The Usage of Gentamicin and Vancomycin versus Normal Saline lavage intraoperatively to treat infected depressed skull fractures in traumatic brain injury patients

2024-10-20T21:04:03+00:00

Traumatic brain injury (TBI) due to head trauma is a common presentation in emergency departments. In the United States, around 1.7 million people suffer TBI with older adolescents (ages 15 to 19 years) and older adults (ages 65 years and older) among the most likely to sustain a TBI. TBI can be associated with injuries involving the skull as well as brain parenchyma. Based on the pattern, skull fractures can be classified into linear, depressed, and comminuted fractures. A skull fracture is called depressed when any portion of the fracture line's outer table lies below the inner table's normal anatomic position. The incidence of DSF has been reported to be 6% in all head injuries and 11% in severe head injuries. DSF can be managed conservatively in some cases but in most cases, it prompts surgical intervention especially when DSF are compound fractures and have dural tears which have shown a prominent association with cranial infections. The overall incidence of infection following depressed skull fractures has been reported to be 10.6% and has been associated with a higher incidence of persistent neurologic deficit, late-onset epilepsy, and death. The purpose of this study is not only to study the impact of such preparations intraoperatively in cases of depressed skull fracture and also to compare the use of a dual preparation for wash i.e. containing both gentamicin and vancomycin with a control group in which normal saline wash was used. No similar studies have been conducted that comment on the impact of gentamicin and vancomycin wash in the treatment of infected depressed skull fractures.

MATERIALS AND METHODS

A Prospective Case-Control Study was conducted in the Neurosurgery Department, Emergency Complex, Mayo Hospital, Lahore for a duration of 6 months; from 01-01-2022 to 30-06-2022. The data were analyzed using the latest version of the statistical package for social science SPSS version 28.

CONCLUSION

Depressed skull fractures are a major economical concern in developing countries with complications associated with recurrent surgical site infections. In this study, the case group (gentamycin and vancomycin wash) showed a significant decrease in duration of hospital stay in terms of surgical outcome and better GOS as compared to the control group. Moreover, there was a decreased incidence of post-operative complications including CSF leakage, flap necrosis, osteomyelitis, subgaleal abscess, cerebral abscess and meningitis in the case group as compared to the control group. Furthermore, there was a decreased need for repeat surgical interventions in the case group as compared to the control group. Therefore, the usage of intraoperative gentamycin and vancomycin lavage is effective in ameliorating the problems associated with infected depressed skull fractures especially in highly burdened trauma settings of developing countries with inadequate surgical sterilization protocols and patient related parameters.

Results of cerebral cavernous malformation surgery in patients with сavernoma-associated epilepsy

2025-01-04T23:00:55+00:00

Objective: to present the results of surgical resection of cerebral cavernous malformations (CCMs) in patients with сavernoma-associated epilepsy. To assess the risk factors for an adverse outcome.

Methods: a retrospective analysis of 50 patients with supratentorial CCMs presenting epileptic seizures was performed. All patients underwent surgical CCM resection along with the hemosiderin fringe excision, except in cases when the CCM was localized in eloquent brain regions. In the first 24 hours after the surgery, patients underwent a brain MRI. The MRI study was evaluated by two independent radiologists. The radicality of the CCM and the hemosiderin ring resection around the CCM was evaluated. Long-term results were evaluated using the Engel Surgical Outcome Scale.

Results: The follow-up period was 36.5/33 (21.2; 47.8) months (Max 70.6 months, Min 11.2 months). Forty-four (88%) patients had no recurrence of seizures in the postoperative period. Additionally, 30 (68.2%) of them stopped taking anticonvulsants completely. Four (8%) patients achieved Engel class II outcome (rare seizures remained), and in 2 (4%) of patients, the dynamics in seizure frequency after surgery was not observed. An analysis of the factors influencing the outcome demonstrated that only the radical removal of the hemosiderin ring statistically confirmed its significance in relieving seizures (p=0.043). In patients who didn’t experience seizures during follow-up, the hemosiderin ring was radically removed in 27 (71%) out of 38 cases, and in the group with unsatisfactory results, the hemosiderin ring was radically removed in only 1 (20%) out of 5 patients.

Gender, age, seizure types, and anatomical features of the CCM did not affect epilepsy outcomes in the postoperative period.

Conclusions: Surgical CCM resection is an effective method of treating CCM-associated epilepsy with low risks of surgical complications. Total excision of the hemosiderin ring around the CCM is a favorable prognostic factor for the patient's recovery from structural epilepsy when this pathology is present.

Neurohirurgija - The Serbian Journal of Neurosurgery

The Usage of Gentamicin and Vancomycin versus Normal Saline lavage intraoperatively to treat infected depressed skull fractures in traumatic brain injury patients

Results of cerebral cavernous malformation surgery in patients with сavernoma-associated epilepsy