Nasalisation - overdo or necessity. A retrospective study

Surgical treatment of nasal polyposis has been successfully treated with functional endoscopic sinus surgery (FESS) or nasalisation – a more radical approach involving removal of the bony lamellae and mucosa of the ethmoid labyrinth, sphenoidotomy, frontotomy, middle turbinectomy and an antrostomy. This study observed the results of 794 surgeries performed by a single surgeon in the period from January 2012 to December 2022 and compared the success of those two methods. The study observed 594 FESS patients and 130 nasalisation patients. In the nasalisation group, 40 patients had unilateral nasalisation, while the remaining 90 had bilateral nasalisation. The patients in both groups were controlled preoperatively as well as 1, 3 and 6 months after surgery. The patients where nasalisation was performed on average had a worse starting point (more intense congestion symptoms). The surgeon discussed their subjective opinion on nasal breathing improvement before and after the treatment as well as endoscopic findings and compared it at each timepoint. The results show that the patients undergoing nasalisation procedure had better results when compared to FESS group. This study indicates that when a more radical tissue removal is performed (nasalisation), the nasal function is improved compared to the more conservative treatment method (FESS)

Nasalisation - overdo or necessity. A retrospective study

Surgical treatment of nasal polyposis has been successfully treated with functional endoscopic sinus surgery (FESS) or nasalisation – a more radical approach involving removal of the bony lamellae and mucosa of the ethmoid labyrinth, sphenoidotomy, frontotomy, middle turbinectomy and an antrostomy. This study observed the results of 794 surgeries performed by a single surgeon in the period from January 2012 to December 2022 and compared the success of those two methods. The study observed 594 FESS patients and 130 nasalisation patients. In the nasalisation group, 40 patients had unilateral nasalisation, while the remaining 90 had bilateral nasalisation. The patients in both groups were controlled preoperatively as well as 1, 3 and 6 months after surgery. The patients where nasalisation was performed on average had a worse starting point (more intense congestion symptoms). The surgeon discussed their subjective opinion on nasal breathing improvement before and after the treatment as well as endoscopic findings and compared it at each timepoint. The results show that the patients undergoing nasalisation procedure had better results when compared to FESS group. This study indicates that when a more radical tissue removal is performed (nasalisation), the nasal function is improved compared to the more conservative treatment method (FESS)

Risk Factors for Subdural Bleeding in Elderly Population

In the elderly, a larger proportion of the intracranial bleeds is related to non-traumatic causes or is caused by slight trauma – such that in a younger patient would not be expected to cause a bleed. In clinical practice, there is a prevailing impression that these bleeds, especially subdural hematomas of chronic and sub-chronic duration with or without acutization (evidence of »fresh« bleeding) are in many cases related directly to the use of anticoagulant therapy. A retrospective survey of medical documentation was performed for patients treated at the Neurosurgery Clinic of KBC Rijeka during the period of 2011 and 2012. Statistical analysis showed a signifi cantly greater incidence of spontaneous SDH (subdural hematoma) in patients taking oral anticoagulation therapy (Fisher exact test, p<0.01). In the article 3 typical cases of such patients are also presented. This survey confi rmed the existence of a relationship between oral anticoagulant therapy and SDH, in particular the subgroup of »spontaneous« SDH. A larger study is planned

Neurosurgical Procedure for Treatment of Traumatic S u bdural Hematoma with Severe Brain Injury: A Single Center Matched-Pair Analysis

Decompressive craniectomy (DC), an auxiliary neurosurgical invasive procedure, has been a part of the treatment regimen for severe brain injury (SBI). Today DC is the standard of care in patients with middle cerebral artery infarction. Our previous positive research results about effectiveness of DC procedure when applied to a specifi c group of SBI patients have made a solid base for a clinical evaluation of DC technique application to patients with isolated SBI with traumatic subdural hematoma (TSDH), despite controversies regarding clinical benefi t of DC technique when applied to STBI patients. A matched-pair analysis has been performed to compare long-term clinical outcomes in patients with and without the DC technique applied. This study has encompassed 150 consecutive STBI patients with TSDH, aged between 18 and 82 years. One hundred patients had required application of DC procedure, while remaining 50 patients represented a matched control group in which the DC procedure had not been applied. The control group match was conducted on the basis of epidemiological and potential prognostic factors, such as age, gender, DC surface area and Glasgow Coma Score (GCS). The main reason for occurrence of STBI with TSDH was traffi c accidents, with sex ration 2:1 (male/female), while 2/3 of patients were aged between 26 and 40 years. Mortality rate of 18% had occurred in the group of patients in which DC procedure was applied early in the fi rst 24 hours after the injury, while mortality rate of 54% had occurred in the group of patients in which DC procedure was applied later than 24 hours after the injury, in comparison to mortality rate of 35% that had occurred in the control matched group of patients. Also, better control of intracranial pressure (ICP) had occurred in patients in which a DC surface was made larger than 40ccm. In addition, less computed tomography (CT) scans were made as a follow up care procedure in patients in which DC procedure was performed and especially if DC procedure had been performed within 24 hours after the injury. However, regardless of many positive results that an early application of DC procedure has had on SBI patients with TSDH, an expected increase in immediate or delayed complications had occurred, for example we had recorded an increased number of encefalocele. Signifi cantly better outcome of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with the DC technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in comparison to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after the time of injury and also better than the control group

Efficancy of Decompressive Craniectomy in Treatment of Severe Brain Injury at the Rijeka University Hospital Centre

Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III »Guidelines« – »option« which has not clear clinical certainty. They do not correspond to »Standards« (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20–25 mm Hg. The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment and if the size of DC is satisfactory

Severe Traumatic Brain Injury after the Assault with an Axe Handle

Traumatic brain injuries represent a major cause of death and disability. We present a case of a 47-year-old patient who sustained a severe brain injury after being assaulted with a handle of an axe. The patient underwent numerous surgeries by various specialists during several months. Following a few failed attempts to cover the skull defects, the vacuum-assisted closure system had been utilized with great success in healing of her complex head wound. Traumatic brain injury requires great effort and collaboration in order to rehabilitate people to the most independent level of functioning possible

Bilateral Congenital Dislocation of the Knee with Ipsilateral Developmental Dysplasia of the Hip – Report of Three Patients

Congenital dislocation of the knee (CDK) is a very rare condition. Here we report our strategy and results in treatment of three children with CDK. All three patients were treated with conservative method, and only one had underwent a surgical procedure on one knee. Of the remaining, we recorded a good outcome with conservative treatment in three knees, while two had poorer outcome as a result of musculoskeletal anomalies. We also present here a unique case of a child born without cruciate ligaments and patellas on both sides. We performed the operative procedure by Z-plasty of the extensor apparatus on one left knee according to Niebauer and King on one child. The clinical result of this procedure was very good. Five years after the operation we decided to perform an MRI examination to assess the postoperative status of the operated knee, especially the position and the shape of left patella. We found the asymmetry and high position of the operated patella resulting in patella alta. Compared to the initial clinical presentation, we consider all patients to have good clinical presentation nowdays