More than just a urinary catheter: achieving hemostasis using Foley catheter in deep cerebral cavities—technical nuances

Background Achieving hemostasis during neurosurgical procedures within deep seated tumors is of paramount importance. Chemical methods like using ORC and gel foam are preferred to bipolar cautery as bipolar cautery causes thermal injury to the normal eloquent surrounding white matter fibers, thereby causing significant morbidities. In addition to the chemical methods, we advocate a new relatively simple mechanical method by using small size Foley catheter inflated with saline can achieve hemostasis in case of deep locating brain tumor surgery with diffuse oozing from the tumor bed and surrounding white matter tissues are of concern. The balloon tamponade effect of the inflated Foley catheter helps in achieving complete hemostasis without damaging the surrounding normal white matter parenchyma. Case presentation A 52-years-old female admitted with history of progressive drowsiness and altered sensorium. Brain MRI was done showing large right-sided trigonal meningioma. Right parieto-occipital craniotomy was done, through the superior parietal lobe, corticotomy was done, and tumor was reached. Gentle retraction was done using curved blades in between the tumor and normal brain parenchyma. During surgery, following tumor removal, there was a diffuse oozing from tumor bed and the surrounding stretched white matter fibers. Hemostasis was attempted with chemical methods like ORC and gel foam. We avoided bipolar cautery to prevent thermal injury to the normal stretched eloquent white matter, as bleeding was not settled over the period of 45 min using chemical methods. Then, we placed a 10 F size Foley catheter in the tumor cavity and inflated with 6 ml of saline over the period of 10 min. Prior to Foley placement, we coated ORC over the tumor bed and the surrounding white matter. This achieved hemostasis to a significant extent and the same was repeated for another 10 min, and finally, complete hemostasis was achieved. Postoperative period went uneventful. Patient was discharged with good neurological recovery. Conclusion Inflatable Foley catheter balloon is a simple, cost-effective technique for achieving hemostasis in deep white matter tumors in addition to the routinely available hemostatic techniques.

Evaluating the histopathological and mechanical effects of a new forceps design: comparison of hemispheric bipolar forceps tip with usual bipolar tip on fresh cadaver cattle brain model

Without electrocautery, many modern surgical interventions are practically impossible. In neurosurgery, bipolar cautery forceps has been evolved to not only be an auxiliary, but as a principal instrument wielded by the dominant hand of the surgeon to navigate through the most delicate tissue that there is. The purpose of this study is to introduce our original bipolar forceps designed exclusively for microneurosurgical interventions and compare its feasibility with a standard bipolar forceps tip. This study has been conducted on two fresh cadaveric cow brains under the operating microscope. The coagulative and ablative effects of the hemispheric bipolar forceps tip (HBFT) have been histologically compared with those of the standard bipolar forceps tip (SBFT). Likewise, their efficacies as a dissection instruments have been compared via performing dissections from the parietal surface down to the corpus callosum. HBFT proved less traumatic to the uninvolved brain tissue during dissection. Also, histological analyses have revealed that ablative effects of the HBFT are more confined to the bleeding point, more effectively sparing the uninvolved brain tissue. Results of this experimental study suggest that HBFT is a better instrument to be used in microneurosurgical interventions, along with other surgical disciplines where selective diathermy is critical.

Successful Treatment of Placental Chorangiomas by Ultrasound-Guided Percutaneous in utero Microcoil Embolization

Placental chorangiomas can cause a high-output fetal state and increase neonatal morbidity and mortality. There is a paucity of data published describing the optimal treatment of these cases, and methods for occlusion to date include placement of vascular clips, bipolar cautery, injection of alcohol or surgical glue, interstitial laser, and microcoil embolization. We report 2 cases of prenatally diagnosed chorangiomas that caused a high-output fetal state and were successfully treated with microcoil embolization. This case series describes our technique and supports microcoil embolization as a potentially safe and effective antenatal treatment option in symptomatic chorangiomas.

Bipolar cautery versus conventional suture ligation of vascular pedicles in thyroidectomy: a comparative clinical study

Background: Thyroidectomies are commonly performed surgeries worldwide. With better knowledge of anatomy and major advent of energy devices, morbidity of thyroidectomy has drastically declined. Two main globally followed procedures to deal with vascular pedicles are conventional suture ligation and electro cautery devices. The objectives of the present study are to compare classical suture ligation and bipolar cautery of vascular pedicles in thyroidectomy, in terms of duration of procedure, hospitalization and operative complications.Methods: Retrospective observational comparative study was conducted in 100 patients who underwent total thyroidectomy in our institution for a period of 3 years from 4 September 2017. Non random sampling techniques applied on all consecutive patients who are eligible according to the inclusion criteria. Patients divided into two groups used: suture ligation (n=50), bipolar cauterization (n=50). The main outcomes measured were surgical and hospitalization time; duration of wound drain and post-operative complications (hoarseness, hypocalcemia and seroma).Student t test (for quantitative) and Chi Squaretest (for qualitative) applied for analysis.Results: Post-operative complications are present more in the suture ligation group (66%) compared to bipolar cautery (24%). The procedure time in ligation is a 131.6±17.7 minutes which is, significantly higher compared to bipolar cautery (97±7.5 minutes). Duration of hospital stay is more in suture ligation (6±0.8 days) compared to bipolar cautery (4.9±1.3 days).Conclusions: As per our study, bipolar cauterization has significant reduction of surgery time, duration of hospital stay and postoperative complications viz seroma, hoarseness of voice, hypocalcemia compared to conventional suture ligation.

Comparison of post operative pain in tonsillectomy: a three year prospective study

<p><strong>Background:</strong> Tonsillectomy is the oldest surgery performed by otorhinolaryngologists worldwide. Through ages different techniques have been tried to improve the post surgical outcome and reduce morbidity among patients. Aim of the current study was to compare the post-operative pain among the patients undergoing tonsillectomy by cold dissection, bipolar cautery dissection and coblation dissection.</p><p><strong>Methods:</strong> 142 Patients undergoing tonsillectomy in ENT department of TMMC during the period of 3 year were included in the study. Patients were randomly distributed to undergo different techniques of tonsillectomy. The post-operative pain in patients was assessed using the pre-standardized visual analogue pain scale and results were analyzed.</p><p><strong>Results:</strong> No statistically significant difference was found among the groups undergoing tonsillectomy by cold dissection, bipolar dissection and coblator dissection as the p&gt;0.05. The immediate post-operative pain was found to be slightly higher among the group undergoing tonsillectomy by coblator dissection and the analgesics dose needed in the post-operative period remained the same for all for patients of all the three groups.</p><p><strong>Conclusions:</strong> No statistically significant difference was found in the post-operative pain scores of patients undergoing tonsillectomy by CD, BD and CBD techniques.</p>

Isolated epiglottic rhinosporidiosis: a rare case report

<p class="abstract">Rhinosporidiosis is a chronic granulomatous disease, caused by <em>Rhinosporidium seeberi</em>. More than 70% of cases are nasal. Usually extranasal rhinosporidiosis is associated with nasal rhinosporidiosis. Isolated extra nasal variety of laryngeal and tracheal rhinosporidiosis are very rare, 7 cases has detected till date. A 45 years male of LSES with habit of pond bath presented to ENT OPD, VIMSAR, Burla, with chief complain of intermittent blood vomiting for last 30 days, associated with foreign body sensation in throat without any dysphagia or dyspnea. On ILE, there is polypoidal pinkish mass studded with white spots found at lingual surface of epiglottis. Ant and post rhinoscopic examination found to be normal. UGIE guided biopsy shows rhinosporiodic mass. Under GA, DL had done mass was excised and base cauterised with bipolar cautery and send for HPE. HPE confirmed the diagnosis. Post operative follow up upto 10 months showed no recurrence. Epiglottic rhinosporidiosis may be one of the differential diagnosis of epiglottic growths especially in endemic zone. Laryngeal involvement of rhinosporidiosis has diagnostic and therapeutic challenges, due to the potential risk of bleeding, aspiration and recurrence.</p>