Epidemiology of surgically managed traumatic brain injury patients

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world TBI is called the ‘silent epidemic’ because problems resulting from TBI are often not immediately visible and TBI patients are not very vociferous. Epidemiological studies of TBI are essential to the targeted prevention and effective treatment of brain-injured patients. Epidemiology analysis of surgically managed traumatic brain injury patients was done. Mean age was 35.9 years. Males were more commonly (80%) involved than females (20%). In 57.5% of cases, falls were responsible for TBI and in 42.5% of cases, Road traffic accidents were responsible. Edh was the most common type of TBI in (50%). Chronic SDH occurred in 25% of cases. Acute SDH and Contusions were both seen in 13.75% of cases. Depressed fractures occurred in 6.25% of cases and ICH occurred in 1.25% of cases. Craniotomy was the most common (42%) surgical procedure performed, followed by burrhole drainage (22.5%). Decompressive craniectomy was done in 18.75% of cases and elevation of depressed fracture was performed in 6.25% of cases. Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. People of all ages are affected by it. Males are more commonly involved as compared to females. Timely hospitalisation and surgical management whenever indicated improves the survival.

Cerebral venous thrombosis with a catch

Background: Cerebral venous thrombosis (CVT) is a rare entity typically occurring in patients in hypercoagulable states. They can also occur in cases of trauma. The symptoms are nonspecific. Case Description: A 28-year-old male presented to the emergency department with a head injury. During the necessary imaging, it was found that he had a depressed skull fracture and other signs of traumatic brain injury. Unbeknownst to the patient and the patient party, it was also revealed that the patient only had one kidney. Wound debridement and excision of the depressed fracture were performed. A postoperative MRI revealed that the patient had CVT. Conclusion: There should be a high index of suspicion for CVT in case of traumatic head injuries. The surgeon should plan management according to the patient’s comorbidities.

EXPERIENCE IN THE TREATMENT OF DEPRESSED FRACTURES OF BONES OF THE CRANIAL VAULT IN CHILDREN USING THE AUTHOR’S METHOD OF PROCESSING BONE FLAPS ACCORDING TO PSHENICHNIY

Objective of the study: to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant trauma by developing a new technique of depressed fracture treatment. Materials and methods of research: from 2015 to 2020 at the Regional Children's Clinical Hospital, Rostov-on-Don, 80 children have undergone reconstructive surgical interventions for damage to the skull bones. Thirty patients with a depressed skull fracture, who underwent a one-stage reconstructive operation according to the method developed by the authors (patent № 2017143056 dated 08/12/17), and concomitant trauma made up the main group. Fifty patients, who underwent reconstructive correction of skull bone defects using the standard technique (cranioplasty with an allograft – titanium plate), made up a comparison group to analyze the effectiveness of the author's method of treating a depressed fracture. All children with concomitant injury underwent X-ray computed tomography (CT) of the brain, cervical spine, chest organs, abdominal cavity, pelvic bones, which made it possible to quickly diagnose and begin the required treatment. Results: no inflammatory changes were observed in the early/late postoperative period among 30 children in the main group. Patients in satisfactory condition were discharged 10–12 days after surgery. Conclusion: the presented author's method of one-stage reconstructive surgery allows to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant injury and their quality of life in general. This method of correcting a depressed fracture of bones of the cranial vault in children has a significant economic effect due to reduction of the length of hospital stay of the inpatients and saves budgetary resources on alloplastic materials used for bone defect hiding. In the presence of a concomitant injury and the severity of the patient’s condition, it is necessary to perform an X-ray examination of the damaged organs and systems in order to quickly establish a diagnosis and prescribe appropriate treatment. In case of damage to several organs and systems requiring surgical treatment, at the first stage, surgical intervention for brain damage is recommended, in the second stage, in the absence of a life-threatening condition, on the same day or at delay, depending on the patient's condition, further surgical correction of other damaged organs and systems should be carried out.

Iron Rod Penetrating Head Injury in a Child

Civilian penetrating brain injury (PBI) is a rare form of traumatic brain injury (TBI) and is rarer in the pediatric population. Pediatric PBI due to various objects has been reported in the literature. Pediatric PBI with an iron rod has not been previously described. We reported a case of civilian penetrating injury in a 6-year-old girl child patient who fell over a projecting iron rod at a construction site from a height of 6 to 8 feet. She was lifted off from the iron rod and taken to the emergency medical services. CT scan of the brain revealed linear intracerebral hemorrhage along the iron rod’s track with a depressed fracture. She underwent emergency surgery because of a compound depressed fracture. She recovered well from his injury without neurological deficit with an excellent clinical outcome.

Pattern of Skull Fractures and Its Outcome in Pediatric Head Injury Patients

Objective: Skull fractures are common in pediatric age group. The surgical management of paediatric patients with a skull fracture differs among institutions and surgeons. Our object of this study was to assess the pattern of skull fractures and outcome in paediatric population. Material and Methods: This study was conducted in the department of neurosurgery of a tertiary care hospital from June 2018 to April 2020. We included 152 children between ages 5 to 11 years who were brought with the head trauma and diagnosed to have skull fracture on computerized tomography (CT) Scan brain. Results: The mean age of patients was 6.91 + 1.84 years. There were 59.8% males and 40.1% females. The most common type of fracture at presentation was depressed fracture in 42% patients, followed by linear (35%) and compound fractures (23%). Parietal fractures were the commonest (63.1%) in our study. Associated intracranial hematomas were seen in 37.5% patients, epidural hematoma being the most common. Surgically treated patients were 36%. Good recovery was seen in 73% patients while mortality was 10.5%. Conclusion: Isolated skull fractures are overall benign conditions. Linear parietal skull fractures have good outcome amongst all fracture types.

Nasofrontal Mucocele Following after Craniotomy Procedure

Introduction : Mucocele is a chronic, expanding, mucosa-lined lesion of the paranasal sinus characterized by mucous retention that can be infected becoming a mucopyocele. They originate from obstruction of the sinus ostium by congenital anomalies, infection, inflammation, allergy, trauma (including surgery) or a benign or malignant tumor. The frontal sinuses are most commonly affected, and subsequently ethmoidal sinuses. Case Report : A 56 years old man, presented with a lump on the left and right forehead accompanied by a protruding left eye since 6 months and is getting wors. Patient with a history of craniectomy debridement surgery indicated for open depressed fracture due to an accident 12 years ago, then underwent a titanium mesh cranioplasty 11 years ago. From examination of the head CT scan revealed a solid mass lesion filling the left and right frontal sinuses expands into the left orbital cavity. Bifrontal craniotomy was performed on the patient. Discussion : Mucoceles are mucous-secreting expansive pseudocystic formations, and capable of expansion by virtue of a dynamic process of bone resorption and new bone formation. They result from obstruction of a sinus ostium and frequently are related to a previous condition as chronic sinusitis, trauma, surgery or expansible lesion. With continued secretion and accumulation mucus, the increasing pressure causes atrophy or erosion of the bone of the sinus, allowing the mucocele to expand in the path of less resistance. This may be into the orbit, adjacent sinuses, nasal cavity, intracranial or through the skin; intracranial and orbital extension were demonstrated in this patient. Conclusion : Frontal mucoceles are benign and curable, but early diagnosis and treatment of them is important. Open surgery remains a valid procedure in frontal mucoceles with orbital and/or intracranial extension and in cases where the district anatomy is unfavourable for a purely endonasal approach.

Correlation of fracture depression area and dural tear among patients with depressed skull fracture

Introduction: Depressed skull fracture means to have a fracture that has a depth of more than a bone thickness. Consequently, the force is very small to a blunt object, which is often seen in the frontoparietal region due to the low bone thickness in the area. On the other hand, tearing of the dura matter beneath the depressed fractures has a great value from the prognostic and surgical point of view. This study aimed to investigate the relationship between the area of the depressed fracture and dural tear using computerized tomography scan at admission. Methods: This cross-sectional study was performed on 40 patients who had been diagnosed with depressed skull fractures atImam Reza Educational Center, Tabriz University of Medical Sciences, Tabriz, Iran,within2016-2017. The level of consciousness, the Glasgow Coma Scale, and symptoms on admission were evaluated for each patient. The collected data were analyzed in SPSS software (version 22) using studentchr('39')s t-test and Chi-square test for statistical analysis of parametric and nonparametric variables. A p-value of less than 0.05 was considered significant. Results: The mean age of the cases was obtained as 34/9±14/32 (18-60) years. The mean depressed fracture area (6/93±5/52) ranged from 0/79-19/63cm² (7.13±5.99) for the patients with dural tear and 6.93±5.66 for the ones with intact dura. The cut-off point for predicting dural tear was determined 6.92 cm² with 84% sensitivity. Conclusions: It was revealed that there was a significant correlation between the area of fracture depression and dural tear. Furthermore, in patients with dural tear, fracture depression level was considerably higher than that in patients with intact dura.

A STUDY ON CORRELATION OF DEGREE OF MIDLINE SHIFT ON CT SCAN AND GLASGOW COMA SCALE IN PATIENTS OF ACUTE TRAUMATIC HEAD INJURY

Background: The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Results: External injury of scalpel is seen in 92% of cases, blackening of eye in 50% & vomiting in 50%. Cerebral contusion (50%) was the most common CT scan finding followed by depressed fracture (32%), subdural hematoma (22%) than extradural hematoma (6%). Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusions: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome. Keywords: CT scan, Glasgow coma scale, acute traumatic head injury.

Traumatic Fractures Involving Major Dural Venous Sinuses: A Reappraisal Study from the Tertiary Trauma Care Center in Nepal

Objective: The surgical management of compound depressed fractures overlying dural venous sinuses confers major challenges for the neurosurgeons. On one hand, the depressed fracture and associated compound wound herald the risk of venous occlusion and fatal brain swelling, on the other hand, the surgical attempt in managing them foresees major risks of bleeding and air embolism. Materials and Results: A retrospective analytical study was conducted from the hospital records pertaining to the cohorts of patients admitted with traumatic fractures overlying major dural venous sinuses. Among 45 patients included on our study, six patients were managed conservatively, and the rest 39 patients required surgical intervention due to compound depressed fractures heralding high risk of venous flow obstruction. The age of our patients ranged from 6 to 60 years with a high male predominance (77% vs. 22.22%).The most common mode of injuries was road traffic accidents in 66.67% (30/45) of cases. The most common location of depressed fracture was in the anterior third of SSS, seen in 57.77% of cases. The surgical complications were seen is 2.23% of cases, with the single instances of air embolism, profuse bleeding and cortical venous thrombosis seen respectively. The overall mortality seen in our study was 6.67%, whereas the operative mortality was only 4.45%. Conclusion: The refinement in the surgical nuances has now enabled us in managing depressed fractures overlying major dural venous sinuses with minimal risks of complications, thereby preventing the high risks of venous hypertension they otherwise invariably harbinger.