Head injury is a leading cause of death in young age group. Extra Dural hematoma, a complication of head injury, is often fatal if not treated in time. The surgical outcome of EDH is dependent upon many variables including preoperative GCS, time between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume. In order to reduce the mortality near to nil, it is essential to determine the magnitude of effect of affecting factors on surgical outcome which will also help us in preoperative counseling and prioritizing the operative candidates. This study was conducted determine the factors affecting surgical outcome of traumatic intracranial extradural Hematoma in Punjab Institute of Neurosciences/ Lahore general hospital, Lahore. It was a Cross sectional study conducted for 3 years from 28th May 2012 to 28th May 2015.The study was conducted on the patients admitted through emergency and diagnosed as Extramural hematoma. These patients underwent surgical evacuation of EDH on emergent basis and outcome was measured by Glasgow Outcome Scale (GOS) after 48 hours of surgery. Using GOS, good surgical outcome was observed in 80.9% (157 out of 194) patients. Preoperative GCS, anisocoria, hematoma volume, associated intracranial injuries and time between injury and surgery were the factors affecting the outcome significantly (p value=0.000) while age and sex of the patient had no significant effect. In Conclusion, good surgical outcome is associated with patients with solitary Extra Dural Hematoma of volume less than 60 ml, preoperative GCS more than 8, absence of anisocoria and undergoing surgical evacuation within 6 hours of injury. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, Page: 13-18

The incidence of head and spinal injury is on the rise in developing countries. The number of deaths and burden of disability may be reduced, if not completely stopped, through preventive measures after an epidemiological survey on trauma. The goal can be achieved to a significant extent through the use of guidelines from the countries that have achieved a reduction in the incidence of neurotrauma. To determine the incidence and outcome of neurotrauma in developing countries, a study was necessary using standardized assessment parameters for global interpretation. Such a study was conducted to determine the sociodemographic characteristics, morbidity, and mortality of patients with head and spinal injury admitted to various neurosurgical centers in Pakistan from July 1, 1995 to June 30, 1999. A total of 260,000 patients were admitted with head injury over a 4-year period. The majority of patients presented during second decade (i.e., 33.2%) followed by first and third decade. There were 195,000 (75%) males, and 65,000 (25%) females with a ratio of 3:1. Road traffic accident was the commonest cause of head trauma. Mild, moderate, and severe head injury was observed in 135,200 (52%), 78,000 (30%), and 46,800 (18%) patients, respectively. Conservative management was carried out in 176,800 (68%) patients. Surgery was required in 83,200 (32%), 50% of which had depressed skull fracture, simple or compound. Follow-up period varied from 2 months to 2 years with a mean of 11 months. Patient's outcome was assessed according to Glasgow Outcome Scale (GOS). Good outcome was observed in 174,200 (67%). The total mortality was 46,800 (18%). In this study, 2654 patients ranging in age from 5 to 70 years had spinal injuries. There were 1922 males (72%) and 732 (28%) females. British Medical Research Council Scale was used for assessment of motor power of patients with spinal trauma. Of these, 780 patients (29%) had complete spinal cord injury. Surgical intervention was performed in 1800 patients (68%) and the rest were managed conservatively.

Background & Objective: A Craniotomy (CO) or decompressive craniectomy (DC) are the two main surgical procedures employed for evacuation of acute traumatic subdural hematoma (ASDH). However, the optimal surgical procedure remains controversial. The beneficial effect of early surgical evacuation of acute subdural hematoma in improving outcome also remains unclear. Our objective was to study the role of these two parameters in determining the outcome in patients undergoing surgical evacuation of acute traumatic subdural hematoma. Methods: A retrospective analysis of 58 patients presenting with acute traumatic subdural hematoma and with presenting Glasgow Coma Scale (GCS) ≤ 8 that had been operated in Lahore General Hospital between June 2014 and July 2015 was performed. The demographic data, preoperative GCS, type of surgical procedure performed and timing of surgery were analysed. Results: Forty (69%) patients underwent CO, and eighteen (31%) patients underwent DC. The CO and DC groups showed no difference in the demographic data and preoperative GCS. Six patients survived in the craniotomy group, while none survived in the decompressive craniectomy group (p=0.083). The relationship of timing of surgery with survival in the craniotomy group was found not to be clinically significant (p=0.87). Conclusion: In this study craniotomy was associated with a better outcome as compared to decompressive craniectomy, however, the difference did not reach statistical significance. Early surgery was also found not to be associated with an improved outcome. doi: https://doi.org/10.12669/pjms.36.3.1771 How to cite this:Altaf I, Shams S, Vohra AH. Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1771 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

No abstract

Objective:Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.Methods:A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn’t stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.Results:There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).Conclusion:Incisional CSF leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant CSF lumbar drainage, instead of an initial trial of conservative therapy alone.