Outcome in chronic subdural hematoma after subdural vs. subgaleal drain

Objective: To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space

Study Design: Quasi experimental study

Place and Duration of Study: Combined Military Hospital, Lahore, from July 2015 to June 2016

Methodology: Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space [Group 1], and subdual space [Group 2], [n=31 patients each]. Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p <0.05 was utilized using Statistical Package of Social Sciences [SPSS version 17]

Results: Median age of the 62 patients was 72 +/-12.5 years. Headache was the most common symptom reported in both groups, [n=47,75.8%] patients. Median thickness of hematoma was 15 +/-6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 [35.4%] vs. 6 [19.3%], and intracerebral hemorrhage 4 [12.9%] vs. 2 [6.4%]. Clinical outcome was good in both groups 27 [87%] in Group 1 and 28 [90%] in Group 2

Conclusion: Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another

Non-communicating extradural arachnoid cyst of dorsal spine

Extradural arachnoid cyst in the spine is an uncommon cause of spinal cord compression in the paediatric population. Most reported cysts have communication with the intrathecal subarachnoid space through a small defect in the dura. The reported child had spinal cord compression caused by a large spinal extradural arachnoid cyst in dorsal spine that did not communicate with the intradural subarachnoid space. Surgical excision of cyst was done with recovery of neurological deficit postoperatively

Frequency of hydrocephalus in postoperative cases of myelomeningocele. Need of ventriculoperitoneal shunt?

To assess the frequency of hydrocephalus in postoperative cases of myelomeningocele and the need of ventriculoperitoneal shunt placement. Descriptive study CMH Rawalpindi from Sep 2008 to Nov 2009. Forty patients of either sex with myelomeningocele were included. These patients did not have hydrocephalus at the time of presentation. They were operated upon for myelomeningocele. Postoperative follow up was carried out at 1, 2 and 3 months to look for the development of hydrocephalus. Data was analyzed using SPSS version 17. Out of forty patients 22 [55%] were males and 18 [45%] were females. The age ranged from newborn to 10 months. Thirty five [87.5%] patients had lumbosacral myelomeningocele, 2 [5%] patients thoracic, 2[5%] patients cervical while one patient [2.5%] presented with both cervical and lumbosacral myelomeningocele. Postoperatively 21 [52.5%] patients developed hydrocephalus which were subsequently confirmed on CT scan head and were then subjected to ventriculoperitoneal shunting. High frequency of hydrocephalus was observed in postoperative cases of myelomeningocele and patients presenting with one entity must be looked for the other. Postoperative cases of myelomeningocele should be regularly followed for the evidence of hydrocephalus

Effect of head positioning on outcome after Burr hole craniostomy for chronic subdural haematoma

To determine the effect of position of the patient's head after burr hole craniostomy on the outcome of chronic subdural haematoma, in terms of haematoma efflux, hospital stay and recurrence rate. Quasi experimental. Combined Military Hospital, Rawalpindi, from February 2007 to February 2008. Sixty patients were divided in two equal groups of 30 patients each. Group A patients were kept flat after the burr hole craniostomy and group B patients were kept with head end of bed elevated by 30°. The results were statistically analysed through software SPSS 14. The mean age was 59.98 +/- 13.7 years. There was predominance of males [M:F=3.2:1]. The location of haematoma was frontoparietal in majority [72%], right sided in 31 [51.6%], left sided in 20 [30%] and bilateral in 9 [15%] patients. Average daily output was 152 ml in group A and 142 ml in group B. Haematoma efflux was found to be sufficient in 26 [86.6%] patients of group A and 27 [90%] of group B. Wound infection occurred in 2 patients of group A and 1 in group B. Seizures occurred in 2 patients of group A and 3 of group B. Although, there was longer hospital stay for group A vs. group B [p=0.002], recurrence rate was insignificant amongst the two groups as 10% vs. 13% [p=0.688]. Assuming a 30° head up position soon after operation in cases of chronic subdural haematoma does not significantly affect the outcome and recurrence