Radiolological predictors of recurrence of chronic subdural hematoma

Objective: Chronic subdural hematoma is one of the most common clinical entities encountered in daily neurosurgical practice. Considerable recurrence rates have been reported for chronic subdural hematoma following surgical evacuation. Many studies have suggested various radiological factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. This study focuses on determining the radiological factors predictive of chronic subdural hematoma recurrence

Methods: A retrospective analysis of 113 patients diagnosed with chronic subdural hematoma who were surgically treated between August 2013 and December 2014 was performed. The radiological features were analyzed to clarify the correlation between these radiological factors and postoperative recurrence of chronic subdural hematoma

Results: Twenty patients [17.7%] experienced recurrence. Chronic subdural hematoma recurrence was found to be significantly associated [p<0.05] with preoperative hematoma thickness >/= 20 mm. Midline shift, hematoma density and bilaterality were not significantly associated with recurrence. Post operative drainage also significantly [p<0.05] reduced chronic subdural hematoma recurrence

Conclusion: Preoperative hematoma thickness >/= 20 mm is an independent predictor of recurrence of chronic subdural hematoma. Postoperative drainage also significantly reduces chronic subdural hematoma recurrence

Management of cerebrospinal fluid leak following posterior cranial fossa surgery

Objective: Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management

Methods: A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn't stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP [ventriculo-peritoneal] shunt was done in patients with gross hydrocephalus on postoperative CT brain

Results: There were 25 [17%] cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated [p=0.003] with the stoppage of CSF leakage, and the settlement of meningitis [p= 0.014]

Conclusion: Incisional CSF leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant CSF lumbar drainage, instead of an initial trial of conservative therapy alone

Anterior cervical reconstruction using titanium mesh cages

Surgical management of cervical lesions with reconstruction procedures has remarkably expanded the options available in the last decade. Anterior cervical corpectomy with titanium mesh reconstruction is one of the effective method of cervical spine reconstruction. We studied 17 consecutive cases in who corpectomy and decompression was performed. Fusion with titanium mesh cages filled with local bone pieces were placed inside the cage. Clinical status improved in 13 patients whereas in 3 it remained unchanged, based on Nurick's classification. At 3 months follow up, 13 [76.4%] patients reported successful arm pain relief and 12 [70.5%] with neck pain relief with visual analog score below five. Complications included cage in kyphosis, radiculopathy, cage subsidence and wound infection. Outcome after cervical fusion procedures with a titanium mesh cage lead to early and good stability of the cervical spine, excellent neurological improvement, low risk of complication and rare need for endogenous bone graft harvest avoiding donor site morbidity, less postoperative pain and decreased hospital stay and cost

Traumatic basal ganglia haemorrhage

Traumatic Basal Ganglia Haemorrhage [TBGH] is a relatively rare lesion seen in traffic accidents. Traumatic Basal Ganglia Haemorrhage is probably secondary to shifting of the brain as a result of acceleration or deceleration forces. The purpose of the study was to asses outcome of TBGH cases managed conservatively among head injury patients at our hospital and compare with other studies. We studied 16 patients with TBGH diagnosed on Plain CT Scan done on admission between Jan 2000 to Dec 2002. All patients were treated conservatively. We evaluated outcome in these patients. Consciousness became clear in all patients. Expressive and nonfluent aphasia occurred in 6 patients, weakness of opposite side was observed on 10 patients. Good recovery was seen in 11 patients and 4 had moderate disability. In TBGH a good outcome was observed

Traumatic fronto basal cerebrospinal fluid fistula; neurosurgical treatment

CSF rhinorhoea is one of the complications of head injury which should initially be managed conservatively and on failure surgical intervention is m and atory to prevent life threatening meningitis.In the present study we analyzed 75 cases of CSF rhinorrhoea from Jan 1998 to Jan 2002 secondary to head injury. There were 61 males and 14 females with an average of 35 years. CT and MRI were the main diagnostic modalities used for the investigation of the site of fistula. Twenty two patients were operated. Surgical treatment consisted of intra cranial approach. Spontaneous closure of the fistula was observed in 53 patients with conservative management. In 22 patients surgical intervention was required. Post operative closure of the CSF fistula was seen in 91% of cases with minimal morbidity. Intra cranial approach is effective, safe and intra cranial traumatic pathologies can be dealt along with the CSF fistula

Diagnostic yield of computerized tomography assisted stereotactic biopsy of gliomas

Twenty one patients underwent computerized tomography guided stereotactic biopsy procedures for untreated gliomas. Biopsies were taken from hypodense centre and enhancing margin as seen on contrast enhanced computerized tomographic scan with diagnostic yields of [number of biopsies yielding tumour / number of biopsies obtained] 14:21 [67%] and 18:21 [86%] from the two zones respectively. Although tumour was identified in both the zones but yield was higher in the enhancing margin. These findings suggest that stereotactic biopsies should be targeted at enhancing margin for improved diagnostic yield

Sterotactic biopsy of brain tumours

Computerized tomography assisted Stereotactic biopsy technique using Leksell stereotactic frame was performed on 27 patients with small, multiple and deep seated brain tumours. There were 19 men and 8 women with an age range from 17 to 65 years. Histological diagnosis of 18 glial tumours, 9 non-glial tumours [5 colloid cysts, 4 metastatic lesions] was obtained. There was no mortality and minimal morbidity of 3.7%, histological diagnosis provided the information regarding differentiation from infectious and vascular lesions and grading of malignancy leading to logical guidance for therapeutic management of each lesion, confirming the value of stereotactic biopsy in brain tumours

Acoustic neurinoma surgery; can facial nerve be saved?

In a prospective study at Lahore general and Nishter hospital Multan thirty five cases of acoustic neurinoma were treated over 5 years. Duration of symptoms was between 3 months to 2 years. At presentation 20 patients had involvement of facial nerve. This involvement was of lower motor neurone type. Radiological investigations performed were CT scan in 29 cases and MR in 6 cases. Twenty five patients had Tumour bigger than 5 cm. There was no patient with tumour smaller than 3 cm. The cases were operated upon in parkbench position. Retrosigmoid subocciptal craniectomy was done and tumour was dissected under magnification by operative microscope. Preoperatively it was not possible to identify the nerve in 20 and it was anatomically preserved but deformed [flattened and very flimsy] in 14 patients and normal looking facial nerve was seen in 1 patient only. Postoperatively there was complete nerve deficit which did not improve after 4 years of follow-up

Stereotactic management of colloid cysts of 3rd ventricle

Stereotactic aspiration is a valuable surgical alternative for colloid cysts. From Oct 1994 to Oct 1995, 5 patients had computerized tomography-guided Stereotactic removal of colloid, cysts. Leksell CT compatible stereotactic frame was used with complete removal in 2 and partial removal in 3 cases. Volume of colloid material removed ranged from 3-6 ml. Average time spent in hospital was 7 days. No mortality and minimal morbidity was seen. There is no evidence of recurrence in average follow up of 8 months. Stereotactic removal of colloid cysts is safe and provides a new option for management of colloid cysts