Acute subdural haematoma and its various aspects; A Clinical study

Acute subdural hematoma is one of the most common types of intra cranial hematoma caused by trauma accounting for more than 20% severe head injuries and resulting in highest mortality. Various studies have been made to understand the consequences and surgical outcomes of SDH patients. Therefore, the present study was designed to evaluate the clinical spectrum and assess the outcome of surgery in SDH patients. Methods: Present study included 50 patients of both sexes from 1 to 70 years age group with head injury, diagnosed to have traumatic subdural haemorrhage. Clinical examination included pupillary anisocoria, hemodynamic status, extent of hematoma either focal or diffuse, midline shift, GCS, status of basal cisterns, blood pressure. All the patients included in the study underwent surgical procedure for the removal of haematoma. Results: There was 100% mortality rate in patients with bilaterally dilated pupils. Whereas, there was 24.13% and 5.5% mortality rate respectively in unilateral dilated and normal pupil patients. Most of the patient had GCS <8 (40%), followed by GCS 9-12 (34%) and GCS 13-15 (26%) at the time of admission in the hospital. Further, GCS <8, GCS 9-12and GCS 13-15 were found in 32%, 40% and 28% correspondingly in patients after resuscitation. Conclusion: Findings of present study showed that there was an inverse relation between interval between injury and surgery with prognosis, Greater the interval poor will be outcome of surgery. Basal cistern obliteration is a reliable marker of increased intra cranial pressure which is responsible for poor outcome. Further, hypotension is also one of the important factors affecting the outcome of surgery in SDH patients.

Surgical Outcome of Spontaneous Supra Tentorial Intra-Cerebral Haemorrhage

Intra-cerebral haemorrhage (ICH) is responsible for strokes in up to 20 % patients in European countries while this became higher up to 30 % in Asian countries. Various different approaches have been applied for the surgery of ICH in the search of ideal surgical technique and prompt management without any success. Therefore, the present study was designed to assess the advantages and risk of open craniotomy surgical technique for the treatment of spontaneous supra tentorial intra-cerebral haemorrhage. Methods: This was a descriptive type of study which was conducted in a tertiary care centre. This study included thirty patients of both gender male (21) and female (9) from 18 to 70 years age. Patients with hypertension, spontaneous supratentorial haemorrhage, having Glasgow Coma Scale (GCS) 8-13 and volume of blood 20 ml or above were included in the study. ICH patients with GCS 14-15 and GCS level less than 7 were excluded from the study. Results: Results of the current study showed that 6 patients with ICH more than 50 ml had GCS less than 8. Whereas, GCS 9-10 and GCS 11-13 were recorded in 17 and 7 patients respectively before the operation. Further, GCS level was unchanged even after surgery in 6 patients who had pre-operative GCS less than 8. After surgery GCS level improved to 9-10 and 11-13 in 9 and 15 patients respectively. Conclusion: Findings of the present study suggest that GCS level and Size of haematoma significantly affects the surgical prognosis in patients with spontaneous supra tentorial intra-cerebral haemorrhage patients. Moreover, results of current study showed that GCS level less than 8 and blood volume of haemorrhage more than 50 ml have been found associated with higher rate of mortality in ICH patients.

Acute Simultaneous Bilateral Extradural Hematoma.

Bilateral extradural hematomas are uncommon consequence of head injury with many unique features .In our case the fracture line over the skull was extending across the sagittal sinus.This case report emphasizes the specific features as to their etiopathology, clinical presentation, diagnosis and management principles.

Trans-Septal Trans-Sphenoidal Surgery For Pituitary Adenomas:A Retrospective Study.

In this retrospective study 100 patients of pituitary adenoma who underwent Trans-septal Trans-sphenoidal surgery over 10 years period were evaluated. The mean presenting complaints of these patients were headache and decreased vision. Majority of tumors in our study were non functioning adenomas (39%) followed by prolactinomas (38%), growth hormone producing tumors constituted 20%, where as cortisol secreting adenomas were 3%. There was no operative mortality in our series. Post-op CSF rhinnorrhoea was noted in 3 patients - out of these one patient required surgical repair of fistula in immediate postoprated period while other two patients were managed with lumbar drain. Total excision of tumor was attained in 38% of patients as these were evaluated by post-oprated CT scan and MRI with contrast. 30% of patients were given radiotherapy immediately after the surgery. These were patients in whom residual tumor was more than 1 cm in size and the hormone levels did not return to normal. The patients were followed up from 9 months to 10 years with a mean follow up of 4 years. There were total of 18 recurrences on follow up study.