ABSTRACT
Background: Spontaneous intracerebral haemorrhage (ICH) is associated with the high mortality among cerebrovascular events, and most of the survivors end with significant morbidity. Spontaneous intracerebral haemorrhage (ICH) is the second most common cause of stroke comprising 7.5-30% of all strokes. Surgery mainly helps in decrease in secondary injury and early rehabilitation. Aim: To analyse the outcome and advantages of minimal invasive surgery i.e., burr hole or twist drill craniostomy with intraclot streptokinase injection to dissolve clot and aspiration to reduce mass effect in primary intracerebral hematoma, this help to prevent secondary injury and recovery of salvageable brain. Materials and methods: Prospective study was done over from November 2014 to January 2017 in our department for the patients of spontaneous large intra cerebral hematoma > 80ml who underwent clot evacuation with fibrinolytic therapy with minimally invasive procedure with twist drill burr hole. Total 62 patients were included in the study. All the patients were followed with CT sequential scans to see for the clot size and followed with clinical status. Karla Ravi, Nandigama Pratap Kumar, Ginjupally Dhanunjaya Rao, Savarapu Sai Kalyan, Gollapudi Prakash Rao. Management of spontaneous large intra cerebral hematoma with minimal invasive procedure (twist drill burr hole) with fibrinolytic therapy. IAIM, 2017; 4(11): 229-240. Page 230 Results: Our analysis of 62 patients was consistent with the hypothesis that hematoma evacuation leads to improved neurological outcome, the outcome has been correlated with the rate of clot reduction. Conclusion: Minimally invasive surgery is a safe and effective option in the management of spontaneous ICH especially in the patients whom major surgical procedures pose a significant risk. MIS is associated with lower mortality and better outcomes compared to surgical evacuation or conservative management. Our study have clearly shown an improved outcome after minimally invasive surgery and still there is some emptiness to determine the exact protocol to insist these type of studies to deal with bed occupancy and a burden to the society.
ABSTRACT
Background: Spondylolisthesis is defined as a displacement of one vertebra over the next lower vertebra in the sagittal plane. High-grade spondylolisthesis (HGS) is defined as greater than 50% slippage of a spinal vertebral body relative to an adjacent vertebral body as per Meyerding classification, and most common location being L5/S1 followed by L4/L5. The treatment of symptomatic high grade lumbo sacral spondylolisthesis has its own technical difficulties for surgical stabilization and fusion unlike low grade listhesis. We used single transvertebral fibular graft and implant stabilization to the vertebra one level above the pathological vertebra via posterior approach to treat the high grade spondylolisthesis of lumbo sacral spine. Materials and methods: Prospective study done from January 2012 to January 2016 for the management of High grade spondylolisthesis (Grade 3 and Grade 4), patient aged between 15-60 years. Total 15 patients were included in the study. High grade listhesis patients who were not willing for surgery were excluded from the study. All the patients were operated posteriorly with pedicle screw and rod stabilization with trans vertebral single fibular graft with posterolateral fusion was done under fluoroscopic guidance Results: Preoperative and post-operative status was analyzed in reference to the clinical symptoms and radiological evaluation. All the patients showed improvement following surgery without any implant failure. Conclusion: This procedure is technically simple, safe and effective method to treat high grade listhesis with no additional peri operative or postoperative complications.