Post-Operative Complications of Surgery for Chronic Subdural Hematoma (SDH) and Prevention

Objective:  The study aimed to determine the rate and type of complications during surgery for treatment of chronic subdural hematoma and assess ways for their prevention. Material and Methods:  A total of 50 patients of chronic SDH were selected from the Neurosurgery Department of Bahawal Victoria Hospital. Patients were treated surgically with a single burr hole evacuation under local anesthesia, introduced a subdural drain, nursed in a head-down position for 24 hours, and given plenty of fluids orally and intravenous route. The surgical technique involved a formation of a single burr hole at the point of maximum density. Results:  Out of 50, 43 patients recovered smoothly postoperatively and discharged on the 7th postoperative day. Two patients were re-operated due to inadequate evacuation or reaccumulation. One patient developed subdural empyema post-operatively and expired in spite of good antibiotic cover. In one patient subdural drain penetrated the brain parenchyma resulting in dysphasia. Another patient formed an intracerebral hematoma due to irrigation of the cavity with pressure. One patient with GCS 4/15 developed seizures postoperatively and expired after one hour. One patient developed gross subdural tension pneumocephalus after removing the subdural drain was re-operated and recovered. Conclusion:  Single burr hole evacuation of chronic SDH under local anesthesia is the most accepted surgical treatment. Using proper aseptic surgical techniques, the introduction of the minimum necessary length of the subdural catheter to avoid penetration into the brain parenchyma, followed by careful irrigation of the subdural cavity can help prevent complications

To Determine Frequency of Cerebrospinal Fluid (CSF) Rhinorrohea after Trans-sphenoidal (TSS) Surgery

Introduction: Trans-sphenoidal approach has been a major technique for surgical treatment of sellar pathology since the 1960s. With the development of technical possibilities and increase in surgeons’ expertise, mortality and morbidity after such interventions have decreased. Postoperative cerebrospinal fluid (CSF) rhinorrhea, however, remains the most serious and life – threatening complication. The purpose of this study was to determine the magnitude of cerebrospinal fluid rhinorrhea after trans-sphenoidal surgery, so that proper protocols could be taken for its prevention and management in order to reduce the morbidity of these patients. Materials and Methods: A total of 116 patients, 20 to 60 years of age with sellar and supra-sellar tumours of any size were included. Patients with Rathke’s cleft cyst, meningoceles, recurrent pituitary adenomas and h/o previous surgery and radiation were excluded. All the patients had undergone trans-sphenoidal removal of the tumour and were followed after 24 hours, one week and one month post-operatively and noted for presence of any cerebrospinal fluid rhinorrhea. Results: Mean age was 45.23 ± 8.71 years in our study. Out of the 29 patients, 44.82% were male and 55.72% were females with ratio of almost 1:1. According to type of tumour, 56.90% were sellar and 43.10% were suprasellar. Cerebrospinal fluid (CSF) rhinorrhea was found in 3 (10.34%) patients, whereas there was no Cerebrospinal fluid (CSF) rhinorrhea in 26 (89.65%) patients. Conclusion: This study concluded that frequency of CSF rhinorrhea after trans-sphenoidal surgery (TSS) is 10.34% in our population. Abbreviations: CSF: Cerebrospinal Fluid. TSS: Trans-sphenoidal Surger

To Determine Outcome of Lumboperitoneal Shunt in Patients of Normal Pressure Hydrocephalus

The patient presenting with gait disturbance, cognitive decline, or urinary incontinence represents a common cli-nical dilemma for the practicing neurologist and neurosurgeon. Although these symptoms are suggestive of normal pressure hydrocephalus (NPH), they are not specific to the diagnosis and commonly occur in neuro-degenerative conditions or nonspecifically in advanced age. A lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension and normal pressure hydrocephalus.Objective: The objective of the study is to determine outcome of lumboperitoneal shunt in patients of normal pressure hydrocephalus.Study Design: Case series study.Place and Duration of Study: This study was conducted from December 19, 2012 to June 18, 2013 in the department of neurosurgery, Bahawal Victoria Hospital Bahawalpur.Subject and Methods: 96 patients of normal pressure hydrocephalus, admitted in neurosurgery ward BVH Bahawalpur were included in the study. LP shunt procedure was done under general anesthesia. 3 weeks after operation complete clinical examination, urodynamic study and CT scan brain was done to see outcome of LP shunt.Results: Total 96 patients were included in our study. The mean age of patients was 67.43 years with standard deviation of 5.395 years. Out of 96 patients, 47 (48.96%) were female and 49 (51.04%) patients were male. Out of 96 patients, 81 (84.38%) patients showed improved gait and 15 (15.62%) patients showed no improvement. Out of 96 patients, 49 patients showed improvement in incontinence while 47 patients showed no improvement. Out of 96 patients, 53 patients showed improvement in memory while 43 patients showed no improvement in memory.Conclusion: Lumboperitoneal shunt placement is a safe and effective shunting for normal pressure hydro-cephalus, resulting in significant symptomatic improvement with a low risk of over-drainage

The Management options for Post Traumatic CSF Rhinorrhea: A Case Series study

Objective: A descriptive case series study was aimed to evaluate management options for traumatic csf rhinorrhea and develop a better option Materials  and Methods: The  study was conducted  at Neurosurgery department,  Bahwal Victotoria hospital Bahawalpur . This study involved 80 patients aged between 20-55 years of both genders diagnosed of CSF rhinorrhea presented with trauma. Results: In the department of Neurosurgery BVH, Bahawalpur 2000 patients were admitted with head injury in two years from April 2021 to February 2022. A total of 80 patients of these had cerebrospinal fluid (CSF) rhinorrhea. This study was conducted to evaluate the management options of CSF rhinorrhea in the patients with head injury. CSF rhinorrhea was stopped in 70 patients with conservative management. In 10 patients cerebrospinal fluid rhinorrhea continued after the conservative management of 2-6 weeks and surgical repair of Dural tear at the base of skull was done in these patients. Site of CSF rhinorrhea leakage was located in these patients with the help of CT Scan and MRI skull.In all these patients Dural tears was repaired with a graft of fascia Lata or periosteum, pasted on the site of defect with fibrin glue. CONCLUSION:We concluded that all post traumatic C.S.F rhinorrhea cases should be managed conservatively because most of the C.S.F leaks stop spontaneously with proper conservative management. So surgical repair should be delayed for 2-12 weeks after a leak has been identified