Purpose The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.

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Introduction: Mortality is an important self-assessment tool in medical practice. This study assesses various factors associated with mortality in Neurosurgery ICU (NS-ICU). Methods: A prospective, cross-sectional study was carried out from January 2017 to December 2017 in 416 patients admitted to NS-ICU. The age, sex, diagnosis, GCS, pupil’s abnormality, vital parameters, laboratory parameters, comorbidities were compared in between mortality and survival group. The individual component of GCS was further evaluated. Results: Out of 416 patients, 374 (89.90%) patients were in survival group and 42 (10.10%) patients in mortality group. Trauma 188(45.20%) and Cerebrovascular accident 133(31.97%) were commonest diagnosis on admission. The GCS, eye-opening and motor component of GCS, abnormal pupils, hypertension (HTN), diabetes mellitus (DM), diastolic blood pressure (DBP), heart rate (HR), operated cases and serum urea levels were found to have significant difference between mortality and survival group. These parameters were further subjected to binary logistic regression which showed DBP (B-0.01, p=0.00), HR (B0.02, p=0.00), motor score of GCS (B-0.50, p=0.04), operated cases (B 1.13,p=0.00), abnormal pupils (B1.85,p=0.00), DM (B1.56, p=0.00) to have significant association with mortality. Conclusions: High heart rate, low diastolic BP, low motor score of Glasgow Coma Scale, abnormal pupils, diabetes mellitus and operated cases were found to be significantly associated with mortality.

Background: Tracheostomy is a commonly performed procedure in neurosurgical Intensive Care Units (ICU) performed to secure airway, aid in pulmonary toileting, and minimize ventilator-associated pneumonia (VAP) in cases requiring prolonged mechanical ventilation. Although early tracheostomy has been advocated rampantly in recent days, its benefit over late tracheostomy and the timing itself has been very controversial. In this study, we tried to study the effect of timing of tracheostomy in the outcome of patients in our ICU. Materials and methods: This is a retrospective study carried out over a period of one and a half years in a tertiary care center in western Nepal. Early tracheostomy was defined as those done within 4 days of endotracheal intubation and late were those done thereafter. Outcomes were studied in terms of length of ICU stay, hospital stay, mechanical ventilation, duration of tracheostomy in situ, VAP and mortality and complication over 90 days. Statistical analysis was done using SPSS 20.0. Results: There were 67 cases included in the study, out of which 27(40.3%) underwent early and 40 (59.7%) underwent late tracheostomy. The Mean duration of ICU stay, tracheostomy in situ duration, mechanical ventilation duration, and VAP were the parameters showing a significant difference between the two groups. There were 13 (19.4%) cases having complications in our series of which 6 (9%) of cases were from the early tracheostomy group and 7 (10.4%) of the cases were from the late tracheostomy group (p=0.63). Conclusion: Early tracheostomy is beneficial in a neurosurgical patient in terms of a decrease in ICU stay, duration of mechanical ventilation, duration of tracheostomy in situ, and VAP.

Introduction: Otorhinolaryngological injuries in head injury are something which are very common but yet are overlooked, missed and at times forgotten. In this study, we tried to see the epidemiological characteristics, clinical presentations and management of these associated injuries in cases of head injuries in a tertiary care center in western Nepal. Methods: An analytical study was done in all cases of head injury admitted to neurosurgical ward and ICU in between January 2019 to December 2019. Various clinical and epidemiological details were collected from the patient’s records obtained from Medical Records Department and charted in a preformed performa. All the continuous data were presented in terms of mean and standard deviation and categorical data in terms of percentage. Statistical analysis was done using SPSS 22.0 software. Results: Soft Tissue lacerations were the commonest findings in all head injuries; nose and face lacerations (29.5%), ear lacerations (23.5%) followed by facial bone fractures (19.2%). There were 41(52.6%) cases with mild head injury, 23 (29.5%) cases with moderate head Injury and 17 (17.9%) cases with severe head injury in patients those had associated ENT findings. There was no any statistically significant difference in outcome or hospital stay in between the head injuries with and without ENT manifestations (p=0.187) and (p=0.219) respectively. Conclusion: Skull base tumors are treated based on findings of diagnostic nasal endoscopy and imaging results. CT scans and MRIs are becoming more significant in the diagnosis of diseases. Endoscopic techniques to the skull base were beneficial in treating the malignancy. Chemotherapy can be used as a gold standard first-line treatment with radiation and surgery for significant types of head and neck tumors. immunotherapy-like checkpoint inhibitors targeting PD1 are the second-line treatments of advanced HNSCC. Prospective research and trials will be required in the future.

Introduction: Whether to scan a minor head injury with Glasgow Coma Scale (GCS) 15 who appears well and has a normal physical and neurological exam or not is an issue commonly faced in all emergency departments. In this study, we tried to assess the predictability of clinical parameters in predicting traumatic intracranial lesions in Computed Tomography (CT) scans of patients with minor head injuries with GCS 15.Methods: A prospective observational study was carried out in between January to December 2016 in Manipal Teaching Hospital, Pokhara, Nepal. Various clinical predictors of 415 cases of minor head injury with GCS 15 were assessed to see if they could predict the abnormal CT scans in these cases. Clinical variables found significant in bivariate analyses were further analyzed using logistic regression to calculate the odds of each variable to detect abnormal CT scans.Results: There were 119 (28.7%) abnormal CT scans in the study. Vomiting, LOC (Loss of Consciousness), seizure and headache were the significant predictors of abnormal CT scans with an odds of 4.254 (95% CI: 2.373-7.627), 2.396 (95% CI: 1.258-4.562), 5.803 (95% CI: 1.110-30.336) and 1.967 (95% CI: 1.008-3.839) respectivelyConclusion: Vomiting, LOC, seizure and headache are important clinical predictors of abnormal CT scan in cases of minor head injuries with GCS 15.

Introduction: Posttraumatic seizures are the seizures that arise from traumatic brain injury and brain harm due to physical trauma. This study aims to study various clinic-demographic factors associated with post traumatic seizure in Western Nepal. Methods: A retrospective analytical study was carried out in a tertiary hospital of Nepal to determine factors associated with post traumatic seizures. Various parameters were tested for association with post traumatic seizure using student’s t test for quantitative and chi square or Fischer Exact test for categorical variables. All the variables showing significant association were subjected to binary logistic regression. P-value ≤0.05 was considered statistically significant. Results: There were 66 (21.02%) cases with post traumatic seizure in our study. Univariate analysis showed significant association of fall injury (p=0.004), loss of consciousness (p=0.001), post traumatic amnesia (p=0.012), severity of head injury (Glasgow coma scale) (p=0.011) and depressed fractures (p<0.001). A binary logistic regression was done amongst parameters with significant association with post traumatic seizure which showed patients with fall injury (OR 3.150, P=0.003, CI= 1.473-6.734) and depressed skull fractures (OR 26.278, p<0.001, CI= 12.155-56.809) had statistical significant association. Conclusion: Injuries secondary to fall, post traumatic amnesia, loss of consciousness, severity of head injury in terms of GCS and depressed skull fractures were significantly associated with post traumatic seizures in our study. On multiple regression model with adjusted odds of 3.15 (1.473-6.734) and depressed skull fractures with an adjusted odds of 26.278 (12.155-56.809) were significantly associated with post traumatic seizure.