Anterolateral versus posterolateral decompression and spinal stabilization in thoracolumbar Potts spine: a comparative study.

AIM: To assess and compare the clinical, radiological, and functional outcomes of anterolateral and posterolateral decompression and spinal stabilization in the thoracolumbar tuberculous spine. MATERIAL AND METHODS: 30 patients with thoracolumbar spinal tuberculosis were treated surgically between September 2014 and 2018. Fifteen patients underwent anterolateral decompression and spinal stabilization from September 2014 to September 2016. These patients were studied retrospectively (group A). Fifteen patients underwent posterolateral decompression by costotransversectomy and spinal stabilization from September 2016 to September 2017 were studied prospectively. Neurological recovery, correction of kyphotic deformity, pain (visual analog score) and ESR, and duration of stay were assessed. Neurological outcome was assessed using Frankel grading, and pain was assessed using visual analog scale. RESULTS: The average follow-up period in both the groups is 12 months. There was a statistically significant difference in the kyphotic angle correction between anterolateral and posterolateral groups at the end of 12 months (follow up). No statistically significant difference was found between the two groups for ESR, visual analog scale for pain, and neurological recovery (Frankel's grading) at the end of 12 months. CONCLUSION: Both anterolateral and posterolateral approaches are sufficient thoracic and thoracolumbar tuberculous spine but, the posterolateral approach allows a significant correction of kyphotic angle, better improvement of pain and lesser duration of stay.

Delayed Intracerebral Hemorrhage after Placement of a Ventriculoperitoneal Shunt in a Case of Hydrocephalus: A Rare Case Report and Review of Literature.

Ventriculoperitoneal (VP) shunt is a frequently performed operation to achieve cerebrospinal fluid (CSF) diversion but is associated with many complications. Postoperative delayed intracerebral hemorrhage is a kind of rare but catastrophic complication of a VP shunt which questions the survival of a seemingly recovered patient. Here, we present one such case where the patient presented to casualty in altered sensorium and with a history of vomiting. On examination, the Glasgow Coma Scale (GCS) score was E2V1M3; pupils were middilated but reactive. Computerized tomography of the brain showed ventriculomegaly and hydrocephalus, and an emergency VP shunt was done. There was an initial phase of good recovery followed by sudden loss consciousness, vomiting, and a fall in the GCS scores on postoperative day 7. Computed tomography showed an intracerebral hematoma along the shunt track and an intraventricular bleed. The presumed cause for this occurrence is a deranged coagulation profile.

Surgical Outcomes in Depressed Skull Fractures: An Institutional Experience.

AIMS: The aim is to study the various factors associated with depressed skull fractures (DSFs) and their relationship with outcomes in patients who underwent surgery. SETTINGS AND DESIGN: This was a cross-sectional study in a hospital setting. PATIENTS AND METHODS: One hundred and fifty patients who underwent surgeries over a period of 6 years at our institute for DSFs were followed up and outcomes were analyzed. Patients having other medical- or trauma-related surgical morbidities were excluded. All age groups were studied. STATISTICAL ANALYSIS USED: The statistical analysis was performed using Chi-square test. RESULTS: There was a significant relationship between the mode of injury, Glasgow coma scale (GCS) score at admission and discharge, and underlying brain injuries with the outcomes. The variables such as pneumocephalus, dural tears, type of fracture and site of the fracture, and age and sex distribution of the patient were not statistically influencing the outcomes. CONCLUSIONS: Patients who underwent surgery for DSFs, with good GCS at admission and discharge, with no underlying brain injury, and who did not sustain injuries in a road traffic accident had better outcomes.

Outcome Analysis of Posterolateral Decompression and Spinal Stabilization for Tuberculous Spine.

AIM: This is a prospective study to analyze the clinical, radiological, and functional outcomes of posterolateral decompression and spinal stabilization with pedicle screws and rods done for the thoracolumbar tuberculous spine. MATERIALS AND METHODS: This study was conducted at Gandhi Medical College and Hospital from September 2016 to September 2017 on 30 patients who underwent posterolateral decompression and spinal stabilization using pedicle screw and rod fixation for active spinal tuberculosis. Pain, erythrocyte sedimentation rate (ESR), kyphotic angle correction, and Frankel's grading were taken to study the clinical, radiological, and functional outcome at the end of 1 year. Other parameters taken into consideration were the duration of stay and level of involvement; antituberculous therapy was given to all the patients for 16-18 months until the signs of radiological healing were evident. RESULTS: This study comprised of 30 patients with a mean age of presentation of 39.835 ± 14.75 and M: F ratio of 1:1. The mean duration of stay is 10.67 ± 4.06, and the most common level of involvement is D6-D11. Kyphotic angle was corrected by a mean of 19.08 ± 5.44 at the end of 1 year (P < 0.001). Visual analog score improved from a median of 8 preoperatively to 2 at follow-up (P < 0.001). ESR improved from a mean of 37.08 ± 12.64 mm/h preoperatively to 19.83 ± 13.68 mm/h at follow-up (P = 0.01). There was an improvement in Frankel's grading in most of the patients at the end of 12 months. Radiological healing was evident in the form of the reappearance of trabeculae formation and bony fusion at the end of 12 months. CONCLUSION: Posterolateral approach is a good method for decompression and spinal stabilization because of significant kyphotic correction, improvement in pain, good neurological recovery, less duration of stay, and less morbidity.

Posttraumatic Isolated Intraventricular Hemorrhage a Rare Entity: Case Series.

BACKGROUND: Traumatic Intraventricular hemorrhage is commonly associated with other lesions like intracerebral contusions, subdural hemorrhage and subarachnoid hemorrhage. Isolated post- traumatic intraventricular hemorrhage is uncommon. It is mostly seen in the pediatric population and rarely seen in adults. AIMS: To analyze the Demographics, mode of Injuries and outcome in injuries causing isolated post traumatic intraventricular hemorrhage which is a rare entity. MATERIALS AND METHODS: This is a Retrospective analytic study of six cases, conducted at our Hospital in a span of eight years [2010-2018]. RESULTS: Mean age of presentation is 36 years and all were males. The most common clinical presentation included loss of consciousness followed by vomiting and ENT bleed. Four cases presented with severe head injury and two with mild head injury as per Glasgow coma scale score. Mode of injury was acceleration and deceleration in all the cases. NCCT and CT Angiogram brain were done in all the cases which revealed isolated intraventricular hemorrhage without any vascular or tumoral pathology. All the patients were managed conservatively. CONCLUSION: The outcome was equivocal (3 patients had a bad outcome and 3 good outcomes) in our study.

Spontaneous Resolution of Epidural Hematoma: A Rare Case.

An epidural hematoma is a life-threatening condition which necessitates early surgical intervention. Conservative management is undertaken in smaller hematomas; rarely, a massive hematoma may show spontaneous resolution which can be picked up only by a repeat computed tomography before surgery. Here, we report one such case where we noted a surprisingly rapid resolution of an epidural hematoma, which was relatively a large clot and where the last minute call to have a repeated computed tomography scan changed the line of management altogether from a surgical one to conservative. The patient in this particular case is a 20-year-old male, with a history of fall from height. The initial scan showed a large epidural hematoma which requires surgical evacuation, whereas the subsequent scans showed near-complete resolution and hence was managed conservatively. Rare cases like these should always be kept in mind, and the importance of a repeat scan should never be disregarded.

Contrecoup Extradural Hematoma Without Fracture: A Case Report and Review of Literature.

Extradural hemorrhages are commonly seen in coup head injuries, rarely seen in contrecoup head injuries. Acute extradural hemorrhage in the coup head injuries associated with a fracture is common, but the incidence of acute contrecoup extradural hemorrhage not associated with the fracture is extremely rare. Only 21 cases have been reported previously. A 28-year-old male patient presented to the emergency department with complaints of sustaining injuries in a road traffic accident by fall from a two-wheeler. No history of loss of consciousness, vomiting, seizures, and ear/nose bleed. On examination, the patient was conscious and coherent with a Glasgow Coma Scale score of 15/15 and a laceration on the right frontotemporal region which was sutured. Contrast tomography of the brain revealed an extradural hemorrhage of 10 mm thickness in the left parieto-occipital region with soft tissue swelling in the right temporoparietal region, without any evident fractures in the calvarium. The patient was managed conservatively. Contrecoup extradural hematoma is a rare entity, and those without fracture are extremely rare. Early diagnosis, careful observation, and management lead to a good outcome.

Dorsal Spinal Intradural Intramedullary Epidermoid Cyst: A Rare Case Report and Review of Literature.

Epidermoid cysts are commonly seen intracranial lesions but their occurrence in the spine is rare. They account for <1% of all the benign tumors of the spine. These are benign epithelial-lined cysts filled with keratin. They are classified into two types: congenital or acquired. Congenital epidermoid cysts are more commonly associated with spinal dysraphic states such as syringomyelia, dermal sinus and spina bifida whereas the acquired cysts are associated with repeated lumbar punctures. Based on the location, they can be extradural, intradural, extramedullary, or intramedullary. Most of the epidermoids are intradural extramedullary. Intramedullary epidermoid cysts are very uncommon. We report a case of a 6-year-old female patient with dorsal epidermoid cyst with neurological deficits. Magnetic resonance imaging of the spine showed a well-defined lesion from D9 to D12 which was hypointense on T1W1 and heterogeneously hyperintense on T2W2. Surgery was performed to excise the lesion and to decompress the spinal cord. Histopathological examination of the excised lesion confirmed it as an epidermoid cyst.

Simple Improvisation to Enhance Utility of Fluorescein Sodium in Resection of Intracranial Lesions at Routine Neurosurgical Centers.

INTRODUCTION: Fluorescein sodium is one of the fluorophores that is used in the resection of intracranial lesions. It is commonly used along with a customized microscope, which is expensive and not available universally. In this study, we describe a simple, inexpensive method for better visualization of intracranial and spinal cord lesions with fluorescein. MATERIALS AND METHODS: After a test dose, 20 mg/kg of fluorescein sodium was administered intravenously at the time of intubation. A blue light source was used before resection for precise localization of the intracranial lesions after durotomy. Most of the resection was done under the white light, while the blue light was used intermittently to delineate the pathologic tissue from the normal tissue and to ensure safe maximal resection. The intensity of fluorescein staining under white light and blue light was noted. RESULTS: The study comprised 40 cases of gliomas, meningiomas, abscesses, spinal cord tumors, and cerebellopontine angle lesions. Thirty-five lesions showed good fluorescence under the blue light, which helped us achieve better resection of the pathologic lesions. CONCLUSIONS: Fluorescein sodium is a safe dye; it can be used to aid in precise localization and safe maximal resection of the pathologic tissue with the help of a blue light source at any center with challenged resources. The blue light enhances the fluorescence and visualization of the pathologic tissue, and this technique can be adopted by any surgeon without much difficulty even with a basic neurosurgical setup.

A Frontal Giant Intradiploic Giant Pearl (Epidermoid Cyst) With Intracranial and Extracranial Extension: A Rare Entity.

Craniofacial epidermoid cysts are rare tumors representing 0.2%-1% of all the intracranial tumors. Intradiploic variants account for 25% of these cysts. These cysts are benign, slow-growing, congenital tumors derived from ectodermal remnants misplaced during embryogenesis. Mean age at presentation of these lesions is 40 years; epidermoid cysts are typically asymptomatic (Toglia JU, Netsky MG, Alexander E Jr. Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis. J Neurosurg 1965;23:384-93). Giant extradural epidermoid cysts with profound deformation of the brain and extensive lytic skull lesions may allow a normal life without any significant neurological deficits. Computed tomography scan and magnetic resonance imaging play an important role in the diagnosis of the lesion and management protocol. Histologically, epidermoid cysts are lined by stratified squamous epithelium and are filled with anucleatic keratin (Hao S, Tang J, Wu Z, Zhang L, Zhang J, Wang Z. Natural malignant transformation of an intracranial epidermoid cyst. J Formos Med Assoc 2010;109:390-6). Complete removal of the cyst along with its capsule is the treatment of choice. Recurrences of intradiploic epidermoid cyst have been reported. Here, we report a case of 14-year-old girl presenting with a giant frontal intradiploic epidermoid cyst with an intracranial and extracranial extension without any neurological deficits. Bifrontal craniotomy was performed and cyst was excised in toto.

Traumatic intracranial prolapse of eye ball - a case report.

We report a rare condition in a child where the skull fracture was associated with prolapse of orbital contents into anterior cranial fossa. CT scan findings are very much pathognomonic. This patient was operated, orbital contents have been relocated and orbital roof was reconstructed, but vision could not be restored.