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Titanium cranioplasty for head injury

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OBJECTIVES:

Titanium cranioplasty (TC), the operative repair of a skull defect with an ergonomically manufactured plate to restore cosmesis, cranial function and reduce complications is a common neurosurgical procedure. It is technically simple but has high complication rates. This study aimed to determine the incidence and predictors of complications following TC.

DESIGN:

Retrospective review.

SUBJECTS:

All patients undergoing TC over a 42-month period in our institution.

METHODS:

Data was collected from the hospital database and case-notes. 3D CT reconstructions accurately measured defect size and location. Statistical analysis included correlation, independent variable analysis and descriptive methods.

RESULTS:

A total of 95 TCs were analysed in 92 patients (3 cases of bifrontal cranioplasty). The commonest indications for TC were bony defect following removal of infected bone flap (n = 20), acute subdural haematoma (n = 18) and post-malignant infarction (n = 11). The commonest site was frontotemporoparietal (n = 61) and the overall complication rate was 30.4%. The commonest complication was infection and the overall removal rate was 8.4%. The mean cranioplasty area was 73.26 cm(2) (range 12.78-178.26 cm(2)). There was a significant relationship between area and length of post-operative hospital stay (p = 0.008, Pearson Rank). There was no significant relationship between area and complications, removal rates or infections. There was no relationship between age and total complications, post-operative hospital stay and infections. There was a non-significant trend for older patients to have their cranioplasty removed.

CONCLUSIONS:

TC size is predictive of postoperative length of stay. However, the TC size is not predictive of complications or removal rate. Also, there was no association between interval since primary operation and complications. There was a non-significant trend for greater rates of TC removal in the elderly. There were no predictors of complications identified but they are common and patients should be consented accordingly.

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Dr Pankaj Gupta

MCh (Neuro Surgeon)

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About Us

 

conference presentations on Neurological

The Neuro OPD Allahabad is a highly integrated department of neurologists with sub-specialization in the evaluation, and treatment of disorders affecting the nervous system. The Clinic offers state-of-the-art expert consultative, diagnostic and therapeutic services for a full range of neurological conditions such as Cognitive Disorders, Epilepsy, Movement Disorders, Multiple Sclerosis, Neurogenetics, Neurorehabilitation, Neuromuscular Disorders, Neuro-Oncology, Neuro-Otology, Sleep Disorders, and Stroke. Patients whose illnesses do not fall into these categories, and those who do not yet have a diagnosis, are seen in the general Neurology clinic. Our department has earned outstanding reputation in subspecialty care of neurological disorders due to a high level of clinical expertise, academic achievement and innovative research. Our most important mission is to provide each patient with the best neurological health care available by combining our extensive experience with the latest advances in neurology. Our faculty and staff work together as a team to bring each patient the highest quality of care in a warm, friendly and professional environment.

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Specialities

Electroencephalography (EEG)

An electroencephalogram (EEG) is a diagnostic test that measures the electrical activity of the brain in order to detect and evaluate neurological conditions such as epilepsy, dementia and narcolepsy, as well to determine the rate of recovery for patients who are unconscious or in a coma.

During the EEG procedure, electrodes are placed on the head to record the electrical activity in the brain, which is interpreted by the doctor. Patients will be asked to breathe deeply, look at bright, flashing lights or go to sleep in order for the doctor to collect a range of brain activity. Brain activity is produced as a series of wavy lines that are analyzed by the doctor. This test takes one to two hours to perform; some patients may be asked not to eat, drink or sleep for several hours before their exam.

There is a small risk that this procedure may trigger a seizure in patients with epilepsy, but this risk is considered small and can be adequately handled by your doctor if it does occur. There is no pain associated with the EEG procedure.

BOTOX Injections

Botulinum toxin, commonly known as Botox, is a synthetic chemical that can be used to block nerve signals for treatment of a wide range of conditions. Although most commonly known for its cosmetic purposes, at ANC it is used strictly for therapeutic purposes. Botox injections offer an effective therapeutic treatment for many medical conditions, including muscle spasms, cervical dystonia and other neurological disorders.

Botox injections are administered directly into the affected muscle with no need for anesthesia. The injection effectively blocks nerve signals sent to the muscle to prevent it from contracting and reduce pain.

Patients may need anywhere from one to ten injections during a single treatment session in order to successfully block the nerve signals. The results of treatment are often most effective during the first two to six weeks after the injection, and will continue to last for up to six months. Results can be maintained through routine follow-up injections.

Some patients may experience bruising or eyelid drooping as a side effect of Botox, but these symptoms usually go away on their own within a short time. Patients who are pregnant or breastfeeding should not receive Botox injections.

Vagal Nerve Stimulator

Vagal nerve stimulation is long-term treatment for epilepsy commonly used on patients who have not had successful results from anti-seizure medication and other more conservative treatment methods. This treatment involves implanting a generator device that is similar to a pacemaker in order to send regular pulses of electrical activity to the vagus nerve, located in the neck.

The vagus is one of twelve cranial nerves in the brain, and serves to provide function to the larynx, diaphragm, stomach, heart and sensory functions within the ears and tongue. Most patients with epilepsy experience a significant reduction in the number and frequency of seizures with this treatment.

Although your ANC physician does not implant your device, they will monitor, maintain and reprogram your implant during your office visits with them.

Procedure

The stimulation generator is implanted into the upper left area of the chest during a procedure performed under general anesthesia. An incision is made in the chest to implant the device and a connecting wire that runs under the skin to the vagus nerve in the neck. This procedure usually takes one to two hours to perform.

Results

After the procedure, the generator will stimulate the vagus nerve at regular intervals determined by your doctor. If a seizure occurs in between these intervals, the patient can activate the stimulator manually. Most patients are not aware that the device is active and do not experience any unordinary sensations during stimulation.

Risks

While the implantation procedure is considered safe for most patients, there is a risk of injury to the vagus nerve, carotid artery and jugular vein. Injury to these structures may cause coughing, hoarseness, swallowing difficulties and a tingling sensation in the neck. Infection and bleeding are also possible complications from any surgical procedure.

Patients can reduce their risk of these complications by choosing an experienced doctor to perform their procedure, and by following their doctor’s instructions after surgery.

Deep Brain Stimulator

Deep brain stimulation (DBS) is a surgical procedure used to treat the symptoms of Parkinson’s disease for patients who do not respond to medication. This treatment option inactivates the parts of the brain that trigger the disease without destroying nearby brain tissue.

During the DBS procedure, a small device called a neurostimulator is implanted under the skin of the chest. This battery-operated device is similar to a pacemaker for the heart and is designed to deliver electrical stimulation to the areas of the brain that control movement in order to prevent tremors and other symptoms of Parkinson’s disease. The device is connected to electrodes that are placed in the brain in order to directly deliver the electrical signals.

The areas in the brain where electrodes are to be placed are targeted before the procedure with the use of MRI or CT scanning.  For most patients, the electrodes will be placed on the thalamus, subthalamic nucleus and globus pallidus.

After the DBS procedure has been performed, most patients experience significant symptom relief, but may still need to take medication to treat the disease, although dosage can be reduced. Dosage reduction also helps reduce the occurrence of side effects and can lead to an overall higher quality of life for patients with Parkinson’s disease.

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