Neurosurgery Emergency Research Articles

Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Thrombocytopenia: A Blessing in Disguise

AbstractAcute subdural hematoma (SDH) constitutes one of the most common emergencies in neurosurgery and its spontaneous resolution is an uncommon phenomenon. Several theories have been described to explain this phenomenon including redistribution of subdural blood, dilution by cerebrospinal fluid, and brain atrophy. Rapid resolution of acute SDH related to thrombocytopenia is a rare phenomenon. We report a case of a patient who showed rapid resolution of acute SDH with thrombocytopenia and also discuss such a rare case with speculation of the thrombocytopenia as a factor to promote this phenomenon.

The transition from cranial surgery to neurosurgery in East London, 1760–1960

ABSTRACT The emergence of neurosurgery from the practice of cranial surgery between the eighteenth and the twentieth centuries in London, UK, is well documented, including the role of Sir Victor Horsley, the first neurosurgical appointee at the National Hospital Queen Square in 1886. The process of this transition elsewhere in London and the subsequent foundation of other neurosurgical units are less well described. In East London, the status of St. Bartholomew’s Hospital (Barts) as the oldest London hospital still active on its original site and its comprehensive archives allow an unusually long history of surgical practice in the specialty to be studied. Using these archives and other primary and secondary sources, this article describes the transition of cranial surgery in East London from the general surgeons, limited to the treatment of brain and skull injury, to the specialized discipline of neurosurgery. We discuss the culmination of this process in the foundation of three neurosurgical units at London Hospital, Whitechapel, by Sir Hugh B. Cairns from 1927; at Barts Hospital, Smithfield, by John E. A. O’Connell from 1937; and at Oldchurch Hospital, Romford, by Leslie C. Oliver from 1945. Two modern neurosurgical units, in Whitechapel and Romford, have taken forward the work begun by this group.

Evaluation of Neurosurgical Emergencies in the Pediatric Emergency Department: Clinical Warning Signs

BackgroundWe aimed to evaluate the patients who underwent neuroimaging with suspicion of neurosurgery pathology and identify the clinical warning signs for the early recognition of neurosurgical emergencies. MethodsPatients aged one month to 18 years who underwent neuroimaging with a preliminary diagnosis of intracranial pathology requiring emergency surgery and symptom duration less than one month were included in the study. Patients were divided into three groups according to their definitive diagnosis as neurosurgical emergencies, neurological emergencies, and nonurgents. ResultsA total of 140 patients were included in the study (the median age was 8 [interquartile range IQR 3 to 13] years and 52.8% were male). Neurosurgery emergency group and neurological emergency group were significantly younger than the nonurgent group (P < 0.001). Vomiting, meningeal irritation findings, and papilledema (grade 2 and above) were more common in the neurosurgical emergency group (P 0.029, 0.023, and < 0.001, respectively). For neurosurgical emergencies, in the presence of papilledema (grade 2 and above) and focal neurological deficit, the specificity was 99.2%, positive predictive value (PPV) 83.3%, negative predictive value (NPV) 88.1%, and odds ratio (OR) 36.8 (P < 0.001, confidence interval [CI] 4.04 to 336.0); in the presence of altered consciousness and focal neurological deficit, the specificity was 97.5%, PPV 50%, NPV 86.6%, and OR 6.4 (P = 0.014, CI 1.20 to 34.4). ConclusionsYounger age, presence of vomiting, signs of meningeal irritation, papilledema grade 2 and above, and altered consciousness are the crucial “warning signs” of a potential neurosurgical emergency.

Canadian Women in Neurosurgery: From Early Pioneers to World Leaders

Since the emergence of neurosurgery as a distinct specialty ∼100 years ago in Canada, it took >40 years for Canadian women to enter the field in the province of Quebec, and longer in the other provinces. We provide a historical overview of Canadian women in neurosurgery, from the early pioneers to the modern-day leaders and innovators in the field. We also define the current participation of women in Canadian neurosurgery. Chain-referral sampling, historical books, interviews, personal communications, and online resources were used as data sources. Our historical review highlights the exceptional journey and unique experiences of female neurosurgeons, describes their achievements, and identifies career obstacles and enabling factors. We also incorporate comments from Canadian female neurosurgeons, both retired and in active practice, addressing gender inequities in the field, and provide advice and encouragement to the new generations to come. Despite the achievements of these female trailblazers, women represent a small proportion of the Canadian neurosurgery trainees and the active workforce, in stark contrast to the increasing number of women in medical school. To the best of our knowledge, this study represents the first historical overview of female women neurosurgeons in Canada. Providing a historical context will help us to better understand the important role of women in modern neurosurgery, identify persistent gender issues in the field, and provide a vision for aspiring female neurosurgeons.

Division of Labor or a New Discipline? The Troubled Emergence of Neurosurgery in the Netherlands, 1890–1929

Abstract In the early twentieth century, Amsterdam neuropsychiatrist Louis Muskens (1872–1937) asserted that surgery of the human central nervous system ought to be performed by neurologists rather than surgeons. Only neurologists, he believed, possessed the knowledge, skills, and experience to safely perform these operations. Muskens practiced what he preached, by himself taking up the practice of nervous system surgery. In the Netherlands, however, a strict division of labor had already emerged between surgeons and neurologists. Both regarded surgical performance as an activity to be reserved for surgeons, requiring specific skills, experience, and innate qualities, whereas the diagnosis and localization of nervous system disorders was seen by both as belonging to the domain of neurology, whose practitioners possessed a comprehensive, dynamic, scientific understanding of the nervous system, observational skills, and expertise in diagnostic technology. Even though Muskens’s views and surgical practices were ultimately rejected by both his surgical and neuropsychiatric colleagues, his controversial campaign against the existing division of labor between surgeons and neurologists was an important catalyst for the emergence of neurosurgery as a medical specialty in the Netherlands, one performed by a specially trained “neurosurgeon” exclusively dedicated to nervous system surgery. The case of Muskens provides a striking example of the ways in which professional identities shaped medical practice and the formation of a new discipline.

Development and Validation of an Automatic System for Intracerebral Hemorrhage Medical Text Recognition and Treatment Plan Output.

The main purpose of the study was to explore a reliable way to automatically handle emergency cases, such as intracerebral hemorrhage (ICH). Therefore, an artificial intelligence (AI) system, named, H-system, was designed to automatically recognize medical text data of ICH patients and output the treatment plan. Furthermore, the efficiency and reliability of the H-system were tested and analyzed. The H-system, which is mainly based on a pretrained language model Bidirectional Encoder Representations from Transformers (BERT) and an expert module for logical judgment of extracted entities, was designed and founded by the neurosurgeon and AI experts together. All emergency medical text data were from the neurosurgery emergency electronic medical record database (N-eEMRD) of the First Affiliated Hospital of Chongqing Medical University, Chongqing Emergency Medical Center, and Chongqing First People’s Hospital, and the treatment plans of these ICH cases were divided into two types. A total of 1,000 simulated ICH cases were randomly selected as training and validation sets. After training and validating on simulated cases, real cases from three medical centers were provided to test the efficiency of the H-system. Doctors with 1 and 5 years of working experience in neurosurgery (Doctor-1Y and Doctor-5Y) were included to compare with H-system. Furthermore, the data of the H-system, for instance, sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristics curve (AUC), were calculated and compared with Doctor-1Y and Doctor-5Y. In the testing set, the time H-system spent on ICH cases was significantly shorter than that of doctors with Doctor-1Y and Doctor-5Y. In the testing set, the accuracy of the H-system’s treatment plan was 88.55 (88.16–88.94)%, the specificity was 85.71 (84.99–86.43)%, and the sensitivity was 91.83 (91.01–92.65)%. The AUC value of the H-system in the testing set was 0.887 (0.884–0.891). Furthermore, the time H-system spent on ICH cases was significantly shorter than that of doctors with Doctor-1Y and Doctor-5Y. The accuracy and AUC of the H-system were significantly higher than that of Doctor-1Y. In addition, the accuracy of the H-system was more closed to that of Doctor-5Y. The H-system designed in the study can automatically recognize and analyze medical text data of patients with ICH and rapidly output accurate treatment plans with high efficiency. It may provide a reliable and novel way to automatically and rapidly handle emergency cases, such as ICH.

Prospective analysis of factors affecting the surgical outcomes of pediatric depressed skull fractures

Background: Around 42% of the pediatric patients present with skull fractures and the prognosis depends on several factors including type and location of fracture along with severity of associated brain trauma. The objective of this study was to find the factors affecting the outcome in childhood depressed skull fractures.Patients and methods: This prospective observational study included 68 patients with depressed fractures presenting in the neurosurgery emergency department of Children Hospital Lahore. After detailed history and routine investigations, patients underwent the standard surgical procedure and were closely observed during the hospital stay. All were followed up for one month after being discharged from the hospital.Results: The mean age of the children was 7.72±3.80 years. The male-to-female ratio was 1.42:1. Most of the patients had a history of fall (N=39, 57.4%). Twenty-nine (42.6%) had simple and 39 (57.4%) had complex fractures. Mostly presented with injuries at parietal (25%) and frontal (20.6%) region. Forty-seven (69.1%) were having GCS in between 13-15 (mild), 12 (17.6%) in between 9-12 (moderate) and 09 (13.2%) of the children were having GCS ≤8 (severe) at the time of presentation. Regarding outcome, good recovery was noticed in 49 (72.1%) children, moderate disability in 8 (11.8%), severe disability in 4 (5.9%), the vegetative state in 3 (4.4%), and death in 4 (5.9%) of the patients. A strong association was found between the GCS category and outcome of the surgery (p&lt;0.001). No significant association was found between outcome and mode of injury (p=0.45), site (p=0.553), and type of fracture (p=0.66).Conclusion: Children with depressed fractures and a history of trauma normally present with minor brain injury and have a good post-surgical outcome.

123 Effectiveness of the “Emergency Neurosurgery Referral Card”

Abstract Aim The recording of patient and clinical information is important during the neurosurgery referral process, as time-critical communication with the referring teams and appropriate clinical decisions are dependent on the accuracy and completeness of the information recorded. A ‘Neurosurgery Emergency Referral Card’ was introduced to assist the process for the on-call registrars/consultants. Method Following the first audit cycle was carried out over 52 weeks (1st January 2020 – 31st December 2020), which assessed the percentage of incomplete data entry in the referral database, a ‘Neurosurgery Emergency Referral Card’ was introduced. Data entry was then re-audited (12 weeks; 21st May 2021 – 21st August 2021). Results Referral type (emergency, urgent, semi-urgent, non-urgent) is the most inadequately recorded data field, with a completion rate of 68%. Following the implantation of the card, it improved to 89%. The pre- and post-implementation completion rate for patient age was 82% and 98% respectively, and 85% and 96% respectively for time of referral. The completion rates for the remaining data fields in the 1st cycle (e.g., referring doctor, diagnosis, gender) were generally above 94% but still improved with the usage of the card. The average improvement in referral taking after implementation is 6%. Conclusions Even in the digital age, a ‘low-technology’ yet simple physical card can be an effective adjunct to improve referral accuracy and efficiency.

Importance of Magnesium Sulphate in Improvement of GCS Score after Severe Traumatic Brain Injury

Background: Grounded on a series of studies, magnesium Sulphate (MgSO4) administered after extensive axonal damage has emerged as a valuable neuroprotective mediator. This study was held to investigate whether magnesium Sulphate had therapeutic safety and efficacy in patients with severe diffuse axonal injury and its effect on improving GCS scoring. Methods: This double-blind, randomized and placebo-controlled clinical trial study was held from October 2020 to September 2021, patients with severe extensive damage to the axons were studied who presented to the Neurosurgery emergency of tertiary care hospital, and written knowledgeable permission was taken from all subjects. 42 patients who met the eligibility criteria were randomly assigned to our study. Adult patients with severe diffuse axonal injury within the first hour of closed traumatic brain injury (TBI) and meeting eligibility conditions were divided randomly into 2 groups. The treatment regimens contained preliminary intravenous 50 mg / kg magnesium sulfate as loading dose within one hour of injury, followed by QID 50 mg / kg magnesium sulfate up to 24 hours post-injury. The results were mortality, GCS, and assessment of motor function up to two-months after injury. Results: Magnesium had a substantial optimistic impact on GCS after two-months (P = 0.04). The result of motor function improved more in the MgSO4 group than in the control group, but it was not statistically important (p = 0.52). Finally, it is concluded that direction of magnesium sulfate after severe DAI can play a neuroprotective role. Keywords: Magnesium sulfate; Severe diffuse axonal injury and results.

The Evolution of Neurosurgery Throughout the Ages: From Trepanations in Prehistory to The Robotic Era

Abstract Introduction Throughout the historical course, the emergence of neurosurgery invariably involved the narrative about different eras, marked by relevant discoveries in the field of medical science. From prehistoric mystical and therapeutic reports to the Robotic Era in the 21st century, there were changes that contributed to current neurosurgery. Thus, this study will analyze articles and studies that describe the history of neurosurgery and demonstrate the main advances in the field of science. Materials and methods This is a narrative review of scientific literature, carried out by searching the following databases: Scientific Electronic Library Online (SCIELO), Online System for Searching and Analyzing Medical Literature (MEDLINE), Latin American Literature and Caribbean in Health Sciences (LILACS), and Public Medical Literature Analysis and Retrieval System Online (PubMed).The following descriptors were used: History of neurosurgery and Neuroanatomy, together with the Boolean operator “AND”. In addition, the descriptors History of Neurosurgery and Robotics were used between the Boolean operator “AND”. In this sense, in order to establish a linearity of the narrative presented, the evolution of neurosurgery in five eras was didactically separated. Conclusion Neurosurgery, throughout history, has undergone several transformations. There was a series of events that made neurosurgery one of the most evolutionary and progressive sciences. This is because technology combined with scientific knowledge was, in fact, what made it possible to get where we are. In this sense, the studied ages allow the comprehension of a history that needs to be understood and valued by all students of the neurological and neurosurgical sciences.

Total intracranial volume as a covariate for predicting prognosis in patients with primary intracerebral hemorrhage

ObjectivesThe initial hematoma volume is reliable and stable imaging predictor for the outcome of patients with intracerebral hemorrhage, and the total intracranial volume varies between patients. However, the role of total intracranial volume in predicting the prognosis of spontaneous intracerebral hemorrhage has not been previously addressed. Methods782 patients with spontaneous intracerebral hemorrhage were selected in this retrospective cohort at the Neurosurgery Emergency Unit of The First Affiliated Hospital of Harbin Medical University. Due to missing CT images, initial CT exceeding 24 h, traumatic cerebral hemorrhage, and aneurysm, 145 patients were excluded and the remaining 637 patients were included in our analysis. Functional outcome was assessed using the modified Rankin Scale(mRS) and mortality at 3-months after spontaneous intracerebral hemorrhage. CT image datasets were calculated by 3D-Slicer. The initial hematoma volume was normalized to the total intracranial volume to evaluate poor functional outcomes (mRS, 4–6) and mortality. ResultsThe results demonstrated that normalized initial hematoma volume can be used as an indicator of poor functional outcome (mRS, 4–6) (AUCNrIHV=0.753, 95%-CI:0.710–0.795, p < 0.001), mortality (AUCNrIHV=0.808, 95%-CI:0.754–0.862, p < 0.001) and hematoma expansion (AUCNrIHV=0.690, 95%-CI:0.613–0.767, p < 0.001). Meanwhile, the initial hematoma volume in predicting poor functional outcome (AUCIHV=0.749, 95%-CI:0.707–0.792, p < 0.001), mortality (AUCIHV=0.816, 95%-CI: 0.763–0.870, p < 0.001) and hematoma expansion (AUCIHV=0.704, 95%-CI: 0.626–0.782, p < 0.001) was similar to the normalized initial hematoma volume. ConclusionsThe normalized initial hematoma volume has no apparent benefit in predicting the prognosis of patients with cerebral hemorrhage compared with initial hematoma volume.

Gliosarcoma in a Paediatric Patient: A Rare Entity and Review of Literature

Primary Gliosarcoma is a rare malignant tumour of central nervous system in adults. It is usually a variant of Isocitrate Dehydrogenase (IDH) wild type glioblastoma. Its incidence is approximately 2% of glioblastomas and has a dismal prognosis. Most common age group is between 40-60 years of age is commonly seen in males. Paediatric gliosarcoma is even rarer than adults ones. Most common location is temporal and frontal lobes (cerebral hemisphere). Histologically it shows biphasic pattern and is composed of both glial and mesenchymal components. Both these components has monoclonal proliferations. Here, a 20-month-old boy resident of Gorakhpur presented with persistent crying for short duration in neurosurgery emergency. On magnetic resonance studies a frontotemporal lesion was found, for which he underwent tumour excision. The tumour proved to be a primary gliosarcoma. Due to malignant nature of tumour patient did not survive. Gliosacrcoma is rare adult tumour but can rarely occur in children. A differential diagnosis of gliosarcoma should be kept in mind while dealing with congenital tumours in children due its aggressive nature with poor survival outcome.

Comparative Analysis of COVID-19 Outbreak and Changes in Neurosurgical Emergency Patients.

ObjectiveCOVID-19 has spread worldwide since the first case was reported in Wuhan, China, in December 2019. Our institution is a regional trauma and emergency center in the northern Gyeonggi Province. The changing trend of patient care in the emergency room of this hospital likely reflects the overall trend of patients in the area. In the present study, whether changes in the surrounding social environment following the outbreak of COVID-19 changed the incidence of neurosurgical emergency patients and whether differences in practice existed were investigated. MethodsThe overall trend was analyzed from January 2020 which is before the outbreak of COVID-19 to September 2020. To remove bias due to seasonal variation, the previous 2 year's records during the same period were reviewed and compared. Confirmed COVID-19 patients in the northern Gyeonggi Province were identified using data released by the government. And patients who came to the emergency department with head trauma and stroke were identified. ResultsBased on the present study results, the total number of neurosurgery emergency patients decreased over the study period. In the trauma patient group, the number of patients not involved in traffic accidents significantly decreased compared with patients involved in traffic accidents. Among the stroke cases, the rate of ischemic stroke was lower than hemorrhagic stroke, although a statistically significant difference was not observed. Meanwhile, an increase in the risk of mortality associated with trauma or stroke cases was not observed during the COVID-19 outbreak compared with the same time period in the previous year. ConclusionDue to the occurrence of COVID-19, non-essential activities have decreased and trauma cases not associated with traffic accidents appeared to decrease. Due to the decrease in overall activity, the number of stroke patients has also decreased. This trend is expected to continue even in the post-COVID-19 era, and accordingly, the results from the present study are relevant especially if the current situation continues.

Intradural Cauda Equina Tumors: Early Surgical Experience of a Small Neurosurgical Team

Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. Purpose: To present our experience and outcome of management of cauda equina tumors. Study Design: A retrospective clinical case study. Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre- and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. Conclusion: The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.

The Aftermath of COVID-19 Lockdown- Why and How Should We Be Ready?

Severe acute respiratory syndrome, coronavirus 2 (SARS-COV 2) has inexplicably and irreversibly changed the way of neurosurgery practice. There has been a substantial reduction in neurosurgical operations during the period of lockdown. The lockdown might be the most effective measure to curtail viral transmission. Once we return to the normalization of the lifestyle, there will be a backlog of unoperated pending cases along with the possibility of further spread of the coronavirus. We reviewed the available literature and protocols for neurosurgical practice in different geographic locations. We drafted a consensus statement based on the literature and protocols suggested by the World Health Organization (WHO) and various professional societies to prevent the spread of SARS-COV2 while streamlining the neurosurgical practice. The consensus statement suggests the patient triage, workflow, resource distribution, and operational efficacy for care providers at different stages of management. The priority is set at personal protection while ensuring patients' safety, timely management, and capacity building. We performed a detailed subsection analysis for the management of trauma and set up for COVID-free hospitals for simultaneous management of routine neurosurgical indications. In this time of medicolegal upheaval, special consent from the patients should be taken in view of the chances of delay in management and the added risk of corona infection. The consensus statements are applicable to neurosurgical setups of all capacities. Along with the glaring problem of infection, there is another threat of neurosurgery emergency building up. This wave may overwhelm the already stretched systems to the hilt. We need to flatten this curve while avoiding contagion. These measures may guide neurosurgery practitioners to effectively manage patients ensuring the safety of caregivers and care seekers both.

Establishment and management of neurosurgery emergency observation ward during the COVID-19 epidemic period

During the COVID-19 epidemic period, the front-line antiepidemic departments have attracted much attention. However, to meet people's daily needs for the diagnosis and treatment, emergency department and intensive care unit are also the focus of work to control the source of infection, cut off the transmission route, and reduce the risk of novel coronavirus transmission while treating patients. In order to further strengthen the management, our department of neurosurgery took active measures in the emergency treatment for patients and summarized the coping strategies and relevant experience from the aspects of establishment of emergency observation wards, medical staff management, patients and family management, daily environment and object surface disinfection management, material management, and nursing quality management, hoping to provide reference for the nursing management of emergency wards after the outbreak of public health emergencies.

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007-2014.

OBJECTIVESince 2007, a continuous neurosurgery emergency service has been available in the International Security Assistance Force (ISAF) field hospital in Mazar-e-Sharif (MeS), Afghanistan. The object of this study was to assess the number and range of surgical procedures performed on the spine in the period from 2007 to 2014.METHODSThis is a retrospective analysis of the annual neurosurgical caseload statistics from July 2007 to October 2014 (92 months). The distribution of surgical urgency (emergency, delayed urgency, or elective), patient origin (ISAF, Afghan National Army, or civilian population), and underlying causes of diseases and injuries (penetrating injury, blunt injury/fracture, or degenerative disease) was analyzed. The range and pattern of diagnoses in the neurosurgical outpatient department from 2012 and 2013 were also evaluated.RESULTSA total of 341 patients underwent neurosurgical operations in the period from July 2007 to October 2014. One hundred eighty-eight (55.1%) of the 341 procedures were performed on the spine, and the majority of these surgeries were performed for degenerative diseases (127/188; 67.6%). The proportion of spinal fractures and penetrating injuries (61/188; 32.4%) increased over the study period. These spinal trauma diagnoses accounted for 80% of the cases in which patients had to undergo operations within 12 hours of presentation (n = 70 cases). Spinal surgeries were performed as an emergency in 19.8% of cases, whereas 17.3% of surgeries had delayed urgency and 62.9% were elective procedures. Of the 1026 outpatient consultations documented, 82% were related to spinal issues.CONCLUSIONSCompared to the published numbers of cases from neurosurgery units in the rest of the ISAF area, the field hospital in MeS had a considerably lower number of operations. In addition, MeS had the highest rates of both elective neurosurgical operations and Afghan civilian patients. In comparison with the field hospital in MeS, none of the other ISAF field hospitals showed such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future training and material planning in comparable missions.

Hematoma Epidural Agudo

O hematoma epidural agudo é considerado uma emergência neurocirúrgica por ameaçar a vida e tem ocasionado problemas em Conselhos de Medicina e na justiça comum quando causa sequelas ou óbito por negligência médica. Os autores chamam atenção para o diagnóstico precoce e tratamento adequado, para evitar complicações ao paciente e transtornos médico-legais para a equipe assistente

Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study.

The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29% (n = 83) were males and 11.70% (n = 11) were females. Commonest mode of injury was road traffic accident in 56.38% (n = 53) followed by fall from height in 29.78% (n = 28). In our study, 25.53% patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n = 24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08% (n = 17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58% patients had good GOS, 19% had moderate disability, and 9% remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging.