No abstract

immunoglobulin therapy and anti-Rh-D therapy would be useful in chronic patients not responding to steroids. If the medical management fails to improve the platelet count, other options such as splenectomy, immune-suppressants, corticosteroid sparing agents, monoclonal antibodies and thrombopoietin receptor agonists would be beneficial. [2] A routine preoperative platelet count was considered for this patient though he was asymptomatic in the pre-operative period. [7] This helped in identification of chronic ITP and optimises the patient adequately and thereby avoids potentially catastrophic complication of peri-operative intracranial bleeding during craniotomy.

Lumbar drain catheter insertion for prolonged periods of time is necessary in a myriad of neurosurgical patients which entails its tunneling. We describe a safe and simple technique of catheter insertion and tunneling using two Tuohy needles instead of one, which prevents unintentional catheter damage during the procedure.