Outcome of patients operated for depressed skull fracture with dural tear

Objective:  The objective of this study was to determine the outcome of patients operated for depressed skull fracture with a dural tear. Material and Methods:  A descriptive case series (n = 155) was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months. Results:  The mean arrival GCS was 10.64 ± 2.33. About 21.9% (n = 32) patients presented with a GCS of ? 8, while the remaining 78.1% (n = 123) presented with a GCS of ? 8. About 8.4% (n = 13) patients died due to the complications of the brain injury. The most common postoperative complication was found to be progressive neurologic deficit (PND) occurred in 21 (13.5%) patients. Penetrating injury to the head was also associated with unfavorable outcomes after surgery (p = 0.046), which shows that penetrating injury is associated with increased brain damage and hence consequently poor outcomes. Conclusions:  The neurologic status as denoted by the Glasgow coma scale is one of the most important factors which predicts the outcome. Surgical management of depressed skull fractures with dural tear has favorable outcomes in about two-thirds of patients. The remaining one-third patient remains in the severely disabled group. Every effort should be made to reduce the occurrence of complications as they are directly related to postoperative functional outcomes

Dysfunction of the temporalis muscle following pterional craniotomy: Analysis of 20 cases

Background & Objectives: Temporalis muscle dysfunction following pterional approach for skull base approaches is commonly encountered which is very discomforting for patients however, literature regarding its management is insufficient. This study presents 20 cases over the course of 4 years and discuss the pitfalls in the management of temporalis muscle dysfunction following pterional craniotomy for various lesions.Materials and Methods: Sixty patients were operated using the pterional craniotomy, out of which 20 patients were included in the study. In these cases we used three methods of temporalis muscle dissection namely, the submuscular, subfascial & interfascial. Postoperatively, patients were followed for a median of 8 months. Detailed description of the follow-up findings and their statistical associations is presented.Results: Twenty patients with 12 (60%) males & 8 (40%) females with mean age of 43.8 ± 10.9 years were operated. Twelve (60%) patients were operated using the submuscular approach, 6 (30%) by the subfascial method and 2 (10%) by interfascial technique of temporalis muscle dissection. Of the 20 patients, 8 (40%) reported trismus, 10 (50%) had temporal region and jaw pain and 14 (70%) complained of difficulty chewing. For these patients, we employed local heat therapy (n = 14, 70%), chewing exercises (n = 12, 60%) and oral range-of-motion exercises (n = 9, 45%). 78.5% of patients responded with resolution of pain after local heat therapy, 80% with jaw range-of-motion exercises. The temporal hollowing was assessed by plastic surgeon, but none of the patient pursued plastic surgery intervention.Conclusion: Temporalis muscle dysfunction following pterional craniotomy occurs in about one-third of patients. It is a cause of significant patient concern. Physiotherapy and oral analgesics can alleviate the common symptoms. Patients must be informed about this complication to avoid undue psychological distress. Early diagnosis & management leads to better patient response

The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction. Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25. Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%). Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes