Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyse the clinical spectrum, and to evaluate the postoperative outcome.Methods: This is a prospective observational Study which included 150 patients admitted in King George hospital, Andhra Medical College, Visakhapatnam, India over the past two years (01st August 2013 to 30th August 2015) with head injury, diagnosed to have Traumatic subdural Hemorrhage. A detailed clinical history, physical examination, CT scan was performed in all patients. Patients who were subjected to surgery, post-operative out-come were compared.Results: The maximum patients suffering from SDH are in the age group of 20-40 years (63%) with male predominance (73%). The most common mode of injury is RTA (73.33%). 40% of cases presented to hospital with gcs <8. Pupillary reaction, hypotension, CT scan findings i.e. thickness of hematoma >10mm and midline shift of >5mm, Basal cisterns obliteration, post traumatic seizure and delay in interval between the surgery had greatly affected on outcome of patients. Out of 150 cases, surgical approach was considered in 120 patients while remaining 30 patients were managed conservatively.Conclusions: Interval between injury to surgery with interval <4 hours having favourable outcome. Basal cistern obliteration, which is an indicator of increased intra cranial pressure is the single most important factor for unfavourable outcome. Hypotension and post traumatic seizures influence high mortality.
Background: In India 11% of deaths are due to trauma and 78% of injury deaths are due to head injury. The aim of this study was to analyse the clinical spectrum and to evaluate the postoperative outcome in patients with head injury with an extradural hematoma.Methods: This was a retrospective observational study which included 100 patients admitted in King George hospital, Andhra medical college, Visakhapatnam, Andhra Pradesh, India over the past two years (01/10/2014 to 30/09/2016) with head injury, diagnosed to have traumatic extradural hemorrhage. A detailed clinical history, physical examination and CT scan was performed in all patients. For patients who were subjected to surgery operative and post-operative findings were noted.Results: The maximum patients suffering from EDH are in the age group of 21-30 years (28%) with male predominance (95%). The most common mode of injury is RTA (58%) under the influence of alcohol. Majority of cases reached hospital within 6 hours from time of injury (44%). 95% of patients with EDH presented with LOC followed by vomiting in 68% of cases, followed by Headache in 42% of cases. 53% of the cases presented with mass effect over brain parenchyma with frontal EDH as most common location. Out of 100 cases, surgical approach was considered in 57 patients while remaining 47 patients were managed conservatively. Recovery from clinical and functional morbidity was satisfactorily acceptable, following treatment.Conclusions: Early presentation with mild to moderate GCS has good clinical outcome with minimal disability.
Background: Atlantoaxial dislocation refers to a loss of stability between the atlas and axis (C1-C2), resulting in loss of normal articulation. Cervical spine C1-C2 motion segment is the most technically challenging.Methods: This is a prospective and retrospective Study which included 34 patients admitted in King George hospital, Andhra medical college, Visakhapatnam over the past two years (January 2014- January 2016) with AAD.Results: The age of the patients ranged from 3 to 60 years with mean age being 37.67 years. Commonest presenting sign is local tenderness at the back of upper cervical region in 91.17%. Most common procedure done was single sitting trans oral odontoid decompression with posterior occipito cervical fusion with occipital plate and C2, C4 polyaxial screws and lateral mass rods in 18 cases out of 34. The next common procedure performed was C1 lateral mass and C2 pars screw fixation 8 out of 34.Conclusions: Trans oral odentoidectomy and posterior ocipito cervical fusion is ideal and still holds good for irreducible AAD with ventral compressive pathology.
Background: The prevalence of chiari malformation, defined as tonsillar herniations of 3 to 5 mm or greater, is estimated to be in the range of one per 1000 to one per 5000 individuals. The objective was to study the clinical presentation and outcome of ACM syrinx after foramen magnum decompression, c1 posterior arch removal duraplasty and without duraplasty.Methods: The study included 75 cases admitted with ACM with syrinx in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India, during a period of five years.Results: Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns and also correlated with reduction in size of the syrinx cavities. Postoperatively all the patients had decreased neck pain and two third of the patients had improvement in nystagmus, headache and dissociative anaesthesia in few cases.Conclusions: In the available literature, the treatment options offered for ACM syrinx are foramen magnum decompression and c1posterior arch removal, release of compression bands, which were followed in our institute also. We have compared pre-and post of MRI. Clinical improvement has been observed in 2 thirds of patient after a period of 2 year period follow up.
Background: Craniovertebral junction tuberculosis (CVJ-TB) is a rare entity occurring in only 0.3 to 1% of tuberculous spondylitis. It causes severe instability and neurological deficits. Present study includes 16 cases of CVJ tuberculosis with neck pain and progressive quadriparesis. Radiological evaluation showed wide spread disease around clivus, C1, C2, C3 with extensive bony destruction, cord compression, basilar invagination and atlantoaxial dislocation.Methods: The study included all the cases admitted with cv junction tuberculosis in neurosurgery ward in King George hospital, Visakhapatnam during a period of three years from 2014 to 2016. Four cases were managed conservatively and four cases were treated by only posterior occipitocervical fusion. We performed two stage operation in single sitting i.e. transoral decompression and posterior occipitocervical fusion in 12 cases. The pathological findings confirmed tuberculosis.Results: Postoperatively all the patients had decreased neck pain and two third of the patients (10 of 16 patients) had improvement in motor power.Conclusions: In the available literature, the treatment options offered for cvj-tb have ranged from a purely conservative approach to radical surgery without well-defined guidelines. In this study, we followed a radical approach as the patients included in our study presented with extensive TB cv junction. So, we recommend radical surgery for extensive TB of cv junction.
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