role of dural tenting sutures in preventing edh in routine surgery
TRANSCRIPT
ROLE OF DURAL TENTING ROLE OF DURAL TENTING SUTURES IN PREVENTING SUTURES IN PREVENTING EDH IN ROUTINE SURGERYEDH IN ROUTINE SURGERY
DEEPAK AGRAWAL, BS SHARMA, VS MEHTADEEPAK AGRAWAL, BS SHARMA, VS MEHTADeptt. Of Neurosurgery, AIIMSDeptt. Of Neurosurgery, AIIMS
New DelhiNew Delhi
AIIMS 2002AIIMS 2002
Walter Dandy (1932)Walter Dandy (1932)““A NUMBER OF PERMANENT SILK A NUMBER OF PERMANENT SILK SUTURES TIGHTLY DRAWN BETWEEN SUTURES TIGHTLY DRAWN BETWEEN THE DURA AND THE GALEA OR THE DURA AND THE GALEA OR SUBAPONEUROTIC TISSUE…[WILL] SUBAPONEUROTIC TISSUE…[WILL] HOLD THE DURA FIRMLY AGAINST HOLD THE DURA FIRMLY AGAINST THE BONE AND MAKE POSTOP EDH THE BONE AND MAKE POSTOP EDH FROM THIS SOURCE IMPOSSIBLE”FROM THIS SOURCE IMPOSSIBLE”
AIIMS 2002AIIMS 2002
WHAT IS THE NEED OF THIS WHAT IS THE NEED OF THIS STUDY?STUDY?
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The use of dural tenting sutures today The use of dural tenting sutures today is a perpetuation of a tradition is a perpetuation of a tradition introduced 70 years back.introduced 70 years back.
Pts were hypotensivePts were hypotensive Blood was not replacedBlood was not replaced Minimal monitoring of cardiovascular Minimal monitoring of cardiovascular
statusstatus
AIIMS 2002AIIMS 2002
Era of evidence based medicineEra of evidence based medicine Conditions like significant systemic Conditions like significant systemic
hypotension almost nonexistentent hypotension almost nonexistentent nownow
Possibility of causing bleeding from Possibility of causing bleeding from dural or cerebral vessels is presentdural or cerebral vessels is present
Slightly longer operating timeSlightly longer operating time
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AIM:AIM: TO ASSESS THE EFFICACY OF DURAL TO ASSESS THE EFFICACY OF DURAL
TENTING SUTURES IN PREVENTING TENTING SUTURES IN PREVENTING POSTOP EDH FORMATION POSTOP EDH FORMATION FOLLOWING ELECTIVE FOLLOWING ELECTIVE SUPRATENTORIAL CRANIOTOMYSUPRATENTORIAL CRANIOTOMY
AIIMS 2002AIIMS 2002
MATERIALS AND METHODSMATERIALS AND METHODS
PROSPECTIVE RANDOMISED STUDYPROSPECTIVE RANDOMISED STUDY
JUL 2001 TO JUNE 2002JUL 2001 TO JUNE 2002
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300 PTS
150 PTSHITCH
150 PTSNO HITCH
MATERIALS & METHODSMATERIALS & METHODS
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HOWEVER, ALL PTS IN WHICH THE SURGEON FELT THERE WAS NEED FOR HITCH SUTURES WERE EXCLUDED FROM THE STUDY AND NOT RANDOMISED
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300 pts
150 hitch 150 no hitch
89 M 61 F78 M 72 F
RESULTS RESULTS (Sex distribution)(Sex distribution)
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0
10
20
30
40
0 TO10
11 TO 20
21 TO 30
31 TO 40
41-5051-60
61-7071 TO 80
AGE GROUPS
HITCH NO HITCH
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0
20
40
60
80
100
TUMOR VASCULAR OTHERS
HITCH NO HITCH
TYPE OF SURGERY
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OUTCOMEOUTCOME
1
2
0
2
0
0.5
1
1.5
2
HITCH NO HITCH
POSTOP EDH
OPERATED NOT OPERATED
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CONCLUSIONSCONCLUSIONS
DURAL TENTING SUTURES ARE DURAL TENTING SUTURES ARE SUPERFLUOUS IN ROUTINE SUPERFLUOUS IN ROUTINE SUPRATENTENTORIAL CRANIOTOMYSUPRATENTENTORIAL CRANIOTOMY
AIIMS 2002AIIMS 2002
THANK YOUTHANK YOU