Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'.

Background and Objective: Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy. Methods: This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student t-test or corresponding nonparametric test (Mann-Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome. Results: : The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher. s: Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.

Comparing the effects of epidural methylprednisolone acetate injected in patients with pain due to lumbar spinal stenosis or herniated disks: a prospective study.

OBJECTIVE: Satisfactory results have been seen with epidural steroid injections (ESI) in patients with herniated disks (HD), but the role in lumbar spinal stenosis (LSS) has been less investigated. We compared long-term effects of ESI in HD and LSS patients. METHODS: In a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32) or LSS (n = 28) were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test. RESULTS: There were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05). DISCUSSION: Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.

Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: does maximal resection of the tumor lengthen the median survival?

BACKGROUND: The ETR that should be undertaken in patients with GBM remains controversial. This study aims to reiterate some independent predicting factors and to underscore the role and the ETR in increasing the survival of patients in the situation of developing countries, that is, without preoperative MRI or tractography. The authors submit additional information to be added to the list of CTRs in the management of malignant brain tumors. METHODS: The authors prospectively analyzed a cohort of 35 consecutive patients with histologically proven GBM who underwent tumor resection in surgically amenable areas for the first time at Sina Hospital, Tehran, between 2003 and 2005. Demographic data, volumetric measurements, and other characteristics identified on preoperative and immediate postoperative MR imaging as well as intraoperative and postoperative clinical data were collectively analyzed by SPSS for Windows, version 11.5 (SPSS, Chicago, Ill). RESULTS: Cox proportional hazards model multivariate analysis identified the following independent predictors of survival: Karnofsky performance scale ≥80 (P = .01), ETR (P = .01), tumor location in functionally silent prefrontal area (P = .002) vs tumor location in corpus callosum (P = .001), postoperative RT (P = .004), and postoperative chemotherapy (P = .001) CONCLUSION: Maximal resection of the tumor volume is an independent variable associated with longer survival times in patient with GBM. Gross total resection should be performed whenever possible, although not at the expense of increased morbidity.