Trans-Thoracic Extra-Pleural Percutaneous Spinal Fixation-A Technical Note.

Study Design: Cross-sectional analysis of defined parameters of patients who underwent the presented technique. Patients undergoing thoracic spine fixation for various pathologies. Objective: This technique attempts to limit the incision size in extrapleural thoracotomy for multi-level spinal fixation. Summary of Background Data: Dorsal spine is traditionally approached by either transpleural or extrapleural approach. The extrapleural approach carries a limitation of being restricted in number of levels it can address. By incrementally modifying the present technique, we were able to employ the approach in greater number of levels with lesser morbidities. Method: Classical extrapleural thoracotomy approach is employed with incision size limited to the levels of pathology (~5 cm). Thereafter, proper exposure using Kittner dissection and defining of screw entry points follows. Stab incision is made and screws placed percutaneously through a K-wire-defined trajectory. Results: Eighteen patients underwent fixation through this technique, of which 11 were infectious, four were traumatic, and the rest were neoplastic in pathology. None except three patients had ICU stay of more than 1 day. All patients had a pain score of 6 or lower except for two. Conclusion: Combining the technique of percutaneous screw placement with traditional extrapleural thoracotomy reduces the size of the incision, tissue damage, and morbidity while reducing the cost and duration of hospitalization without comprising the extent of pathology that can be dealt with.

Falcine and parasagittal intracranial chondrosarcomas of the classical variant: report of two cases with review of literature.

Intracranial primary extraskeletal chondrosarcomas are extremely rare. We report two cases of the classical variant which were dural based: one falcine and the other parasagittal are presented. Only 10 cases of this variant have been reported in this location. The pathology and management of these lesions have been reviewed.

A system of radiological criteria for grading and prognosticating temporal lobe contusions.

INTRODUCTION: Temporal contusions are common in patients with head injuries and require close monitoring due to the propensity of these patients to deteriorate rapidly and fatally. This study attempts to introduce a radiological grading system for temporal lobe contusions and analyse its prognostic value so as to better identify patients at risk of deterioration. METHODS: The study was conducted as a cross-sectional observational study from April 2011-March 2017 on 42 patients with temporal lobe contusion. Each patients was graded according to the proposed system from a minimum of four to a maximum of 13 and then further grouped in three grades - grade 1 (score = 4), grade 2 (score 5-7) and grade 3 (score > 7) - and their clinical course was closely observed. RESULTS: The minimum and maximum scores observed were four and 11 respectively. The proposed grading system has statistically significant correlation to the Glasgow Coma Scale (p-value < 0.05). All patients in grade 1 (17) could be managed conservatively, while all those in grade 3 (five) needed immediate surgical intervention. Of 20 patients in grade 2, 11 had a score of 5-6 and did not require surgery, whereas nine patients had a score of seven and of these eight required delayed surgical intervention. This correlation was statistically significant (p-value < 0.05). CONCLUSION: The proposed temporal lobe contusion grading system is a good radiological tool to predict the clinical course of patients and thereby identify patients at higher risk of delayed deterioration.