Asian journal of neurosurgery
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This study aims to evaluate the efficacy of hypertonic saline versus crystalloids (normal Saline/lactated Ringers) in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and grey literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case-control studies and prospective cohort studies on decompressive craniectomy in TBI (>18-year-old). ⋯ The subgroup analysis showed that the group who had hypertonic solution significantly decreases the number of interventions versus the crystalloid group OR: 0.53; 95% CI: 0.48-0.59; P < 0.00001 and also reduces the length of intensive care unit stay (OR: 0.46; 95% CI: 0.21-1.01; P = 0.05). Hypertonic saline decreases the financial burden, but neither impacts the clinical outcome nor reduces the mortality. However, further clinical trials are required to prove if hypertonic saline has any role in improving the clinical and neurological status of patients with TBI versus the normal saline/lactated Ringers.
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Chronic subdural hematoma (CSDH) is predominantly a disease of the elderly. On accounting its risk-to-benefit ratio, there was always controversy regarding the management of the CSDH as to which procedure is superior. ⋯ The duration of procedure was significantly more in BHC than in TDC. In postoperative outcome, there was no significant difference in the GCS score, motor power improvement, motor power deterioration, overall clinical improvement, and improvement in CT scans of both the groups. Postoperative residue requiring reoperation was significantly more in TDC group. There was no significant difference in the development acute SDH, reoperation rate, complications, death, and hospital stay in both the groups. Avoiding the complications of general anesthesia and giving the equal postoperative improvement and complications of BHC, the TDC is considered as an effective alternative to the BHC in the surgical management of CSDH.
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The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case-control studies, and prospective cohort studies on DC in moderate and severe TBI. ⋯ However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.
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Conventionally, intradural spinal tumor excision requires longer skin incision, bilateral subperiosteal muscle stripping, and total laminectomy, thereby decreasing the stability of the spine and increasing the morbidity. Minimally invasive surgery (MIS) for intradural spinal tumor excision preserves the posterior supporting structures of the spine in the midline and on the contralateral side and decreases morbidity and achieves the resection of the tumor. ⋯ Anteriorly or laterally placed intradural spinal tumors confined to the spinal canal can be excised safely and effectively using tubular retractor system, with adding the advantages of the MIS surgery. When in doubt, always convert the MIS to open surgery to avoid injury to vital structures.