This study was carried out to find out the age, sex, mode of injury, localization, clinical presentation, CT findings, operative measures and outcome of extradural haematoma in the patient population at Dhaka Medical College. 610 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 6th October 2008 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Out of 610 cases 86.32 % were male and 13.78 % were female. The male and female ratio was 6.27: 1. Age ranged from 2.5 to 83 years. Commonest age group was 21 to 30 years. Commonest mode of injury was Road traffic Accident 53.45%, followed by Assaults. Most common clinical presentation was headache / Vomiting 63.61 %, followed by altered sensorium 60.66 %. In this present prospective study of 610 cases of EDH, temporo parietal site was involved in 33.45 % followed by frontal region in 23.28 %. Sixty five patients (10.66 %) died; 19 of these had associated brain injuries and 28 cases were deeply unconscious. Extradural haematoma is a neurosurgical emergency where early surgical intervention is associated with the best prognosis. Many factors affects the outcome of extradural haematoma surgery and the most important one is the duration of time between incident/accident and operation in neurosurgical operation theater; mortality can be close to 0% if this time interval can be minimized.
Temporal Lobe Epilepsy (TLE) is one of the most common surgical epilepsy that is usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-Venous Malformation (AVM) etc],trauma, infection (Tuberculosis),parasitic infestation (e.g. Schistosomiasis) etc. Here we report three cases of surgically treated TLE in pediatric age that was due to MTS and low grade ganglioglioma. In all three cases the only presenting symptom was complex partial seizure (Psychomotor epilepsy) for which all underwent scalp electro-encephalography (EEG) and Magnetic Resonance Imaging (MRI) of Brain. All three patients were managed by amygdalohippocampectomy plus standard anterior lobectomy. In post operative period the cases were seizure and disease free till last follow up. We did not face any nominal dysphasia, memory disturbances, hemi paresis or visual field defect. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10370 BJCH 2011; 35(1): 26-31
Through and through orbitocranial penetrating injury by in situ teta is extremely rare. We managed such a case in Dhaka Medical college hospital with many limitations. In spite of all possible supports that were available in our set up, patient did not survive. Presentation, investigations, surgical and other supportive management will be highlighted in this case report. Key Words: Orbitocranial injury; penetrating injury; teta. DOI: 10.3329/jdmc.v18i2.6285 J Dhaka Med Coll. 2009; 18(2) : 185-187
Epilepsy patients are usually managed medically but some cases are resistant to medical treatment and needs surgical treatment. Temporal lobe epilepsy (TLE) is commonly intractable. The underlying cause may be mesial temporal sclerosis(MTS), cortical dysplasia(CD), tumors (ganglioglioma, dysembryoplastic neuroepithelial tumor-DNET), post traumatic gliosis, infection (tuberculosis) parasitic infestation (schistosomiasis, neurocystocercosis) etc. In this type of epilepsy surgery is the treatment of choice (even there is no symptoms other than seizure). Here we report two cases of surgically treated TLE that were due to low grade ganglioglioma and high grade ganglioglioma. In both cases the only presenting symptoms was complex partial seizure (Psychomotor epilepsy) for which they underwent scalp EEG (Electro Encephalography) and MRI (Magnetic Resonance Imaging) of brain. Both patients were managed by complete tumor excision with amygdalohippocampectomy plus standard anterior lobectomy. One patient with high grade ganglioglioma recurred within two months of operation and expired within five months. The other case was seizure and disease free till last follow up.
Cranio vertebral (CV) junction is one of the critical sites for surgery. It's anatomy, physiological aspects and pathological involvement varies in a wide range of margins. Common problems are developmental anomalies, traumatic involvement, inflammatory, infective and neoplastic lesion. Management of these problems varies a lot from each other. Aim of the article is to overview the pathologies in this area and to study presentations, investigations, surgical procedures and results of these pathologies. We prospectively analyzed 32 cases of Cranio-vertebral (CV) region surgery in the Department of Neurosurgery Dhaka Medical College Hospital and Mitford Hospital, Dhaka, from 2000 to 2008. In our series, male and female ratio was 7.2:1. Pathologies were atlanto- axial dislocation (AAD), Chiari malformation type –I, schwannoma, meningioma, hydatid cyst and tuberculosis. Common clinical findings were- neck pain, quadriparesis, quadriplegia, hand atrophy, autonomic dysfunction and hypertension. Various types of surgical procedures were done in this series according to the pathology. Death was in 01 case, neurological deterioration seen in one case, 2 cases were neurologically stable and 28 cases (87.5%) improved neurologically where one was non useful improvement (Frankel grade-C). Complete pre operative radiological study is a very important adjunct for a successful surgical result. Proper evaluation of patients with selection of appropriate surgical procedures along with safe surgical techniques are the necessary things for successful surgery in this area. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7952 (J Bangladesh Coll Phys Surg 2011; 29: 78-84)
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