Papers by sajag K U M A R gupta
Aim. To evaluate the results of surgical care in chronic subdural haemorrhage patients. Design of... more Aim. To evaluate the results of surgical care in chronic subdural haemorrhage patients. Design of the study. Prospective Study location. Department of Neurosurgery, tertiary care centre Methodology. The study comprised 65 individuals of both genders with chronic subdural haemorrhages who were above the age of 18. Patients' full medical histories, including age, gender, and place of residence, were documented. The Markwalder Grading System was used to classify patients. A CT scan was performed pre and post-surgery, as well as at the time of discharge. The Glasgow coma scale was used to record the outcomes. Results. There were 57 (87.6%) male individuals and 8 (12.3%) female individuals. majority of them presented with headache (61.5%), followed by extremity weakness/paresis (52.3%). As Per, Markwalder's grade on admission, 33 (50.7%) people were in grade 1, and 30 (46.1%) people were in grade 2. The clinical picture at discharge was evaluated according to the Markwalder grade: 52 people (80%) were grade 0, 2 people (3%) were grade 1, 9 people (13.8%) were grade 2 Conclusion: The major risk factors for the development of CSDH in our setup are male sex, mild head trauma, old age and alcohol intake. CSDH is more common on the left side. majority of patients had duration of trauma in between 4-12 weeks Majority of patients had grade 1 on Markwalder grading on admission. The majority of patients had a Thickness of CSDH is 10-20 mm MLS in CSDH is 5-10 mm on admission. The symptoms that present most frequently are headache and motor weakness, and the result is related to the person's pre-operative neurological condition, G.C.S., and concurrent systemic disorders. Surgical procedures should be individualised according to the radiological characteristics of chronic subdural haematoma.
Introduction. Symptomatic chronic subdural haemorrhages (CSDH) continue to be one of the most com... more Introduction. Symptomatic chronic subdural haemorrhages (CSDH) continue to be one of the most common diagnoses in modern neurosurgery. The current standard procedure for symptomatic CSDH is a burr-hole craniostomy with irrigation and the installation of close-system drainage. The purpose of this study is to conduct a direct comparison of two surgical procedures for the treatment of symptomatic CSDH that are effective in prior studies. Our main goal was to compare the efficacy of placing a subperiosteal drain (SPD) and a subdural drain (SDD) after a single burr-hole craniostomy and irrigation and to show any significant differences in terms of overall surgical complications, functional outcome and mortality rate at three months, and complications at six months. Materials and methods. From August 2022 to December 2023, the study was conducted in the Department of Neurosurgery at a tertiary care centre, with a total of 25 patients in both treatment groups. Results. Overall, there was no statistically significant difference between the two groups in terms of patient general characteristics, pre-and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality, and functional outcome at discharge and at three months follow-up. Despite not reaching statistical significance, we found a decreased risk of surgical complications, particularly post-operative cerebral haemorrhage, with SPD system implementation. Conclusions. According to our findings, both therapy modalities are extremely successful in the treatment of CSDH. therapy with a single burr-hole craniostomy, irrigation, and implantation of the SPD system, on the other hand, has a reduced overall surgical complication rate and can be regarded as a therapy of choice for the management of symptomatic CSDH.
Objectives: The purpose of this study was to examine the recurrence of chronic subdural hematomas... more Objectives: The purpose of this study was to examine the recurrence of chronic subdural hematomas after burr hole evacuation with and without the use of a subdural drain. The study was designed as a randomised control study. Setting:
Background: Research aimed to see if minimally invasive percutaneous pedicle screw fixation (MIPP... more Background: Research aimed to see if minimally invasive percutaneous pedicle screw fixation (MIPPS)or open pedicle screw fixation (OPS) worked effectively for geriatric osteoporotic fractures (#) of the spine. Methods: In the department of neurosurgery at the tertiary care centre, 60 cases of geriatric osteoporotic vertebral # were divided into a MIPPS set (n=30 MIPPS) and an OPS set (n=30, conventional OPS). Results: The experimental set surgical time, surgical bleeding, incision size, days of hospital stay, and incidence of postoperative complications were smaller than those in the control set (all P <0.05). Both sets' Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) improved 6 months following surgery, with the experimental set showing the most improvement (all P<0.05). Conclusions: Both sets of MIPPS and OPS may accomplish adequate internal fixation, with the former having reduced trauma, a less surgical duration, a quicker recovery, fewer postsurgical problems, and less post-surgical discomfort.
Tension pneumocephalus is a rare and potentially fatal neurological disease. To avoid deadly cons... more Tension pneumocephalus is a rare and potentially fatal neurological disease. To avoid deadly consequences, it demands urgent and rapid intervention. The most prevalent cause of tension pneumocephalus is a head injury. Air can enter the cranium by a fracture affecting the paranasal sinus or the middle ear cavity, or even more rarely, through a complex depressed fracture of the skull vault. Its treatment consists of a simple twist drill and aspiration of intracranial air with or without the insertion of an underwater seal. 100% oxygen should be delivered using a non-breathable mask that hastens air resorption. The authors provide a series of five examples with posttraumatic tension pneumocephalus, focusing on its treatment and review of literature.
Nepal journal of neuroscience, Dec 31, 2023
Introduction: Many different minimally invasive procedures can be used to treat lumbar disc herni... more Introduction: Many different minimally invasive procedures can be used to treat lumbar disc herniation. In the management of lumbar disc herniation, Open microdiscectomy MD is the gold standard and is used as a benchmark for comparison with more recent techniques like tubular discectomy. The purpose of this study was to assess the complication rates of tubular discectomy and to compare the postoperative outcomes of individuals undergoing tubular discectomy with those undergoing MD. Material and Methods: A retrospective analysis of 250 patients who underwent single-level lumbar discectomy either by tubular TD or MD between JULY 2018-JUNE 2023 was performed. The differences in the 2 groups' demographics, surgical length, intraoperative blood loss, overall hospital stay, pain score on the visual analogue scale (VAS), Oswestry Disability Index (ODI) score both before and after the procedure, and complications were assessed. Results: Out of the 250 patients, 130 patients were treated with MD and 120 by tubular discectomy TD. The mean age in MD and tubular TD group was 45.5 and 45.8 years. There was a improvement in VAS and ODI scores at 4 weeks in both the groups. There was a greater reduction of back pain in the TD group at 2 weeks compared to MD group but at 1 month both are comparable. Average surgical time was shorter in MD (71.6 min) as compared to TD group (80.2 min). the Average blood loss was higher (90.2 mL) in MD group as compared to TD group (35.8 mL) (Table 3). Length of incision as measured from the surgical scar was 1.7 cm in TD while it was 3.0 cm in MD group. Average hospital length of stay in TD (1.2 days) which was less than MD group (2.1 days). Likewise, MD group patients took 5.9 weeks to return to activity which was higher than the TD group (4.1 weeks). There were 9 cases (6.9%) of dural tear in MD and 10 cases (8.3%) in TD group. Conclusion: Sciatica caused by disc herniation can be effectively and safely treated with lumbar discectomy, whether it is TD or MD. In comparison to MD, the TD method for treating symptomatic lumbar radiculopathy is superior in that it causes less postoperative back pain, less blood loss, a shorter hospital stay, and a quicker return to work. Despite the learning curve, TD has been demonstrated to be a viable choice for treating lumbar disc herniation in patients who are carefully chosen.
Nepal Journal of Neuroscience
Introduction: Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in eld... more Introduction: Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. The risk factors for recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. The aim of this study was to study the potential risk factors, including preoperative, operative and post-operative ones for CSDH recurrence. Materials and Methods: The study population comprised of all > 18 year age group patients who were operated for chronic subdural hematoma in Neurosurgery Department of tertiary care center. It was prospective cohort study. Patients who met inclusion criteria, postoperative outcomes were assessed at discharge, then at one month and three months afterwards in the neurosurgery OPD. Both the treatment options i.e. BHC Burr hole craniotomy and minicraniotomy as require...
Nepal Journal of Neuroscience
Chronic subdural haematoma (CSDH) is an encapsulated collection of old blood between the dura mat... more Chronic subdural haematoma (CSDH) is an encapsulated collection of old blood between the dura mater and arachnoid caused by tear of bridging veins. Chronic subdural haematoma is considered when the blood is more than three weeks old. It is fairly common disease, especially in the elderly with incidence ranging 1.72 to 7. 35 per 100,000 population with male predominance. Elderly population is associated co- morbidities that can impact on immediate postoperative outcome and overall survival. Although history of trivial trauma is present in majority of cases but some cases may be secondary to coagulation defect, intracranial hypotension, and use of anticoagulant and antiplatelet agents. It commonly presents with headaches, confusion, drowsiness, vomiting, and seizures. On examination, patient have various neurological deficits including a low Glasgow coma scale, hemiparesis/hemiplegia, ocular palsy, and other deficits are seen .Diagnosis is usually confirmed by NCCT scan head however M...
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Papers by sajag K U M A R gupta