Thromboprophylaxis in neurosurgical patients at Jordan university hospital: a prospective comparative study

Venous Thromboembolism [VTE] is potentially a life threatening complication in patients undergoing major neurosurgical procedures. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury or in patients who need intracranial surgery. Intermittent Pneumatic Compression [IPC] and elastic stocking are widely used as prophylaxis against venous thrombo-embolism in these patients. The aim of the study is to assess and compare the value of VTE prophylaxis using a control group with Low dose Unfractionated Heparin [LDUH] every eight hours alone with a study group using Intermittent Pneumatic compression [IPC] and elastic stocking along with Single dose Unfractionated Heparin [SDUH] at the time of anaesthesia in induction on patients undergoing brain and spinal surgery. A prospective case-control study was conducted at Jordan University Hospital, over 15 months during the period 2005-2006. A total of 223 patients were included. In the study group, 113 patients using single dose of unfractionated heparin at the time of anaesthesia induction along with Intermittent Pneumatic Compression [IPC] intraoperatively and compression Elastic Stocking [ES] post operatively were used until full ambulation. In the control group, there were 110 patients in whom unfractionated heparin at a dose of 5000 units every 8 hours was used until full ambulation or for 7 days. All patients underwent either brain surgery or spinal surgery. The characteristics of the two groups were fully comparable except for the duration of surgery which was statistically longer in the study group [P= <0.001]. Deep Vein Thrombosis [DVT] occurred in 3 patients in the study group, compared to 6 patients in the control group, of these 6 patients, 4 patients developed PE in addition to DVT and one of the four patients expired. The observed differences among these rates are statistically not significant [P=0.288]. When pooled together, patients who developed VTE in both groups were older than those who did not have VTE. This difference was statistically significant [P=0.07]. The combination of elastic stocking, intermittent pneumatic compression along with single dose unfractionated heparin at the time of anaesthesia induction is comparable in effectiveness of reducing the incidence of VTE as the low dose unfractionated heparin alone in patients undergoing neurosurgical procedures of the brain or spine, despite the trend towards better results of the combined method

Descriptive epidemiological analysis, MRI signals intensity and histopathological correlations of meningiomas

To present our experience in operated meningioma cases regarding their prevalence, anatomical location, multiplicity, presenting signs and symptoms, and the possible correlation between MRI signal intensity and histological grades to set criteria for radio-pathological diagnosis. In this retrospective study, 120 operated meningioma cases in the Department of Neurosurgery, Jordan University Hospital [JUH], Amman, Jordan between January 1997 and January 2007 were reviewed. Our study included 90 cases, and their medical records, histopathological reports, and neuroimages were analyzed thoroughly. Meningioma was more common in females than males with a ratio of 2.2:1. Para-sagittal meningiomas were the most common [23.3%]. Multiple intracranial meningiomas were found in 4.4% of the cases. Most cases were of benign histopathology and exhibited iso-intense signals on Tl and T2, and appeared with hyper-intense signals on FLAIR with vivid enhancement. The prevalence of meningioma among genders and its anatomical location at JUH corresponds to the published medical literature worldwide. There was no correlation between signal intensities [as seen on T1WI, T2WI, and FLAIR sequences], enhancement pattern on one side, and histological grades on the other side

Venous air embolism associated morbidity and mortality in patients undergoing neurosurgical procedures in the sitting position

To identify the morbidity and the mortality related to Venous Air Embolism [VAE] during posterior fossa surgery in the sitting position. This study was conducted at Jordan University Hospital, Amman, Jordan. Records of 73 patients undergoing posterior fossa surgery in the sitting position from 1990 to 2005 were retrospectively reviewed to determine the incidence of VAE, the nature of perioperative morbidity and mortality and their relation to VAE. The incidence of VAE was 13.5%. Intraoperative hypotension secondary to VAE was [9.6%]. Intraoperative hypotension was 19% during the positioning of patients and 29% during the procedures. Patients who received blood transfusion were 10 [19.2%] children and 5 [9.6%] adults. Average blood transfusion in children was 200 mls and 360 mls in adults. Postoperatively, six [11.5%] patients were electively intubated and ventilated. Postoperative evacuation of posterior fossa haematoma was performed in seven [13.5%] patients. Six [11.5%] patients died within one month after surgery. There was no intraoperative or postoperative morbidity or mortality related to VAE. Our results indicate the absence of morbidity and mortality related to VAE. With early detection and prompt treatment of VAE, the sitting position is safe for neurosurgical procedures