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INTRODUCTION: Chiari malformations are a group of clinicopathological entities with a variety of clinical presentations, different pathophysiology, and variable outcomes. It has a typical set of clinical presentation. In this study is to observe the different clinical presentations of the patients with Chiari malformation in our population. As the time of initial presentation is delayed that might change the sign and symptoms with which patient initially presents. MATERIALS AND METHODS: This was a cross-sectional observational study with prospectively collected data of 46 patients with Chiari malformation. The duration of the study is from 2017 to 2020. Patient's data will be compiled and analyzed through Statistical Package for Social Sciences (SPSS) Version 25. Qualitative variables are presented as frequencies and percentages. Quantitative variables are presented as mean ± standard deviation. Effect modifiers are controlled through stratification. The Chi-square test is used for finding association between categorical variables. P ≤ 0.05 is considered as statistically significant. RESULTS: According to our data 36% of our patients presented with motor weakness which is followed by sensory deficit, however in previous literature headache was the commonest clinical presentation. CONCLUSION: Clinical presentation in our population differs from other studies and the reason behind this is the delayed presentation of the patient and lack of awareness of disease and ultimately it will alter the outcome of disease and treatment.
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BACKGROUND: Endoscopic third ventriculostomy (ETV) is an advanced surgical procedure and plays a major role in the management of hydrocephalus. The complications associated with this procedure are grave and unforgiving. Image guidance system (IGS) can help reduce these complications. This technical note describes the technique for utilizing image guidance in carrying out ETV with safety and efficacy. METHODS: The authors have performed ETV on more than 75 cases. We describe a step-by-step technique for the implication of image guidance while performing ETV including the trajectory planning, coregistration, approach, and third ventricular floor perforation. For illustration, we present the case of a 54-year-old female with moderate-intensity headache and central vertigo for 2 months presented with no significant findings on examination. Magnetic resonance imaging (MRI) showed dilated lateral and third ventricles with normal sized fourth ventricle. A diagnosis of aqueductal stenosis was made and ETV was performed under image guidance. RESULTS: Since 2012, we performed 78 cases of ETV with the help of image guidance. None of the patients had any episode of intraoperative hemorrhage. Two patients (2.56%) had fornix contusions. CONCLUSION: Image guidance can help reduce complications and is becoming an essential tool in performing ETV. IGS ETV technique may benefit young neurosurgeons the most and can help them overcome the learning curve with safety.
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BACKGROUND: Traumatic brain injuries represent a significant cause of morbidity and mortality worldwide and road traffic crashes account for a significant proportion of these injuries. It is one of the leading causes of death, especially among young adults, and, according to the World Health Organization, this will surpass many diseases as the major cause of death and disability by the year 2020 and lifelong disability is common in those who survive. It is also known as the silent epidemic. Many CT scan scoring systems for brain injury have been developed but none of them are validated. These scores are based on structural findings of CT scan to predict the prognosis. Marshall and Rotterdam are the two most widely used scoring systems. METHOD: This was an observational study with prospectively collected data. 903 consecutive patients with TBI. This study aimed to compare the Helsinki CT scoring system with the Rotterdam scoring system to find out the better score for the prognostic purpose by using the Glasgow outcome score. RESULTS: Helsinki CT scoring system was found to be the most accurate score among the others in predicting the outcome of the patient based on morphological findings in CT scan. These scores also guided us regarding the treatment plan and patients with the good prognostic outcome are usually treated aggressively. Also these scores guide clinicians whether to opt for a conservative approach or any intervention. CONCLUSION: In this study we compared, Rotterdam vs. Helsinki CT Scoring System. We observed that the Helsinki score was a better outcome predictor for TBI than the Rotterdam score and can be used as a single validated score in predicting outcome and guiding the treatment.
