No abstract

Penetrating brain injury (PBI) is any injury that causes penetration of the scalp, skull, meninges, and brain. It is a traumatic brain injury caused by either low-velocity sharp objects (e.g. a knife), high-velocity projectiles (shell fragment or bullets) or blast injury is the consequence of the detonation of complex explosives with or without PBI and closed head injury. To evaluate the factors (pre-operative and operative) that affect the surgical outcome of civilian PBI. This study was done from February 2017 to October 2018 prospectively & retrospectively. The study involved only the civilian patients that got a penetrating head injury and surgically treated in Neurosurgical Teaching Hospital/Baghdad/Iraq. The data include thirty-nine (39) operated patients with PBI. Data information includes the Glasgow Coma Scale (GCS), radiological investigations (computerized tomov graphy (CT-scan) and plain X-ray) the outcome determined by Glasgow Outcome Score (GOS). The patients were followed up during the time of hospitalization. The surgical outcome of the penetrating head injury in this study was assessed by GOS and was as follow, good recovery 10 patients (25.6%), moderately disabled 11 patients (28.2%), severely disabled 5 patients (12.8%), vegetative 6 patients (15.4%), Dead 7 patients (18.0%). Good outcome 21 patients 53.8% while poor outcome 18 patients 46.2%. GCS is significant factor (p-value = 0.002), time not affecting, CT-finding is significant factor (p-value = 0.000), blood pressure >= 90 mm Hg is a good predictor factor (p-value =0.001), speech difficulty is poor predictor factor (p-value = 0.004), outcome of inlet alone better than inlet and outlet. There are many factors affecting the surgical outcome in civilian penetrating head injury, and the significant factor is pre-operative GCS, CT-scan which is the best radiological investigation for pre-operative and post-operative assessment and show the details of the injury, blood pressure > = 90 mm Hg which is a good prognostic factor.

Pediatric head injury accounts for a large number of admissions in emergency rooms, it is a major cause of morbidity and mortality in children over 1 year of age. The aim of this study is to assess the outcome of surgically treated pediatric patients with head trauma in Baghdad. Patients and methods : This prospective cross sectional study was conducted in neurosurgery hospital in Baghdad including fifty two patients of pediatric age group from 1 year to 14 years old with surgically operated head trauma, in the period from 1/10/2014 till 1/10/2015. All the patients were received; examined and managed properly and followed up till 6 months after surgery. The outcome was truly affected by the mechanism of injury (p=0.001), falls from heights was the most common mechanism and it was significantly related to mortality, it also increased the rate of disability, while it had no significance regarding a good functional recovery. There were associated orthopedic injuries which also affected the outcome significantly (p=0.01) increasing the mortality and disability. The outcome was truly affected by pediatric coma scale (p=0.001), functional recovery was increased with higher score and mortality increased with lower score, and disability increased in both severe and moderate scores. Pediatric trauma score had a significant effect on the outcome (p=0.001), in score (less than 0) it increased the mortality, in score(0-5) morbidity was increased. Falls from heights are the most common mechanism of pediatric head trauma and greatly affect the outcome. Concomitant orthopedic injuries are associated with poor outcome. pediatric coma scale, pediatric trauma score are significant tools in predicting outcome.

Intracranial aneurysms are a weakened arterial wall due to loss of internal elastic lamina resulting in dilations of the intracranial arteries and these aneurysms are susceptible to rupture, resulting in lifethreatening hemorrhage; therefore represents chief cause of hemorrhagic stroke. Rhoton rules are used for the planning the operative approach to these aneurysms.Aim of the study: to evaluate the application of Rhoton rules in our patients with intracranial aneurysms.A retrospective series of 283 aneurysms, from 1 st of January 2016 to 1 st of December 2018 in Neurosurgical Teaching Hospital Baghdad/Iraq, diagnosed by CT angiography with 3D reconstruction were included in this study to evaluate the age, sex, site, size, locations and application of Rhoton rules in these aneurysms.Of the 283 patients studied, we found 127 aneurysms at the anterior communicating artery (location 1), 80 at the posterior communicating artery (location 2), 37 at the bifurcation of the internal carotid artery (location 3), 21 at the middle cerebral artery (location 4), and 18 in the posterior circulation (location 5). The four rules of Rhoton about intracranial aneurysms: rule one (100%), rule two (84.5%), rule three (84.8%) & rule four (84.8%).The rules of Rhoton is a heterogeneous concept which summarizes several hemodynamic principles and is verified in 80% of aneurysms in Iraqi patients, with different frequencies depending on the rule and location. These findings should be verified in other populations, as our patients are of Hispanic origin in 99.7% of the cases.