International Journal of Neurology and Neurosurgery

Decompressive craniectomy (DC) followed by Cranioplasty (CP) has become most common life saving surgery
in neurosurgical practice. Till to date timing of CP is a matter of debate. Early surgery is associated with
complications due to resolving hematoma and persistent brain edema. Delayed surgery has complications like
sinking skin flap syndrome due to exposure of cranial defect to atmospheric pressure. Autologous bone flaps
remain the most commonly used compared to synthetic materials for CP, but the mode of preservation is usually
on surgeon’s preference due to limited studies on which mode is superior. Recent studies suggested that fixation
of bone flaps by titanium microplates and screws had less bone resorption and better fusion rates.
Aim: To compare efficacy and outcomes of early (<3months) versus late (>3 months) CP, subcutaneous versus
cryopreservation of bone flap and titanium microplates and screws versus prolene fixation of bone flap
Materials and Methods: A total number of 56 cases who underwent CP with various indications between
September 2018 to July 2021 in our institute were included. The decision of procedure was made according to
patient and surgeon discretion. All the cases were operated under General Anaesthesia.
Results: A total of 56 patients were included, 44 males (78.57%) and 12 females (21.43%), 40 (71.42%) were early
and 16 (28.58%) were late Cranioplasties. Storage of bone flap was subcutaneous in 40 (71.42%) patients and
was cryopreserved in 16 (28.58%). Bone flap was fixed with Mini plates and screws in 44 (78.57%) patients and
with prolene in 12 (21.43%) patients. Fusion rates of bone flap was relatively higher in patients who underwent
Early CP (95%) than in Late CP (75%) and in patients where bone flap was fixed with titanium microplates and
screws (95%) than in patients where prolene was used for fixation (67%), with no significant difference depending
on where bone flap was preserved, subcutaneously (90%) or by cryopreservation (88%).
Conclusion: Early and late cranioplasties had significant difference in outcomes with early CP having better
fusion rates, lesser duration of surgery and hospital stay. Fixation of bone flap with titanium microplates and
screws had better outcomes compared to prolene fixation. Subcutaneous and cryopreservation bone flap storages
had similar outcomes, with subcutaneous preservation requiring additional surgery. Our study concluded that
early CP with cryopreservation and titanium microplates and screws fixation of bone flap had better outcomes
with better fusion rates, less morbidity and better cosmetic appearance.
 

Abstract
Spinal instability forms the basis of spinal degeneration. Muscle weakness related to their disuse,
abuse or injury initiates and later propels the process of degeneration. All the known and socalled ‘pathological’ processes like osteophyte formation, disc space reduction, buckling of intervertebral ligaments are secondary processes and are possibly natural protective in nature and are
reversible after spinal stability is restored. It is not compression or deformation of neural structures
but it is segmental spinal instability that causes symptoms in spinal degeneration. Identification
of unstable spinal segments and their stabilization and aiming for arthrodesis forms the basis of
surgical treatment. Decompression of neural structures by resection of bones and soft tissues can
have negative connotation in the treatment.
 

Abstract
Background: Tracheostomy is being considered as a procedure of choice in cases where prolonged mechanical
ventilation is required. The objective of this study was to determine the convenient timing of tracheostomy in
neurosurgical patients.
Materials and Methods: A prospective hospital based study was conducted between March 2019 and September
2020 among all admitted neurosurgical patients requiring mechanical ventilation. The patients were divided into
three groups, early tracheostomy group, intermediate tracheostomy group and late tracheostomy group. The
patients were followed up for 90 days.
Results: Among 75 patients who underwent tracheostomy, 32% belonged to early tracheostomy group, 52%
belonged to intermediate tracheostomy group and 16% belonged to late tracheostomy group. The mean age of the
study population was 46.88. The average number of days on ventilator and average number of days of hospital
stay were much higher in patients belonging to late tracheostomy group. Ventillator associated pneumonia (VAP)
was also higher in late tracheostomy group.
Conclusion: Early tracheostomy is beneficial with respect to decreased duration of mechanical ventilation, decreased
hospital stay and complications like VAP