Raman Mohan Sharma

Abstract

Introduction: Surgeons face unique challenge in the management & prognosis related issues with intracranial gunshot injuries. These injuries are more commonly seen in military conflict zone. With easy availaibility of weapon and increase in the conflict between civilian and paramilitiary forces, clinician are facing more numbers of civilian gunshot injuries. In India the presentation and prognosis of gunshot injuries is different as many of these gunshot injuries are by country made weapons. Country made weapons have low velocity and caliber; henceforth the outcome and the management issues are different. We present our experience with 23 patients who sustained intracranial gunshot injuries, and identify the factors determining the outcome and management Material and Methods: From March 2016 to September 2019 data was collected from 23 cases who were treated for intracranial gunshot injuries in Department of Neurosurgery at J. N. Medical College, Aligarh. History, type of weapon used, clinical condition and radiological findings were noted. Outcome was assessed by Glasgow’s Outcome scale. Results: Overall mortality was 26.08% (6/23). Of the 4 patients in GCS (3-7) group there was 100% mortality. Of the 5 patients in GCS group (8-12) mortality was 2 and one patient in persistent vegetative stage. All patients survived in GCS group (13-15). 5 patients underwent surgery; there was one mortality in the surgical group. Better outcome was noted in single lobe involvement and trajectory involving supratentorial noneloquent areas. Conclusion: Early aggressive resuscitative measures may help in better management. GCS at presentation is the most important factor affecting outcome. CT scan offers to be an important predictor of prognosis and also help in planning the management. Suicidal wound, hypotension and midline shift has poor prognosis. We don’t recommend aggressive exploration of the bullet tract & pellet removal for every patient. Keywords: Intracerebral gunshot, Cranial gunshot, Civilian, Firearm injuries

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Abstract

Introduction: Endoscopic excision of colloid cysts a minimally invasive and highly effective technique in management of third ventricular colloid cyst. Materials and Methods: Clinical and radiological data of patients undergoing endoscopic colloid cyst excision were retrospectively analyzed in the period July 2017 to August 2018. Operative video were analyzed for the colloid cyst anatomy and the surgical technique used. Results: Five cases underwent endoscopic surgery during the study period. Three patients had dilated foramen, two patients had retroforaminal type and coapted type of morbid endoscopic anatomy. Gross total excision could be achieved in two patients, two patients had near total excision and one patient had partial excision who had intraventricular bleed which was managed. There was no mortality. All the patients return to their respective jobs postoperatively. Conclusion: Endoscopic excision is a safe and effective surgical technique for colloid cyst excision. The extent of excision depends on the experience of surgeon and the endoscopic anatomy of the colloid cyst. Keywords: Colloid CYST, Third Ventricle, Endoscopic, Neuroendoscopic excision

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