Comparative Outcome Analysis of Enterprise and Neuroform Stent-Assisted Coiling of Cerebral Aneurysms: A Review of the Literature.

INTRODUCTION: One of the popular treatment strategies for complex cerebral aneurysms with wide necks or low dome-to-neck ratios is stent-assisted coiling. The most widely used intracranial stents for stent-assisted coiling are Neuroform (NF) and Enterprise (EP) stents. The purposes of this study are to review the recent literature of the past 5 years to compare outcomes between the EP and NF stent-assist coiling systems so as to comment on the safety, efficacy, complications, and recurrence rate of stent-assisted coiling in general. METHODS: PubMed was used to search for all published literature of NF or EP stent-assisted coiling of unruptured cerebral aneurysms from January 2014 to August 2019 with the search terms of "Enterprise stent-assisted coiling," "Neuroform stent," and "Neuroform vs. Enterprise stent." RESULTS: Twenty two publications met the inclusion criteria which encompass 1764 patients and 1873 aneurysms. Out of these 1873 aneurysms, 1007 aneurysms were treated with EP stent and 866 aneurysms were treated with NF stent. The overall outcome was low rates of thromboembolic complications (4.37%) and intracranial hemorrhage (1.13%), low permanent morbidity (1.70%) and mortality (0.40%), and lower rate of recanalization (11%). Data analysis shows an overall higher rate of complication and recurrence of aneurysm and lower overall rate of aneurysmal occlusion in the patients where EP stent was used in comparison to NF stent. However, this difference was not statistically significant. CONCLUSIONS: The review of two stent-assisted coiling devices using EP and NF stents including 1873 aneurysms in 1764 patients revealed that overall, it is safe and effective with comparable outcomes.

Management of Chronic Subdural Hematoma: Burr Hole versus Twist Drill - A Prospective Study.

INTRODUCTION: Incidence of chronic subdural hematoma (CSDH) is about 5/100,000/year in the general population and still rising. Two surgical techniques, namely, burr-hole evacuation (BHE) versus twist-drill evacuation (TDE) are commonly used to manage such patients but the preferred surgical method continues to attract debate, and the time for an evidence-based approach is now overdue. In vogue with recent trends, a minimally invasive surgical approach is considered as best; therefore, we tried to establish the hypothesis that TDE is as safe and as effective as BHE for CSDH treatment. MATERIALS AND METHODS: A prospective, randomized, controlled study including forty patients was conducted. The primary outcome variable studied was clinically significant recurrence rate. The secondary outcome variables in postoperative period and follow-up assessment of the patients include Glasgow coma scale (GCS), Markwalder grade, postoperative complication, and operative mortality rate. RESULTS: In our study, results of BHE seem to be superior than TDE in terms of recurrence rate (5% vs. 15%), complication rate (15% vs. 20%), and mean Markwalder neurological grading score and mean GCS at time of discharge (0.16 vs. 0.45 and 14.95 vs. 14.65, respectively). TDE seems to be better than BHE in terms of duration of hospital stay (7.4 vs. 8.05). However, these differences were not statistically significant. TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and least invasive. Overall results were comparable across both techniques without any significant difference. CONCLUSION: Although both techniques appear to be similar in respect of their primary and secondary outcome variables, but TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and small incision.

Neglected Recurrent Scalp Sinus: Calvarial Tuberculosis with Intracranial and Extracranial Extension.

BACKGROUND: Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions. CASE PRESENTATION: A 43-year-old man presented with a generalized seizure, altered mental state, scalp swelling, and pus-discharging sinus over the scalp. Magnetic resonance imaging of the brain indicated a conflicting diagnosis of anaplastic meningiomas and chronic osteomyelitis with intracranial extension. Débridement and drainage of intracranial pus was performed. Histopathologic examination revealed TB. After surgery, the patient's general condition improved, and he was started on antitubercular drugs. CONCLUSIONS: Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.

Thrombocytopenia in Paediatric ICU: Incidence, Transfusion Requirement and Role as Prognostic Indicator.

INTRODUCTION: Thrombocytopenia is defined as platelet count less than 150×10(9)/L, it has a greater incidence in Intensive Care Units (ICUs) compared to wards and its most common cause is increased platelet consumption. AIMS: To investigate incidence of thrombocytopenia, platelet transfusions requirement, associated diseases and relationship between thrombocytopenia and mortality. MATERIALS AND METHODS: Eleven months hospital records between October 2013 and August 2014 of the PICU in a tertiary care teaching hospital was investigated retrospectively and 275 critically ill children formed the sample. STATISTICAL ANALYSIS: Odds ratio with 95% confidence interval was used. Probability value (p-value) of less than 0.05 was considered statistically significant. Results were confirmed using χ(2) test. RESULTS: Out of 275 patients {168 males (61.09%) and 107 females (38.91%)}, 89 patients had thrombocytopenia. Out of these 89 patients, 43 patients (48.31%) had severe, 24 patients (27.91%) had moderate and 22 patients (24.72%) had mild thrombocytopenia. The 43 patients having severe thrombocytopenia received platelet transfusion and out of these 43 patients 24 (55.81%) received more than one transfusion and 18 (41.86%) of the transfused patients expired. Among thrombocytopaenic patients, Sepsis (25.84%) was the most common diagnosis followed by Pneumonia (19.10%), Meningitis (13.48%), Diabetic Ketoacidosis (5.62%), Enteric fever (7.86%), Tubercular Meningitis (3.37%), Infantile Tremor Syndrome (2.25%), Congenital heart disease (5.62%), Burns(3.37%), Brain Haemorrhage (2.25%%), Hepatic abscess (1.12%), Chronic Renal Failure (3.37%), Malaria (2.25%) and Hepatitis (4.49%). There is a statistically significant association between thrombocytopenia and mortality. A significant association was established between mortality in thrombocytopenic patients of sepsis. CONCLUSION: Thrombocytopenia is commonly associated with sepsis. Mortality rate is higher in thrombocytopenic patients.