Bk Ojha

A randomized study of twist drill versus burr hole craniostomy for treatment of chronic subdural hematomas in 100 patients

Abstract Chronic subdural hematoma (CSDH) has been treated by a variety of surgical approaches like twist drill craniostomy (TDC), burr hole craniostomy (BHC), craniotomy, etc. There are large variations in cure rates and recurrence rates among the surgical options in literature and like all surgical techniques, there is a paucity of well-designed trials to sort out the issue. It is an accepted fact of surgery that the least invasive approach will often be the best approach. We set out with the hypothesis that TDC is as safe and as effective as BHC for CSDH treatment. A prospective randomized controlled trial for 100 patients was done to compare the results of TDC and BHC (both with drain) in patients of unilateral CSDH. Recurrence rate was the primary outcome variable evaluated. A strict clinic-radiological criteria was used to avoid ambiguity in the study. Forty-eight patients underwent TDC and 52 patients underwent BHC. Mortality was 2% (patients in low GCS), and 2% unexpected mortality occurred (unrelated causes). Complication rate was 14% overall and was similar in both groups. Overall outcome (primary and secondary) was comparable across both groups with no significant difference. Cost, invasiveness and duration of surgery was significantly less in the TDC group. The cure rate, recurrence rate, mortality and morbidity of TDC with drain is significantly similar to that of BHC with drain for treatment of defined patients of unilateral sub-acute and chronic subdural hematoma. The cost, duration and invasiveness of TDC surgery is significantly less than that for BHC surgery.

Posterior spinal dysraphism with lumbocostovertebral syndrome.

We report a 5-year-old male child with absent rib, hemivertebra, superior lumbar hernia (features of lumbocostovertebral syndrome) and posterior spinal dysraphism, which is the second case in the English literature with such a combination of defects. Radiology and management of the case is discussed.

Extra-axial primary non-Hodgkin's CNS lymphoma mimicking meningioma, in a 5-year-old immunocompetent child: a rare entity

We describe a case of a 5-year-old immunocompetent girl who presented with features of raised intracranial pressure with left eye ptosis of 1-month duration. CT scan and MRI of the brain showed an extra-axial, intensely contrast enhancing lesion in the left temporoparieto-occipital region, consistent with meningioma. On open tissue biopsy and immunohistochemistry staining, a diagnosis of B cell non-Hodgkins lymphoma was made. Six cycles of chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisolone regimen were given and showed a good clinical outcome without any recurrence during follow-up of 5 months.

Correlations of polymorphisms in matrix metalloproteinase-1, -2, and -7 promoters to susceptibility to malignant gliomas.

Background: Oligodendrogliomas are infiltrative astrocytic tumors. They constitute about 1-5% of intracranial tumors. These have been graded into benign and malignant grades. The single nucleotide polymorphisms (SNPs) in the promoter regions of MMP genes may influence tumor development and progression. This study was done to explore the correlations of the promoter SNPs in MMP-1, MMP-2 and MMP-7 genes susceptibility in development and progression of oligodendrogliomas. Objectives: We aimed to investigate the association of MMP1 (−1607A > G), MMP-2 (−1306 C/T) and MMP-7(−181A > G) gene polymorphism in oligodendrogliomas (grade I, II, III). Materials and Methods: In the present case control study, we enrolled a total of 30 cases of oligodendrogliomas (grade I to III) confirmed by histopathology and 30 healthy cases as control. Polymorphism for MMP-1 gene (−1607A > G), MMP-2 (−1306 C/T), MMP-7(−181A > G) were genotyped by restriction fragment length polymorphism. Results: Frequencies of MMP-1 (−1607A > G) genotypes and 2G alleles were significantly associated with the cases of oligodendrogliomas (30%) in relation to healthy controls (13%). [OR = 6.89; P = 0.02; 95%CI= (1.33-35.62)] and [OR = 2.66; P =0.01; 95% CI= (1.26-5.64)]. A significant association of MMP-2 (−1306C/T) polymorphism with oligodendroglioma (P = 0.54) was not found, suggesting that MMP-2 (−1306C/T) polymorphism is not associated with increased oligodendroglioma susceptibility. Frequencies of MMP-7(−181A > G) genotypes and 2G alleles were significantly associated with the cases of oligodendrogliomas (33.33%) in relation to healthy controls (13.33%). [OR = 5.65; P = 0.02; 95%CI= (1.26-25.36)] and [OR = 2.49; P =0.01; 95% CI= (1.17-5.27)]. Conclusions: MMP-1 (−1607 A > G), MMP-7(−181A > G) genotypes and 2G alleles were significantly associated with oligodendroglioma (grade I, II, III), but MMP-2 (−1306C/T) polymorphism is not associated with increased oligodendroglioma susceptibility.

Subaxial (C3–C7) cervical spine injuries: Comparison of early and late surgical intervention

This study was carried out to determine whether the timing of surgery affects neurological outcome in patients with subaxial cervical spine trauma. We studied 41 patients with a fracture and/or fracture-dislocation of C3 to C7 cervical vertebrae who were treated operatively during the period January 2004 to June 2009. Surgery was performed as soon as the patients medical condition allowed, within 2 weeks of trauma in 20 patients and after 2 weeks of the injury in 21 patients. Outcome was assessed using Frankel grading. In both groups only those patients who had incomplete spinal cord injury showed neurological improvement after surgery. There was no statistically significant difference in final neurological outcomes in patients having early as opposed to delayed surgery. Similarly there was no statistically significant difference in two groups based on level of injury and associated cord injury. Surgical intervention for cervical injuries is safe, as no postoperative neurological deterioration was recorded. Timing of surgery does not affect neurological outcome.

High-voltage electrical burn of the head: Report of an unusual case

Abstract Deep burns of the scalp and skull can be caused by high-voltage electrical injuries. Electrocution can occur while working and illegal handling of the lines. Compared to conventional burns, these injuries are characterized by an increased morbidity and mortality. We encountered an unusual case of high-voltage electrical burn of the head causing charring of scalp, bone and dura with herniation of infected brain matter.

Positional hoarseness: an unusual symptom in jugular foramen mass

We came across a case of jugular foramen mass causing positional hoarseness on turning the head left and disappearing on returning the head to a straight position. Hoarseness of voice due to vagus nerve involvement is seen in jugular foramen mass but positional hoarseness has never been seen before. We report this rarest presentation and discuss the pathophysiology behind it.

Winnowing fan blade head injury

Abstract The farms can be a dangerous working place especially for children. Children spend most of their time there with their parents in the fields and it is where accidents happen. Approximately 200,000 children in India suffer from head injury every year and majority can be prevented. Head injury from the winnowing fan blades is rare among children and limited data is available in the literature. We present the, mechanism of injury, clinico-radiological findings, the management and preventive measures that can be taken for head injuries that occur due to the winnowing fan. Keywords: children, winnowing fan blade, head injury prevention.

Contralateral motor deficit in extradural hematoma: Analysis of 35 patients

We work at one of the busiest trauma centers of the country and deal with more than 200 cases of extradural hematomas per year. The striking frequency of the association of motor deficits with extradural hematomas prompted us to take up this study and delineate the factors that could lessen the morbidity by decreasing the convalescence of the affected patients. We primarily found that the association between EDH and motor deficits was common, and early intervention resulted in faster recovery of motor power, (70% in patients operated within 24 hours of trauma, and 53.3% in patients operated after 24 hours of trauma. recovered complete power within 4 weeks.) We concluded a clinically significant association of extradural hematomas and concurrent motor deficits, and found that timely intervention in patients presenting with mild head injury enabled us to achieve complete recovery of motor power. Contributing factors included the concurrence of signs of herniation and associated parenchymal injuries.

Spontaneous umbilical CSF fistula due to migration of the peritoneal end of VP shunt: A case report and review of pathogenesis

Abdominal complications after ventriculoperitoneal (VP) shunt surgery for hydrocephalus have been known to occur. The more common complications include peritoneal pseudocyst, obstruction of the lower end, and shunt infection. Perforations of the intra-abdominal hollow viscera leading to spontaneous extrusions of the peritoneal catheter via the natural orifices have also been reported. A rarer phenomenon still is the migration of the lower end of the VP shunt through the anterior abdominal wall, leading to the formation of a spontaneous umbilical fistula at a site unrelated to the surgical site. Eight cases have been described in the literature so far with various causes elucidated. We report this condition in a child 4.5 years after his shunt surgery and postulate different mechanisms for both early and late presentations of this condition.