Management of Depressed Skull Fractures: Selective Conservative Management of Non Missile Injuries

Objective: To determine the outcomes of management of depressed skull fractures. Study Design: Descriptive Study Place and Duration of Study: Department of Neurosurgeries, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat and Chandka Medical College Hospital, Larkana from 1st March 2020 to 28th February 2021. Methodology: Eighty patients of both sexes were enrolled in this study. Patients were aged between 12-70 years of age. Patient’s detailed demographics age, sex and body mass index were recorded. Diagnosis of skull fractures from closed head injury patients were undergone for CT scan Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. Patients were followed for 4-months. Outcomes were assessed by Glasgow Coma Scale (GCS). Results: Fifty five (68.8%) patients were males and thirty five (31.2%) were females with mean age was 18.21±7.32 years and mean body mass index was 20.04±3.14 kg/m2. Road traffic accident (56.25%) was the most common cause of the injury followed by fall from the height 25 (31.25%). The compound fractures have 48 (60%) and simple fractures were 32 (40%). Surgery was done among 70 (87.5%) cases and 10 (12.5%) patients were conservatively treated. Among these 50 (62.5%) patients were completely recovered. Cerebrospinal fluid leak was the most common complication and was found in 13 (16.25%) cases. Conclusion: The use of antibiotics and anticonvulsants had effective results during peri-operative periods to avoid infection and epilepsy. The initial stage of operation is particularly necessary when the fracture is larger than 5mm. Cerebrospinal fluid leaks occur after surgery as the most common complication. Keywords: Depressed skull fracture, Non-missile injuries, Cerebrospinal fluid

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Surgical management and Outcomes of Depressed Skull Fractures

10.53350/pjmhs211572327 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2327-2329

Author(s):

Haider Ali ◽

Mohammad Mushtaq ◽

Naeem ul Haq ◽

Muhammad Anwar Ullah ◽

Saqib Ali ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Surgical Management ◽

Road Traffic ◽

Skull Fracture ◽

Outcome Data ◽

Skull Fractures ◽

Medical College ◽

Severity Of Injury ◽

Male Patients

Objective: To determine the outcomes of surgical management in patients presented with depressed skull fractures. Study Design:Prospective Study Place and Duration of Study: Conducted at Neurosurgery department of Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 16th January 2019 to 15thJanuary 2020. Methodology: 65patients of both genders with ages were 10 to 60 year were included in this study. Patients were aged between 12-70 years of age. After taking informed written consent from all patient’s/parent/guardians, detailed demographics age, gender,body mass index cause of fracture, type of fracture and site of fracture wererecorded. CT scan was performed on all patients.Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. Patients were held under examination for 12-weeks.Glasgow Coma Scale (GCS) was used for final outcome. Data was analyzed by SPSS 27.0. Results:Out of all the patients, male patients were 45(69.23%) and female patients were 20 (30.76%). 35(53.85%) with ages <30, 20(30.76%) with ages 30 to 50 and 10(15.38%) with ages >50 were reordered in study. Mean body mass index was 20.04±3.14 kg/m2.The most common cause of the injury was road traffic accident 45(69.23%) followed by fall from the height 20 (30.76%). 40(61.53%)were compound fracture and 25 (38.46%) were closed fracture. 55 (87.5%) cases were treated surgically and 10 (12.5%) patients were treated conservatively. 45(69.23%) patients were completely recovered, 10 (12.5%) were moderately disabled and 7(10.77%) were severely disabled and 3(4.61%) were died. Conclusion:If treated promptly most of the cases of compound depress skull fracture revealed good results but outcomes of the depress skull fracture revealed contingent severity of injury and absence or presence of intracranial lesion. Key words: Depressed skull fracture, Non-missile injuries, Compund skull fracture, conservative management

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Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index

Operative Neurosurgery ◽

10.1093/ons/opx070 ◽

2017 ◽

Vol 14 (1) ◽

pp. 66-71 ◽

Cited By ~ 8

Author(s):

Salomon Cohen ◽

Samuel H Jones ◽

Sivashanmugam Dhandapani ◽

Hazem M Negm ◽

Vijay K Anand ◽

...

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Surgical Resection ◽

Body Mass ◽

Endoscopic Surgery ◽

High Body Mass Index ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Consecutive Series ◽

Endonasal Endoscopic Surgery

Abstract BACKGROUND Postoperative cerebrospinal fluid (CSF) leak is a persistent, albeit much less prominent, complication following endonasal endoscopic surgery. The pathology with highest risk is suprasellar meningiomas. A postoperative lumbar drain (LD) is used to decrease the risk of CSF leak but is not universally accepted. OBJECTIVE To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas. METHODS A consecutive series of newly diagnosed suprasellar meningiomas was drawn from a prospectively acquired database of endonasal endoscopic surgeries at our institution. An intraoperative, preresection LD was placed and left open at 5 cc/h for ∼48 h. In a subset of patients, the LD could not be placed. Rates of postoperative CSF leak were compared between patients with and without an LD. RESULTS Twenty-five patients underwent endonasal endoscopic surgical resection of suprasellar meningiomas. An LD could not be placed in 2 patients. There were 2 postoperative CSF leaks (8%), both of which occurred in the patients who did not have an LD (P = .0033). The average body mass index (BMI) of the patients in whom the LD could not be placed was 39.1 kg/m2, compared with 27.6 kg/m2 for those in whom the LD could be placed (P = .009). In the subgroup of obese patients (BMI > 30 kg/m2), LD placement was protective against postoperative CSF leak (P = .022). CONCLUSION The inability to place an LD in patients with obesity is a risk factor for postoperative CSF leak. An LD may be useful to prevent postoperative CSF leak, particularly in patients with elevated BMI.

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Body mass index and the risk of postoperative cerebrospinal fluid leak following transsphenoidal surgery in an Asian population

Singapore Medical Journal ◽

10.11622/smedj.2016159 ◽

2018 ◽

Vol 59 (5) ◽

pp. 257-263

Author(s):

I Sun ◽

JX Lim ◽

CP Goh ◽

SW Low ◽

RW Kirollos ◽

...

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Body Mass ◽

Transsphenoidal Surgery ◽

Asian Population ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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Body Mass Index and Imaging Abnormalities in Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone

Otolaryngology ◽

10.1177/0194599814541627a160 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P80-P80

Author(s):

Andrew M. Rivera ◽

Daniel Jethanamest ◽

Simon I. Angeli

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Temporal Bone ◽

Body Mass ◽

Cerebrospinal Fluid Leaks

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Cerebrospinal fluid opening pressure: The effect of body mass index and body composition

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.105597 ◽

2020 ◽

Vol 188 ◽

pp. 105597 ◽

Cited By ~ 1

Author(s):

B.R. Wakerley ◽

R. Warner ◽

M. Cole ◽

K. Stone ◽

C. Foy ◽

...

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Body Composition ◽

Body Mass ◽

Opening Pressure

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Lack of Sex Difference in Cerebrospinal Fluid (CSF) Leptin Levels and Contribution of CSF/Plasma Ratios to Variations in Body Mass Index in Children

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.84.9.3021 ◽

1999 ◽

Vol 84 (9) ◽

pp. 3021-3024 ◽

Cited By ~ 4

Author(s):

A. Wiedenhoft

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Sex Difference ◽

Body Mass

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Body Mass Index Has a Linear Relationship with Cerebrospinal Fluid Pressure

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.11-8220 ◽

2012 ◽

Vol 53 (3) ◽

pp. 1422 ◽

Cited By ~ 70

Author(s):

John P. Berdahl ◽

David Fleischman ◽

Jana Zaydlarova ◽

Sandra Stinnett ◽

R. Rand Allingham ◽

...

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Linear Relationship ◽

Body Mass ◽

Fluid Pressure ◽

Cerebrospinal Fluid Pressure

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Middle Ear Obliteration with Blind-Sac Closure of the External Auditory Canal for Spontaneous CSF Otorrhea

Otolaryngology ◽

10.1177/0194599816678211 ◽

2016 ◽

Vol 156 (3) ◽

pp. 534-542 ◽

Cited By ~ 4

Author(s):

Shawn M. Stevens ◽

Ryan Crane ◽

Myles L. Pensak ◽

Ravi N. Samy

Keyword(s):

Body Mass Index ◽

Cerebrospinal Fluid ◽

Body Mass ◽

Middle Ear ◽

External Auditory Canal ◽

Cardiac Risk ◽

Mastoid Obliteration ◽

Duke Activity Status Index ◽

Blind Sac Closure ◽

Status Index

Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre- and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated. Results Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9 kg/m2; P < .05), incidence of super-morbid obesity (45% vs 7.6%; P = .015), anticoagulation usage (36% vs 0%; P = .004), cardiac risk scores (1.2 vs 0.1 dB; P < .0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow-up was 30.8 ± 8.6 months. Conclusion Middle ear and mastoid obliteration with blind-sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated.

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