welcome back to this training session for emergency operative neurosurgery in this session we’ll discuss regarding how do you operate or operate upon a patient with frontal and temporal contusions what is the conclusion conclusion is bleeding within the brain parent conclusion is bleeding which is intermixed with some normal brain parent care so contusions are usually almost always because of head injury that is a traumatic they are components of traumatic brain injury so let us let us know how to operate upon these serious conditions of the brain okay and let me share my screen so we’ll be discussing saturday for several conditions of the frontal and temporal bones and also i will speak about the low bar resection in case of a temporal condition so before i go into the operative procedure per se let us discuss regarding the indications for surgical intervention these cases and operative interventions indicated in the setting of the frontal are a temporal condition which is greater than 20 centimeter tube in volume which is more than 20 cubic centimeters in volume and which is also associated with with one of the following glasgow comma scale of six to eight midline shift of at least five mm and cisternal compression any lesion irrespective of a location which is greater than 50 cubic centimeter also also requires surgery and also any lesion irrespective of size which is causing progressive neurological decline which is causing refractory intracranial hypertension which is defined as icp more than 20 millimeters of mercury which is not responsive to maximum medical therapy or when you see mass effect on a ct scan and also a temporal lobe hematoma greater than 30 cc in volume with or without any midline shift or elevation of the middle cerebral object these patients are particularly prone for transcendental herniation because the space of the middle cranial fossa is very limited so these are all the classical indications for a patient with frontal or temporal for required search so this is a patient with frontal contusion obviously this volume appears to be more than 30 cc in volume you can see the midline shift you can see the ipsilateral cortical sulci being obliterated similarly this is a patient with temporal condition the volume is more than 20 cc again the sylvan fissure is obliterated you can see the ventricles they are compressed they are not seen obviously the intracranial pressure is very high in both these patients one important action which you have to take is the choice of surgical approach two different approaches are described one is a bicarbonate and the modified tyrional approach for frontal lobe conclusion which are medially located which is medially located frontal conditions a bicarbonal approach is more appropriate but for a condition which is which is located lateral in the frontal lobe or when the frontal contusion is associated with a temporal lobe or when the patient has a temporal contusion alone then modified territorial approaches preferred in this episode i will speak about periodontal approach modified t real approach in my next session i’ll be speaking about by frontal approach so as everything as any operative neurosurgical procedure positioning makes an important difference important part of the procedure so you can see the position over here this position is almost similar to the position which you keep for either for decompressive cranial for decompressive cranectomy are for evacuation of an acute subdural hematoma so i am not speaking much about this particular step you can refer to our previous videos on decompressive cranictomy our previous videos on evacuation of an acute subdural hematoma it’s nearly same as that even the skin flap for a modified tereonal is nearly same as a classical falconer flap which you take for decompressive craniotomy but depending on incision you can taper the extent of the posterior extent of the flow if it’s a frontal if it’s a lateral frontal contusion the flower need not be so large you can tailor the poster extent of the flop but when you are deciding the extent of flow you should take into consideration the location and volume of the frontal contusion and also you should take into consideration the location of the edema around the conclusion the flap which are taking into taking into consideration the flow which are planning should take into consideration the combined volume of the conductor along with the very contusional edema it should encompass both of them elevation the temporalis muscle similar as the decompressive cranictomy the bone removal which is almost similar as evacuation of a decompressive cranictomy are evacuated evacuation required subdued hematoma the bone flap remover almost same as the previous procedures opening of the dura mater almost same now now once you have opened up the temporal country opened up the edura mata now come comes the temporal condition into view so what are the steps for evacuation of the temporal condition first identify this silicon beneficial so step one is identify sylvian fissure so how do you identify sylvan fission identification of the sylvan pressure is best done in relation to the location of the sphenoid bridge so this is the sphenoid ridge if necessary you may drill the base of the sphenoid bridge until flush with the anterior middle cranial fossa to augment the surgical exposure then inspect the cortical surface second step inspect the cortical surface identify the ideal area of entry an area of obvious confusion or cortical disruption is the ideal site of entry once you have identified the site of entry so second step was identify the site of entry once you have identified the site of entry cauterize is supervision vessels and the parameter is the planned entry side use a number left level blade or 15 blade approach the hematoma cavity in the sub pile plane with a combination of gentle suction and bipolar electrocautery once you enter into the hematoma cavity use a gentle section to evacuate any liquid clot and also the solid plot in a piece with in a piecemeal fashion continue evacuation until you see the gliotic brain are the normal brain are the edematous brain now what are the important [Music] pearls are important hints in this phase you can identify the sylvan fissure either with the help of a spinod ridge or with the help of the middle cerebral vein but of both the landmarks phenol ridge is a more reliable landmark when you are entering into the cortical cavity you can use a malleable retractor which is supported by cotton with a cotton party which is moistened with saline so you can use your malleable retractor over this cotton party gently so this helps in retraction it helps in illumination going into the cavity at the same time protects the underlying brain and one more important this part of the surgery that is evacuation hematoma is always done and is always at the best done in our ensuite it’s always done with the help of the operating microscope coming to the next step some cases where the temporal condition is very large in the event that the temporal lobe is severely confused you may plan for an anterior temporal lobe one you are operating on the non dominant temporal lobe that is on the right side usually we can remove up to five to six centimeter of the temporal lobe if it is on the non dominant side that is on the left side try to remove the less amount which is less than three to four centimeter in any cases the usually the posterior limit is the junction of the sylvan feature and the central sulcus but these are just guiding points but not always and depending on the extent of contusion extent of permanent damage to the plane extent of edema the operating surgeon can take addition up to the extent of temporal lobectomy so once this is done ensure perfect hemostasis use a combination of surgical cell combination of abjal sometimes you can use pressure from cotton party ensure complete hemostresses once you have done with complete hemostasis plan just like uh you plan for the bacterial actual subdural hematoma assess what is the extent of edema in the brain assess whether the brain is below the surface of inner table of the skull or above above that if you feel there is no edema if you feel that the chances of developing an edema in the future date is less you can do a primary primary closure not develop edema in available future days you can do an expansive uroplastic expansion uroplasty some of the surgeons in my place they prefer not to do a water type duroplasty but they closely deal of attack of sutures and then augment their neuroplasty with archer in our experience it’s a beautiful technique when we open up the open up the brain for boom plow replacement bone flap replacement we usually say perfect layer which is formed over it similarly just like the previous in previous sessions this session of decompressive green activation of acute subdural lymphoma you can decide whether to remove the bone flap or replace it black back then you close the temporalis muscle and the skin in layers after placing a closed suction drain so this completes my session on operator session operative session on evacuation of frontal and temporal conditions with the approach being a modified tyrional approach in that in my next session we’ll discuss the by frontal approach for medial frontal confusions so let us complete our session over here thanks for attending this session thanks for subscribing to my channel do share this videos with your neurosurgery colleagues your junior colleagues this will be definitely useful and as we all know these emergency neurosurgical techniques are life-saving and when done meticulously this can although they say still a high mortality depending on the presenting jesus of the patient this technique is life-saving and it can save lives of hundreds of people enough in our career so bye for now thank you let’s meet again in our next session for by frontal decompressive cranictomy for medial frontal contusions thank you
Training module for neurosurgeons Dr.Kalyan Description Dr.Kalyan Bommkanti is one of the best neurosurgeons in hyderabad and is also one of the best spine surgeons in hyderabad. He received training in endoscopic spine surgeries, also known as key hole spine surgery or minimally invasive spine surgery. He has experience in treating a number of complicated brain surgeries, complicated spine surgeries like complex brain tumors, complex spine tumors, complicated spine fractures, complicated head injuries. He has an extensive experience in teaching junior doctors. He consults and operates at: (For appointment WhatsApp on 8520003683) Global Gleneagles hospital,Lakdikapul, Hyderabad. Aware Global Gleneagles hospital, L.B. Nagar, Bairamulguda, Hyderabad. Kalyan’s Neuro and Spine clinic, Kharkhana, Secunderabad. Shenoy hospital, East Marredpally, Hyderabad. Prasad Hospitals, Nacharam, Hyderabad. Brain tumor clinics For appointment see details below (+91-8520003683). Brain tumors are serious disorders and should be treated as soon as possible. Many patients have a lot of doubts and queries regarding brain tumors, symptoms of brain tumors, diagnosis of brain tumor, surgery for brain tumor, treatment options for brain tumors. Patients also like to know regarding latest and advanced treatment options for brain tumor surgery like intraoperative neuromonitoring, awake craniotomy, ultrasonic aspirator, microsurgery, endoscopic surgery for brain tumors. Dr. Kalyan Bommakanti is a famous neurosurgeon from hyderabad and will try to answer these queries at leisure as a part of brain tumor clinics on you tube live Disclaimer The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. We make no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE or video. All Tags #best neurosurgeon in hyderabad, #best neurosurgery hospital in hyderabad, #best neurosurgeon in hyderabad reviews, #neurosurgeon in hyderabad, #best hospitals for neurosurgery in Hyderabad, #best neuro doctor in hyderabad,# best hospital for neurological problem, #best neurology hospitals in hyderabad,# Neurosurgeon in Hyderabad, #best neurosurgery hospitals in hyderabad,# brain surgery what to expect, #Micro surgery of Brain tumor in hyderabad, #best neurosurgery hospital hyderabad, #neurosurgeon brain tumor, #best hospital for neurosurgeon in hyderabad,#best hospital for neurosurgery in hyderabad, # best hospital for brain surgery in hyderabad, #best hospital for brain tumor in hyderabad, #best brain hospital in hyderabad, #best neuro hospital in hyderabad, # Best Neurosurgeon Hyderabad, #famous neurosurgeon in hyderabad, #best epilepsy surgeon in hyderabad, # doctor, #best spine surgeon,# best hospital for brain tumor surgery in Hyderabad,# Best brain surgeon in Hyderabad, #best brain tumor surgeon in Hyderabad. #brain tumor surgery videos, #best brain tumor surgery hospital in india, #awake surgery for brain tumors, #best brain surgeon, #brain tumour symptoms,brain tumour surgery in india, #meningioma surgery, #brain tumor surgery hyderabad, #Micro surgery of Brain tumor, #best hospital for brain tumor surgery,#a complex brain tumor surgery,#best neurosurgeon in hyderabad,#glioma surgery in hyderabad,#best brain surgeon in hyderabad, #best brain tumor surgeon in Hyderabad, #brain tumor symptoms #best spine surgeon in hyderabad india, #best spine surgeon hyderabad, #best hospitals for neurosurgery in Hyderabad, #best spine hospitals hyderabad, #best spine surgeon in hyderabad, #Top 10 Best Spine Hospitals in India, #treatment of bulging disc in hyderabad, #best spine surgery hospital in hyderabad, #best neurosurgeon in hyderabad, #top spine hospitals hyderabad, #best neurosurgery hospitals in hyderabad, #best neurosurgeon in hyderabad reviews, #best neurosurgery hospital in hyderabad, #successful story of spine surgery, #best hospital for spinal cord surgery in hyderabad, #best neuro spine doctors in hyderabad, #best spine surgery doctors in hyderabad, #best spinal cord surgeon in hyderabad,