Pakistan Journal Of Neurological Surgery
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Effect of Intraoperative Local Dexamethasone on Dysphagia Incidence and Severity Following Anterior Cervical Spine Surgery
Full text linkObjective: To evaluate the effectiveness of intraoperative local dexamethasone in reducing the incidence and severity of dysphagia following anterior cervical spine surgery (ACSS).
Material and Methods: The retrospective research analyzed 74 patients who experienced elective ACSS (January 2024 to February 2025). The first patient group received 10 mg of local dexamethasone before surgical bonding however the other patient group received no steroid treatment. The Bazaz scale together with the Dysphagia Short Questionnaire (DSQ) served to evaluate dysphagia levels and pain and disability ratings relied on the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). The researchers combined their assessment of failure rates with fusion success to build their analysis. SPSS software analyzed the obtained data and researchers established p < 0.05 as the statistical significance threshold.
Results: The research follow-up included 64 patients for an average period of two years. Interactive dexamethasone medication administration to surgical patients improved their swallowing function evaluation scores during their second postoperative day (Bazaz: 1.16 ± 1.35) versus patients not treated with the steroid (Bazaz: 2.10 ± 1.33; p < 0.0001). Statistics showed that dexamethasone administration in surgery patients did not affect their pain scores or their fusion rates and hospital stay durations. Dexamethasone administration in the research study demonstrated no adverse effects that emerged during the study period.
Conclusion: The surgical application of dexamethasone at the local site achieves effective and safe swallowing discomfort reduction following ACSS interventions without affecting overall surgical outcomes
Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center
Full text linkObjective: This study sought to assess and juxtapose the diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke, focusing on infarct delineation, hemorrhagic conversion, and posterior circulation involvement.
Materials and Methods: This retrospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar. A total of 200 patients aged 18 years or older, presenting with clinical suspicion of AIS, were included. All patients underwent both non-contrast CT and MRI within 24 hours of symptom onset. Imaging was reviewed independently by two experienced neuro-radiologists. Data on infarct detection, infarct volume, posterior circulation involvement, and hemorrhagic transformation were recorded.
Results: MRI detected acute infarcts in 92% of patients, significantly more than CT (66%) (p < 0.001). In posterior circulation strokes, MRI identified 60 cases versus 24 on CT (p < 0.001). Detection of hemorrhagic transformation was similar between modalities (CT: 87.5%, MRI: 85.7%; p = 0.68). MRI showed higher diagnostic accuracy with a sensitivity of 92%, specificity of 87%, and AUC of 0.95, compared to CT (sensitivity: 66%, specificity: 81%, AUC: 0.75). MRI also identified larger infarct volumes (p < 0.01).
Conclusion: MRI provides superior diagnostic performance in acute ischemic stroke, especially for early and posterior circulation infarcts, while CT remains crucial for initial hemorrhage exclusion. A combined approach may enhance diagnostic accuracy and improve outcomes in stroke care
Management of Thoracolumbar Spinal Fracture at Tertiary Care Hospitals: A Retrospective Study
Full text linkObjective: This study aimed to evaluate the fracture types, neurological deficits via the ASIA grading system, and to analyze fracture management strategies, post-fracture and surgical complications, in patients with thoracolumbar fractures.
Materials and Methods: A retrospective observational study was conducted on 114 TLS patients aged 16-75 years with known cases of TLS fracture. Data included demographics, mechanism of injury, radiographic investigations, fracture classifications, ASIA grades, treatment types, and outcomes. Descriptive statistics were used for analysis.
Results: The current study found that the majority of patients were male (64%) and aged 20-29 years (36%). Falls from height were the leading mechanism of injury. AO classification revealed a predominance of A1 (26.3%) and A2 (21.9%) fractures. ASIA A (complete neurological deficits) was found in 35.1% of patients, and ASIA E (no neurological deficit) in 31.6%. Conservative treatment was employed in 55.3% while 44.7% of patients underwent surgery, mostly through a posterior approach. Common complications included spinal cord compression (35.1%), pressure sores (21.9%), and neuropathic pain (13.2%). Overall, 70% of patients showed good recovery.
Conclusion: The study concluded that posterior surgical intervention is preferred, yielding favorable outcomes. Hence, early diagnosis and appropriate interventions are also crucial for minimizing complications and improving prognosis
Spectrum of Intracranial Complications in Patients with Dental Abscess
Full text linkObjective: To analyze the demographic characteristics, primary dental infections, and spectrum of intracranial complications in patients diagnosed with intracranial infections secondary to dental abscesses.
Materials & Methods: This retrospective observational study reviewed data from 180 patients diagnosed with intracranial complications resulting from dental abscesses at Lady Reading Hospital over 15 months (January 2024 to March 2025). Data collected from electronic medical records included patient demographics, type and location of dental abscess, microbiological findings, and intracranial complications confirmed by CT or MRI. Logistic regression analysis was used to identify risk factors.
Results: The mean age of patients was 45.1 years. The most common primary dental infection was periapical abscess (60%). The most frequent intracranial complication was brain abscess (35%), followed by meningitis (20%) and cavernous sinus thrombosis (25%). Older age, diabetes mellitus, and immunocompromised status were identified as significant risk factors for brain abscess development.
Conclusion: Intracranial complications secondary to dental abscesses represent a significant clinical concern. Early diagnosis and prompt management are crucial to improving patient outcomes. This study highlights the demographic and clinical patterns of these infections, which can aid in risk stratification and timely intervention
Association Between Benzodiazepine Administration and Respiratory Depression in Acute Seizure Management
Full text linkObjective: To assess the correlation between benzodiazepine use and the incidence of respiratory depression in patients treated for acute seizures at Lady Reading Hospital, Peshawar.
Materials and Methods: This prospective observational study was conducted from May to October 2024 at the Neurology and Emergency Medicine Departments of Lady Reading Hospital. A total of 200 patients, aged 10 years and above, who presented with acute seizures and received benzodiazepines as part of initial management, were enrolled. Respiratory parameters were monitored before and after benzodiazepine administration. Respiratory depression, defined as hypoventilation, oxygen saturation <90%, or the need for assisted ventilation, was recorded and correlated with the type, dosage, and route of benzodiazepine.
Results: Among 200 patients, 44 (22%) developed respiratory depression. The incidence was higher with intravenous lorazepam compared to intramuscular midazolam. Patients aged >60 years and those with chronic obstructive pulmonary disease had a higher risk. Respiratory depression correlated significantly with higher cumulative benzodiazepine doses (p < 0.05).
Conclusion: Benzodiazepines are the cornerstone of acute seizure management due to their rapid action, but they carry a measurable risk of respiratory depression. Careful dosing and vigilant monitoring are crucial to minimize complications. AEDs provide long-term seizure prevention but are not substitutes for first-line emergency therapy
Lateral Intraventricular Epidermoid Cyst: A rare case report
Full text linkAbstract:
Epidermoid cysts originate from ectopic embryonic epithelial cells and are a very common type of benign intracranial tumor. However, the incidence of intraventricular epidermoid cysts is low, and lateral intraventricular epidermoid cysts are even rarer. Here, we present a case of lateral intraventricular epidermoid cyst and review the relevant literature. A 33?year?old male who was presented with complaints of aphasia, vomiting, inability to walk and previous history VP shunt which was blocked on examination. A computed tomography of the brain showed a low?density mass in the lateral ventricle and enlargement of the left ventricle. Cranial magnetic resonance imaging further confirmed that the mass was an epidermoid cyst. The patient underwent microscopic surgical resection combined with endoscopy via the Keen’s point as a tract to reach the ventricle. The mass was satisfactorily removed, and the patient recovered well. Lateral intraventricular epidermoid cysts often present with clinical symptoms due to the invasion of surrounding brain tissue or blockage of the cerebrospinal fluid system. Diagnosis relies on examination by magnetic resonance imaging, and treatment relies on surgical resection. The prognoses of patients are mostly excellent and depend on whether the tumor is resected cleanly or not.
Key Words:
Epidermoid cyst, lateral intraventricular, prognosis, surger
Immediate Pain Relief in Patients of Trigeminal Neuralgia After Microvascular Decompression (MVD)
Full text linkObjectives: The study was conducted to observe the pattern of pain relief and analyze the influence of demographic factors and co-morbidities in patients undergoing microvascular decompression for trigeminal neuralgia.
Materials and Methods: This prospective observational study conducted from July 2020 to July 2023 included 50 diagnosed cases of trigeminal neuralgia scheduled for MVD. Data homogenization, including detailed demographics at our institution, preoperative data including American Society of Anaesthesiologists (ASA) status, and Charlson comorbidity index, rigorously documented surgical parameters, The study design was structured follow-ups at 1, 6, and 12 months.
Results: Early postoperative outcome revealed 60% complete pain relief, 30% partial relief, and 10% no relief. Age was a significant correlate of outcomes, reinforcing the need for age-sensitive interventions. Nuances of the surgery, especially revision MVD, were associated with increased recurrence rates, emphasizing the need for precision. This study identifies preoperative variables that may affect long-term relief, well known factors in the literature (including multiple sclerosis) correlate with lower rates of relief and diagnostic tissue confirmation, which underscores the need for individualized metrics and longer-term follow-up in studies.
Conclusions: The data presented offers important information for furthering the knowledge of the clinical outcomes when undergoing MVD, highlighting the need for accurate objective measures in surgical assessments. The correlations identified provide routes to improving protocols and inform the precision of pain relief in patients with trigeminal neuralgia
Current Concepts in Cranioplasty: Indications, Materials, Surgical Techniques, and Complications
Full text linkObjective: This study evaluates the clinical outcomes, materials used, and complications associated with cranioplasty thus providing a comprehensive analysis based on patient’s data.
Materials and Methods: This retrospective observational study was conducted at Ali Institute of Neurosciences, Irfan General Hospital, Peshawar from November 2023 to December 2024. A total of 55 patients who underwent cranioplasty were included in the study. The study analyzed patient demographics, indications, material selection, surgical techniques, and postoperative complications.
Results: The most common indication for cranioplasty was post-traumatic defects (63.6%), followed by decompressive craniectomy (25.4%), tumor resection (5.5%), and infection-related bone flap removal (5.5%). The materials used included polyetheretherketone (PEEK) (34.5%), bone cement (30.9%) titanium mesh (18.2%), and acrylic mesh (16.4%). Postoperative infections occurred in 7% of patients and were successfully managed with antibiotics or revision surgery. No cases of implant rejection or resorption were observed.
Conclusion: Cranioplasty plays a crucial role in restoring cranial integrity improving neurological and aesthetic outcomes. Advances in biomaterials particularly PEEK, have enhanced procedural success in our study. While the surgery remains essential for functional and cosmetic rehabilitation optimizing material selection and infection prevention strategies can further improve patient outcomes
Functional Outcomes After Surgery for Acute Subdural Hematoma: A Comparison Between Decompressive Craniectomy Versus Craniotomy in Post-Traumatic Patients
Full text linkFunctional Outcomes After Surgery for Acute Subdural Hematoma: A Comparison Between Decompressive Craniectomy Versus Craniotomy in Post-Traumatic Patient
Functional Outcome of Chronic Subdural Hemorrhage on Glasgow Comatose Outcome Scale Extended
Full text linkObjectives: Chronic Subdural hemorrhage is one of the most common neurosurgical disorders, mainly affecting the older population. The main objective is to assess the functional outcome of patients with Chronic Subdural hematoma on GCOSE.
Materials and Methods: This is a prospective cross-sectional study conducted at Liaquat University Hospital Hyderabad with a duration of January to December 2023. Patients presented with CSDH and different management was performed at the time of discharge or death GCOSE scale was recorded on a predesigned questionnaire.
Results: A total of 63 patients were included in the study, the mean age was 58.26, of which 69.8% were males, the most common presentation was One-sided weakness 58.9%, followed by the altered level of consciousness 57.3%. The mean pre and postoperative GCS was 10.98 and 11.87 respectively. Most of the patients had unilateral collection 89% with a few having bilateral CSDH 11%. The outcome GCOSE was such that 50% of the patients were found in grade VIII i.e. upper good recovery, all the patients that underwent through and through drainage had the best outcome with a p-value of 0.001, however, 22% of the patients were found in grade I (dead).
Conclusion: The functional outcome of Chronic subdural hematoma is best delineated with GCOSE as compared to the modified ranking scale and GOS.
Keywords: CSDH, functional outcome, GCS, GCOSE, head trauma, Glasgow outcome scale, Glasgow outcome scale extended, modified ranking scale