Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation-The FIT-score.

OBJECTIVE: It remains difficult to estimate prolonged functional impairment in patients with chronic subdural hematoma (cSDH) treated with burr hole trepanation. We aim to establish a score that reliably predicts postoperative functional impairment. PATIENTS AND METHODS: Retrospectively analysis of a prospective institutional database. cSDH patients operated in 2013-2016 were identified. Clinical outcome was dichotomized into presence (modified-Rankin-Scale (mRS) ≥ 2) or absence of functional impairment (mRS 0-1) at discharge and last follow-up. A score was developed, based on the effect sizes of a set of outcome predictors. Its accuracy was tested using Area Under the Receiver-Operating Characteristic (AUROC) curve analysis. The 2017 cohort served for internal validation. RESULTS: A cohort of 253 patients (mean age 75 years, 75% male) was analyzed, of which 77 patients (30%) remained functionally impaired. In multivariate analysis, severe motor deficits at admission (OR 5.84, 95% CI 2.71-12.59, p < 0.001), age (≥85 years: 5.53, 2.14-14.32, p < 0.0001) and disorientation at admission (2.65, 11.39-5.05, p = 0.003) were associated with persistent functional impairment. Based on those variables, we created the "Functional Impairment after burr hole Trepanation" (FIT-score), which showed an AUROC of 0.77 (95% CI 0.70-0.83) for impairment at discharge and 0.76 (0.70-0.82) for impairment at follow-up. Internal validation confirmed the model with an AUROC of 0.79 (0.68-0.91) at discharge and 0.77 (0.64-91) at follow-up. CONCLUSIONS: The FIT-score is likely to assist the physician when counseling patients and relatives pertaining to the need for postoperative rehabilitation and mid- to long-term supportive home care.

Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians.

INTRODUCTION: The traditional care of patients with subacute/chronic subdural haematoma (S/CSDH) often involves delayed mobilization after burr-hole drainage. It is thought that delayed mobilization aids brain re-expansion thereby reducing the risk of recurrence. However, there is paucity of information regarding its efficacy and safety over early mobilization. We evaluated the efficacy and complications of each type of mobilization following burr-hole drainage of S/CSDH. METHOD: This was a prospective study from October 2004 and September 2010. A total of 50 patients who had burr-hole drainage of S/CSDH were sequentially allocated to either early (day 2) or late (day 7) mobilization (EM or LM) groups (25 patients in each group). Wound related complications, recurrence of haematoma, complications of prolonged bed rest and Glasgow Outcome Score (GOS) at discharge were studied in the two groups. Patients who could not obey commands to mobilize in the early post-operative period were excluded. RESULTS: There were 43 (86%) males and 7 (14%) females. The mean age was 57 years (range: 27-90 years). Fourteen (28%) of the patients were elderly (age > 65 years). Two complications, wound infection in a 76-year old man in the LM group and tension pneumocephalus requiring re-opening burr-hole drainage in a 55-year old man in the EM group were recorded. There was no recurrence or problem associated with prolonged bed rest in the two groups. Five (10%) patients had moderate disability (GOS 4) at discharge (1 EM, 4 LM) while the others (90%) had good recovery (GOS 5) (24 EM, 21 LM). These differences were not statistically significant (p-value: 0.349). CONCLUSION: It appears that both EM and LM are equally beneficial in the post-operative care of patients following burr-hole drainage of S/CSDH. There is no significant complication referable to the specific type of mobilization. The authors, therefore, advocate EM of patients to reduce the length of hospital stay.

[Rehabilitation of patients with defects of the bones of the skull after craniocerebral injury]. / Reabilitatsiia bol'nykh s defektami kostei cherepa posle cherepno-mozgovoi travmy.

Patients with defects of the cranial bones were followed up for from one to ten years and over by employing clinical, electrophysiological, psychological, and social research methods. Combined assessment of cerebral dysfunctions showed the presence of general cerebral symptomatology which, in the period of decompensation, manifested itself in hypertensive and hypothalamic crises, as well as in psychopathological disturbances. The latter were controlled by courses of rehabilitation treatment. In the period between the crises, the patients with a substituted defect of the cranial bones were capable of many kinds of working activities, which suggests that the acknowledgement of an "anatomical defect" in which event the degree of disability is established once and for all is warranted only in cases of unsubstituted defects of the cranial bones (3 X 1 cm, according to the Manual of identifying the degree of disability, 1956).

A study of regeneration in parietal bone defects in rabbits.

A study was undertaken to study the regeneration potential of surgically created parietal bone defects in newborn and fully grown rabbits. The results indicated that regeneration is greater in the newborn rabbits, especially if the periosteum and dura are preserved.