Prognostication in Traumatic Brain Injury- A Prospective Study of 100 Patients in Tertiary Care Hospital in Rural Area.

Traumatic brain injury is a major health issue responsible for considerable mortality and morbidity worldwide especially in subjects under the age of 40 yrs. It is important to assess and grade the TBI as soon as possible to guide management and decrease the comorbidities. Various guidelines have been issued by the neurosurgical societies to immediately assess and intervene when ever required. In this study, we have tried to assess the role of basal cisternal effacement in the management and prognosis of RTA patients, and hence tried to simplify the prognostication process and improve the patient management.METHODS100 subjects were studied who were having history of traumatic head injury. NCCT was done for all the patients using 128 slice Multidetector CT- Ingenuity (Philips Medical Systems, USA). Other parameters like pupillary reaction, GCS at the time of presentation, midline shift and associated fractures and bleed were assessed. All the patients were followed up till the time of discharge. The data so obtained was analysed.RESULTSParameters like age, pupillary reflex, GCS at presentation, associated intracranial bleed, associated cranial vault fractures and presence or absence of midline shift correlated well with the final outcome with p value consistently <0.05. We analysed that the degree of obliteration of perimesencephalic cistern was a good prognostic marker in traumatic head injury patients. 36% of patients had favourable outcome out of which none of the patients had obliterated perimesencephalic cistern or interpeduncular cisterns. 64% patients had unfavourable outcome out of which 60% and 48% had obliterated or partially obliterated perimesencephalic cisterns and interpeduncular cisterns respectively, and only 4% and 16% had normal perimesencephalic cisterns and interpeduncular cisterns respectively.CONCLUSIONSIt is important to investigate, grade and prognosticate traumatic head injury patients at the earliest. Our study and various other studies prove that various clinical predictors including age, Glasgow coma scale, and pupil reactivity correlate with outcome of patient. Presence of midline shift, intraventricular haemorrhage, and obliteration of cisterns in patients of traumatic brain injury also correlate with the outcome and can be used; thus, making the prognostication process much easier. These findings can be used on the first day of admission itself.

Observación del sistema ventricular y espacio subaracnoideo de la base del cráneo por neuroendoscopia flexible: Estructuras normales / Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures

En las últimas dos décadas a nivel mundial y en la última década en Latinoamérica, especialmente en México, la endoscopia cerebral como parte de la cirugía neurológica de mínima invasión ha sido un paso de gran importancia para el tratamiento de enfermedades neurológicas T4 como hidrocefalia congénita o adquirida, malformaciones Chiari, neurocisticercosis, enfermedad vascular cerebral, tumores o quistes ventriculares y paraventriculares, quistes aracnoideos e hidrocefalias secundarias a disfunciones valvulares. Entre las regiones más inaccesibles al sistema nervioso central se encuentran los ventrículos laterales, el tercer ventrículo, el acueducto cerebral, el cuarto ventrículo y el espacio subaracnoideo de la base del cráneo. Gracias a los sistemas de fibra óptica y luz en combinación con la experiencia de nueve años consecutivos y más de 600 endoscopias realizadas, en su mayoría endoscopias cerebrales flexibles, presentarnos el abordaje por medio de neuronavegación con endoscopía cerebral flexible de la anatomía normal y sus variantes de todo el sistema ventricular y el espacio subaracnoideo de la base del cráneo, incluyendo el espacio subaracnoideo de la médula cervical. También presentamos las estructuras relacionadas a estos sitios como: venas, arterias, nervios craneales, glándula pituitaria y plexos coroideos.

Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non accessible regions of the central nervous system. Due to light rand fiber optic systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.

States of Basal Cisterns on CT Scan and Outcome Prediction in Severe Diffuse Head Injury

The author studied the relationship of age, Glasgow coma scale, Glasgow outcome scale and appearance of basal cisterns as seen on intial computerized tomography on 95 patients with severe diffuse head injury. The results were as follows : 1) The poor outcome rates were 76.8%, 41.2% and 16.6% among those absent, compressed, and normal basal cisterns, respectively. 2) The correlation with the initial GCS score and the status of basal cistern indicated significant difference of poor outcome rate in the patients with absent or compressed basal cisterns between GCS score 3-5 group and GCS 6-8 group while the patients with normal basal cisterns indicated significantly reduced poor outcome rate regardless of GCS score. 3) When outcome was observed in connection with the patient's age and the status of the basal cisterns, a good recovery was significantly increased in the children with normal basal cisterns while the poor outcome rate was very high in the elderly patients even if the basal cisterns were normal. Therefore, the status of the basal cisterns on CT Scan should be used as non-invasive method for predicting the outcome of severe diffuse head injured patients.