A prospective study to determine the risk factors associated with post traumatic seizures: A single institution experience.

Background: Post traumatic seizures (PTS) are a known sequel of traumatic brain injury (TBI). Incidence of PTS is dependent on many factors including study design and characteristics of the study population. As incidence of TBI increases and death due to TBI decreases, more individuals will be at risk of developing and living with chronic complications. The objective of the present study was to determine the frequency and risk factors for PTS following TBI. Methods: A prospective study was conducted on patients admitted with TBI from April 1, 2019, to May 31, 2020, to determine the frequency, time to event, and risk factors for PTS following TBI. We classified the severity of head injury using a standard criterion, into mild, moderate and severe injury. Follow-up of 3 months was undertaken for all patients. Variables include age, sex, trauma severity, Glasgow coma scale, onset of PTS, and neuroradiological finding. Results: We enrolled 450 post traumatic subjects, out of which 36 (8%) developed seizures. Of the total of 36 patients detected to have hemorrhagic contusion on computerized tomography scan, 12 patients developed seizures. We found that the independent risk factors associated with occurrence of PTS were frontal- temporal lobar contusion and severity of head injury. All these findings were statistically significant. Conclusion: We found that the independent risk factors associated with occurrence of PTS were frontal-temporal lobar contusion and severity of head injury. Type of management (Operative vs. Non operative) does not affect the outcome of PTS.

Clinicoradiological Profile and Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms: A Single-Institute Experience.

INTRODUCTION: Prevalence of intracranial aneurysms is estimated to be from 1% to 5% of population, most of them are small and located in the anterior circulation. The real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage (SAH). SAH is a catastrophic event with a mortality rate of 25% to 50%. Permanent disability occurs in nearly 50% of the survivors. Fifteen percent of patients expire before reaching the hospital and 25% die within 24 h. The purpose of our study is to report the clinicoradiological data and outcome of microsurgical clipping of ruptured anterior circulation aneurysms in our center. MATERIALS AND METHODS: This study included ruptured anterior circulation aneurysms admitted to tertiary care hospital in northern India from January 2018 to June 2020. The final outcome of patients was analyzed with Glasgow Outcome Score (GOS) at the time of discharge from the hospital. RESULTS: A total of 53 patients with ruptured anterior circulation aneurysm underwent microsurgical clipping comprising 25 (47.2%) males and 28 (52.8%) females. The mean neck size of all aneurysms was 3.43 ± 1.66 mm. The mean hospital stay was longer in patients having preoperative intraventricular hemorrhage (IVH) (35.96 ± 27.27 days) and postoperative complications (43.36 ± 29.76 days) compared to patients who did not have IVH (21.10 ± 15.47 days) and postoperative complications (18 ± 6.54 days). P value was ≤0.05. Patients with preoperative hydrocephalus had GOS 3.44 ± 1.20 at discharge compared to nonhydrocephalus who had GOS 4.32 ± 1.07 (P = 0.009). Patients with Intracerebral Hemorrhage (ICH) and non-ICH had GOS 3.31 ± 1.38 and 4.28 ± 1.01, respectively (P = 0.009). CONCLUSION: Poor outcome at the time of discharge after the surgical treatment of anterior circulation aneurysms was associated with poor world federation of neurological surgeons grade on admission, presence of IVH, hydrocephalus, intracerebral hemorrhage, and postoperative cerebral infarcts.

Comparative Study of Subgaleal and Subdural Closed Drain in Surgically Treated Cases of Chronic Subdural Hematoma.

BACKGROUND: Chronic subdural hematoma (CSDH) is seen most common in geriatric patients, and trauma is the most important reason for CSDH. Operative treatment of CSDH in symptomatic patients is yet the gold standard of therapy because it allows decompression of the subdural space and aids improvement in neurological status. Burr-hole craniostomy is the most common accepted treatment for CSDH. There is still controversy regarding which type of drain placement is best in the outcome: subdural or subgaleal drain. AIM: The aim of the study was to compare the outcome of subgaleal versus subdural drain in surgically treated patients of CSDH. MATERIALS AND METHODS: Patients were assigned by simple random sampling in two groups. The study was conducted from February 2016 to July 2017. A total of 70 patients were enrolled into the study and were divided in two groups (Group 1 - Subgaleal drain; Group 2 - Subdural drain). Statistical analysis was done using Chi-square and t-test. Outcome was assessed at the end of hospital stay by modified Rankin scale. Postoperative computed tomography scan was done after 24 h of surgery. RESULTS: This study concluded that both types of drains are equally effective for the treatment of CSDH. There is a statistically significant difference in the occurrence of seizure in both the groups as there was no seizure in subgaleal drain group compared to 5 (14.3%) patients who had seizures postoperatively in subdural drain group (P = 0.020). There was insignificant difference with respect to preoperative Glasgow Coma Scale/sex/preoperative hematoma volume/postoperative hematoma volume/preoperative midline shift. CONCLUSION: Subgaleal drain is safe and technically easy, as subgaleal drain has no direct contact with brain parenchyma, thus less chances of brain laceration, intracerebral hematoma formation, and seizures.

Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional Experience.

BACKGROUND: Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1-2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1-3% of all pediatric head injuries. MATERIALS AND METHODS: The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale. RESULTS: Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1-5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14-15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis. CONCLUSION: Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.

Intramedullary mature teratoma of spinal cord: A rare tumor with review of literature.

BACKGROUND: Spinal teratomas are rare in adults. The clinical findings are nonspecific, reflecting only in the intramedullary location of these lesions. The potential differential diagnosis for intramedullary spinal teratomas include schwannomas, dermoids, epidermoids, and neurofibromas. CASE DESCRIPTION: A 25-year-old male presented with RLE weakness (iliopsoas/quadriceps [4/5], and extensor hallucis longus/dorsiflexor [0/5]) and urinary incontinence. As the contrast, MR showed a heterogeneous intramedullary lesion with well-defined edges located at the T12-L1 level, the patient underwent a focal laminectomy for gross total tumor excision. Pathologically, it proved to be a mature teratoma. CONCLUSION: Teratomas should be considered among the differential diagnostic considerations for intramedullary spinal cord lesions. Although gross total resection is preferred, these lesions have a low recurrence rate, and therefore, partial removal is also valid, where lesions are densely adherent to adjacent neural structures.

Endoscopic Third Ventriculostomy in Failed Ventriculoperitoneal Shunt in Pediatric Population.

INTRODUCTION: Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients. MATERIALS AND METHODS: The authors retrospectively reviewed the management and outcome of 36 failed VP shunts in pediatric patients for the treatment of hydrocephalus. The surgeries were performed between November 2010 and January 2016 in a tertiary care hospital. The minimal follow-up period was 3 months. We divided the patients into the following age groups: <1 year (eight infants), 1-10 years (18 children), and 10-18 years (10 children). The success of the procedure was determined by age, sex, type of hydrocephalus, and the number of shunt revisions and malfunction before ETV. Children with different age (P = 0.839) and sex group did not show any significant data (P = 0.798). Children with communicating hydrocephalus had a success rate of 52.9% (17 patients), and children with noncommunicating hydrocephalus had a success rate of 84.2% (19 patients). The success rate in children with only one shunt malfunction was 57.1% (21 patients), whereas in 15 children with two or more shunt malfunctions, the success rate of ETV was 86.7%. CONCLUSIONS: The authors conclude that ETV is an effective alternative for the treatment of hydrocephalus in children. Age does not present a contraindication for ETV in failed VP shunt.

Prospective Randomized Comparative Study to Evaluate Epidural Fibrosis and Surgical Outcome in Patients Undergoing Lumbar Laminectomy with Epidural Autologous Free Fat Graft or Gelfoam: A Preliminary Study.

INTRODUCTION: Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF. MATERIALS AND METHODS: The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI. RESULTS: Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery. CONCLUSION: Use of free fat graft at laminectomy site helps in reducing EF.

Pneumorrhachis following Chest Injury: A Rare Entity.

Pneumorrhachis (PR) - the phenomenon of intraspinal air - is a rare radiological finding. The presence of intraspinal air is usually after epidural injections, spinal manipulations, synovial cysts, degenerative disc disease, and epidural abscess. PR is mostly asymptomatic but can also be symptomatic. We report a case with PR after chest trauma and attempt to explain its development.