Introduction:Anterior cranial fossa (ACF) defects still remains a reconstructive challenge to neurosurgeons due to the difficult location, inaccessibility, and unfavorable vascular anatomy. Usual reconstructive methods reported complications such as recurrent cerebrospinal fluid leak due to bone resorption and tissue breakdown. This is mainly due to the avascularity of the bone graft and inability to provide bony structural support for the skull base. An ideal reconstructive modality should provide a rigid bony support to prevent brain herniation as well as ensure a water tight barrier between sinonasal tract and intracranial compartment.Methodology:Hence, we thought of a novel technique of taking the outer table of the primary craniotomy flap with its intact myofascial pedicle and moulded it with multiple osteotomies (moulded osteomyofascial pedicled split (MOPS) craniotomy flap) to fit into uneven ACF defects. Advantages of our flap include (1) It is a pedicled vascularized bone flap. (2) It is taken from primary craniotomy flap; hence, no separate craniotomy is required. (3) The inner table is intact and leaves no secondary calvarial bone defect on the donor site. (4) Osteoplastic flap is moulded to fit into the defect, thus providing good contour.Results:MOPS flap was used in five patients with ACF defects due to varied etiologies such as encephalocele defect, frontal mucocele, skull base meningioma, and complex naso ethmoid fracture. Age of the patients included in the study varied from 21 to 60 years. Male:female ratio was 4:1. ACF defects were reconstructed using MOPS flap in all cases. There were no postoperative complications and 1-month postoperative computerized tomography scan showed no evidence of bone resorption with acceptable cosmesis.Conclusion:MOPS craniotomy flap provides a novel, easily mastered, and cost-effective technique with minimal complication in reconstruction of complex ACF defects with acceptable esthetic and functional outcome.

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.