Carbon monoxide poisoning is one of the most prevalent types of accidental poisoning worldwide, especially in houses and hotels with malfunctioning or badly maintained appliances. Most carbon monoxide poisoning cases remain undetected because of common symptoms of flu and lack of knowledge. Two people died as a result of unintentional carbon monoxide poisoning in the restroom, which we reported. On the next day of Valentine's Day, a boy and a girl, both about 23 years old and healthy students, were discovered dead inside a bathroom in a compromised position. Medicolegal autopsy revealed the Cherry-red discolouration of the skin, mucous membranes, conjunctivae, nail beds, and areas of hypostasis was seen in both the deceased. Further analysis of the crime scene reveals that the bathroom lacks adequate aeration. Suggestive of a carbon monoxide poisoning which was later confirmed in laboratory analysis of post-mortem blood by UV visible spectrophotometry revealed the presence of dangerous levels of carboxyhaemoglobin i.e., 38.27% in male and 36.79% in female. This method of detecting carboxyhaemoglobin in blood is easy and inexpensive. This case serves to increase awareness of fatal carbon monoxide poisoning by gas geysers. Carbon monoxide poisoning is linked to a high death and morbidity rate. Due to the rising usage of gas water heaters in homes, public awareness of the hazards associated with carbon monoxide, with an emphasis on preventive measures at home, is essential for avoidance.
Objective Anterior midline skull base meningiomas involving olfactory groove, planum sphenoidale, and tuberculum sellae were usually managed with bifrontal craniotomy until the dawn of advanced microsurgical techniques. With the emergence of microsurgical techniques, midline meningiomas could be tackled solely from a unilateral pterional approach. We present our experience with pterional approach in managing anterior skull base midline meningiomas, including the technical nuances and outcomes. Methods Fifty-nine patients who underwent excision of anterior skull base midline meningiomas through a unilateral pterional craniotomy between 2015 and 2021 were retrospectively analyzed. The surgical technique and patient outcomes in the context of visual, behavioral, olfaction, and quality of life were evaluated during the follow-up. Results A total of 59 consecutive patients were assessed over an average follow-up period of 26.6 months. Twenty-one (35.5%) patients had planum sphenoidale meningioma. Olfactory groove and tuberculum sellae meningioma groups consist of 19 (32%) patients each. Visual disturbance was the predominant symptom with almost 68% of patients presented with it. A total of 55 (93%) patients had complete excision of the tumor with 40 patients (68%) achieving Simpson grade II excision, and 11 (19%) patients had Simpson grade I excision. Among operated cases, 24 patients (40%) had postoperative edema among which 3 (5%) patients had irritability and 1 patient had diffuse edema requiring postoperative ventilation. Only 15 (24.6%) patients had contusion of the frontal lobe and were managed conservatively. Five patients (50%) with seizures had an association with contusion. Sixty-seven percent of patients had improvements in vision and 15% of patients had a stable vision. Only eight (13%) patients had postoperative focal deficits. Ten percent of patients had new-onset anosmia. The average Karnofsky score was improved. Only two patients had recurrence during follow-up. Conclusion A unilateral pterional craniotomy is a versatile approach for the excision of anterior midline skull base meningioma, even for the larger lesions. The ability of this approach in the visualization of posterior neurovascular structures at the earlier stages of surgery while avoiding the opposite frontal lobe retraction and frontal sinus opening makes this approach more preferable over the other approaches.
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