ABSTRACT
This study was carried out in the department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh, during the period of January 2003 to December 2006 to elucidate the effectiveness of surgical treatment in the management of low grade astrocytoma of brain. For this purpose, a total number of 50 cases admitted during the study period with low grade astrocytoma of brain supported by clinical features and radiological investigations (CT and MRI scan) were included in this study. The mean age of the patient was a 27.3+/-16.9 year ranging from 1.8 to 65.0 years. Males (64.0%) were more in comparison to females (36.0%) with a male female ratio of 1.8:1. The main presenting complaints were headache (100%), convulsion (84.0%), vomiting (80.0%), visual impairment (20.0%), motor deficit (16.0%) and ataxia (14.0%). All cases had a definite diagnostic investigation at the time of admission. Plain x-ray skull was done in all patients followed by CT scan (70%), MRI scan (60%) and both CT and MRI scan (64.0%). Out of 50 patients 60.0% had gross total removal of tumor and 40.0% sub total tumor resection. Histopathological study was done in all cases after tumor resection. Among the gross total tumor removal cases highest percentage had good recovery (93.4%) in the immediate post operative period. Only one (3.3%) patient developed severe disability and equal percentage had moderate disability. Another 2(4.0%), those underwent subtotal tumor resection died during subsequent follow up period at 8th and 14th postoperative day.
Subject(s)
Astrocytoma/surgery , Brain Neoplasms/surgery , Adolescent , Adult , Aged , Astrocytoma/diagnosis , Astrocytoma/mortality , Astrocytoma/pathology , Bangladesh/epidemiology , Brain Neoplasms/diagnosis , Brain Neoplasms/mortality , Brain Neoplasms/pathology , Child , Child, Preschool , Combined Modality Therapy , Contrast Media , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The study was done for determination of the potential factors of good outcome in spontaneous intracerebral haematoma (SIH) which could be useful for selecting patients for surgical procedure. Subjects were 45 patients with spontaneous intracerebral haematoma (SIH)-Volume >20ml. They were admitted and surgically treated consecutively in Dhaka Medical College with in the 1st day to 4th day of ictus. Haematoma volume was measured on computed tomography (CT) at admission. Good outcome was measured by Glasgow Outcome Scale (GCS) score. Out of 45 patients with ICH, 18(40%) patients had basal ganglia haematoma, 13(28.88%) patients had lobar haematoma, and 2(4.45%) patients had cerebellar haematoma and 7(15.55%) patients had pure ventricular haematoma and 5(11.12%) patients ventricular extension from other location. Among these last 12 patients, 10(83.33%) patients died comparing only 7(21.21%) patients without ventricular involvement died. Fisher's exact test result shows p value is <0.001(Highly significant) and best outcome obtained in cases of lober haematoma in CT scan of brain, the mean volume was 46 cc. and there was strong association between the volume of haematoma and Glasgow outcome scale, that is, more the volume of blood, less the Glasgow Outcome Scale (GOS) and vice versa. P value was <0.001 (Highly significant). In another study the surgical outcome is best if it is done within 48 hours. Fisher's exact test result shows p value is <0.05. So, Good surgical outcome in spontaneous intracerebral haematoma (SICH) can be predicted on admission by volume of haematoma, location of haematoma, time lapse since ictus to surgery. These predictors may be helpful in selecting patients for surgical treatment.
