scholarly journals Spectrum of remote site extradural hematomas following decompressive craniectomy: Does fracture always co-exist?

2021 ◽  
Vol 12 ◽  
pp. 443
Author(s):  
Apinderpreet Singh ◽  
Chetan Wadhwa ◽  
Madhivanan Karthigeyan ◽  
Pravin Salunke ◽  
Hanish Bansal ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Skull Fractures ◽  
Midline Shift ◽  
Remote Site ◽  
Head Injured ◽  
Surgical Evacuation ◽  
Severe Tbi ◽  
Treatable Condition ◽  
Management Issues

Background: Remote-site extradural hematomas (EDHs) after decompressive-surgeries for traumatic brain injury (TBI) are rarely encountered. Typically, they form contralateral to the injured side, with an overlying fracture. We present a subset which developed EDH immediately after decompressive-hemi-craniectomy for TBI, most without an evidence of fracture, and not limited to contralateral location. Methods: Nine such patients were retrospectively identified. Plausible mechanisms, management issues and outcomes have been discussed. Results: All nine patients were victims of severe-TBI. Six did not have any skull-fractures. Eight showed hemispheric-injuries while one had bifrontal-contusions. In hemispheric-injuries, midline-shift was at least 8 mm except one with midline-shift of 6 mm. The EDH was straddling the midline in 2 (bifrontal-1, bi-occipital-1), and juxtaposed to the previous craniectomy in 1, apart from a contralateral-bleed in 6; all, except one, needed evacuation. In most patients, venous-source of bleed was identified. All had improved from their preoperative Glasgow coma scale (GCS) at follow-up. Conclusion: A fracture need not always co-exist in EDH following decompressive craniectomy. However, an extra-caution is suggested in its presence. Given the need for surgical-evacuation in most patients and an inability to assess immediate postoperative-GCS in severely head-injured, a routine postoperative-computed tomography is recommended to avoid overlooking such potentially treatable condition.

Predictors of surgical outcome among patients with spontaneous supratentorial intracerebral hemorrhage: A prospective single institutional study

2021 ◽  
Vol 18 (2) ◽  
pp. 23-29
Author(s):  
Somraj Lamichhane ◽  
Ruchi Devbhandari ◽  
Sabin Tripathee ◽  
Manisha Chapagain
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Decompressive Craniectomy ◽  
Young Patients ◽  
Functional Independence ◽  
Modified Rankin Scale ◽  
Dominant Hemisphere ◽  
Co Morbidity ◽  
Surgical Evacuation

Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH.   Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS).   Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere.   Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

scholarly journals Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

2019 ◽  
Vol 32 (2) ◽  
pp. 392-399 ◽  
Author(s):  
Yuanliang Ye ◽  
Qiujing Wang ◽  
Weiyang Ou ◽  
Jian He ◽  
Zhenhui Zhao
Keyword(s):  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Endoscopic Procedure ◽  
Midline Shift ◽  
Multivariate Logistic Regression ◽  
Randomized Controlled ◽  
Group A ◽  
Group B

Abstract Background Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC. Methods This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes. Results The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months’ follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes. Conclusion Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

scholarly journals Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

2020 ◽  
Author(s):  
Eduardo Soriano-Navarro ◽  
Vanessa Cano-Nigenda ◽  
Fernanda Menéndez-Manjarrez ◽  
Esmirna Farington-Terrero ◽  
Juan José Méndez-Gallardo ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Decompressive Craniectomy ◽  
Cerebral Venous Thrombosis ◽  
Cerebral Oedema ◽  
Therapeutic Option ◽  
Midline Shift ◽  
Sagittal Sinus ◽  
Life Saving ◽  
Venous Infarcts

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.

scholarly journals The Effect of Size of Decompressive Craniectomy on Outcome in Deep Spontaneous Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Sashanka Kode ◽  
Ajay Hegde ◽  
Girish R. Menon
Keyword(s):  
Retrospective Study ◽  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Surgical Outcome ◽  
Bone Flap ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Mortality And Morbidity ◽  
Hematoma Evacuation

Abstract Introduction Spontaneous intracerebral hemorrhage (SICH) is one of the most devastating forms of stroke with a mortality of 30 to 40%. We aimed to evaluate the effect of craniotomy size and volume of decompression on surgical outcome, complications, mortality, and morbidity in patients with supratentorial capsuloganglionic bleeds who underwent a decompressive craniectomy (DC) at our institute. Materials and Methods It is a retrospective study done between January 2015 and December 2019. All patients with capsuloganglionic bleeds who had DC and hematoma evacuation were included in the study. Results A total of 55 patients underwent DC for SICH at our hospital during the study period. Mean anteroposterior (AP) diameter of the bone flap was 12.42 cm. The volume of decompression did not influence mortality and morbidity in our study but a larger AP diameter was associated with a higher incidence of hydrocephalus. A smaller craniectomy with an AP diameter of < 12 cm caused a lesser reduction in midline shift (MLS). Persistent postoperative MLS had a significant impact on mortality and its reduction was dependent on the size of craniectomy (p =–0.037) Conclusion DC with a recommended AP diameter of 12 to 13 cm achieves optimal results in terms of reduction in MLS. Larger DC volume carries a higher risk of hydrocephalus and requires close follow-up.

Data warehousing management issues in online recruiting

2002 ◽  
Vol 21 (1) ◽  
pp. 1-8
Author(s):  
Binshan Lin ◽  
Victoria S. Stasinskaya
Keyword(s):  
Personal Data ◽  
Employment Opportunities ◽  
Missed Opportunities ◽  
Employment Services ◽  
Online Recruiting ◽  
Large Databases ◽  
Job Candidates ◽  
Management Issues ◽  
Analyze Data

Online recruiting is becoming one of the major trends in Human Resource Management. Managers are capable of finding quickly and efficiently qualified candidates to fill variety of professional positions within United States and overseas. Varieties of websites were created online to store resumes for the employer's search in the form of database warehouses and datamarts. Datamarts target specific segments of the employment opportunities. Managers run queries to search and analyze data abstracted from these large databases. Major issues for managers in using online recruitment present accuracy, verifiability, and accountability of the data selected. An obstacle for potential employees using online employment services is the privacy of the data submitted by them from current employers and other websites collecting their personal data without consent for marketing purposes. Another issue in online employment databases remains inefficiencies in the ways the data is be retrieved, stored and analyzed. The lack of personal touch during online employment limits communicational flow between potential employees and the employer, leading to the frustrations of the job candidates and missed opportunities on the behalf of the employers. A follow-up service from the site can serve as a communicational link in the process.

Cognitive and Functional Outcomes of Early Versus Delayed Cranioplasty after Decompressive Craniectomy

2018 ◽  
Vol 15 (01) ◽  
pp. 029-035
Author(s):  
Arun Kumar ◽  
Biswaranjan Nayak ◽  
Krishnamurthy B. H ◽  
Sushant Patro ◽  
Abhijeet C. R ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Functional Outcomes ◽  
Tertiary Care ◽  
Age Distribution ◽  
Total Sample ◽  
Individual Case ◽  
Care Hospital ◽  
Early Cranioplasty ◽  
State Examination

Abstract Introduction Delay in doing cranioplasty (CP) after decompressive craniectomy (DC) may cause motor, cognitive, and language deficits. Studies show doing CP before developing such symptoms helps in improving the outcome. CP improves cerebrospinal fluid (CSF) dynamics and cerebral blood flow, which may lead to better cognitive and functional outcome. Objective The aim of the study was to assess cognitive and functional outcomes of early versus delayed cranioplasty (DCP) after DC. Methodology This was a prospective observational study on 42 patients aged over 16 years and up to 70 years, who had undergone CP after DC for severe traumatic brain injury in in-patient and outpatient department of neurosurgery at a tertiary care hospital in Bhubaneswar, Odisha, India from the period of March 01, 2016 to December 31, 2017. Cognitive and functional outcomes were compared in early and DCP groups in preoperative and follow-up period at 1 month, 3 months, and 6 months. Early cranioplasty (ECP) was within 2 months, and DCP was beyond 2 months. Results Total sample size under this study was 42; 21 in ECP and 21 in DCP group. Mean age was 41.40 ± 15.95 years. The age distribution was quite young with 38.1% in 30 to 49 age group and had very high proportion of males (85.7%). This analysis revealed that both the ECP and DCP groups have resulted in significant improvement in mini-mental state examination (MMSE) and Glasgow Outcome Scale Extended (GOSE) score after CP. But in the ECP group, there has been steady and significant improvement in MMSE and GOSE score at different follow-ups starting from postoperative 1 month in MMSE score and from 3 months up to 6 months in GOSE score. Conclusion Neurosurgeon should evaluate and carefully monitor each individual case and take up CP as early as possible with suitable indication.

scholarly journals Sinking Skin Flap Syndrome: Phenomenon of Neurological Deterioration after Decompressive Craniectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Noman Ahmed Jang Khan ◽  
Saad Ullah ◽  
Waseem Alkilani ◽  
Hassan Zeb ◽  
Hassan Tahir ◽  
...  
Keyword(s):  
Mental Status ◽  
Decompressive Craniectomy ◽  
Rare Case ◽  
Skin Flap ◽  
Altered Mental Status ◽  
Hemodynamic Instability ◽  
Neurological Deterioration ◽  
Normal Anatomy ◽  
Midline Shift ◽  
Ct Head

Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. Management is largely conservative. We here present a case of a patient with large craniectomy who was admitted to our hospital with pneumonia. Later on, he developed worsening mental status and CT head revealed sinking skin flap with significant midline shift. This is a very rare case of neurological deterioration after craniectomies, commonly known as sinking skin flap syndrome. To our knowledge, only few cases have been reported so far.

scholarly journals Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

2014 ◽  
Vol 21 (1) ◽  
pp. 109-112
Author(s):  
P. Sasikala ◽  
Bindu Menon ◽  
Amit Agarwal
Keyword(s):  
Ct Scan ◽  
Movement Disorders ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Midline Shift ◽  
Rare Presentation ◽  
Surgical Evacuation ◽  
Significant Mass Effect ◽  
Significant Mass

Abstract Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

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