More than one third of patients with subarachnoid hemorrhage (SAH) develop clinically significant vasospasm, as a leading morbidity and mortality factor for these patients. It is widely accepted that a) Degradation products of blood are the causative factors of vasospasm b) The amount of subarachnoid blood seen on admission CT is correlated to the risk of vasospasm c) Reducing the subarachnoid clot burden at the time of surgery reduces the risk of vasospasm. But there is no existing method to clear the blood from subarachnoid spaces satisfactorily. We have evaluated safety and feasibility of fluid exchange catheter system in SAH, to achieve this goal. We were successful in clearing cisternal blood in three patients with aneurysmal rupture with fluid exchange catheter system. Baseline CT scan of brain was performed immediately after the surgery and then at the end of irrigation. The amount of subarachnoid blood was evaluated. This innovative, fluid exchange catheter system infuses and aspirates micro volumes of drug solution in a cyclic mode, ensuring isobaric exchange of fluids. The result is good clearance of blood in subarachnoid spaces were seen in all the patients. Also, significant improvement in neurological deficits secondary to vasospasm was seen. We conclude that the fluid exchange catheter system is safe and adoptable in neurosurgical practice.
Introduction: Traumatic spinal cord injuries are on the rise. Spine injuries are one of the common causes of major morbidity and mortality. These are frequently related to high energy trauma like falls, road traffic accidents (RTAs) and assaults. Objectives: To analyse the clinico - epidemiological pattern of traumatic spinal cord injuries,common injury modes, presentations, age and gender distribution, level of injuries, pre-hospitalisation practices, severity of neurological deficits and treatment options. Methods: A prospective study was conducted on 43 patients with traumatic spinalinjuries from Jan 2012 to June 2013. Data on epidemiology, mode of injury and presentation, level of spinal injury, severity of neurological deficits and the patient's knowledge about such injuries were analysed. Results: The most common mode of injury was fall from height followed by RTAs. Maximum injuries were to the cervical spine (55.8%),followed by thoracic (25.5%) lumbar (16.2%) and thoraco - lumbar injuries(2.3%).The average patient age was 40.2 years with a male to female ratio of 42 : 1. None of the patients received any prehospital treatment. Among thesewere 21 paraplegics (48.8%),9quadriplegics (20.9 %), 4 withquadriparesis (9.3%) and 9 with paraparesis. All patients were stabilised surgically. Mortality accounted to 23.25%. Conclusion: There is anemergent need to create awareness among the rural population regarding traumatic spinal injuries, preventive safety measures in the work field and safe driving practices to reduce the incidence and prevalence of these injuries. Pre hospital first aid, transportation and medical facilities should be improved and made accessible and affordable to the susceptible weaker population.
Osteomyelitis has long been one of the most common, difficult and challenging problem confronted by the surgeons in daily practice. The key to successful management is early diagnosis and appropriate treatment. The first line in treatment of vertebral osteomyelitis is conservative. There is an increased risk of deep infection with the use of spinal instrumentation. Therefore, the placement of implants in an infected area remains a matter of debate. We present two patients with lumbar vertebral osteomyelitis using antibiotic impregnated PMMA for vertebral body reconstruction and pedicle screw fixation. Post-operative follow-up showed satisfactory results both symptomatically and neurologically. The antibiotic impregnated bone cement acts as both interbody spacer and an antibiotic carrier. However, a long term outcome in both the cases requires further evaluation.
Intracranial meningiomas continue to challenge our best clinical efforts to eliminate them once discovered and deemed appropriate for treatment. Malignant meningiomas constitute 10% to 15% of all meningiomas and limited information exists regarding adjuvant treatment. The external whole brain irradiation is recommended. Traditional chemotherapy has proven ineffective; thus, new chemotherapeutic agents and new methods of delivery should be developed. Immunotherapy may be considered for patients with malignant meningiomas when all others previous treatment have failed. We report a rare case of Psammomatous anaplastic meningioma. A 45-year-old man presented with head ache since 15 days and vomiting since 13days. Magnetic resonance image demonstrated a large left frontal mass with heterogenous enhancement and moderate peri-lesional edema. The tumor and the infiltrated dura were radically removed. Postoperatively, the patient remained neurologically intact.
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