Decompressive craniectomy is a life-saving procedure in malignant MCA infarction.

OBJECTIVES: To investigate the indications, timings, and outcomes of decompressive craniectomy (DC) performed for malignant middle cerebral artery (MCA) infarctions at our tertiary care center. METHODS: This retrospective case series involved patients who underwent DC for malignant MCA infarction at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, between January 2012 and December 2018. Demographic, clinical, and radiological data were collected, and stroke- and surgery-related complications and discharge outcomes were assessed. RESULTS: Eighteen patients (mean age: 50±10 years), of whom 13 (72%) were men, underwent DC during the study period. Of the patients, 9 (50%) had severe stroke (NIHSS 16-25), 10 (56%) had right MCA infarction, and 11 (61%) received either intravenous thrombolysis or endovascular thrombectomy or their combination. Indications for surgery included clinical deterioration as seen in 16 (89%) patients, ipsilateral pupillary dilatation as seen in 11 (61%) patients, and signs of raised intracranial pressure in 6 (33%) patients. Surgery was performed within 48 h in 14 (78%) patients. The mean Intensive Care Unit stay was 15±7 days. Seven (39%) patients were discharged home and 3 (17%) were transferred to an inpatient rehabilitation unit, and 2 (11%) patients died. All patients had stroke-related complications; one (6%) patient developed cerebrospinal fluid leak, 3 (17%) had sunken skin flap syndrome and wound infection each, and 2 (11%) developed epidural hematoma. CONCLUSION: The DC was life-saving in the our patients with malignant MCA infarction. Most of the patients had surgery within 48 hours. More than one-third of the patients were discharged home, while mortality occurred in only 2 patients. Moreover, stroke- and surgery-related complications were common in our cohort.

Neurological Impairment Recovery in Surgically Treated Patients With Nontraumatic Spinal Cord Injury.

INTRODUCTION: The incidence of nontraumatic spinal cord injury (NTSCI) is reported to be higher than that of traumatic spinal cord injury in many countries, making it an area of growing significance. OBJECTIVES: With the aging of the global population in coming decades, it is anticipated that the incidence of NTSCIs will increase dramatically. Our aim was to identify and report the causes, patterns, and outcomes of NTSCI in a tertiary care center. METHODS: We have reviewed all adult patients who had a NTSCI and were surgically treated with a minimum follow-up of 12 months postoperatively. Demographic and clinical data were collected. Preoperative and postoperative American Spinal Injury Association (ASIA) impairment scales and past follow-up outcomes were assessed. RESULTS: Of 164 patients, 95 (58%) had full recovery and reached ASIA E score at their last follow-up while 69 (42%) were not able to achieve full recovery till ASIA E score. Urinary incontinence and/or bowel incontinence on admission, degenerative pathologies, and thoracic injury level were all notable indicators of limited ASIA score improvement at the last follow-up. CONCLUSIONS: Surgically treated NTSCI could result in good neurological recovery with a low complication rate.

The Outcomes and Revision Rate of Total Hip Arthroplasty in a Single Tertiary Center: A Retrospective Study.

Introduction Total hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital. Methods A retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases. Results A total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014). Conclusion All in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision.