Pakistan Journal Of Neurological Surgery
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Comparison of the Efficacy of Oral and Local Steroids in the Management of Carpal Tunnel Syndrome
Get PDFObjective: This research was conducted to compare the efficacy of oral steroids with local steroid injection in the carpal tunnel as regards relieving the symptoms and improvement in neurophysiological parameters.
Materials and Methods: This study was performed at the Neurology Department, Punjab Institute of Neurosciences, Lahore. 72 patients were part of the study and divided into 2 groups; Group A (oral steroids) and B (steroid injection). Patients in Group A received a local injection of 1.5cc Normal Saline and oral prednisolone (20 mg once daily for two weeks, followed by 10 mg once daily for the next two weeks), whereas those in Group B received a local injection of 15 mg triamcinolone and an oral placebo for four weeks. The outcome was assessed using the Global Symptom Score.
Results: The average age of the patients involved in the study was 47 years. There were 33(46%) males and 39(54%) females. The mean Global Symptom Score for group A was 28.9 at baseline (0 week) and 23.5 at 4 weeks. In group B, it was found to be 27.1 at 0 week and 16.05 at 4 weeks. Independent T-test for comparing groups A and B showed a non-significant p-value at 0 week and significant at 4 weeks (p-value of 0.04).
Conclusion: The study concluded that local injection of steroids (triamcinolone) is more efficacious in improving carpal tunnel syndrome symptoms as compared to patients receiving oral steroids
Transpedicular Fixation for the Alleviation of Neurogenic Claudication and Backache in the Management of Spondylolisthesis
Get PDFABSTRACT
Objective: To evaluate the surgical outcome of transpedicular fixation for degenerative spondylolisthesis in terms of alleviation of neurogenic claudication and backache
Materials & Methods: This prospective observational study was carried out at the department of Neurosurgery, Medical Teaching Institute, Bacha Khan Medical Complex, Swabi over a period of two years i.e. from 1st July, 2021 to 30th June, 2023. Patients presenting with backache and neurogenic claudication and having spondylolisthesis on radiological investigations were subjected to transpedicular fixation and evaluated for improvement in symptoms and fusion rate at 6 months follow up.
Results: 60 patients participated in the study. Mean age was 41.42±7.29 years and 63.3% were females. L5-S1 was the most common level involved in 40% of the patients and 50% of the patients had Grade 2 spondylolisthesis. There was significant reduction in mean back-pain score on NRS post-operatively (Pre-op was 6.73±1.94 Vs. post-op was 1.57±1.34, P value = 0.00). The neurogenic claudication reduced from 88.3% Vs. 10% (P value = 0.00). The fusion rate was 90% at 6 month follow up.
Conclusion: Transpedicular fixation for degenerative spondylolisthesis is the most effective procedure in terms of relief of neurogenic claudication and backache
The Prevalence of Post-operative Complications Following Meningomyelocele Repair
Get PDFObjective: To assess the incidence of post-operative complications after meningomyelocele repair in patients presenting with Meningocele.
Materials & Methods: All the patients presenting with meningocele and myelomeningocele, age between 1 day to 5 years, both genders and patients with ASA grade I and II were included. All the baseline /routine hospital investigation was done, the lesions were assessed for age, size duration of symptoms, and location and were checked for cerebrospinal fluid leaks. The presence of associated abnormalities was evaluated. The patients were given antibiotics as per protocol before and after surgery to prevent infection. All patients were observed closely in the post-operative period for development and timely management of any complications.
Results: Among 145 children, 9% of children had defects in the cranio cervical and 91% of children had defects in the lumbosacral. 15% children had myelomeningocele size ?3 cm while 85% of children had myelomeningocele size >3 cm. 83% of children were male and 17% of children were female. 18% of children had wound infection, 6% of children had wound dehiscence and 26% of children had CSF Leak. Stratification of postoperative complications concerning age, gender, location of NTD (cranio cervical/lumbo sacral), size (? 3 cm & > 3 cm), duration of symptoms (? 1 month & 1 month), malnourished (yes/no) showed the insignificant differences.
Conclusion: The frequency of post-operative complications i.e. wound infection was 18%, wound dehiscence was 6% and CSF Leak was 26% after meningomyelocele repair in patients presenting with Meningocele
Patients Experiencing Cerebrospinal Fluid Leak After Undergoing Elective Posterior Fossa Surgery
Get PDFObjective: This descriptive case series anticipated to explore the occurrence and related factors of CSF leaks in patients undergoing elective posterior fossa surgery, highlighting on identifying possible risk factors and exploring treatment modalities.
<Materials & Methods: Included 97 patients undergoing elective posterior cranial fossa surgery at Lady Reading Hospital, Peshawar, from July 2021 and January 2022. Thorough patient demographics, surgical indications, and outcomes were precisely documented and investigated.
Results: 70 patients experienced symptoms for one month or fewer, whereas 27 patients underwent symptoms for longer durations, emphasizing a predominant manifestation of short-term symptoms. 43 patients had a BMI of 27 Kg/m2 or less, even though 54 patients had a BMI exceeding 27 Kg/m2. With reference to patients with diabetes mellitus, 17 patients were diabetic, with the bulk, comprising 80 patients, being non-diabetic. 20 patients were hypertensive, while 77 patients were non-hypertensive. 46 patients were diagnosed with hydrocephalus, while 51 patients showed symptoms related to loss of consciousness. The study established that 15% of patients experienced CSF leaks postoperatively, with males including a greater proportion of affected individuals. Conclusion: The results highlight the significance of comprehensive preoperative assessments and surgical techniques to minimize the risk of CSF leakage. Whereas conservative methods such as re-suturing the wound and CSF lumbar drainage were first employed, surgical repair became compulsory in some cases. This exploration offers a valuable understanding of the incidence and management of CSF leaks succeeding posterior fossa surgery, proposing guidance for healthcare professionals in elevating patient outcomes
Patterns and Rates of Early Complications in Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus
Get PDFObjective: To evaluate the frequency and pattern of early complications of endoscopic third ventriculostomy in patients with obstructive hydrocephalus.
Materials and Methods: This descriptive case series was conducted at the Department of Neurosurgery, MTI/Lady Reading Hospital, Peshawar, involving patients diagnosed with obstructive hydrocephalus who underwent third endoscopic ventriculostomy under general anesthesia, followed by a seven-day monitoring period for complications such as wound infection, CSF leak, seizures, and meningitis.
Results: A total of 127 patients were enrolled. The patients' ages varied from 6 months to sixty years. The mean age of the patients was 36.41 ± 9.36 years. Male to female ratio was 2.4:1. Overall complications were observed in 20 patients (15.7%). The most common complication was a CSF leak observed in 07 patients (5.5%), followed by wound infection in 05 patients (3.9%), meningitis and seizures were reported in 4 patients (3.1%) each.
Conclusion: In terms of complications, endoscopic third ventriculostomy is a safe procedure with a lower complication rate. The CSF leak was the most common reported complication
Modified Nakaguchi Classification: Is it a New Way to Measure Outcome of Chronic Subrural Hematoma through GCOSE?
Get PDFObjective: The ? value of the Modified Nakaguchi classification is 0.78, the highest from other available classification systems for CSDH. The main objective of this study was to evaluate the outcome of CSDH concerning the type of CSDH according to the modified Nakaguchi classification.
Material and Methods: It is a single cohort study conducted at Liaquat University Hospital Hyderabad and Jamshoro in the Neurosurgical Department. The patient's known case of chronic subdural hematoma was included in the study after evaluation of inclusion and exclusion criteria and variables like type of CSDH and GCS and GCOSE on discharge were noted on the pre-designed Questionnaire.
Results: A total number of 63 patients were included in the study, with 69.8% being male and 30.2% female, and the overall mean age was 58.3 years. The most common presentation according to the Modified Nakaguchi Classification was Hypo-dense (30%) and Graded (27%) type. The mean pre-operative GCS was 10.98 and the post-operative GCS mean was 12.87 with a significance of 0.001. A total of 50.8% of patients had upper good recovery on Discharge GCOSE out of which 28.13% of Hypodense and Graded type. Total mortality was 22.2% out of which 28.6% was hypodense and Graded type respectively. The recurrence of CSDH was 11.1% and the most common type was Hypodense (57%).
Conclusion: The Modified Nakaguchi Classification doesn’t define the outcome significantly, however, the surgical intervention related to its specific type is significantly associated with the outcome of the patient on the Glasgow coma outcome scale extended
Comparative Study of Post-Operative Functional Outcomes of Open Carpal tunnel Release vs. Arthroscopic Carpal tunnel Release
Get PDFObjective: This study aimed to compare treatment modalities OCTR and ACTR in treating carpel tunnel syndrome. This study assesses the important key indicators including symptom severity, functional status, pain intensity, time of recovery, and rate of complications.
Methods: 80 patients presented in the hospital diagnosed with moderate to severe CTS were included over one year. Both surgical groups were assigned 40 patients and data was collected using the pre-operation and post-operation assessments utilizing the Shoulder and Hand Score, Disabilities of Arm, Visual Analog Scale for pain, Boston Carpel Tunnel Questionnaire, grip strength recovery, time taken to work again and incidence of complications.
Results: DASH Score: At six months post-surgery, the mean DASH score for ACTR (21.85) was slightly better than OCTR (23.91). BCTQ Scores: ACTR had better outcomes in both the symptom severity (mean 1.99 vs. 2.21) and functional status (mean 2.29 vs. 2.54). Pain Levels: Patients undergoing ACTR reported lower pain levels (VAS mean 2.65 vs. 2.92). Grip Strength Recovery: ACTR showed a significant advantage with patients regaining 89.07% of baseline grip strength compared to 84.60% for OCTR. Recovery Time: ACTR patients returned to work sooner (mean 39.28 days) compared to OCTR (mean 45.55 days), and ACTR exhibited a lower complication rate (7.46% vs. 9.53%).
Conclusion: Both OCTR and ACTR are highly effective surgical techniques for CTS treatment, offering significant symptom relief and functional recovery. While ACTR consistently demonstrated better benefit
Pattern of Traumatic Brain Injuries and Their Frequencies in Motorcyclists
Get PDFObjective: To identify different patterns of Traumatic Brain Injury (TBI) and their frequencies among motorcyclists presenting to our Neurotrauma unit.
Material and Methods: This cross-sectional study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. A total of 156 patients were enrolled. An elaborate history was taken from all patients after initial stabilization. Baseline investigations and radiological work-ups, including CT scans of the brain, were performed to identify the pattern of injuries. Patients were followed up until discharge to monitor improvement in TBI.
Results: Out of 156 patients, 90.4% (n=141) were males with an average age of 33.3±9.39 years and 9.6% (n=15) were females with an average age of 34.0±10.4 years. The severity of TBI was categorized as mild in 53.2%, moderate in 32.1%, and severe in 14.7% of cases. The most common patterns of TBI observed were contusions (42.3%), extradural hematomas (23.1%), cranial fractures (10.3%), intracerebral bleeds (7.7%), subdural hematomas (7.1%), traumatic subarachnoid hemorrhages (6.4%), and other TBI patterns (3.2%).
Conclusion: The study concluded that different patterns of TBI exist among motorcyclists. It is recommended that preventative measures such as helmet use be enforced to reduce the occurrence of such injurie
Frequency and Clinical Presentation of Spina Bifida at Liaquat University Hospital
Get PDFObjective: The study was conducted to observe the clinical presentation and variation of Spina Bifida in the study population.
Materials & Methods: This retrospective study analyzed the prevalence and clinical presentation of Spina Bifida among surgical patients, in which 172 cases admitted via OPD were included. Data collected covered demographics and clinical details, including age, gender, cousin marriage, region, type of Spina Bifida (meningocele or meningomyelocele), hydrocephalus association, and defect width were diagnosed by MRI lumber spine and CT scan brain which was done in all patients.
Results: Over three years, a total of 1,756 elective surgeries were performed, with 172 cases identified as Spina Bifida, representing approximately 9.8% of the total surgeries conducted. Sub-classification of Spina Bifida cases delineated 166 (96%) cases as Spina Aperta and 6 (4%). Predominantly featured myelomeningocele (MMCs), comprising approximately 81% of the aperta cases. Further stratification of MMCs based on size revealed varying proportions, with approximately 64 (37%) less than 3*3cm, 76 (44%) between 3*3cm and 5*5cm, and 32 (19%) exceeding 5*5cm, indicating a spectrum of severity within this subset of cases. Anatomical distribution delineated the majority of Spina Bifida cases (approximately 95.9%) located in the lumbar region, with fewer occurrences observed in the dorsal (2.9%) and cervical (1.2%) regions.
Conclusion: These findings underscore the multifaceted nature of Spina Bifida, encompassing diverse clinical presentations, anatomical variations, and associated anomalies, necessitating a comprehensive and multidisciplinary approach to management tailored to the individualized needs of patients
Improved Outcomes in the First 72 Days of Medical Management of Cerebral Abscess in Post-Traumatic Patients
Get PDFObjective: We studied the results of medical and surgical management of cerebral abscesses in post-traumatic patients after road traffic accidents (RTA).
Material and Methods: It is a comparative observational study of 40 patients in Lahore General Hospital/Punjab Institute of Neurosciences (PINS), Lahore. Our patients were presented with fever, vomiting, headache, fits, etc.
Results: The age range of our patients was 15-60 years. The mean age of our patients was 40 years, we gave medical management along with bed rest to all 40 patients (100%) for 3 weeks. Anti-epileptic, mannitol, antibiotics, and painkillers were the medication that was given. Our 30 (75%) patients who were managed medically, had headaches, and vomiting which did not resolve for we had to operate on the patients. Surgical management was done in 10 (25%) patients. Surgical excision was done in 9 (97%) patients and burr hole evacuation was done in 1 (3%) patients. All patients who recovered from medical management are those who were treated within 1st week after the occurrence of cerebral abscess.
Conclusion: The results of medical management of cerebral abscess are better than surgical management if patients are treated during the first week after the occurrence of cerebral abscess. With good antibiotics etc