Outcome Following Decompressive Surgery for Malignant Middle Cerebral Artery Infarction

Nepal, Pankaj; Rijal, Suman

doi:10.3126/egn.v2i1.27457

Cited by 3 publications

(6 citation statements)

References 13 publications

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“…This value could help the neurosurgeon in the setting of emergency craniotomy or elective craniotomies in the absence of Neuronavigation for proper placement of burrs and craniotome to prevent sinus injury. 11,12 In the literature the safety limit of placement of burr hole is somewhere around 15 mm from the midline sagittal suture; however, as for the finding in our study the burr hole placed 25 mm to the right and 20 mm to the left seems necessary to prevent sinus injury in all cases of craniotomy around superior sagittal sinus because even a small dural tear over the lateral limits of sinus will also lead to devastating bleeding or air embolism. 13 Dural venous sinus seems to make a groove in the inner table of the skull bone and it corresponds to the size of the sinus but it doesn't seem to grow or shrink with the advancing age.…”

Section: Figure 2: Distribution Of Gendermentioning

confidence: 49%

Lateral Limit of Superior Sagittal Sinus in Respect to External Part of Sagittal Suture

Nepal¹,

Magar

2020

Eastern Green Neurosurg.

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Background: Sagittal suture has been used as an external landmark of superior sagittal sinus since the very beginning of neurosurgery. However, most of the time the sinus is not exactly under the suture line, rather, it has some displacement to one side. So, to analyze the variation of the lateral limit of superior sagittal sinus from the external part of sagittal sinus this study was performed. Materials and methods: Consecutive cases of MRI brain with contrast done in B&C Medical College Teaching Hospital was collected over 3 months, Age, gender, right, and left lateral limits of the superior sagittal sinus from the sagittal suture at its mid-point was collected in preformed proforma. Mean and standard deviation was calculated for the continuous variables, ANOVA was done to evaluate the association of gender with the lateral limits of sinus and Pearson correlation was done to see the relation of age with the lateral limits of the sinus. All the analysis was done using IBM SPSS 20. Results: There were a total of 40 patients enrolled in the study. The mean age was 39.8 years with male (75%) predominance. The lateral right limit of the superior sagittal sinus was up to 23mm and in the left up to 17.1mm from the outer limit of the sagittal suture. There was no significant association of gender with both the right and left limits of the superior sagittal sinus. Similarly, there was no significant correlation of age with the lateral limit of the superior sagittal sinus. Conclusion: The mean existence of superior sagittal sinus is 9.57mm in the right to 5.78mm in the left side from the outer limit of the sagittal suture. However, in extreme stances it's lateral limits can extend up to 17mm in left to 23mm in the right from the outer limit of the sagittal suture.

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Section: Figure 2: Distribution Of Gendermentioning

confidence: 49%

Lateral Limit of Superior Sagittal Sinus in Respect to External Part of Sagittal Suture

Nepal¹,

Magar

2020

Eastern Green Neurosurg.

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“…Thirty-four studies reported the mean age of the patient population [ 10 , 12 – 14 , 19 – 23 , 26 – 28 , 30 , 31 , 33 , 36 – 41 , 45 , 48 , 50 – 53 , 56 , 57 , 59 , 60 , 62 – 64 ]. As indicated in Table 1 , the pooled mean age was 62.4 years, ranging from 51.9 [ 38 ] to 70.5 years [ 18 ]. From 46 studies reporting data on sex distribution, 44 studies showed a higher percentage of stroke in males [ 10 , 12 – 14 , 16 , 19 – 21 , 23 – 28 , 30 – 33 , 35 – 41 , 43 – 45 , 47 – 51 , 53 – 59 , 61 – 64 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…From 23 studies investigating aspects of acute care [ 13 , 30 , 40 , 49 ], four studies consisted of data on length of hospital stay [ 13 , 30 , 40 , 49 ], four studies highlighted complications [ 13 , 16 , 30 , 48 ], and 19 studies reported mortality [ 11 , 17 , 21 , 26 , 29 , 30 , 32 , 34 , 36 , 38 , 40 , 41 , 45 , 48 , 51 , 52 , 56 , 57 , 62 ]. 12 studies included treatment modalities [ 21 , 31 , 32 , 36 , 38 , 42 – 45 , 48 , 57 , 61 ] [ 42 , 44 , 61 ].The outcome of stroke was described in 22 studies [ 11 , 17 , 21 , 26 , 29 , 30 , 32 – 34 , 36 , 38 , 40 , 41 , 43 – 45 , 48 , 51 , 52 , 56 , 57 , 62 ], and the long-term outcome (3 months after stroke) was investigated only in seven studie...…”

Section: Resultsmentioning

confidence: 99%

“…Mortality was reported in 19 studies [ 11 , 17 , 21 , 26 , 29 , 30 , 32 , 34 , 36 , 38 , 40 , 41 , 45 , 48 , 51 , 52 , 56 , 57 , 62 ]. Maximum mortality at three months was found in a study by Shrestha S et al (28.57%), while at six months, mortality was high in a study by Nepal PR et al (58.8%) [ 38 , 57 ]. The meta-analysis showed mortality in 16.9% of patients (proportion 0.169, 95% CI: 0.130–0.217, I 2 : 88%) (see Fig.…”

Section: Resultsmentioning

confidence: 99%

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Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Paudel,

Tunkl,

Shrestha

et al. 2023

BMC Neurol

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Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required.

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“…raniotomy is the most common procedure done in neurosurgical patients. [1][2][3][4] During a craniotomy, there is a high chance of unintentional dural tear which is attached to the skull bone. 2,5,6 Dural tear may occur in both layers or only in the outer layer.…”

mentioning

confidence: 99%

Incidence of Dural Injury during Craniotomy - a Single Center Study

Limbu¹,

Dhimal²,

Biswakarma³

2020

Eastern Green Neurosurg.

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Background: During a craniotomy, there is a high chance of unintentional dural tear and may occur in both layers or only in the outer layer.ith the objective to see the incidence of dural tear during craniotomy using high-speed craniotome, this study was performed. Materials and methods: This is a prospective analytical study collected over the duration of 4 months. Cases of craniotomy done using the craniotome were collected. Age was presented as mean and standard deviation (S.D). Gender, diagnosis, and dural tear were presented in frequencies and percentages. Analysis of gender, diagnosis categories, and age categories with a dural tear was done using the Fischer exact test. Similarly, Pearson's correlation was done between the number of burr holes made and dural tear in SPSS20. Results: There were a total of 25 craniotomies performed during the study period using craniotome. The mean age of presentation was 43.32 (17.65) years. The incidence of the dural tear was noted in 20% of the cases which includes a single layer or both the layers of the dura. There was a significant association between different age categories and dural tear; where elderly patients seem to have more percentage of the dural tear. Conclusion: There was a 20% incidence of dural tear during craniotomy with a significantly higher incidence in the elderly population.

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Outcome Following Decompressive Surgery for Malignant Middle Cerebral Artery Infarction

Cited by 3 publications

References 13 publications

Lateral Limit of Superior Sagittal Sinus in Respect to External Part of Sagittal Suture

Lateral Limit of Superior Sagittal Sinus in Respect to External Part of Sagittal Suture

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Incidence of Dural Injury during Craniotomy - a Single Center Study

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