We present a case of post-traumatic hematoma developing between the 2 layers of the cranial dura in a 2-year-old child following head injury. This child presented with history of fall from a height in altered sensorium with paucity of movements on the left side. Computerized tomography scan of the brain showed a right parietal linear fracture with an underlying hyperdense biconvex hematoma. Emergency evacuation of the hematoma was done. On elevation of the scalp flap, a fibrous membrane was seen protruding between the fracture lines. Following craniotomy, the hematoma was identified between the 2 layers of the dura and the fibrous membrane that protruded between the fracture lines was identified as the endosteal layer of dura. The hematoma was evacuated after opening the outer endosteal layer. After evacuation of the hematoma, the endosteal and meningeal layers could be identified separately and the point where these 2 layers split to enclose the hematoma was identified at the outer border of the hematoma. The child had no neurological sequel at the time of discharge.

Background: Management of intra parenchymal hematoma is a dilemma for neuroscientists, still a life-threatening entity which needs multidisciplinary approach.13% of all strokes constitutes hemorrhagic. Mortality and morbidity of patients depends on the status of initial presentation. Prognosis of the surgeries may vary from person to person and according to the comorbidities. The aim of the study was to determine effectiveness of decompressive craniectomy (DC) with hematoma evacuation in reducing the mortality.Methods: Patients with spontaneous intra parenchymal hematomas were selected and those having herniation syndrome were considered for surgery. Patients were evaluated after 30 days and 6 months and mortality was calculated.Results: 126 patients were selected for surgery, in that 102 patients underwent DC with hematoma evacuation and 24 patients who were not willing for surgery were considered as control group. Mortality of patients at 30 days of surgical group was 19.6% and 58.3% respectively, while 6 months mortality was 31.3% and 70.8% for surgical and control group.Conclusions: Surgical intervention can effectively reduce the mortality in spontaneous intra parenchymal hematomas.

Background: Cranioplasty is done after decompressive craniectomy surgeries either for cosmetic reasons or to afford protection against the development of the syndrome of the trephined which is deterioration after cranial decompression procedures. The aim of the study was to study functional recovery after cranioplasty based on improvement of Barthel activities of daily living (ADL) score.Methods: This was a prospective study done over 6 months period, December 2020 to May 2021. The functional recovery following cranioplasty was assessed based on improvement in Barthel ADL score. Pre-operative and post-operative Barthel ADL score after 3 months after cranioplasty of patients are found out. The change in Barthel score is analyzed and significance found out using paired t test.Results: In this study, 62 patients were included. 42 patients had improvement of ADL score. 14 patients had no change and 6 patients had worsening of score. After cranioplasty, ADL score has improved and it was statistically significant (p<0.001). Also, patients with low level of dependency (level 1, 2 and 3) have decreased in number and patients with higher levels of dependency (level 4 and 5) have increased in number after the surgery, suggesting that there is shift of patients from lower level of dependency to higher levels.Conclusions: Cranioplasty seems to offer patients clear benefits in terms of neurological improvement in many cognitive domains as well as in quality of life. Hence, cranioplasty advocated for functional/neurological recovery rather than cosmetic reasons.

Background: Minimally invasive spine surgeries (MIS) are often considered superior to their open counterparts in view of smaller incisions, reduced blood loss, less post-operative pain and less hospital stay. In this study, we compared the clinical outcome of MIS and open procedure of lumbar laminectomy/discectomy. The objective of this study was to compare clinical outcome between the MIS and open procedure of lumbar laminectomy/discectomy.Methods: This was a retrospective study conducted at Government medical college, Kottayam, Kerala, India where we studied the patients who underwent MIS and open laminectomy/laminectomy with discectomy during the period January 2018 to January 2020.Results: We studied a total of 200 patients, among which 60% were males with a mean age of 50.58 years and 40% were females with a mean age of 53.59 years, 45.5% had L5 S1 IVDP, 30% had L4/5 IVDP, and 24.5% had L4/5 lumbar canal stenosis, 75.5% underwent laminectomy with discectomy and the rest (24.5%) underwent laminectomy with foraminotomy, 60% underwent open surgery and 40% underwent MIS.Conclusions: MIS was superior to its open analog in terms of intra operative blood loss as well as hospital stay. But open surgeries required less operation time, less C arm exposure, had better pain control and functional outcome and less recurrence in our study.