better outcome is expected with minimal morbidity.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"78 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82492233","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}
Yatendra Shukla, P. Sundaram, Jinendrakumar Ramalingam, J. D. Costa, Ameya Parab, Subhash Jakhar, G. Chauhan, R. Bharti
Abstract Objective Decompressive craniectomy (DC) is an urgent procedure which is done to decrease intracranial pressure. A study of the complications would suggest measures to improve the care. This study was focused on analyzing the complications after cranioplasty (CP) and to identify risk factors that may be associated with the failure of the procedure. Method : This study was conducted over 41 months at level-1 trauma center and medical college. It included patients undergoing CP for a defect arising out of previous DC or inability to replace the bone flap (Glasgow Coma Scale > 13, size > 5 cm, without surgical site infection). All patients underwent CT imaging before and after the procedure. The CP technique largely depended on the patients, based on the cost of prosthesis and availability. Result : Hundred patients were included in the study. Postoperatively, total 22 patients suffered complications of which few had more than one complication. Titanium implant appeared to be a better implant, with no complication ( p < 0.05). Complication was common in younger age group, chemically cured PMMA (polymethyl methacrylate) and ethylene oxide) sterilized bone flap). Complications were higher among patients with multiple comorbidity and stroke patients. Conclusion : Titanium flap had no complication and in case of autologous abdominal subcutaneous flap, apart from bone flap absorption, patients had no major complication. Therefore, both implants are preferred implants for CP. Heat-cured PMMA can be used in case of nonavailability of a better option, as it is economical feasible and can be molded at any dental lab.
{"title":"Complications of Different Types of Cranioplasty and Identification of Risk Factors Associated with Cranioplasty at a Tertiary Care Centre: A Prospective Observational Study","authors":"Yatendra Shukla, P. Sundaram, Jinendrakumar Ramalingam, J. D. Costa, Ameya Parab, Subhash Jakhar, G. Chauhan, R. Bharti","doi":"10.1055/s-0043-1761603","DOIUrl":"https://doi.org/10.1055/s-0043-1761603","url":null,"abstract":"Abstract Objective Decompressive craniectomy (DC) is an urgent procedure which is done to decrease intracranial pressure. A study of the complications would suggest measures to improve the care. This study was focused on analyzing the complications after cranioplasty (CP) and to identify risk factors that may be associated with the failure of the procedure. Method : This study was conducted over 41 months at level-1 trauma center and medical college. It included patients undergoing CP for a defect arising out of previous DC or inability to replace the bone flap (Glasgow Coma Scale > 13, size > 5 cm, without surgical site infection). All patients underwent CT imaging before and after the procedure. The CP technique largely depended on the patients, based on the cost of prosthesis and availability. Result : Hundred patients were included in the study. Postoperatively, total 22 patients suffered complications of which few had more than one complication. Titanium implant appeared to be a better implant, with no complication ( p < 0.05). Complication was common in younger age group, chemically cured PMMA (polymethyl methacrylate) and ethylene oxide) sterilized bone flap). Complications were higher among patients with multiple comorbidity and stroke patients. Conclusion : Titanium flap had no complication and in case of autologous abdominal subcutaneous flap, apart from bone flap absorption, patients had no major complication. Therefore, both implants are preferred implants for CP. Heat-cured PMMA can be used in case of nonavailability of a better option, as it is economical feasible and can be molded at any dental lab.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"136 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78543410","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. Waghralkar, P. Ojha, G. Goel, A. Banerjee, A. Mahajan
Abstract Pseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA.
{"title":"Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization","authors":"M. Waghralkar, P. Ojha, G. Goel, A. Banerjee, A. Mahajan","doi":"10.1055/s-0043-1761602","DOIUrl":"https://doi.org/10.1055/s-0043-1761602","url":null,"abstract":"Abstract Pseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"79 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73708861","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. Saranraj, K. Giridharan, Sudhakshina Nathan, Nadasha M. Babu, M. Balamurugan
Abstract Introduction Spontaneous intracranial hypotension (SIH) is a misdiagnosed condition characterized by low cerebrospinal fluid (CSF) volume and an orthostatic headache that worsens with upright posture due to CSF leak at spinal dural defects. SIH due to CSF leak at multiple spinal levels is a rare condition, and only a few cases have been reported in the literature. Here, we report a case of SIH with a CSF leak at multiple spinal levels. The treatment options and efficacy of epidural blood patch (EBP) injection were discussed in this article. Case Report A 36-year-old man presented with complaints of orthostatic headache for 2 months and a computed tomography myelogram demonstrated CSF leaks at multiple spinal levels through the dural defects at C5-C6, C6-C7, C7-T1, T1-T2 levels, and at L1, L2, L3, and L4 vertebral levels on the left side. He was managed with a targeted EBP injection and he improved symptomatically within 24 hours of the EBP injection. Summary SIH is an entity that results from CSF leakage, often through spinal dural defects due to mechanical tear by osteophyte complex, disc prolapse, connective tissue disorders, CSF-venous fistula, and leaking meningeal diverticula. SIH can result from single or multiple dural leaks, but spinal leaks at multiple levels are uncommon. To the best of our knowledge, a total number of 163 cases have been reported in the literature so far. With good success rates, targeted EBP injection with autologous blood is an effective treatment option for both single-level and multiple-level spinal leaks.
{"title":"Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review","authors":"M. Saranraj, K. Giridharan, Sudhakshina Nathan, Nadasha M. Babu, M. Balamurugan","doi":"10.1055/s-0043-1761428","DOIUrl":"https://doi.org/10.1055/s-0043-1761428","url":null,"abstract":"Abstract Introduction Spontaneous intracranial hypotension (SIH) is a misdiagnosed condition characterized by low cerebrospinal fluid (CSF) volume and an orthostatic headache that worsens with upright posture due to CSF leak at spinal dural defects. SIH due to CSF leak at multiple spinal levels is a rare condition, and only a few cases have been reported in the literature. Here, we report a case of SIH with a CSF leak at multiple spinal levels. The treatment options and efficacy of epidural blood patch (EBP) injection were discussed in this article. Case Report A 36-year-old man presented with complaints of orthostatic headache for 2 months and a computed tomography myelogram demonstrated CSF leaks at multiple spinal levels through the dural defects at C5-C6, C6-C7, C7-T1, T1-T2 levels, and at L1, L2, L3, and L4 vertebral levels on the left side. He was managed with a targeted EBP injection and he improved symptomatically within 24 hours of the EBP injection. Summary SIH is an entity that results from CSF leakage, often through spinal dural defects due to mechanical tear by osteophyte complex, disc prolapse, connective tissue disorders, CSF-venous fistula, and leaking meningeal diverticula. SIH can result from single or multiple dural leaks, but spinal leaks at multiple levels are uncommon. To the best of our knowledge, a total number of 163 cases have been reported in the literature so far. With good success rates, targeted EBP injection with autologous blood is an effective treatment option for both single-level and multiple-level spinal leaks.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"4018 3 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86707745","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. Bauer, Matthew C. Findlay, Majid Khan, H. Alexander, B. Lucke-Wold, Forrest Hamrick, Joshua C. Hunsaker, W. Couldwell, M. Karsy
Abstract Background Frailty is increasingly recognized as a predictor of surgical outcomes; however, its utility in anterior cranial fossa (ACF) surgery remains unclear. We analyzed whether age and frailty are independent predictors of outcomes after ACF surgery using a retrospective cohort study. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried, by Current Procedural Terminology codes, for ACF procedures in 2005 to 2020. Cases included open approaches, endoscopic approaches, and all tumor types except for pituitary adenoma. A propensity score–matched data set was analyzed via multiple logistic regression. Results Unmatched multivariate analysis of ACF cases demonstrated that severe frailty (modified 5-item frailty index [mFI-5] ≥ 3) was independently associated with having any (odds ratio [OR] = 3.67) and minor (OR = 5.00) complications (both p < 0.001). Analysis of individual mFI-5 components demonstrated poor functional status was significantly associated with any (OR = 3.39), major (OR = 3.59), and minor (OR = 3.14) complications (all p < 0.001). After propensity score matching, only age was modestly impactful on minor complications (OR = 1.02) and extended length of stay (eLOS) (OR = 1.02) ( p < 0.001). Frailty did not maintain its predictive ability after matching. Nonindependent functional status, as a subcomponent of mFI maintained significant predictive ability for any (OR = 4.94), major (OR = 4.68), and minor (OR = 4.80) complications and eLOS (OR = 2.92) (all p < 0.001). Conclusion After propensity score matching, age demonstrated a greater ability to predict postoperative complications in ACF surgery than frailty. Rather than age or frailty, functional status served as a better outcome predictor and potential guide for patient counseling. Further validation of these findings in multicenter or disease-specific studies is warranted as well as aims to preoperatively improve functional status in ACF surgery.
{"title":"Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database","authors":"S. Bauer, Matthew C. Findlay, Majid Khan, H. Alexander, B. Lucke-Wold, Forrest Hamrick, Joshua C. Hunsaker, W. Couldwell, M. Karsy","doi":"10.1055/s-0043-1770908","DOIUrl":"https://doi.org/10.1055/s-0043-1770908","url":null,"abstract":"Abstract Background Frailty is increasingly recognized as a predictor of surgical outcomes; however, its utility in anterior cranial fossa (ACF) surgery remains unclear. We analyzed whether age and frailty are independent predictors of outcomes after ACF surgery using a retrospective cohort study. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried, by Current Procedural Terminology codes, for ACF procedures in 2005 to 2020. Cases included open approaches, endoscopic approaches, and all tumor types except for pituitary adenoma. A propensity score–matched data set was analyzed via multiple logistic regression. Results Unmatched multivariate analysis of ACF cases demonstrated that severe frailty (modified 5-item frailty index [mFI-5] ≥ 3) was independently associated with having any (odds ratio [OR] = 3.67) and minor (OR = 5.00) complications (both p < 0.001). Analysis of individual mFI-5 components demonstrated poor functional status was significantly associated with any (OR = 3.39), major (OR = 3.59), and minor (OR = 3.14) complications (all p < 0.001). After propensity score matching, only age was modestly impactful on minor complications (OR = 1.02) and extended length of stay (eLOS) (OR = 1.02) ( p < 0.001). Frailty did not maintain its predictive ability after matching. Nonindependent functional status, as a subcomponent of mFI maintained significant predictive ability for any (OR = 4.94), major (OR = 4.68), and minor (OR = 4.80) complications and eLOS (OR = 2.92) (all p < 0.001). Conclusion After propensity score matching, age demonstrated a greater ability to predict postoperative complications in ACF surgery than frailty. Rather than age or frailty, functional status served as a better outcome predictor and potential guide for patient counseling. Further validation of these findings in multicenter or disease-specific studies is warranted as well as aims to preoperatively improve functional status in ACF surgery.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"34 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88450658","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}
B. Pai, Sandesh Khandelwal, Vishwanath Narayana, Nagarjun Maulyavantham Nagaraj
Abstract Context Over the last two decades, there have been development of approaches that are minimally invasive but achieve maximum effective results with minimal morbidity. The supraorbital keyhole approach (SOKHA) through the transciliary incision is minimally invasive approach that permits effective management of skull base lesions with minimal injury to the soft tissue and surrounding brain. Aims The aim of this study was to evaluate the efficacy and safety of SOKHA for skull base lesions. Settings and Design This is a prospective study in a tertiary neurosurgical teaching institute in a metropolitan city. Materials and Methods Twenty-one patients of various pathology were operated using the SOKHA through the “eye-brow incision.” The pathologies included pituitary adenoma, craniopharyngioma, epidermoid, tuberculum sella, and planum sphenoidale meningioma. The authors describe in detail the surgical approach employed by them for these various pathologies. Results All neoplastic lesions in this series could be addressed effectively with near total or total excision. No fresh postoperative deficits were noted except a case who developed ipsilateral anterior cerebral artery infarction that resulted in lower limb weakness. One patient developed postoperative abscess requiring surgical excision. At follow-up, all patients revealed a cosmetic scar hidden by the eye brow. Conclusions The SOKHA is an effective minimally invasive procedure with proven safety for the management of anterior, selected middle skull base lesions and to provide excellent cosmesis with minimal trauma to the adjacent brain. The authors, however, feel that it is technically demanding and surgeons should employ a stepwise progression from simple to more complex lesions.
{"title":"Supraorbital Keyhole Approach—A Minimally Invasive Versatile Approach to Skull Base Lesions","authors":"B. Pai, Sandesh Khandelwal, Vishwanath Narayana, Nagarjun Maulyavantham Nagaraj","doi":"10.1055/s-0042-1758799","DOIUrl":"https://doi.org/10.1055/s-0042-1758799","url":null,"abstract":"Abstract Context Over the last two decades, there have been development of approaches that are minimally invasive but achieve maximum effective results with minimal morbidity. The supraorbital keyhole approach (SOKHA) through the transciliary incision is minimally invasive approach that permits effective management of skull base lesions with minimal injury to the soft tissue and surrounding brain. Aims The aim of this study was to evaluate the efficacy and safety of SOKHA for skull base lesions. Settings and Design This is a prospective study in a tertiary neurosurgical teaching institute in a metropolitan city. Materials and Methods Twenty-one patients of various pathology were operated using the SOKHA through the “eye-brow incision.” The pathologies included pituitary adenoma, craniopharyngioma, epidermoid, tuberculum sella, and planum sphenoidale meningioma. The authors describe in detail the surgical approach employed by them for these various pathologies. Results All neoplastic lesions in this series could be addressed effectively with near total or total excision. No fresh postoperative deficits were noted except a case who developed ipsilateral anterior cerebral artery infarction that resulted in lower limb weakness. One patient developed postoperative abscess requiring surgical excision. At follow-up, all patients revealed a cosmetic scar hidden by the eye brow. Conclusions The SOKHA is an effective minimally invasive procedure with proven safety for the management of anterior, selected middle skull base lesions and to provide excellent cosmesis with minimal trauma to the adjacent brain. The authors, however, feel that it is technically demanding and surgeons should employ a stepwise progression from simple to more complex lesions.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"101 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79366274","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}
Kirit Arumalla, N. Mohammed, D. Bhat, D. Shukla, B. Devi
Abstract Introduction The thecoperitoneal shunt is a modality of cerebrospinal fluid (CSF) diversion used to treat various clinical conditions such as idiopathic intracranial hypertension (IIH), normal pressure hydrocephalus (NPH), and CSF leaks. There is a wide variability in the data regarding the utility and complications associated with it. We thus reviewed the outcomes and complications of the shunt done in our setting. Methodology The study is a retrospective review of all the thecoperitoneal shunts performed at NIMHANS (National Institute of Mental Health and Neurosciences) from January 2000 to December 2020. The demographic details, clinical profile, indications for the shunt, magnetic resonance imaging, follow-up and complications, and shunt revisions were collected and analyzed. Results Three-hundred twelve patients underwent shunt primarily at our institute. The mean follow-up of the patients was 5.2 years. The indications include pseudomeningocele in 31.4%, CSF leak from surgical site in 25.3%, IIH in 17.6%, and NPH in 7.3% patients. The shunt was more effective in pseudomeningocele in up to 95% and CSF leaks in 91% compared to 64‰ in IIH, though it is not significant ( p > 0.05). The complication rate was 17% that included shunt block, wound CSF leak, infection, and subdural hygromas. The shunt malfunction was seen in 14.69% patients who underwent revision. Conclusion Thecoperitoneal shunt is a useful treatment option for various pathologies including IIH, NPH, and wound CSF leaks. They have good clinical outcomes and acceptable revision rates especially in conditions with slit ventricle. The complications such as low-pressure headache can be overcome by using adjuncts as programmable valve or antisiphon device.
{"title":"Thecoperitoneal Shunts—Our 20 Years Experience","authors":"Kirit Arumalla, N. Mohammed, D. Bhat, D. Shukla, B. Devi","doi":"10.1055/s-0042-1758777","DOIUrl":"https://doi.org/10.1055/s-0042-1758777","url":null,"abstract":"Abstract Introduction The thecoperitoneal shunt is a modality of cerebrospinal fluid (CSF) diversion used to treat various clinical conditions such as idiopathic intracranial hypertension (IIH), normal pressure hydrocephalus (NPH), and CSF leaks. There is a wide variability in the data regarding the utility and complications associated with it. We thus reviewed the outcomes and complications of the shunt done in our setting. Methodology The study is a retrospective review of all the thecoperitoneal shunts performed at NIMHANS (National Institute of Mental Health and Neurosciences) from January 2000 to December 2020. The demographic details, clinical profile, indications for the shunt, magnetic resonance imaging, follow-up and complications, and shunt revisions were collected and analyzed. Results Three-hundred twelve patients underwent shunt primarily at our institute. The mean follow-up of the patients was 5.2 years. The indications include pseudomeningocele in 31.4%, CSF leak from surgical site in 25.3%, IIH in 17.6%, and NPH in 7.3% patients. The shunt was more effective in pseudomeningocele in up to 95% and CSF leaks in 91% compared to 64‰ in IIH, though it is not significant ( p > 0.05). The complication rate was 17% that included shunt block, wound CSF leak, infection, and subdural hygromas. The shunt malfunction was seen in 14.69% patients who underwent revision. Conclusion Thecoperitoneal shunt is a useful treatment option for various pathologies including IIH, NPH, and wound CSF leaks. They have good clinical outcomes and acceptable revision rates especially in conditions with slit ventricle. The complications such as low-pressure headache can be overcome by using adjuncts as programmable valve or antisiphon device.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"74 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A male in his early 30s presented with a swelling just below the angle of his left mandible for the last 2 months. The swelling had insidious onset, progressive and painless. Examination found 4 4cm, diffuse, soft to firm, pulsatile swelling in the upper part of the neck on left side (►Fig. 1). An oral examination revealed left hypoglossal nerve paralysis. Further examination was noncontributory, including vagus and accessory spinal nerve examination. A probable diagnosis of carotid body tumor was kept, and the patient was subjected to computerized angiography. Angiography revealed dural arteriovenous fistula (DAVF), a rare clinical entity leading to hypoglossal nerve paralysis (►Figs. 2 (A, B)). Patient was advised to undergo digital subtraction angiography for further management, but he refused and chose conservative care with regular follow-up.
{"title":"Dural Arteriovenous Fistula with Hypoglossal Nerve Paralysis","authors":"N. Thakur, Sarita Negi, J. Thakur, S. Thakur","doi":"10.1055/s-0042-1758661","DOIUrl":"https://doi.org/10.1055/s-0042-1758661","url":null,"abstract":"A male in his early 30s presented with a swelling just below the angle of his left mandible for the last 2 months. The swelling had insidious onset, progressive and painless. Examination found 4 4cm, diffuse, soft to firm, pulsatile swelling in the upper part of the neck on left side (►Fig. 1). An oral examination revealed left hypoglossal nerve paralysis. Further examination was noncontributory, including vagus and accessory spinal nerve examination. A probable diagnosis of carotid body tumor was kept, and the patient was subjected to computerized angiography. Angiography revealed dural arteriovenous fistula (DAVF), a rare clinical entity leading to hypoglossal nerve paralysis (►Figs. 2 (A, B)). Patient was advised to undergo digital subtraction angiography for further management, but he refused and chose conservative care with regular follow-up.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"138 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76120650","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}
Rajkumar Pannem, Ridham Ashokbhai Kanderia, R. Arora, R. Mittal
Abstract Tuberculosis (TB) is still one of the major health care problems in many developing countries. Among various forms of TB, central nervous system (CNS) TB causes significant morbidity and mortality. CNS TB can present in various forms: cerebritis, abscess, meningitis, tuberculoma, calcified granuloma, meningitis, or hydrocephalus. But subdural empyema is a very rare form of presentation. Very few cases have been reported till now in the literature. So, high level of suspicion, thorough microbiological and histological investigations to diagnosis, and early and timely inception of anti-TB medication are keys in its management. Here, we are presenting a case of tubercular subdural empyema that was successfully treated with surgical evacuation and anti-TB medication.
{"title":"Tubercular Subdural Empyema with Tubercular Abscess: Lessons Learnt","authors":"Rajkumar Pannem, Ridham Ashokbhai Kanderia, R. Arora, R. Mittal","doi":"10.1055/s-0042-1757207","DOIUrl":"https://doi.org/10.1055/s-0042-1757207","url":null,"abstract":"Abstract Tuberculosis (TB) is still one of the major health care problems in many developing countries. Among various forms of TB, central nervous system (CNS) TB causes significant morbidity and mortality. CNS TB can present in various forms: cerebritis, abscess, meningitis, tuberculoma, calcified granuloma, meningitis, or hydrocephalus. But subdural empyema is a very rare form of presentation. Very few cases have been reported till now in the literature. So, high level of suspicion, thorough microbiological and histological investigations to diagnosis, and early and timely inception of anti-TB medication are keys in its management. Here, we are presenting a case of tubercular subdural empyema that was successfully treated with surgical evacuation and anti-TB medication.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"27 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73924792","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}
Abhishek Katyal, Prakash Singh, Kavita Sandhu, V. Jain, B. Walia
The peritoneal cavity is widely used as the destination of choice for cerebrospinal fl uid (CSF) shunts. Various alternative distal sites have been used, particularly in the presence of certain contraindications, which include the cardiac atria, for ventriculoatrial (VA) shunt, or the pleural cavity for ventriculopleural (VPL) shunt. 1 Each procedure is associatedwith its own set ofcomplications and the choice of selection of the distal site of CSF drainage is often based on surgeon ’ s preference along with patient ’ s factors. 2 While the historical literature describes pleural effusion and pneumothorax as complications of a VPL shunt, there is paucity of data justifying the application of one technique over the other. We report a rare case of postoperative pneumothorax in a case of VPL shunt being further complicated by pneumocephalus. A 41-year-oldgentleman, who is a known case ofoperated grade II tectal plate glioma with hydrocephalus for which resection of glioma and ventriculoperitoneal (VP) shunt
{"title":"Intraventricular Pneumocephalus Complicating Pneumothorax in a Case of Ventriculopleural Shunt: A Rare Complication and Its Management","authors":"Abhishek Katyal, Prakash Singh, Kavita Sandhu, V. Jain, B. Walia","doi":"10.1055/s-0042-1759618","DOIUrl":"https://doi.org/10.1055/s-0042-1759618","url":null,"abstract":"The peritoneal cavity is widely used as the destination of choice for cerebrospinal fl uid (CSF) shunts. Various alternative distal sites have been used, particularly in the presence of certain contraindications, which include the cardiac atria, for ventriculoatrial (VA) shunt, or the pleural cavity for ventriculopleural (VPL) shunt. 1 Each procedure is associatedwith its own set ofcomplications and the choice of selection of the distal site of CSF drainage is often based on surgeon ’ s preference along with patient ’ s factors. 2 While the historical literature describes pleural effusion and pneumothorax as complications of a VPL shunt, there is paucity of data justifying the application of one technique over the other. We report a rare case of postoperative pneumothorax in a case of VPL shunt being further complicated by pneumocephalus. A 41-year-oldgentleman, who is a known case ofoperated grade II tectal plate glioma with hydrocephalus for which resection of glioma and ventriculoperitoneal (VP) shunt","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"119 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89866512","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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