A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

Effect of tongue reconstruction following hemiglossectomy on articulation and speech intelligibility

This study is aimed to investigate the articulatory functions of patients who have undergone tongue reconstruction following hemiglossectomy. The second aim of the study is to compare the speech intelligibility between hemiglossectomy patients who have undergone tongue reconstruction using pectoralis major myocutaneous with those hemiglossectomy patients who had undergone tongue reconstruction using radial forearm free flap.Fourteen patients who have undergone tongue reconstruction following hemiglossectomy as a treatment for oral cancer between the age of 30 to 60 years were taken up for this study. Tamil Articulation Test was used for assessing the articulatory functions of patients. The speech intelligibility of each patient was assessed using the Ali Yavar Jung National Institute for the Hearing Handicapped intelligibility rating scale. Analysis of articulatory errors revealed linguoalveolar consonants were more impaired when compared to other consonants. Patients with radial forearm free flap had somewhat better speech intelligibility compared to patients with pectoralis major myocutaneous flap reconstruction.The type of reconstruction also impacts the speech intelligibility. Effective intervention can be planned based on the comprehensive speech evaluation and analysis of articulatory error relative to place and manner of production.

An interesting case of reruptured endovascularly coiled aneurysm managed with clipping

Endovascular treatment has proven to be effective in the management of intracranial aneurysm, and can achieve permanent occlusion in up to 85% of cases, reducing the bleeding or rebleeding rate. A paradigm shift from microsurgical clipping to endovascular intervention has been observed since the publication of the International Subarachnoid Aneurysm Trial. Aneurysm recurrence after coil embolization remains both a major shortcoming of endovascular treatment and a daunting challenge for neurosurgeons without optimal management strategies.: We present a case report of a patient with history of previously endovascularly coiled and presenting with aneurysmal bleed. Microsurgical clipping is an effective intervention for managing reruptured previously coiled intracranial aneurysm.

Determination of sex of the dry skull using Interstyloid distance and its Medicolegal implications in Tamil Nadu population

Determination of sex using Skeletal remains is a challenging topic with so many tools being used for the sex determination of Skull in this study. The interstyloid process distance were studied in 64 Skulls and were tabulated and analysed. There is a significant difference between the distance in Female skull and Male skull, the former being lesser compared to the later. Further study in this regard may help using Interstyloid process distance as a important tool in identification of the Sex of the Skull.

Post-Covid tracheal resection – first case in India

Prolonged intubations result in tracheal damage and stenosis, the treatment for severe cases is resection and anastomosis. With the progress of the Covid-19 pandemic, this incidence kept rising but the timing and precautions for such aerosolising surgeries remained unclear. To report the first case of tracheal resection and anastomosis in India done during the Covid-19 pandemic along with its rationale. We report a case of 30/male with prolonged intubation and tracheostomy done for Covid-19 pneumonia and ARDS with failure to decannulate and complete loss of voice. After thorough preoperative work-up, he underwent tracheal resection of 4 rings with cricotracheal anastomosis during the covid-19 pandemic in October 2020. He was extubated on table and was asymptomatic after 3 months of follow-up with excellent voice. With good team effort and appropriate precautions, aerosolising airway surgeries resection anastomosis can be safely performed.

Stimulus techniques and microelectrode recordings of subthalamic-nuclei neurons in Parkinson`s during functional-neurosurgery

This study discusses the various procedures and issues involved in the acquisition of microelectrode recordings (MER) signals of subthalamic nucleus stimulations with induced deep brain stimulation electrodes very rigorously. Bellicose-invasive physiological detections through the methods of sub cortical physio logical detections, electrical induced stimulations and micro electrode recordings, stereo-tactic technique, macro-stimulation, stereo-tactic functional neurosurgical technique, stimulations such as macro and micro, induced stimuli with current and microelectrode recordings, impedance information monitoring, micro injections of test substances, evoked potentials, biomarkers/local field potentials, microelectrode fabrication methods and setups, sub cortical atlas-mapping with micro recording/microelectrode recording (M.E.R.). Thus, the study is very significant to the electrophysiological neurosurgical point of view and is very useful to the field of microelectrode recording and functional neurosurgery. This study is concerned with invasive physiological detection of deep brain structures with micro- or macro-electrodes prior to surgery followed by imaging techniques and their use in cortical and subcortical detection; detection relevant to the superficial cerebral cortex regions.

The incidence of thyroid dysfunction in diabetic patients – A study done at a tertiary care center in South India

It has been noted that in the Indian population the incidence of thyroid disorder is common and its incidence rises with advancing age. Screening for thyroid disorder is indicated for the certain high risk patients such as elderly and those already having other endocrinal disorders There are various studies that have shown a finding that a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, of which hypothyroidism is the commonest disorder Owing to this we at the medical college at south India decided to evaluate the occurrence of thyroid dysfunction in patients who have been diagnosed with diabetes mellitus and also to compare the level of thyroid dysfunction in the younger and the older population.Department of surgery, medicine and Pharmacology at Al Azhar Medical College Thodupuzha, Kerala, India for a duration of 3 years on 300 patients. The present study was an observational study during the period of study, the test subjects patients having diabetes mellitus and healthy individuals (Controls)coming for regular health check-up with no co morbidities detected were included in this study as controls.In the non -geriatric age group the mean age was 49.6 years SD + 8.15 years and in the geriatric age group the mean age was 68.78 years SD + 4.83 years. The commonest age group in the study was between the age of 61-70 years with of the study population. The age group in the present study ranged between the age of 30 years and 79 years. The incidence of diabetes mellitus increased with age, but the control of sugars is better with age thyroid dysfunction was as follows 20% had hyperthyroidism (36%) hypothyroidism. There is a linear increase with the prevalence of thyroid disorders with age with a r= 0.77 and p < 0.05.The incidence of thyroid dysfunction also increased with age As compared to the non -geriatric group which was the incidence higher in older age group p < 0.05.This study reveals about at least one in three who have DM are suffering from thyroid dysfunction, that increases with increasing age and uncontrolled sugars in this part of the world, which might warrant routine screening.

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Pilocytic astrocytoma (PA) is a low grade benign tumor, commonly occurs in Cerebellum (42-60%), Optic & hypothalamic region (9-30%), Brain Stem (9%). They rarely spread. It rarely occurs within the ventricle. In this report, we described our experience with cranial pilocytic astrocytoma in a 14-year-old child, who initially treated with near total decompression of tumor. Four and half years later, recurrence of primary tumor with obstructive hydrocephalus occurred for which he underwent ventriculo-peritoneal shunt followed by re-excision. As further treatment was being evaluated for radiotherapy in view of recurrence at the primary site, he got detected to have significant spinal drop metastasis seen on MRI Spine. Finally, he underwent craniospinal irradiation (CSI).

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.