Abstract
Introduction: The burden of head injury due to RTA on the society has now become a major cause of concern. The other main etiological factors contributing to head injuries include alcohol consumption, assault, fall from height and workplace injuries. Patients with suspected head injury are categorized using GCS. A good number of patients admitted with head injury suffer from CSF leak and pneumocephalus. There is a dearth of studies exploring the outcomes in patients with Post-Traumatic pneumocephalus in our setting. The objective of this study was to explore the various outcomes and management of patients suffering from Post-Traumatic pneumocephalus.
Materials and Methods: Fifty consecutive patients with closed head injuries admitted in the surgical wards and neurosurgical wards in 2007 were recruited into this study with written informed consent from the patients or from the bystanders. Various parameters, including baseline demographic features, details of RAT, presence or absence of vomiting, loss of consciousness, ENT bleeding, GCS scores, early and late CSF rhinorrhea, head ache, meningitis, anemia, cranial nerve nerve injuries, details of surgery and CT findings, brain injury and fractures were collected in a standardized pretested data collection form. All data were analysed using R statistical package.
Results: The mean age of these 50 study participants was 47.3±16.7 with a male predominance. Road traffic accidents were the major etiological factor(94%). Frontal sinus fracture was present in 36%. Early CSF rhinorrhea occurred in 12% of patients and delayed in 18% of patients. Pneumocephalus was present in 58% of patients. First ct showed pneumocephalus in 90% of patients. However, in second ct it came down to 20 percent. Majority of patients (84%) required only conservative management. Surgical intervention was resorted to in the remaining 16% of cases.
Discussion: In our study, surgery was the treatment modality in 16% of individuals. Most of them presented with features of delayed and continuous CSF leak not responding to conservative management. Most of them underwent a duroplasty with fascia lata or G-patch. Surgery was associated with a very good outcome. Patients were followed up sequentially for any residual focal neurological deficits or cranial nerve abnormalities. All were detected to be symptom free. One interesting thing to be noted was the incidence of frontal sinus fractures. Incidence of frontal sinus fractures in our study was found to be 36%.
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DOI: https://dx.doi.org/10.18535/jmscr/v5i7.58
