International Journal of Neurology and Neurosurgery

Intracranial vascular malformations, that includes arteriovenous malformations and cavernous malformations, are the most common cause of intracerebral hemorrhage in young adults. Seizures related to cavernous malformations seems to be attributable to surrounding hemosiderin deposition through leaky endothelial junctions. The estimated risk of occurrence of seizures in patients with vascular malformations is 1.5% per person-year of observation. Lesionectomy (excision of the vascular malformation) versus adjacent epileptogenic corticectomy studies have found lesionectomy enough to relieve the patient of the medically refractory epilepsy with class 1 Engels scale [4] outcome and is safer in eloquent areas of brain [3]. We present three interesting cases of vascular malformations with rare presentations and their surgical management. Vascular malformations presenting as refractory seizures is not a rare entity. Lesionectomy should be the management of choice in these patients in accessible lesions as it can lead to good outcome in terms of seizure outcome in these patients.

Keywords: Seizures; Arteriovenous malformations; lesionectomy.

Background: Unknown patients represent a particularly vulnerable group. They are usually neglected individuals, with improper access to proper nutrition, sanitation and health care. They often harbour numerous comorbidities that are undiagnosed and untreated at the time of presentation and the management of such patients is particularly difficult. Objective: To analyze the clinical profile and outcome of patients admitted as ‘Unknown’ with Head injuries. Setting: Institute of neurosurgery, Madras Medical College. Subjects: Patient data was obtained by retrospectively from hospital records, records were perused from January 2014 to January 2019. Data was collected regarding patients admitted as ‘Unknown‘ with Head Injuries. Results: A total of 110 patients were enrolled into the study. 28 patients were found to have severe head injuries, 60 patients were found to have moderate injuries and 22 patients were found to have mild head injuries. 14 patients succumbed, 5 patients were successfully rehabilitated with their families and are on long term follow up, 61 patients were discharged to rehabilitation homes and lost to follow up. 30 patients left the hospital of their own volition. Conclusion: Unknown patients are an often marginalised, under represented and vulnerable subset of the Head Injury population. By describing the magnitude of the problem and the peculiar difficulties seen in treating these patients, we hope, to bring these individuals to the foreground and restate that they require a particularly empathetic approach.

Introduction: Traumatic Brain Injuries are among the leading cause of mortality and morbidity world over. They are the leading cause of death among the younger age groups accounting for several indirect social and economic problems. This becomes more important in developing nations like India. Methodology: 30 pediatric and 30 adult patients that were admitted and diagnosed to have Diffuse axonal Injury were included in our study. The duration of the study was 6 months between June and November 2018 in the Institute of Neurosurgery, Madras Medical College. Discussion: Diffuse axonal injury is caused from widespread tearing of axons and small vessels by shearing forces and is defined as prolonged post-traumatic coma over 6 hours following injury without demonstrable mass lesion. Results: Of the 21 patients with Grade 1 DAI, all 21 had favorable outcome as defined by GOS 4 or 5. 13 of the 20 in Grade 2 DAI had favourable outcomes while only 5 of the 19 with Grade 3 DAI had favourable outcomes. Conclusion: In our study we were able to find out that while there was a statisticaly significant correlation between grade of DAI and the outcome (p=0.002), there was no statistically significant correlation between gender and the outcomes (p=0.3).

Keywords: Diffuse Axonal Injury; Traumatic Brain Injury; Mortality; Pediatrics.

Introduction: The natural course of post traumatic acute thin SDH is different among various patients. Most thin SDH resolve spontaneously, a few progress into chronic subdural hematomas requiring surgical treatment. The causative factors for progression of ASDH to CSDH in not fully studied. Objectives: The objectives of this study were to analyse the occurrence of subacute or chronic SDH preceded by the traumatic acute thin SDH and their various presenting symptoms, risk factors, time of presentation, surgical interventions and outcomes. Material and methods: This was a retrospective study conducted at the Institute of Neurosurgery, Madras Medical College. Patients with symptomatic sub acute or chronic SDH following acute post traumatic thin SDH, who were managed conservatively, in the past were included and analysed by database. Results: Totally 20 patients were analysed. All patients underwent burrhole evacuation. Mean age was 47. 75% were alcohol consumers. 10% of patients were on anticoagulants. Presenting symptoms before surgery were headache (70%), dysarthria (20%), hemiparesis (20%), seizure (25%), and drop in GCS (15%). Mean duration between injury and onset of new signs and symptoms was 14 days. Mortality was 10%. Conclusion: Acute thin SDH without surgical treatment liquefies and may later progressively enlarge, so that new symptoms develop in the subacute stage. Furthermore, this pathological process may contribute to the subsequent development of chronic SDH. Mean onset of symptoms was 14 days from our study. Hence, follow up imaging at end of 2nd week is advisable to identify the enlarging SDH which leads to help in early surgical intervention and prevent irreversible brain damage.

Keywords: Acute Subdural hematoma; Chronic subdural hematoma.

Awake Craniotomy is a Neurosurgical procedure that allows a surgeon to operate brain tumour while the patient is awake inorder preserve eloquent cerebral cortex. Surgery is done in the same way as the conventional craniotomy. This procedure is done with the aid of intra operative monitoring. This procedure is done for the patients who have space occupying lesions in the eloquent areas, mostly commonly speech and motor area. This study was done at The Institute of Neurosurgery, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai. For a group of patients who had tumours in the temporal and frontal lobes. All these patients were intra-operatively monitored during the procedure. The outcome of these patients re-emphasised the efficacy of this procedure in preventing significant morbidity due to the involvement of the eloquent cortex. This study helps us to prove that, awake craniotomy with intra operative monitoring is helpful in patients with tumour in eloquent areas. It reduces post-operative morbidity in patients.

Keywords: Awake; Craniotomy; Eloquent; Frontal lobe; Temporal lobe.

Background: The use of hyperbaric oxygen therapy in cases with traumatic brain injury is based on the hypothesis that injured or inactive neurons would greatly benefited from increased blood flow and oxygen delivery, which later could act to metabolically or electrically may reactivate the cells. Objective: To evaluate the optimal number of hyperbaric oxygen therapy sessions required in patients with head injury and to compare the neurological effects of 10, 20 and 30 sessions of hyperbaric oxygen therapy in patients with traumatic brain injury. Study Design: Prospective randomized clinical trial. Place of Study: The study was carried out at the Prana HBO Centre, which is owned by the Investigator and located in the Northern parts of Mumbai, in India. Methods: Study was conducted over a period of 3 years and patient with Head injury referred to the Hyperbaric Unit at Prana HBO center after the initial evaluation and surgical procedure were included. Patients were randomly assigned to any of the three groups and allotted numbers were concealed to receive HBO therapy. HBO therapy was given with compressed with air at a pressure of 1.8 atmosphere absolute (ata). At this pressure the patient breathed 100% oxygen via facial mask. The HBO therapy protocol included 90 minutes oxygen breathing at 1.8 ata, 6 days a week. Results and Discussion: A significant improvement in GCS scores in group H10 between the end of 10 HBOT sittings and at the end of 30th day. As well significant improvement in scores of group H20 between the end of 20 sittings and at 30th day was being observed. GOS was seen better after 20 and 30 sessions of hyperbaric oxygen therapy as compared to group I of HBOT group III showed maximum improvement in spasticity in comparisons to group I and II, however there was good improvement in spasticity all the three group. Mood swings was less in group III with only 12% patients showing mood swings, whereas in group II and group I it was around 59% and 93% respectively. Fasano carried out first clinical observation and presented a therapeutic effect of hyperbaric oxygen therapy in traumatic brain injury patients and concluded that the HBO improved the outcome following brain trauma. Conclusion: Our findings shows the beneficial effects of HBO therapy in traumatic brain injury patients on GCS score, GOS, spasticity and mood swings with increase in number of multiple sessions. Despite these encouraging results further research is needed to more clearly define the mechanism and potential role of HBOT following traumatic brain injury.

Keywords: HBOT; Traumatic brain injury; Clinical Trial.

Background: Our aim in the present study was to assess the value of Decompressive Craniectony in acute SDH. We sought to assess whether the surgical procedure conferred any increase in short-term survival rates. We included all patients who underwent an operation in our unit for evacuation of an AcSDH sustained as a result of trauma, It is still not clear whether early decompression can improve the outcome in severe head injury (GCS 8 or <8). Aim & Objectives: The study was conducted to assess the value of decompressive craniectomy in acute SDH and to evaluate the outcome / prognostic factors and complications of decompressive craniectomy. Methods: From July 2016 to April 2018, 138 patients with Acute SDH due to trauma under went for Decompressive Craniectomy. The clinical status (GCS), imaging C.T. Scan/ MRI and outcome were analyzed at Neurosurgery unit of Surgery Dept. of Hamidia Hospital which is affiliated with Gandhi Medical College, Bhopal (India). Qui square independent test and Fishers test were used to evaluate the prognostic factor. Result: The study group consisted of 138 male & female, with the mean age being 48.9 ± 29.4 years, ranging between 02 and 75 years. The mechanisms of injury were traffic accidents in 33 (35%); fall in 42 (45%) and blunt injury due to occupational accidents in 17 (20%) patients. Left hemispheric injury was found in 39 (42%); right hemispheric injury in 42 (45%); and bilateral hemispheric injury in 11 (13%) patients. Acute SDH was the only injury in 27 (30%) patients, while the remaining 65 (70%) had accompanying extracranial injuries. Conclusion: Craniotomy can have favorable outcome in few cases of Acute SDH with unfavorable pre operative status, although craniectomy remain the standard surgical modality with pre operative poor clinical status. Early decompression in Acute SDH may be of particular benefit. The age of the patients, pupillary size and reaction at the time of admission was statistically significant predictor of outcome. Though, the indications of Decompressive Craniectony versus Craniotomy remain a matter of debate; the Brain Trauma Foundation has identified the question of craniotomy versus decompressive craniectomy for primary evacuation of AcSDH as an vital area for further research.

Keywords: Traumatic Brain Injury; Decompressive Craniectomy; Acute subdural heamatoma; Outcome; Glasgow coma scale.