Browsing by Author "Ravi Shankar Prasad"

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Clinical, operative, and outcome analysis of giant extradural hematoma: A retrospective study in tertiary care center
(Scientific Scholar, 2020) Rahul Singh; Anurag Sahu; Kulwant Singh; Ravi Shankar Prasad; Nityanand Pandey
Background: This study is aimed to find a critical volume of operated giant or massive extradural hematoma (EDH) that affects outcome significantly and analyze them with respect to their clinical, surgical, and outcome perspective. Methods: This retrospective study includes 253 patients operated for EDH in emergency in the Department of Neurosurgery of IMS BHU, Varanasi, India, a tertiary care center, between August 1, 2018, and November 1, 2019. Giant EDH critical volume was evaluated. Twenty-nine patients with giant EDH with clot volume ≥ 80 ml were further analyzed for clinical, surgical, and outcome predictive factors. Statistical analysis was done using Prism GraphPad ver. 8.0.0. P value was taken at 0.05. Results: Dichotomized group analysis with Glasgow Outcome Score (GOS) 4-5 versus GOS 1-3 for testing clot volume revealed significance difference with P < 0.001. Mean volume of GOS 1-3 came out to be 79.68 ml. Hence, we took clot volume >80 ml for further analysis. The most common age group was 20-40 (55.17%). M2 (31.03%) was the most common best motor response in operated giant EDH cases. Most of them were having severe (79.31%) head injury. Glasgow Coma Scale (GCS) at admission (P < 0.0001), pupillary changes (P = 0.0032), and best motor response (P < 0.0001) was significantly (P < 0.05) associated with outcome following surgery for giant EDH. Conclusion: Giant EDH with volume ≥ 80 ml is associated with poorer outcome. GCS at admission, pupillary changes, and best motor response is predictors for surgical outcome of giant EDH. © 2020 Published by Scientific Scholar on behalf of Surgical Neurology International
Clinical, Surgical and Outcome Predictive Factor Analysis of Operated Acute Subdural Hematoma Cases: A Retrospective Study of 114 Operated Cases at Tertiary Centre
(Georg Thieme Verlag, 2022) Rahul Singh; Ravi Shankar Prasad; Kulwant Singh; Anurag Sahu; Nityanand Pandey
Objective To analyze clinical, surgical and outcome predictive factors of operated acute subdural hematoma (SDH) cases for prognostication and surgical outcome prediction. Material and Methods This retrospective study includes 114 patients operated for acute SDH in the Department of Neurosurgery of IMS BHU, Varanasi, India, a tertiary care center, between 1 August 2018 and 1 November 2019. Each patient was evaluated for age, sex, mode of injury, localization of hematoma, clinical presentation, comorbidity, severity of injury, best motor response, CT findings, and Glasgow outcome scale (GOS) at discharge. The outcome was also evaluated by further making a dichotomized group using GOS in death/dependent (1-3) versus independent (4-5). Statistical tests were done using the GraphPad Prism version 8.3.0. Results The most common age group operated upon in this study was the 40 to 60 years age group (n = 45, 39.48%). Males were 78% with male to female ratio of 3.56:1. The most common clinical presentation was altered sensorium (98.25%). The most common comorbidity was hypertension (n = 32, 28.07%). GCS at admission, severity of injury, pupillary changes, and best motor response (p < 0.0001) were significantly associated with surgical outcome. Conclusion GCS at admission, severity of injury, pupillary changes, and best motor response were significantly (p < 0.05) associated with surgical outcome. Age and gender of patients were not found to be significantly associated. © 2022 Thieme Medical Publishers, Inc.. All rights reserved.
COVID-19-associated Mucormycosis: A clinico-epidemiological study
(Elsevier Inc., 2022) Jaya Chakravarty; Munesh Kumar Gupta; Ragini Tilak; Rajesh kumar; Rajendra Prakash Maurya; Nilesh Kumar; Susheel Kumar Aggarwal; Shiva S; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Manaswi chaubey; Vishambhar Singh; Ashish verma; Tuhina Banerjee; Neeraj Kumar Agrawal; Ravi Shankar Prasad
Background: There was an unprecedented increase in COVID-19-associated-Mucormycosis (CAM) cases during the second pandemic wave in India. Methods: This observational study was done to know the epidemiological profile of CAM cases andincluded all patients admitted with mucormycosis between May 2021 and July 2021. Results: Out of the enrolled 208 CAM cases (either SARS-CoV-2 RT-PCR or serology positive), 204, three and one had rhino-orbital-cerebral, pulmonary and gastrointestinal mucormycosis, respectively. 95.7 % of the patients had diabetes, out of which 42.3 % were recently diagnosed. Mean HbA1c was 10.16 ± 2.56 %. 82.5 % of the patients were unvaccinated. During their COVID-19 illness, 86.5 % were prescribed antibiotics, 84.6 % zinc preparations, 76.4 % ivermectin, and 64.9 % steroids, while only 39.5 % required oxygen therapy. The frequency of blood groups A, B, O and AB in our CAM patients was 29.5 %, 18.9 %, 38.9 % &12.6 %, respectively. At three months follow up, 60 (28.8 %) patients died, four (1.9 %) stopped antifungal treatment, and 144(69.23 %) were on antifungal treatment. 55 % (n = 33) of deaths occurred within 15 days of admission. Mortality was significantly associated with higher age, RT-PCR positive for SARS-CoV-2, raised serum creatinine and alkaline phosphatase during treatment. At 6 months follow-up, eight more patients died, three due to chronic kidney disease, four patients who had stopped treatment and one patient who was on a ventilator due to COVID-19 associated pneumonia and the rest 140(67.3 %) survived. Conclusion: Uncontrolled hyperglycemia, SARS-CoV-2 infection, rampant use of antibiotics, zinc supplementation and steroids were some of the risk factors for mucormycosis. Despite the overwhelming number of patients with an uncommon disease like mucormycosis, the six months mortality was much lower than expected. © 2022
Evaluation of Angular Parameters of Craniocervical Junction and Establishing their Relevance in the Diagnosis of Basilar Invagination
(Georg Thieme Verlag, 2025) Kulwant Singh; Vikrant Yadav; Ravi Shankar Prasad; Anurag Sahu; Nityanand Pandey
Background The craniocervical junction (CCJ), composed of the atlas, axis, and occipital bone, is a critical anatomical consideration incorporating vital osseoligamentous and neurovascular structures. Basilar invagination (BI) is one of the most common CCJ anomalies. Elaborative research has been done on different linear craniometric parameters for diagnosing BI, but the role of the angular craniometric parameters is still under research. This study aims to describe a detailed analysis of the angular craniometric parameters in the population of the northern part of India. We also aim to describe the different angular craniometric parameters that are useful in establishing the diagnosis of BI. Methods A total of 49 patients who underwent surgery for BI and met the criteria for the required bony landmarks used in the angular craniometric analysis were included in this study. Angular craniometric analysis was also performed for 120 controls who were screened for head and spine injuries following trauma, and subsequent scans showed no sign of radiological abnormalities. Results In this study, 49 patients were analyzed, who underwent surgery for BI, of which 67.35% (n ¼ 33) patients were males and 32.65% (n ¼ 16) were females. The values of Boogard’s angle (BgA) greater than 145 degrees and foramen magnum angle (FMA) greater than 18 degrees were highly diagnostic of BI, with 99.41 and 100% diagnostic accuracies, respectively. Similarly, the value of the tentorial twinning line angle (TtwA) less than 31.9 degrees was highly diagnostic of BI with diagnostic accuracy of 78.11%. The diagnostic accuracy of the combination of TtwA with BgA (91.12%) and with FMA (91.72%) was higher than that of TtwA alone. Conclusion FMA and BgA have excellent diagnostic accuracy for BI. TtwA can also be used for establishing the diagnosis of BI in the congenital occipital bone anomalies and comparison of preoperative and postoperative measurements following the surgical procedure like foramen magnum decompression. © 2025. The Author(s).
Evaluation of demographic, clinical characteristics and risk factors in patients with persistent hiccups due to traumatic brain injury: A trauma-ICU based study
(IP Innovative Publication Pvt. Ltd., 2024) Manjaree Mishra; Ghanshyam Yadav; Ravi Shankar Prasad; Shashi Prakash Mishra; Ashish Kumar Yadav
Background: Persistent hiccups in neurocritical care patients can lead to negative outcomes, including exhaustion, sleep deprivation, malnutrition, depression, and even death. This study aims to evaluate demographic and clinical characteristics, risk factors, and management in trauma intensive care unit patients. Materials and Methods: This study investigates persistent hiccups in traumatic brain injury (TBI) patients admitted to the Trauma ICU at Banaras Hindu University, Varanasi, from July 2020 to January 2024. The study involved monitoring and recording hiccups during patients’ ICU stays. Exclusion criteria included not participating, having GERD, advanced cancer, spinal cord injury, other CNS pathologies, deranged liver and renal profile, or on drugs causing hiccups, on sedative and neuro-muscular blocking agents. Results: The study involved 59.8% of patients aged <40 years, with a mean age of 41.75±17.16 years. Most patients were male, with a male-to-female ratio of 1.88:1. Road traffic accidents (RTAs) were present in 60.3% of patients, followed by falls from height (17.5%). 75.7% of patients had severe type TBI, while the remaining had moderate type TBI. Out of 189 patients, 86 (45.5%) died and 103 (54.5%) survived. Age was a significant factor in TBI-related persistent hiccups, with severe TBI significantly associated with female gender and ventilator-associated pneumonia and the need for mechanical ventilation. The type of TBI (moderate or severe) and length of ICU stay were also associated with TBI-related persistent hiccups. A strong relationship was observed between severe TBI patients who fall from height and were not responsive to drugs for hiccups compared to moderate TBI. The length of ICU stay was also associated with TBI-related persistent hiccups, with patients with a length of ICU stay of >14 days having a higher risk of hiccups. Conclusion: Severe TBI is linked to female gender, ventilator-associated pneumonia, and mechanical ventilation. The type of TBI and length of ICU stay are also linked to persistent hiccups. Patients with severe TBI who fell from height are less responsive to hiccup drugs. Patients with over 14 days of ICU stay have a higher risk of developing persistent hiccups. © 2024 Author(s).
Impact of COVID-19 Pandemic on Neurosurgical Practice in a Tertiary Care Center in India
(Georg Thieme Verlag, 2021) Rahul Singh; Anurag Sahu; Kulwant Singh; Ravi Shankar Prasad; Nityanand Pandey; Ramit Chandra Singh
Objectives The aim of the study is to determine the magnitude of repercussions of coronavirus disease 2019 (COVID-19) pandemic on neurosurgical specialty and formulate a management approach. Materials and Methods This combined retrospective and prospective study was done in neurosurgical specialty of IMS-BHU, Varanasi, India, a tertiary care center, between January 1, 2020 and May 31, 2020. Analysis of impact on neurosurgical emergency and electives was done over before pandemic, during lockdown 1 and 2 and during lockdown 3 and 4 timelines. Effects of COVID-19 pandemic on psychology of neurosurgical team (50 members) and on patient party (88) were also evaluated. Virtual learning and webinars as a substitute to residential neurosurgical training were analyzed by a questionnaire given to 13 neurosurgeons of our department. Statistical Analysis Ordinary one-way ANOVA (analysis of variance) and unpaired t -test were used according to data analyzed. p < 0.05 was considered statistically significant. GraphPad Prism software was used for this analysis. Results On an average 8.22 admissions per day were done in neurosurgical emergency before pandemic. After lockdown these figures reduced to 3.2 admissions per day during lockdown 1 and 2 and to 5.36 admissions per day during lockdown 3 and 4. There was significant reduction in neurotrauma admission rate during lockdown (p < 0.0001) at our center. There was 76% reduction in emergency neurosurgical operated cases during pandemic. There was significant reduction in outpatient department (OPD) attendance per day, OPD admissions per day (p < 0.0001), and total elective surgeries (p < 0.0001) during lockdown. Of 50 neurosurgical team members (neurosurgeons, nursing, and ground staff) interviewed, 90% of them had the fear of contacting the COVID-19 disease, fear of well-being of family and children, and difficulty in transport. Three out of 13 neurosurgeons (23.1%) agreed on change in practice based on what they learned from virtual teaching and webinars and only two of them (15.4%) accepted improvement of skills based on virtual learning. Conclusion The COVID-19 pandemic is causing a significant impact on health care systems worldwide. For conserving resources elective surgical procedures should be limited. This pandemic has a negative impact on neurosurgical resident training program and psychology of both neurosurgical unit and patients. © 2021 Georg Thieme Verlag. All rights reserved.
Modified frontal horn index: a novel risk predictor for sunken flap syndrome in the patients undergoing shunt procedures for post-decompressive craniectomy hydrocephalus
(Springer Science and Business Media Deutschland GmbH, 2024) Vikrant Yadav; Anurag Sahu; Ravi Shankar Prasad; Nityanand Pandey; Manish Kumar Mishra; Ravi Shekhar Pradhan
Background: Decompressive craniectomy (DC) is a neurosurgical procedure, frequently used in lowering the refractory intracranial pressure (ICP) following traumatic brain injuries. Post-traumatic hydrocephalus (PTH), a debilitating complication in the patients with traumatic brain injuries, occurs in 11.9–36% patients undergoing DCs. Sunken flap syndrome (SFS) is a rare entity, following DCs or cerebrospinal fluid (CSF) diversion procedures for PTH after DCs and leads to neurological deterioration of the patients. Literature regarding risk factors associated with SFS in the patients undergoing ventriculoperitoneal shunt procedures for hydrocephalus following DCs is scarce. The aim of this study is to determine the incidence of SFS and to establish a relationship between several clinico-radiological features and SFS in patients undergoing shunt procedures for PTH. Results: This retrospective study was conducted in a tertiary care trauma centre upon 60 patients who underwent shunt procedures for PTH. Intraventricular haemorrhage (P < 0.0001), communicating-type hydrocephalus (P = 0.0006), and modified frontal horn index (P < 0.0001) were significantly associated with development of SFS. MFHI > 43 was a significant risk factor in development of SFS. Conclusions: SFS is the common complication following shunt procedures for PTH after DCs. MFHI is significant risk predictor for SFS. MFHI > 43 is associated with higher chances of developing SFS following shunt insertion in PTH. Early cranioplasty following DCs might prevent development of SFS. © The Author(s) 2024.
Redefining Diagnostic Criteria for Basilar Invagination Using Linear Craniometric Parameters
(Turkish Neurosurgical Society, 2024) Vikrant Yadav; Nityanand Pandey; Anurag Sahu; Ravi Shankar Prasad
AIM: To establish the diagnosis of basilar invagination (BI) on the basis of specific bony landmarks Klaus’ index (KI), perpendicular distance between the tip of the odontoid process and palato internal occipital protuberance (PI) line. MATERIAL and METHODS: Forty-nine patients were analysed, who underwent surgery for BI, between July 2020 and June 2023. Radiological assessment was done in all the patients using reconstructed midsagittal images on computed tomography scans. RESULTS: Mean age was 34.82 ± 10.52 years with male preponderance (67.35%) in patients with BI. We also analysed randomly selected 120 control subjects (male: female = 59:61) with mean age 43.5 ± 14.08 years. The mean distance of tip of the odontoid process from PI line in patients with BI was 3.39 ± 3.09 mm. The mean value of KI in the patients with BI was 28.57 ± 1.68 mm. Receiver operating characteristic (ROC)curve was used for analysing the distance of the tip of the odontoid process from PI line in the patients with BI which produced area under curve(AUC) of 0.97 (confidence interval [CI] -0.931 to 0.990, p<0.0001). Cut-off point of 7.5 mm was identified for the distance of tip of odontoid process from PI line with sensitivity of 89.8% and specificity of 97.5% having 95.27% diagnostic accuracy for BI. ROC curve analysis of value of KI for the diagnosis of BI produced AUC of 1(CI: 0.978 to 1.000, p<0.0001). Cut-off value of 33.2 mm for KI was identified for diagnosing BI with 100% accuracy. CONCLUSION: The distance of tip of the odontoid process from PI line <7.5 mm and value of KI <33.2 mm, both of these parameters can diagnose BI with comparable accuracy to most widely used conventional radiological methods. © (2024), (Turkish Neurosurgical Society). All rights reserved.
Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center
(Georg Thieme Verlag, 2022) Rahul Singh; Ravi Shankar Prasad; Ashvamedh Singh; Kulwant Singh; Anurag Sahu
Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12-L1 (41.1%). Sagittal-plane spondyloptosis (76.5%) were more common than coronal-plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor. © 2022. Neurological Surgeons' Society of India.