Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Comparative Analysis of Percutaneous Full Endoscopic Discectomy and Microdiscectomy in the Management of Lumbar Disc Herniation
Get PDFObjective: Percutaneous Full Endoscopic Discectomy and Microdiscectomy are two of the least invasive surgical procedures used in the management of lumber disc herniation. This study aimed to evaluate the clinical outcomes of percutaneous full endoscopic discectomy and microdiscectomy in the management of lumber disc herniation.
Materials and Methods: This retrospective study spanned two years. Patients with the diagnosis of lumbar disc herniation confirmed by clinical symptoms and imaging studies undergoing PFED or MD were included. The primary outcome measures included pain relief, assessed using the Visual Analog Scale (VAS), and functional improvement, and measured using the Oswestry Disability Index (ODI). Secondary outcome measures included the occurrence of surgical complications and length of hospital stay.
Results: This retrospective analysis included 480 participants in the study, with 247 patients undergoing Percutaneous Full Endoscopic Discectomy (PFED) and 233 patients undergoing Microdiscectomy (MD). In the PFED group, patients experienced an average mean reduction in leg pain score of 6.97 ±1.96 on the Visual Analog Scale (VAS) as compared to microdiscectomy (4.95 ± 2.45).
Conclusion: Our study concluded that both percutaneous full endoscopic discectomy and microdiscectomy are safe and efficient surgical techniques in the management of lumber disc herniation. However, PELD showed several possible benefits, such as quicker recovery and earlier LBP reductions, improvement in bowel and bladder symptoms along earlier return to work
Complications following Pediatric Posterior Fossa Tumors Surgery
Get PDFObjective: The goal of this study was to identify complications postoperatively occurring after posterior fossa tumor surgery in the pediatric population.
Methods: A retrospective review of cases of children under 15 years who underwent surgery for Posterior fossa tumors was conducted. Documented complications arising in the postoperative phase, in-hospital mortality rates, their management, and the patient’s general well-being were tracked till discharge. Complications were categorized based on a contracted version of the original Clavien-Dindo system, a system that was specifically designed for ranking the severity of surgical complications.
Results: 64.5% of males and 35.4% of females have a mean age of 9.22 ± 1.7 years. Between the onset of symptoms and the diagnosis, the average duration of time was 42.3 ± 12.8 days. The number of medulloblastoma cases was 19 and 11 cases each of ependymoma and pilocytic astrocytoma. Overall, the mean duration of stay was 8.1 ± 3.9 days. Hydrocephalous and CSF leaks from incision sites were the most frequent postop compilations, accounting for 58.3% of all the complications. Other complications reported were wound site infections in 12.5% of cases, peri-tumor edema in 16.6%, cerebellar mutism in 10.41%, tumor bed bleeds in 6.2%, and hospital-acquired pneumonia in 5.3% of cases.
Conclusion: The development of hydrocephalus and cerebrospinal fluid leaks were the most frequent complications, followed by peri-tumor edema, tumor bed hematoma, cerebellar mutism, oropharyngeal apraxia, also systemic complications including sepsis, postoperative pneumonia, and meningitis
Comparison of Transpedicular Fixation with Fusion with Transpedicular Fixation Alone in Spondylolisthesis
Get PDFObjective: This research evaluated the clinical outcomes of two surgical methods used to treat degenerative lumbar spondylolisthesis in the short term. Fixation through the pedicles with or without inter-body fusion. Utilizing a spinal cage for first- and second-degree condition patients is one of the two methods being compared.
Materials & Methods: A total of 28 individual lumbosacral spondylolisthesis were incorporated in the research. Based on the surgical method and fixation technique employed for their care, they were split into two groups at random. Posterolateral intertransverse bone fusion, transpedicular screw fixation, and posterior lumbar decompression operations were performed on Group A. Conversely, Group B underwent posterolateral interbody fusion via the implantation of interbody cages, transpedicular screws, and posterior decompression.
Results: There existed no statistically significant association in terms of the two groups that is intraoperative and postoperative complications, clinical outcomes, and patient satisfaction, while noteworthy significance was observed about blood loss and rates of post-operative fusion.
Conclusion: Incorporating a spinal implant in conjunction with transverse body fusion results in superior fusion rates and post-operative clinical improvements, while intertransverse bony fusion alone yields comparable patient satisfaction with reduced surgical times
Analyzing Spondylolisthesis in Patients with Proven Spinal Stenosis Using Plain X-Rays and Supine MRI: A Retrospective Study of Five Years
Get PDFObjective: This study aimed to evaluate the frequency of cases in which patients were diagnosed with lumber spinal stenosis using MRI and later were categorized as having spondylolisthesis when evaluated through plain X-rays.
Material and Methods: This retrospective study was conducted at the Ali Institute of Neurosciences, Irfan General Hospital from 2017 to 2022. All those patients were included in the study who underwent lumbar spine MRI between 2017 and 2022 with evident findings of spinal stenosis, patients who subsequently underwent plain X-rays of the lumbar spine, and patients with available medical records and imaging data for review. While all those were excluded who did not undergo plain X-rays following MRI. Data was analyzed using SPSS version 22. Descriptive statistics, such as frequencies and percentages, were used to summarize the categorical data while mean and standard deviation were reported for numerical data.
Results: The mean age of the study population was 45 years, with a range from 26 to 65. Among the patients included in the study (1156), 380 were the cases missed initially on MRI and later diagnosed with spondylolisthesis on plain X-rays. This corresponds to a frequency of 33% of misdiagnosed spondylolisthesis cases based on MRI.
Conclusion: This study highlights that the frequency of missed spondylolisthesis cases on lumbar spine MRI was one-third of the cases and the importance of additional imaging modalities, such as plain X-rays, for accurate diagnosis
Computed Tomography Findings of Traumatic Brain Injury and its Assessment in a Teaching Hospital
Get PDFThe objective of the study was to evaluate the frequency and findings of traumatic brain injury on computed tomography in Tertiary Care Teaching Hospital, Mardan Medical Complex.
Materials & Methods: A prospective cross-sectional study from March 2023 to February 2024 was done in Mardan Medical Complex (MMC), Mardan. Non-probability convenience sampling technique was used with a sample size of 680. Data collection was done from the Radiology and Emergency departments with consent taken. Data descriptive statistical analysis was done through SPSS version 22.
Results: A total of 680 patients were scanned including 471(69.26%) males and 209(30.74%) females. The frequency (389) (57.20%) of traumatic brain injury was high in age group 1-19 and least (60) (8.82%) in age group >60. CT brain scan findings revealed 397(58.39%) normal and 283(41.62%) abnormal patients. In abnormal patients, the most common findings on CT were intra-axial hemorrhage 117(41.36%). The most common mode of injury was RTA 326(47.94%) followed by HOF 212(31.18%).
Conclusion: The study showed that in traumatic brain injury, the majority of the subjects were male as compared to female and the most common mode of injury was road traffic accidents followed by falls from height. The findings of intra-axial hemorrhage were the highest in all traumatic brain injurie
Quality of Life, Psychological Stress, and Cognitive Decline Post-Ruptured Anterior Communicating Artery Aneurysm Endovascular Treatment
Get PDFObjective: The study assessed depression, quality of life, and cognitive function in patients who underwent coiling for anterior communicating artery aneurysm rupture.
Methods: A retrospective sample of patients with ruptured anterior communicating artery aneurysms treated at our facility were enrolled from the timeframe of August 2018 and October 2021. This research includes 60 individuals who had coil treatment in total. They all finished the QoL and cognitive follow-up surveys. The core aim of the questionnaire was to evaluate each participant's cognitive impairments and depressive symptoms. To determine baseline clinical state, retrospective reviews of patient charts were conducted along with demographics, postoperative course, and specifics of endovascular coiling.
Results: There were 22 females and 38 males. The presentation lasted anything from six months to three years, with most of it taking place in a single year. Of those who experienced post-coiling neurological impairments, 27% had none, and 73% had none. While 38% had no symptoms, 21% had mild depression, 20% had moderate depression, and 21% had severe depression symptoms. 62% of patients experienced depressive symptoms and a decline in cognition following therapy for ruptured ACoA aneurysms.
Conclusion: Following therapy for ruptured AComA aneurysms, 62% of patients experienced cognitive deficits and depressive symptoms. The difficulties specific to aneurysms associated with AComA that result from injury to anterior brain areas such as the striatum, ventromedial prefrontal (orbitofrontal) cortex, or frontal cortex may be the source of these symptoms
Effectiveness of Endoscopic Third Ventriculostomy Versus Ventriculo-Peritoneal Shunt in Obstructive Hydrocephalus
Get PDFObjective: To analyze the effectiveness of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal (VP) shunt for the surgical management of obstructive hydrocephalus.
Material and Methods: The comparative cross-sectional study was conducted in the Neurosurgery department of Lady Reading Hospital, MTI Peshawar. The duration of the study was 4 years, i.e.; August 2019 to July 2023. All the patients diagnosed as obstructive hydrocephalus because of posterior fossa tumor, aqueductal stenosis, already shunted, and tectal and non-tectal tumors were in the inclusion criteria, while patients with post-infectious hydrocephalus, congenital hydrocephalus including intra-ventricular hemorrhage and with acute hydrocephalus presenting to the emergency department were in the exclusion criteria. Analysis of the data was done by using statistical software SPSS.
Results: There were a total of 302 patients in the study, which were divided into 2 groups; 155 patients had undergone ETY, while 147 patients had VP shunt. Successful results in the case of ETV were 71%, while in VP shunt was 66%. The complication rate was 10.32% in ETV, while 14.96% in the VP shunt group.
Conclusion: ETV is the better substitute for VP shunt as it’s effective, with less complication rate, an economical, safe, and successful procedure in the surgical management of patients suffering from obstructive hydrocephalus
Outcome Difference between Traumatic and Spontaneous Chronic subdural hematoma
Get PDFObjective: To evaluate the effect of traumatic or spontaneous etiology on outcome of CSDH patients
Material and methods: It is retrospect case control study and was conducted in Liaquat University hospital. The duration of study was 1st Jan 2023 to 1stJan 2024. The patient that was included in study was divide into two groups either spontaneous or old history of trauma less than 3 months. The Pre-operative and post-operative GCS were noted. The post-operative (on discharge) GOSE were noted.
Results: Total numbers of 32 patients with 16 in single group were included, the mean age was 60, out of which 65.6% were males. . After surgery, the mean GCS in spontaneous group was 9.62 and 12.81 in traumatic group (p-0.020). The post-operative GOSE in spontaneous group was mostly Grade I (Dead, 56.2%) and Grade VIII (upper good recovery, 62.5%) in traumatic group. The effect on GOES either spontaneous or traumatic is non-significant that p- 0.051, but the spontaneous CSDH has more chances of being dead as compare to traumatic CSDH and vice versa with Odd ratio of 1.2.
Conclusion: The spontaneous etiology holds grave outcomes as compare to traumatic etiology. Both etiologies do improve the immediate Post-operative GCS but the GOES grading worsens with spontaneous etiology.
Role of Posterior Lumbar Interbody Fusion in the Management of Lumbar Instability in Low- and Middle-Income Countries
Get PDFObjective: This retrospective observational study aimed to determine the effectiveness of PLIF in the case of lumbar instability using the MacNab Criteria for functional recovery outcomes.
Materials and Methods: This retrospective observational study included a total number of 21 patients who underwent the PLIF procedure at the Ali Institute of Neuroscience, Irfan General Hospital. Using the MacNab criteria the recovery outcomes of patients were assessed with demographic data and comorbidities recorded. Descriptive statistics including mean, median, and percentages were used to analyze the data, due to the small sample size no advanced inferential statistics tests were conducted.
Results: The PLIF procedure showed great efficacy in correcting lumbar instability with 85% of patients reporting Good to Excellent recovery outcomes in terms of reduced lower back pain and lumbar instability. Leg pain has been improved in 90% of the cases while 9.5% of cases have reported delayed wound healing and foot drop. Overall, the complication rate was low with the PLIF procedure. These findings determine the effectiveness of PLIF in case of lumbar instability.
Conclusion: PLIF is a significant surgical option for the correction of lumbar instability with high efficacy and low complication rate especially in low and middle-income countries. Further research with large sample sizes is recommended to show the long-term effectiveness of PLIF and to compare its effectiveness with other fusion techniques
Non-Neoplastic Etiologies of Adult-Onset Hydrocephalus
Get PDFObjective: To analyze non-neoplastic causes of adult-onset hydrocephalus and review their associations with clinical parameters.
Materials & Methods: This is a retrospective cross-sectional study conducted at the Department of Neurosurgery of a tertiary care hospital, from 1st January 2024 to 30th June 2024. We included 89 adult patients with hydrocephalus of any cause except brain tumors. To diagnose each type of hydrocephalus, we have established primary selection criteria based on patient history and imaging results.
Results: In our analysis, meningitis was the leading cause of hydrocephalus (n=28, 31.46%), followed by subarachnoid hemorrhage (n=23, 25.84%), trauma (n=21, 23.59%), and hydrocephalus with normal pressure (n=17, 19.1%). Among the four mentioned etiologies, meningitis was more common in the fourth and fifth decade of life (12/28 patients, p = 0.166), whereas the rest of the etiologies were more prevalent in the sixth to seventh decade, highlighting a significant correlation between age and these conditions. Additionally, significant p-values also suggested a correlation between gender and etiology in this cohort. However, when comparing genders, trauma was observed more frequently among male patients while subarachnoid hemorrhage and meningitis were noted more often among female patients.
Conclusion: In our study, meningitis was the most common cause of hydrocephalus. A better understanding of non-neoplastic causes and their links to demographics will improve risk assessment and management in patients