Role of repeat CT scan head in initially inoperable cases of traumatic head injury.

The CT scan has become popular in cases of head injury. In this study 71 cases (M:48; 68.0% and F:23; 32.0%) with traumatic head injury admitted and initially managed conservatively at National Neurosurgical Referral Centre, Bir hospital starting from May 2005 to April 2006. The most common cause of injury was road accidents (43 cases) with motorcycle and bus injuries as the leading causes. Nausea and vomiting were the most common symptom in 41 (57.0%) cases, followed by headache in 31 (43.0%). Contusions were the most common radiological findings in 84.0% followed by extradural haematoma in 8.0% and pneumocephalus in 7.0%. Out of these the most common location for contusion was frontal (16 cases), followed by parietal (12 cases) and then bilateral contusions. The mean volume was 12 ml, 9 ml and 9 ml for frontal, parietal and temporal contusions, respectively. Repeat scan showed increase in volume of contusion in 31 cases (44.0%), no change in 28 cases (40.0%) and decrease in 12 cases (16.0%). The increase was mainly due to edema in 20 cases (64.0%) and due to actual increase in contusion in only 11 cases (35.0%). Only 5 (7.0%) cases needed operative intervention. It is concluded that routine use of repeat scan in mild to moderate head injury has no role unless there is clinical deterioration.

Single burr hole drainage for chronic subdural haematoma.

Chronic subdural haematoma is a common neurosurgical condition and surprisingly surgical treatment ranges from twist drill craniostomy to more radical membranectomy. However, the outcome is generally favourable with appropriate therapy. This retrospective study is aimed at analyzing the result of single burr hole drainage of such haematoma under local anaesthesia over a period of fifteen years. There were a total of 365 patients ranging from 6 months to 89 years with the mean age of 60 years. Recurrence of haematoma was noted in 17 (4.6%) patients and majority of them (65.0%) were managed by aspiration through the previous burr hole. Favorable outcome was noted in 98.6% patients. Those with adverse outcome were in coma preoperatively. This study suggests that single burr hole drainage under local anaesthesia is sufficient in the majority of patients and outcome was favorable even in the elderly provided they presented before lapsing into coma.