Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811658

Traumatic brachial plexus injury (BPI) often results in severe functional impairment due to the extensive distance required for axonal regeneration and the limited regenerative rate (∼1–3 mm/day). Traditional surgical strategies, including nerve grafts and transfers, often fail to deliver optimal outcomes, especially in pan-plexus or proximal injuries, due to delayed reinnervation and irreversible muscle atrophy.This article develops and describes a novel surgical protocol integrating polyethylene glycol (PEG)-assisted axonal fusion with conventional nerve transfer techniques for improved functional recovery in patients with traumatic BPI.This single-center, prospective clinical study enrolled adult patients with partial or complete traumatic BPI. After detailed neurological and radiological assessment, patients underwent nerve transfer procedures (e.g., spinal accessory nerve [SAN]–suprascapular nerve, SAN to musculocutaneous nerve [MCN] using sural nerve Oberlin, intercostal nerve–MCN), during which 50% PEG solution was applied at the coaptation site following the Bittner fusion sequence. Intraoperative steps included hypotonic and calcium-free saline preparation, methylene blue staining of nerve ends, PEG application, and final calcium-enhanced saline rinse. Patients were followed for 6 months with regular assessments of motor and sensory recovery, electromyography/nerve conduction studies, and patient-reported outcomes.PEG-assisted fusion is hypothesized to prevent Wallerian degeneration, promote immediate axonal continuity, accelerate muscle reinnervation, and enhance both motor and sensory recovery compared to conventional methods alone.This study introduces the first PEG-fusion protocol adapted for BPI repair in humans. By combining established microsurgical techniques with a biophysical approach to nerve continuity restoration, this methodology holds promise for improving recovery timelines and functional outcomes in BPI patients.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811645

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811661

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811659

The Glasgow Coma Scale (GCS) score of 3, the lowest on the scale, traditionally indicates a deep coma with poor prognosis and has often been considered a marker of futile care in traumatic brain injury (TBI). This perception, particularly when associated with bilateral fixed and dilated pupils (BFDP), has led to early decisions on limiting or withdrawing treatment.This case series is studied to revisit and reevaluate the need for surgical decompression in patients who has a GCS of 3 with fixed dilated pupils and to understand if such patients can be given a chance when the prognosis appears dismal.We present a case series of three patients with GCS 3 and BFDP who underwent timely neurosurgical intervention. All three cases defied conventional prognostic expectations, achieving meaningful neurological recovery. Additionally, we reviewed the existing literature on outcomes in this patient subset.Despite initial presentations suggestive of grave prognosis—including fixed pupils and large intracranial hemorrhages—early aggressive intervention (e.g., decompressive craniectomy, external ventricular drainage) resulted in progressive neurological improvement. All patients were discharged with GCS scores of E4VtM5 or higher, intact brainstem reflexes, and vital stability.While a GCS of 3 with BFDP is associated with high mortality, it should not be viewed as universally incompatible with survival or recovery. Our case series, supported by literature, underscores the need for individualized management and delayed prognostication. Early surgical intervention, particularly in younger patients, may yield favorable outcomes and should be considered before labeling such cases as futile.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811535

Tension pneumocephalus (TP) is an uncommon but potentially lethal complication of the neurosurgical process. The treatment is usually surgical decompression. We describe here a case of TP following evacuation of subdural hematoma (SDH) and its successful nonoperative management. A 75-year-old elderly male presented to the emergency department with a history of progressive weakness of bilateral upper and lower limbs and altered sensorium for 2 months. His Glasgow Coma Scale was E3V4M6, and pupils were bilaterally equal and reactive to light. A noncontrast computed tomography (NCCT) of the head showed bilateral acute-on-chronic SDH with internal septations and mass effect. The patient was planned and taken for bilateral craniotomy with membranectomy with evacuation of SDH. A repeat NCCT head showed development of bilateral TP with a “Mount Fuji” sign. The patient was placed on high-flow oxygen support and positioned with head-end elevation. Subsequent computed tomography scan showed resolution of intracranial air foci and expansion of the brain. Traumatic pneumocephalus is a dreaded complication of post-neurosurgical procedure. A high index of suspicion based on the clinical and radiological findings helps in identifying TP. Nonoperative management with closed observation is a viable option in clinically silent TP.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810104

Cranioplasty, a vital procedure in reconstructive neurosurgery, has undergone significant evolution with advances in surgical technique and biomaterials. The pseudolayer dissection approach (PDA) represents an innovative technique that enhances surgical precision, reduces soft tissue trauma, and improves patient outcomes. This article reviews the principles, technical nuances, advantages, limitations, and clinical outcomes associated with PDA in cranioplasty, establishing it as a promising method for achieving optimal functional and aesthetic reconstruction.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811547

Neurogenic shock is thus defined as autonomic failure, leading to hypotension, bradycardia, and metabolic vasodilation. The primary pathology lies in the cessation of the sympathetic outflow following the spinal or brain stem injury insult. Thus, an understanding of the neuroanatomic substrate of neurogenic shock's pathophysiology is a prerequisite for a successful approach to diagnosis and therapy. Therefore, this narrative review will comprehensively discuss the neuroanatomic structures involved in the pathology of neurogenic shock, emphasizing their functional significance in the context of the impairment consequences.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811537

Extradural hematoma (EDH) is a collection of blood between the dura and the calvarium. The most common cause of EDH is road traffic injury. The most common age of presentation is 20 to 40 years. The EDH can cross the midline, unlike the subdural hematomas. The source of EDH is mostly arterial. It can bleed from the venous source like the midline sinus as well as from the fractured bones. EDH is mostly present below the fractured bony segment. Presentation of a bifrontal mirror image-like EDH is quite a rare occurrence. We present to you a 24-year-old male with an alleged history of road traffic accident followed by altered sensorium with three episodes of vomiting. Imaging of the brain was done which was suggestive of a bifrontal mirror-like EDH with a depressed fracture in the midline. EDHs are acute emergencies that should be managed with utmost care and prompt decision of surgery. The decision of early surgery can save the patient from prolonged mortality or morbidity.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811536

Skull fractures are the well-known entity in patients with road traffic accidents (RTA) and falls from height. Skull fractures can be classified in view of site (basal or calvarial), pattern (linear, depressed, and diastasis), or type (simple or compound). Most patients commonly present with linear skull fractures. Elevated skull fractures (ESF) are a rare entity of skull fractures present in a few cases with fewer publications in literature. Most skull fractures occur due to a force acting in a perpendicular direction; however, elevated fractures occur due to force acting in a tangential direction on the calvarium. We present to you a 42-year-old male patient with a known case of psychiatric illness presented with a history of a fall from height followed by altered sensorium. On clinical evaluation and imaging, the patient has a large “skull cap” pattern of elevated calvarial fracture with a large extradural hematoma, subdural hematoma, diffuse cortical subarachnoid haemorrhage, and fronto-parietal contusion. He was operated on in emergency with a “S”-shaped incision with the removal of the fractured calvarial segment with lax duroplasty. In the post-operative period, the patient underwent tracheostomy and improved partially. He is on follow-up at present.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811550

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811548

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810106

Traumatic brain injury (TBI) is a major health concern impacting millions of individuals across the globe. Understanding how TBI damages the brain and finding better treatments are urgent needs. Traditional laboratory models, such as cell cultures and animal studies, often cannot fully represent the complex nature of human brain injuries. Recently, organoid-based models have become exciting new tools in brain research. These models are three-dimensional clusters of brain cells grown from human stem cells, which closely mimic the structure and function of the human brain. Because they come from human cells and grow in three dimensions, brain organoids provide a more accurate and detailed way to study how the brain develops and responds to injury compared with older methods. Brain organoids reproduce several essential characteristics of the developing human brain, making them highly valuable for scientific research. They allow scientists to explore the detailed processes involved in TBI and test new treatment approaches in a controlled laboratory setting. This flexibility and closeness to human biology make organoids a promising platform for advancing TBI research. In this review, we discuss the latest progress in using brain organoids to model TBI. We look at how well these models mimic the injury processes seen in real brain trauma and highlight both the challenges and future possibilities for improving and applying organoid-based models. Overall, organoid technology represents a significant step forward in understanding TBI and developing effective therapies.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810105

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810436

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810413

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810103

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1810107

Management of spinal injuries is continuously evolving and the main surgical aim is to restore the spine integrity. Performing short-segment fixation (SSF) or long-segment fixation (LSF) is still under debate and there is limited data concerning the safety and value of including the fracture segment in the fixation construct.A retrospective observational series included 69 patients ≥ 18 years who suffered unstable thoracic, lumbar, or thoracolumbar vertebral fractures that were treated with pedicle screws fixation from January 2021 to January 2024. The aim was to evaluate the safety and value of including the fracture level in the fixation construct; preoperative clinical and radiographic parameters (visual analog scale [VAS], Oswestry Disability Index [ODI], anterior vertebral body [AVB] height) were compared with the postoperative ones at discharge and after 12 months.The mean age was 32.61 ± 9.11 years. Males constituted 55.1%. Back pain was the predominant clinical presentation followed by lower limb weakness, 24.6%. L1 was the most commonly affected level (34.8%) followed by D12 (33.3%). SSF was done in 65.2% and 34.8% were operated with LSF. Patients operated with SSF showed less intraoperative blood loss and shorter operative duration. After 12 months, there was significant improvement in regards to VAS score, Cobb angle, ODI score, and AVB height (p < 0.001).While treating vertebral fractures, provided that the pedicle walls are intact, incorporation of the fractured vertebra in the fixation construct can offer a safe, feasible, and effective method for intraoperative fracture reduction and correction of sagittal deformity, in addition to good stiffness, strong pullout strength, and maintained correction over time.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809970

Automating clinical order entry and data capture in electronic medical records (EMRs) can help ease the workload. Most healthcare facilities have electronic health data in Emergency Departments (EDs), but they still rely on manual documentation as well. Manual documentation is unable to track performance due to the lack of automated data. For physicians accustomed to paper, scanning completed forms offers the least disruptive transition. However, many are reluctant to adopt more advanced computerized physician order entry technologies, such as electronic forms on tablet PCs or voice recognition.This study aimed to determine the feasibility of implementing a near real-time, automated clinical data capture platform for neurotrauma patients within the trauma ED.A pilot study was conducted in a simulated ED environment. Internet of Things (IoT) scanners were used to capture images of ED notes of trauma patients. The accuracy of data extracted from these images using an artificial intelligence (AI)-powered optical character recognition (OCR) algorithm.The AI-powered OCR algorithm achieved excellent results for extracting the data of trauma patients from scanned ED notes with an accuracy of 97% for handwritten notes and 99.5% for typed data. All typed and handwritten notes could be processed into a structured dataset for further analytics.Automated image-based data capture using IoT scanners is a feasible solution for streamlining ED workflows, extracting KPI, and digitizing handwritten notes. This platform ensures data integrity and authenticity with the images serving as the “ground truth.” As there is negligible change in existing workflows, it is easy to implement and integrate. Further validation is, however, needed to assess large-scale implementation.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809896

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809174

Traumatic brain injury (TBI) has emerged as a leading cause of morbidity and mortality around the world, often instigating systemic complications. An underappreciated consequence of TBI is hepatic dysfunction, which can potentiate neuroinflammation and worsen the patient's prognosis. This mini-review describes how neurotrauma drives liver dysfunction mechanisms, alongside the involvement of the systemic inflammatory response and possible treatment modalities to prevent secondary organ injury. A literature review was performed to assess current evidence on TBI-induced hepatic dysfunction, inflammatory mediators, and liver–brain interactions. Neurotrauma activates the systemic acute-phase response that brings hepatocellular injury, metabolic disruption, and immune dysfunction. Changes in the gut–liver–brain axis, an increase of oxidative stress, and changes in cytokine signaling altogether result in secondary liver injury following TBI. Liver dysfunction should be considered a secondary complex consequent with TBI to derive better management for patients. Future studies should be directed toward brain–liver axis-targeted therapeutic interventions to manage systemic inflammatory responses.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808268

Preoperative education is increasingly acknowledged as a cornerstone in improving surgical outcomes and patient satisfaction, particularly in high-risk specialties such as neurosurgery. Our study aims to assess the effects of preoperative education on patient satisfaction and outcomes in a neurosurgical procedure at our tertiary care center in India.A prospective observational study was conducted over 6 months, involving 96 adult patients undergoing elective neurosurgical procedures. Participants were divided into an intervention group, receiving a 45-minute structured preoperative education session, and a control group, receiving only verbal counseling without the additional structured educational session. Patient satisfaction was measured postoperatively, and clinical outcomes, including hospital stay duration, recovery times, and complication rates, were analyzed.Patients in the intervention group reported higher satisfaction scores and demonstrated shorter hospital stays. While the reduction in postoperative complications was not statistically significant, a downward trend was observed. Preoperative education emerged as a significant predictor of high satisfaction.Comprehensive preoperative education in neurosurgery effectively reduces patient anxiety, enhances satisfaction, and facilitates faster recovery. Implementing structured, standardized educational programs is a cost-efficient approach to addressing misconceptions and improving outcomes, particularly in neurosurgery, where the complexity and perceived risks of brain and spinal surgeries often intensify patient concerns. Adopting this strategy in our practice will significantly contribute to delivering high-quality health care.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809620

Pediatric EDH (extradural hematoma) following trauma is a well-known surgical entity with early diagnosis and treatment reducing morbidity and mortality. It is custom not to suggest surgery for a patient with traumatic EDH with a Glasgow Coma Scale (GCS) of E1M1Vt, with no cough or gauge reflux. Case history: a 5-year-old school-going girl presented with posttraumatic temporo-parietal EDH with GCS of E1M1Vt with fixed dilated right pupil. The patient denied surgery due to poor recovery and a high rate of morbidity and mortality. Hospital course: with the patient being young and just a ray of hope, surgery was performed. To a surprise, she completely recovered and was discharged with residual weakness in her left upper and lower limbs and was able to return to her daily work/school. At follow-up, she was able to perform all the daily routine work with residual weakness and required help from others to perform complex tasks. This rare case is being reported because the patient improved from M1 to M6 and returned to school, which was a rare event, and many had lost hope; even literature is scarce to justify this approach.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809619

Traumatic carotid artery injury is a rare yet potentially fatal complication of head and neck trauma. Often masked by primary brain injury, it may remain undiagnosed until the onset of devastating neurological consequences. We present two contrasting cases of traumatic brain injury with carotid artery injury—one where the injury was missed initially, leading to malignant infarction and death, and another where timely detection resulted in a favorable outcome. These cases underscore the importance of heightened clinical suspicion and standardized screening for carotid artery injury in specific trauma patterns, especially in patients presenting with high-risk mechanisms or unexplained neurological deterioration.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809560

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809559

Serious cranial and brain injuries from machete wounds are an uncommon yet serious type of penetrating cranial injury, which can be associated with significant morbidity and mortality. Injuries from machete wounds may present with intricate patterns of skull fractures, brain contusions, intracranial hemorrhage, and deficits related to trauma to the brain. The clinical condition appears to be the principal determinant of prognosis, with most individuals sustaining injury with machete wounds having a poor outcome despite the provision of aggressive care. This narrative review will evaluate the clinical variables, imaging findings, management, and outcomes in association with acute or severe cranial injury secondary to machete wounds. The review will also include a case report of a 47-year-old male motorcycle passenger who sustained severe cranial trauma with upper limb injuries due to a machete assault. While the male underwent surgery and was subsequently provided with comprehensive critical care management, the individual suffered severe brain complications of cerebral edema and ischemic injury leading to herniation of the brain, ultimately leading to death. The review aimed to illustrate sequential imaging, particularly computed tomography imaging, as early as possible to characterize the extent of the damage and facilitate management decisions. Although the findings demonstrate that surgery may improve survival in patients sustaining injury from machete wounds, the overall prognosis could be poor due to the degree of the injury. Multidisciplinary management, which consists of urgent neurosurgical intervention, concomitant intensive care, and ongoing monitoring, is required for improved outcomes.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809142

High cervical spinal cord injuries (SCIs) resulting from road traffic accidents (RTAs) often lead to serious respiratory and cardiovascular issues. This case report details an unusual instance of a C3-C4 SCI that did not present these complications and discusses its management. A 50-year-old man experienced a C3-C4 SCI in an RTA. Even though he was completely quadriplegic (American Spinal Injury Association grade A), he maintained normal respiratory function and stable cardiovascular readings. A magnetic resonance imaging revealed a contusion at the C3-C4 level. He was treated with injection methylprednisolone and underwent a C3-C4 laminectomy. After the surgery, he showed remarkable improvement in both motor and sensory functions. Throughout his hospital stay, there were no signs of respiratory or cardiovascular distress. This unique case underscores the diverse presentations of SCI, particularly high SCI without respiratory and cardiovascular issues, and suggests that early intervention and rehabilitation can lead to positive outcomes. Additionally, this report sheds light on the importance of early diagnosis, treatment, physiotherapy, and rehabilitation, which can facilitate significant recovery with minimal morbidity or mortality. More research is needed to better understand such atypical cases.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808269

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808076

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808074

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808075

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808073

Background Chronic subdural hematoma (CSDH) is a common neurosurgical condition, often presenting with progressive neurological deficits. Surgical evacuation via burr hole craniotomy is a standard treatment. This study evaluates the pressure neutralization technique for gradual decompression using wide bore cannula before dural opening. Materials and Methods This retrospective study included 81 patients with CSDH and previous history of head trauma who underwent gradual decompression using wide bore cannula before dural opening. Preoperative, intraoperative, and postoperative parameters were evaluated. Results The mean patient age was 67 ± 8.7 years, with a male predominance (69.1%). The most common presenting symptoms were hemiparesis (70.4%) and headache (29.6%). Hematoma was predominantly left-sided (61.7%) with a mean thickness of 2.46 ± 0.5 cm. Midline shift exceeded 10 mm in 63.0% of cases preoperatively. Postoperatively, Glasgow Coma Scale improved to 14.84 ± 0.37, with clinical improvement in 77.8% of patients showing resolution of weakness. Midline shift resolved at 76.5%, and residual hematoma was minimal in 16%. The average hospital stay was 4.2 ± 1.3 days, and only one patient (1.2%) underwent postoperative wound infection. Conclusion Gradual decompression using wide bore cannula before dural opening is highly effective in managing CSDH, leading to significant clinical and radiological improvement with minimal complications. Radiological findings, particularly hematoma thickness and midline shift, are reliable indicators of surgical efficacy and patient recovery.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806872

Introduction Papilledema indicates raised intracranial pressure, which is a significant finding in head injury patients. Being a bedside marker, papilledema can be used for predicting the prognosis in head trauma patients. Objective The aim of the study was to assess papilledema as a single prognostic marker in moderate head injury adult patients. Materials and Methods An observational study was done at the Sawai Man Singh Medical College on 120 patients with moderate head injury (Glasgow Coma Scale [GCS] score of 9–12). CT scan and fundoscopy were done in all patients within the first 24 hours and then the patients were followed up for 3 days. Outcomes were noted in terms of Glasgow Outcome Scale (GOS) during a follow-up of 72 hours after admission where a GOS score of 5 was defined as good outcome. Results Papilledema was present in 25 (20.83%) patients, with early papilledema (<24 hours) in 1 (4.00%) patient and delayed papilledema (up to 72 hours) in 24 (96.00%) patients. Common CT findings were contusions (61.67%), subarachnoid hemorrhage (30.83%), and diffuse axonal injury (2.5%). The GCS score was 9 in 45 (37.50%) patients, 10 in 31 (25.83%) patients, 11 in 30 (25.00%) patients, and 12 in 14 (11.67%) patients at admission. Compared with those without papilledema, patients with papilledema had significantly more contusions (84 vs. 55.79%, p = 0.031). There was a significant association of GCS at 24 hours with papilledema (p < 0.05). Even GOS score showed a significant association with papilledema (p < 0.0001). The absence of papilledema demonstrated sensitivity of 96.87% (95% confidence interval [CI]: 89.16–99.62%) and specificity of 41.07% (95% CI: 28.10–55.02%) with an area under the curve of 0.69 (95% CI: 0.60–0.77) for predicting good outcomes. Conclusion Papilledema was present in 25 (20.83%) cases of moderate head injury. The absence of papilledema showed 70.83% predictability for good outcomes, showing a significant association with prognostication of patients allowing its usage for monitoring and management of the patients.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806873

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806944

Recurrent chronic subdural hematoma (CSDH) is a major global problem with high morbidity and mortality. Despite being a treatable entity with a simple procedure such as burr hole and evacuation, it has a high recurrence rate. The placement of a subgaleal drain, which is the current standard of care, is a suboptimal method for preventing recurrences.The senior author devised a new type of burr hole cap (DA-Fix, GPS Precisions, Ghaziabad, India; patent pending) made of medical grade titanium with an integrated subdural evacuation system, with a suction port in the center, designed in such a way as to be completely atraumatic to the underlying brain and vessels. Once fixed, a no. 12 suction drain is connected to the nozzle arising from the center of the DA-Fix and tunneled out away from the primary incision site. This drain was then connected to the suction drain system under half negative suction. We present our initial clinical experience with this novel DA-Fix drain in patients with CSDH.Three patients with CSDH underwent burr hole drainage and placement of the DA-Fix drain. All three patients had the suction drain placed for 4 to 6 days (mean: 5 days) and had good radiological outcomes. Two patients could be discharged, and one patient died in the hospital on the 11th day due to sudden myocardial infarction.We describe a novel noncontact, controlled suction integrated into a burr hole cap with a detachable suction attachment. This invention has the potential to dramatically reduce the recurrence and complication rates of subdural hematoma(s).
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806942

Following decompressive craniectomy (DC), the excised bone flap can be stored either in vivo (subcutaneously in the abdominal wall or thigh) or extracorporeally (cryopreserved). While bone flap preservation techniques and postcranioplasty outcomes have been extensively studied, complications related to abdominal wall bone flap storage remain underreported. A retrospective study was conducted on 92 patients who underwent DC followed by cranioplasty with subcutaneous abdominal wall bone flap preservation.The most common abdominal wall complications included psychological concerns (24%), cosmetic concerns (21.7%), pain at the incision site (19.5%), and abdominal wall heaviness (19.5%). Wound infections occurred in 10% of patients, necessitating bone flap removal in two cases. Other complications included difficulty in squatting (20%), breathing difficulty (2%), and wound hematoma (3%).However, abdominal wall complications, including infection, pain, and cosmetic concerns, should be discussed preoperatively with patients and their families. Despite these challenges, abdominal preservation remains an alternative to cryopreservation in neurosurgical centers with limited infrastructure for bone banking.Abdominal subcutaneous bone flap preservation following DC is associated with a range of complications, though most are manageable with conservative measures. Autologous bone flap storage in the abdominal wall remains a viable option, particularly in high-volume and resource-constrained settings, due to its cost-effectiveness, biocompatibility, and reduced risk of bone resorption compared with cryopreservation. Given its efficacy and cost advantages, it remains a relevant choice in select settings.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1805093

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806759

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1805094

Traumatic bifrontal contusions have an unpredictable course with often rapid deterioration, requiring an aggressive approach. However, integral to an individual's personality, frontal lobe surgeries demand a maximally effective approach but with minimal invasiveness. The author explores the feasibility of a transfalcine corridor for the effectiveness of contusion evacuation in asymmetric bifrontal contusion cases, with one side extensive and the other moderate size, aiming minimal invasiveness on the less affected side without compromising the surgical efficacy. The authors have evaluated the role of transfalcine brain surgeries in the selected cases of bifrontal contusions, and here, they report the experiences of their first two cases performed using this corridor between January 2024 and April 2024 at their institution. Two cases of bifrontal contusions were operated on, with a sizeable contusion on one side and a relatively smaller basifrontal contusion on the other. The craniotomy was focused on the side with the larger contusion. After the contusion was evacuated from that side, the contralateral side was approached through a corridor made in the intervening falx cerebri, and the contralateral frontal contusion was evacuated under the microscope. Both patients showed significant clinical and radiological improvement in their postoperative period with early recovery. Transfalcine bifrontal contusion evacuation is a good option, especially in selected cases with one side larger and relatively smaller contralateral inferior-medial frontal contusion locations.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1802586

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1802587

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1802956

Burst frontal lobe or frontal lobe contusion is commonly seen in road traffic accidents (RTA) or assault. Chronic subdural hematomas are seen in elderly patients with history of nonsteroidal anti-inflammatory drugs use, chronic alcohol intake, and antithrombotic and/or anticoagulant therapy. Extradural and acute subdural hematomas are often seen in young patients following RTA or trauma. The coexistence of all the above-mentioned conditions, that is, lobar contusion, acute-on-chronic subdural hematoma (SDH), and acute extradural hematoma (EDH), in a patient is rare. Based on the Glasgow Coma Scale and imaging findings, early surgical intervention was planned in our patient. Early surgical evacuation of contusion, acute-on-chronic SDH, and EDH, as was done in our patient, will lead to early recovery. Avoiding alcohol intake and use of helmets while riding motorcycles will lead to reduction of such RTA in future.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1802588

Attention and memory deficits are frequently observed in individuals suffering from mild traumatic brain injury (MTBI), particularly in those exhibiting neurostructural abnormalities, commonly referred to as complicated mild traumatic brain injury (C-MTBI). The present case series employed customized cognitive retraining interventions and compensatory techniques designed to enhance attention, memory, and activities of daily living (ADL) of C-MTBI patient. Scores on Glasgow Coma Scale (GCS) and neuroimaging abnormalities detected via computed tomography (CT) or magnetic resonance imaging (MRI) were used to categorize the cases as C-MTBI. All four cases in the present case series were selected using purposive sampling technique. Cognitive dysfunction of the cases was evaluated utilizing the PGI Battery of Brain Dysfunction (PGI-BBD), while assessment of ADL was measured through the Hindi version of the Cognitive Symptom Checklist (CSC). Patients with C-MTBI underwent cognitive rehabilitation (CR) specifically tailored to address the unique requirements and characteristics of their nature of cognitive deficits. Cognitive retraining sessions were systematically organized on a biweekly basis, complemented by an additional weekly session focused on compensatory strategies, which were conducted face to face or through telephonic/video conferencing. All four cases completed CR sessions and after competition of the CR sessions, cognitive functions and ADL were reassessed using the PGI-BBD and CSC, respectively. The present case series highlights the effectiveness of CR program combining cognitive retraining and compensatory strategies in improving attention, memory, and ADLs of C-MTBI patients. All four cases demonstrated significant improvements in cognitive functioning and ADL measures following the CR program, supporting its applicability and therapeutic value.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1801285

Objective Patients with traumatic brain injury (TBI) often continue to have symptoms of neuropsychological dysfunction. Studies have demonstrated cerebral perfusion (CP) deficits following TBI. There is limited literature on the association between CP and neuropsychological outcomes following TBI. This study aimed to analyze the correlation between neuropsychological outcome and CP in patients with mild to moderate TBI. Materials and Methods Patients with mild to moderate TBI and computed tomography (CT) scan suggestive of diffuse axonal injury underwent CT perfusion scan within 48 hours of injury. All patients were evaluated with various neuropsychological tests at 3 months of follow-up. The correlation between CP and neuropsychological outcome was assessed. Results Forty patients (21 with TBI mild and 19 with moderate TBI) were enrolled. Among 21 patients with mild head injury, 14 (66.7%) showed evidence of hypoperfusion in the right frontal lobe and 12 (57.1%) in the right parietal lobe. Among 19 patients with moderate head injury, 12 (63.1%) patients showed hypoperfusion in the right frontal lobe and 7 (36.8%) in the right parietal lobe. CP in the bilateral frontal and left temporal lobe white matters showed a statistically significant negative correlation with the number of mistakes committed in the Stroop A, B, and C tests. Perfusion in the left temporal white matter showed a negative correlation with the trail making test (parts A and B) and a positive correlation with the animal fluency test. The right parietal and left frontal lobes also showed a positive correlation with the AFT. Conclusion We found a significant correlation between CP of the white matter of different lobes during the acute phase of TBI and neuropsychological performance at 3 months after TBI.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1801382

Background Trauma is a leading cause of hospitalization worldwide, with spinal injuries resulting from traumatic events having severe and lasting repercussions. The high incidence of these injuries places a significant burden on families and health care systems. Disparities in epidemiological findings often occur due to the location- or culture-specific factors. This study aims to address the inadequate attention given to morphological patterns and their impact on neurological damage severity, which affects functional outcomes over time. Objectives The main objective of this study was to identify the injury patterns and detect associated spinal or extraspinal injuries in traumatic spine injury (TSI) patients who visited a level 1 trauma care facility in eastern India. Additionally, it aimed to establish a correlation between the severity, morphology, and grades of neurological damage with demographic characteristics. Materials and Methods This retrospective cross-sectional study was conducted at the neurosurgery unit of the trauma and emergency department (TED) at a level 1 trauma center in eastern India. It involved TSI patients admitted between March 15, 2023, and March 14, 2024. Data were collected from paper-based records and compiled into a structured Excel format. The study included adult patients admitted to the TED with traumatic spinal cord injuries and excluded those from outpatient departments or those with incomplete data. Data analysis utilized the Muller AO classification, Injury Severity Score (ISS), and ASIA classification, with statistical analysis performed using IBM SPSS version 19.0. Results Out of 320 patients, 309 met the inclusion criteria. The majority were males (263) with a median age of 39 years. Falling from a height (43.7%) was the most common mechanism of injury, followed by road traffic accidents (37.9%). Polytrauma was present in 73% of patients, with multilevel injuries more severe than single-region injuries. Type A fractures were most common (53.4%), and 67.6% of patients underwent surgery. A significant correlation was found between the ISS and ASIA scores. Conclusion The study revealed differences in spinal injury epidemiology in eastern India compared to other regions, with multiple vertebral level injuries being more common. The findings highlight the need for government health care strategies focused on treatment and rehabilitation, especially for the younger age group that is predominantly affected. Preventive measures should also be strictly enforced to reduce the incidence of such injuries.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1801325

Intracranial hypertension (IH) is a critical condition in neurocritical care and needs effective management to avoid severe outcomes like brain herniation and cerebral ischemia. External ventricular drains, although effective in reducing intracranial pressure, pose risks of infection, hemorrhage, and malfunction. This technical note present the transdiploic cerebrospinal fluid (CSF) diversion device, an alternative technique for CSF diversion utilizing the parietal diploic venous system.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1801286

Spinal epidural hematoma (SEH) is a relatively rare spine space occupying lesion with approximated incidence of 0.1 per 100,000. SEH can be acute or chronic, spontaneous, posttraumatic, or iatrogenic following lumbar puncture (LP) or spine surgery. In this study, we present the case of a 12-year-old girl with a history of leukemia who was referred to us with acute progressive paraparesis and urinary retention following LP that was performed for intrathecal chemotherapy injection. Magnetic resonance imaging revealed SEH opposite the T10–T12 level. Emergency laminectomy and hematoma evacuation were performed. SEH can be a potentially devastating lesion that can result in progressive neurological deficits and permanent disability if it is not diagnosed early and treated properly. Immediate surgical decompression and hematoma evacuation can preserve the neurological function and insure favorable clinical recovery.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800789

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800858

Introduction Brachial plexus injury (BPI) is often associated with a neuropathic pain that usually is managed with analgesics; however, in up to 10% of the patients, it may be associated with a severely disabling chronic pain that does not respond to even maximal medical therapy. Materials and Methods This retrospective analysis included all the patients undergoing microscissors DREZotomy (MDZ) by a single surgeon (D.A.) for post-BPI brachialgia over 4 years (excluding 1.5 years of the COVID-19 pandemic) between 2018 and 2024 at our institution. Pain was quantified using the visual analog scale (VAS) between 0 and 10. Results A total of 32 patients underwent MDZ, of whom 3 patients had a redo DREZotomy. There were no complications and 65.7% patients showed an excellent response to pain with a VAS score of less than 3/10, which was statistically significant (p < 0.001). About 25.1% patients showed a good improvement in the VAS score of between 3 and 5. Conclusion MDZ is a very safe and highly effective technique to relieve the chronic refractory neuralgia in BPI. This technique can be performed with ease even in resource-limited conditions.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800791

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800788

The drainage of chronic subdural hematoma is a very frequently performed neurosurgical procedure. The management often requires subdurostomy with catheter placement for hematoma drainage. Sometimes, the catheter misplacement can lead to complications that could be catastrophic. This technical note introduces the Moscote–Agrawal guiding device, a tool designed to enhance the accuracy and safety of catheter placement during subdurostomy. We hope that this concept can be adapted by neurosurgeons around the world to minimize procedural risks, improve outcomes, and ensure the safety of neurosurgical practices.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800792

Contralateral formation and expansion of hemorrhagic contusion is a significant and rare complication following decompressive craniectomy. Decompressive craniectomy is an important surgical tool for management of raised intracranial hypertension secondary to various pathologies including trauma. These uncommon events are reported in the literature along substantive explanations and theories. We present two cases of road traffic accident (RTA) who following decompressive craniectomy developed expansion of contralateral hematoma. In this article, we are focus on the appearance and expansion of contralateral intraparenchymal contusion following decompressive craniectomy with a deep dive into the existing literature.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1800790

Introduction Coccygodynia is pain localized in the coccygeal region. Symptoms can be relieved after conservative treatment. In refractory cases, surgical treatment gives good clinical results. We report 12 cases of posttraumatic coccygodynia refractory to conservative treatment managed surgically. Materials and Methods This was a retrospective analysis including the records of all patients operated on in the neurosurgery departments and units of the Conakry University Hospital and the Sino-Guinean Friendship Hospital for posttraumatic coccygodynia refractory to conservative treatment over a 4-year period from January 2019 to December 2022 with a minimum postoperative follow-up of 12 months. Results Twelve cases were identified over a 4-year period with a mean age of 36 years and a male predominance (7 males/5 females). Coccygodynia was the main complaint and was present in all patients. The mean visual analog scale was 8.7 and the mean body mass index was 24.1. Sacrococcygeal computed tomography scans were performed in all patients. The indication for surgery was given after failure of conservative treatment. Three patients underwent partial resection of the coccyx and nine underwent total resection. All patients underwent postoperative sacrococcygeal radiography. Progress was favorable in 75% of patients. Morbidity included two cases of surgical site infection and zero mortalities. Conclusion Although the number of cases in this study was small, our positive results in terms of symptom improvement and satisfaction rates suggest that coccygectomy is a relatively safe and effective means of treating traumatic coccygodynia when nonsurgical methods have failed.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1795154

Background Traumatic brain injury (TBI) is a leading cause of mortality and morbidity particularly among young people. Identification of prognostic factors can be considerably helpful for clinical decision-making and prediction of outcome. Objective The aim of this study was to identify prognostic factors supposed to be of value in predicting functional outcome in moderate TBI patients. Materials and Methods This was a prospective case series study conducted from March 2023 to January 2024 involving 72 TBI patients with a Glasgow Coma Scale (GCS) score of 9 to 13. Demographic, clinical, laboratory, and management data were collected, analyzed, and correlated with patient outcomes. Based on the Extended Glasgow Outcome Scale (GOSE), patients were assigned to have either favorable outcome (GOSE score: 5–8) or poor outcome (GOSE score: 1–4). Results The mean age was 38.76 ± 18.30 years. The mean GCS score on admission was 11.68 ± 1.27. Surgical intervention was indicated in 29 patients (40.3%). The average length of hospital stay was 9.01 ± 7.88 days. Sixty-five patients (90.3%) had a favorable outcome and 7 patients (9.7%) had a poor outcome. Prognostic factors with significant impact on outcome included the GCS score on admission (p = 0.002); pupillary responses (p = 0.011); blood pressure (p = 0.005); acute subdural hematoma (ASDH) as a primary lesion (p = 0.049); and time to admission, comorbidities, blood glucose, hemoglobin%, oxygen saturation, coagulation profile, endotracheal intubation, and tracheostomy (p < 0.001). Conclusion In moderate TBI patients, delayed hospital arrival, low GCS score, unequal pupils, pretrauma comorbidities, hypotension, hypoxia, anemia, endotracheal intubation, tracheostomy, and ASDH were associated with unfavorable functional recovery and could be considered as poor prognostic factors.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1791736

Frontal depressed fracture generally results from high-speed motor vehicle accidents. The frontal fractures can be closed or open depending upon the involvement of the overlying skin. Frontal fracture can be comminuted if the bone is broken in at least two or more places. Because of the proximity of the frontal bone to critical structures like the frontal sinus, frontal dura with underlying brain parenchyma, and orbit with its content, an injury resulting in a frontal depressed fracture can result in a multitude of clinical symptoms. If not addressed promptly with an experienced team, these fractures can result in cerebrospinal fluid leak, osteomyelitis of the frontal bone, meningitis, and ocular and olfactory dysfunction with poor cosmetic outcomes. Thus, repairing the frontal depressed fracture should be considered a priority. The standard practice is to elevate the depressed fracture and repair any dural defect. In case of a comminuted fracture, elevation is not possible, and we generally remove the fracture pieces and repair the defect using titanium mesh. In this case report, we propose a novel technique of repair of the defect using a split calvarial graft, which is fashioned after separating the outer table from the inner table of the posterior frontal bone. This technique reduces the theoretical risk of infection and is cost-effective as our procedure does not require any external implant in cranioplasty.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1789615

Objective In patients with mild traumatic brain injuries (mTBIs), with Glasgow Coma Scale (GCS) scores of 13 to 15, isolated subdural hematomas (iSDHs) are identified as a prevalent category of intracranial hemorrhage. The primary objective of our research was to investigate the relationship between the characteristics of iSDHs, as revealed through computed tomography (CT) scans on patient admission, and the consequent necessity for neurosurgical intervention. Materials and Methods This was a 1-year study, employing a prospective observational design at our institution. We enrolled adult trauma patients diagnosed with mTBIs and concurrent iSDHs, intent on documenting the hemorrhages' quantitative parameters such as maximum length and thickness, among other related variables. The eventual execution of neurosurgical procedures constituted our primary outcome, aiming to establish a decisive correlation between CT scan metrics of iSDHs upon admission and the imperative for subsequent surgical intervention. Results A total of 50 patients were included in our study: 14 patients received a neurosurgical intervention and 36 patients did not. The neurosurgical intervention group had a mean maximum SDH length and thickness that were 38 mm longer and 9.6 mm thicker than those of the non-neurosurgical intervention group (p < 0.001 for both). Conclusion In this study, we evaluated the odds of a neurosurgical intervention based on hemorrhage characteristics on CT, in patients with an iSDH and mTBI. Once validated in a second population, these data can be used to evaluate the necessity of interhospital transfers and to better inform patients and families of the risk of future neurosurgical intervention and prognosis.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1789617

The displacement of the condyle into the middle cranial fossa after a high kinetic trauma represents a rare and low prevalence situation in the clinical routine of the maxillofacial surgeon. After a motorcycle accident, a 19-year-old male patient evolves with displacement of the left mandibular condyle to the middle cranial fossa, requiring surgical management in association with the neurosurgical team for repositioning and reconstruction of the glenoid fossa. After craniotomy, the condyle was visualized in the middle fossa. After bone disimpaction with a driller, the condyle was repositioned and the glenoid fossa was reconstructed with a titanium mesh. After 12 months of follow-up, no neurological or functional sequela was observed. The displacement of the mandibular condyle to the cranial fossa is rarely reported in the literature. It requires a multidisciplinary team for its management. Long-term follow-up is also necessary, especially in young patients.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1787836

Background Traumatic brain injuries (TBIs) pose significant challenges globally. The implementation of TBI prevention programs is highly reliant on the prevalent misconceptions. There is a paucity of research exploring the misconceptions regarding TBIs among young adults in India. Therefore, the present study explores the prevalence and nature of misconceptions regarding TBIs among young adults. Materials and Methods This prospective survey study, with 150 participants aged 18 to 25 years, utilized the Common Misconceptions about Traumatic Brain Injury questionnaire comprising 40 items across 7 domains. The data was analyzed using Jamovi (2.3.28 solid). Results The results revealed that the participants have high rates of misconception regarding brain injury sequelae, brain damage, and seatbelt prevention and low rates regarding the posttraumatic amnesia. Overall, females exhibited a higher rate of misconceptions compared with males. Higher years of education were associated with lesser misconceptions. Prior exposure to TBI had no significant impact on overall awareness of TBI. Conclusion This study highlights important misconceptions about TBIs among young adults. Education and gender might play a vital role in these misconceptions. These findings might inform the development of preventive modules for TBIs and to enhance their effectiveness.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1787699

Introduction Traumatic brain injury (TBI) poses a significant global health challenge, accounting for over 50% of trauma-related deaths and emerging as a leading cause of mortality and disability. Objective This article studies the demographic characteristics, clinical features, imaging findings, and outcomes of TBI patients. Materials and Methods This was a retrospective observational study conducted on 490 patients with TBI. Data regarding age, gender, socioeconomic status, and residential location were extracted from medical records. Neuroimaging reports, including computed tomography (CT) scans results, were analyzed for structural and functional insights. Results The majority of TBI cases involved individuals aged 21 to 40, with a higher incidence in males. Road traffic accidents were identified as the most common mode of injury, followed by falls. Most of the patients had moderate Glasgow Coma Scale scores at admission. CT scans indicated skull fractures, cerebral edema, and subdural hematomas as common findings. Most patients did not require ventilator support, and the majority had a hospital stay of less than 10 days. At discharge, 89.8% exhibited favorable outcomes, while 4.3% experienced mortality during treatment. Follow-up data demonstrated an overall mortality rate of 8.8%, with 89.2% achieving complete recovery within a month. Conclusion The study underscores the importance of understanding the multifaceted aspects of TBI, emphasizing the need for integrated approaches in tertiary medical care to optimize patient outcomes and contribute to effective public health strategies.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1782610

Postoperative vision loss following spine surgery is a rare and devastating complication with variable incidence. Various risk factors have been identified in the literature. A 16-year-old male presented with neck pain, spastic quadriparesis, and tingling paraesthesia in the left upper limb for the past 3 years. Radiological workup was suggestive of atlantoaxial dislocation with occipitalization of the posterior arch of the atlas (C1). The patient was prone to a horseshoe headrest and underwent occipito-C2-C3 fixation by removing the posterior rim of foramen magnum. Postoperatively, the patient complained of loss of vision in the right eye. Ophthalmology evaluation revealed a loss of perception of light in the right eye due to central retinal artery occlusion. An injectable steroid was started, but there was no improvement in vision in the involved eye. Proper head positioning and avoidance of intraoperative hypotension are modifiable factors to avoid such devastating complications.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1787698

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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1782608

Background Posttraumatic hydrocephalus (PTH) is an important cause of morbidity after decompressive craniectomy (DC) following traumatic brain injury (TBI). Early diagnosis and treatment of PTH can prevent further neurological compromise in patients who are recovering from TBI. Objective The aim of this study was to assess the proportion of patients who develop hydrocephalus after undergoing DC and to identify the factors associated with PTH requiring surgical treatment in patients undergoing DC for TBI. Methods Data of patients undergoing DC for TBI in the Trauma Neurosurgery Unit, Medical College Hospital, Trivandrum, between June and December 2020 were collected prospectively. Results A total of 48 patients who underwent DC were studied. Six (12.5%) patients developed PTH. The patients were divided into two groups: PTH (patients who developed hydrocephalus) and non-PTH (patients who did not develop hydrocephalus). Age, sex, mode of injury, severity of injury, and preoperative radiological findings were not associated with the development of PTH. A distance of craniectomy margin from the midline of less than 2.5 cm was found to be statistically significant. No statistical difference was found in the outcome among the PTH and non-PTH groups. Conclusion Craniectomy with a superior limit too close to the midline can predispose patients undergoing DC to the development of hydrocephalus. We therefore suggest performing wide DCs with the superior limit greater than 25 mm from the midline.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1787115

Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons. Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay. Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p < 0.001). Delayed surgery > 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023). Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.
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Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1786688

Objective The aim of this study was to compare the outcome of anterior versus posterior fixation for traumatic subaxial cervical spine subluxation in terms of mean intraoperative blood loss, surgical time, and length of hospital stay. Materials and Methods A prospective observational study was conducted from August 25, 2022 to August 24, 2023 at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, including 60 patients (30 in each group) fulfilling the inclusion criteria. Group A had anterior cervical fixation, while group B underwent posterior cervical fixation. Patients were monitored for intraoperative blood loss, surgical time, and length of hospital stay. All the results were collected and recorded on a proforma. Results The mean age of the patients in group A was 45.40 ± 3.75 years and that in group B was 45.50 ± 4.13 years. In all, 48.8% (n = 21) were males and 52.9% (n = 9) were females in group A, while 51.2% (n = 22) were males and 47.1% (n = 8) were females in group B. The mean intraoperative blood loss was 71.60 ± 0.77 mL in group A and 101.76 ± 0.85 mL in group B. The mean surgical time was 72.73 ± 0.98 minutes in group A and 94.73 ± 0.58 minutes in group B. The mean length of hospital stay was 7.63 ± 0.55 days in group A and 12.80 ± 0.71 days in group B. Conclusion It was concluded that the anterior approach is better than the posterior approach for traumatic subaxial cervical subluxation spine in terms of low blood loss, less surgical time, and reduced hospital stay.
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