BackgroundAcute hydrocephalus can cause neurological deterioration after aneurysmal subarachnoid hemorrhage (aSAH). Predicting which patient would require shunting is challenging.MethodsThis prospective study was conducted upon twenty patients who suffered acute hydrocephalus due to subarachnoid hemorrhage of ruptured aneurysms. Surgical or non-surgical management of hydrocephalus was conducted. Glasgow Coma scale (GCS) was assessed, and hydrocephalus was graded by bicaudate index. Fisher grade was determined from CT scan. Aneurysm site was determined by conventional or CT angiography. Either surgical clipping or endovascular coiling of aneurysms was performed.ResultsInitially, 3 (15%) patients had emergency CSF diversion on admission due to poor GCS on arrival. Initially, the remaining 17 patients were managed conservatively. Five patients did not require any intervention. Twelve patients had external ventricular drainage placement, 4 were weaned, and 8 failed weaning. High bicaudate index (> 0.2) correlated with shunting. Aneurysm site correlated well with shunting (ACoA or PCoA).ConclusionsPatients with fair GCS can be managed conservatively. Any deterioration warrants shifting to CSF diversion. Higher bicaudate index will usually need CSF diversion. The value of Fisher carries no significant value. Aneurysm location (ACoA or PCoA) correlates with an increased incidence of ventriculoperitoneal shunt placement.

Objective Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. Methods Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010–2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. Results Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14–86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. Conclusion Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.

BackgroundMeningeal melanocytoma is considered a rare lesion arising from leptomeningeal melanocytes. Nearly two thirds of meningeal melanocytomas were reported in the intracranial compartment and the remaining one third in the spine. Spinal melanocytomas can be extradural or intradural, with extradural variant being more common, and the majority of cases have been single reports.MethodsA 5-year-old male presented with a 4-month history of non-radiating low back pain persistent at rest, with otherwise non-remarkable medical history. The patient was neurologically intact with no deficits. Preoperatively, routine laboratory investigations were non-remarkable. MRI imaging was done and showed a lesion at the level of T11 to L4, hyperintense on T1 and hypointense on T2 with homogenous contrast enhancement. Intraoperatively, the lesion was hemorrhagic, brownish, and rubbery in consistency attached to the ventral dura. Microscopic picture revealed dense cytoplasmic brown melanin pigments, with no significant mitoses or nuclear atypia. What is unique about our case is the age of the patient (5 years).ResultsTo the best of our knowledge, after reviewing the literature, this is the youngest case to be reported.ConclusionsSMM is an extremely rare tumor with a benign course. Complete surgical excision should be attempted. Age of presentation may be as young as in our case and the diagnosis of such a tumor should never be excluded in this early age group with persistent low back ache.

Evaluation of tissue oximetry in per i o pe ra t ive mo n i to ri n g of co I o recta I surgery SirWe read with interest the recent article by Van Esbroeck and colleagues on tissue oximetry in colorectal surgery (Br J Surg 1992; 79: 584-7). We wish to raise a number ofpoints about this paper. The introduction

Background: Laparoscopic repair of perforated peptic ulcer (PPU) has become an accepted way of management. Omentopexy was the main method of repair for decades. Objective: The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as omentopexy.Patients and Methods: This prospective study included 50 patients who were diagnosed with perforated peptic ulcers and underwent laparoscopic repair of perforated peptic ulcers at our institute from September 2019 to September 2020. They were divided into two groups: Omentopexy (group A) (n=20) and repair with simple closure only (group B) (n=30). Patients' age, sex, pulse, blood pressure, respiratory rate, Boey score, perforation size, operation time, leakage, wound infection, and length of hospital stay were evaluated. The data were compared by Mann-Whitney U test and the Pearson's chi-square test. Results: No patients died nor leaked. After matching, the simple closure and omentopexy groups had similarity in age, gender, pulse rate, respiratory rate, Boey score, perforation size and wound infection. There were statistically significant differences in systolic blood pressure (P = 0.002), operating time (136.40 ± 10.45 versus 106.83 ± 6.89 minutes; P < 0.0001), and length of hospital stay (7.20 ± 1.32 versus 5.67 ± 0.55; P < 0.0001). Conclusion: Laparoscopic repair of a perforated peptic ulcer without an omental patch is a safe option and shortens the operating time.