Pakistan Journal Of Neurological Surgery
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EGFR-1 Expression in Meningioma: Insights into Gender Distribution and Grade
Get PDFObjective: Meningioma is the most common primary brain. Histopathological grading (from I to III) is essential for prognostication and therapeutic decisions. EGFR-1 overexpression has been implicated in tumor progression and poor outcomes in various cancers. However, its role in meningioma pathophysiology and gender disparities remains unclear. This study aimed to determine the expression of EGFR-1 in grade I and grade II meningioma and explore associations with clinicopathological parameters.
Materials & Methods: This cross-sectional study was conducted at Ayub Teaching Hospital in collaboration with the Neurosurgery Department, Histopathology Laboratory of Ayub Medical College, and Health Diagnostic Laboratory. Non-probability consecutive sampling technique was used to include meningioma patients aged 23-54 years after obtaining ethical approval. Data was collected from medical records, and histopathological examination and immunohistochemical analysis were performed on meningioma tissue samples. Statistical analysis was conducted using SPSS Version 25, and associations between clinicopathological parameters and EGFR-1 expression were evaluated using appropriate tests.
Results: We included 39 meningioma patients, with a female predominance of 22 (56.4%). The majority had grade I tumors (89.7%). EGFR-1 expression was observed as severe 30 (76.9%), moderate 7 (17.9%), and mild 2 (5.1%). No significant association was found between gender and meningioma grade or EGFR-1 expression. However, a significant association was observed between meningioma grade and EGFR-1 expression in grade I tumors (p = 0.049), but not in grade II tumors (p = 0.248).
Conclusions: A significant correlation between meningioma grade and EGFR-1 expression in Grade I meningioma suggests that EGFR expression could serve as a prognostic biomarker
PAC System for Radiographic Comparison of Standing and Supine Lateral Views in Patients with Low-Grade Spondylolisthesis
Get PDFObjective: Supine views may not adequately depict low-degree spondylolisthesis, thereby confusing surgeons in deciding the best therapy plan. The study aimed to compare the standing vs. supine radiographs for the radiological parameters.
Materials and Methods: A retrospective investigation was conducted on the standing and supine lateral radiographs of 73 patients with graduation I and II spondylolisthesis at the orthopedic Outdoor patient department. The measurements included lumbar lordosis angle, sacral inclination, slip angle, disc slip, and disc height, which were obtained from the PACS.
Results: Mean age was 47.28 years with 41% male and 58.9% females. Prevalence showed 46.57% having L4, 5 level involvement and 53.4% having L5, S1 level involvement in spondylolisthesis. The degree of lumbar lordosis turned out to be 41.7 upon standing while it was 34.39 degrees upon supine position. The size of the disc slip was 0.85cm and 0.74 cm in standing and supine positions respectively. Standing sacral inclination was 45.5 degrees and 40.51 degrees in supine. The slip angle was higher in standing (4.5 degrees) versus 3.97 degrees in the supine position. Disc heights were nearly the same in standing or supine (1.2 cm vs. 1.1 cm) positions. There existed a significant difference between standing vs. supine positions for the following: lumbar lordosis, disc slip, sacral inclination, and slip angle.
Conclusion: Supine views may not accurately show important radiological findings, affecting the choice of treatment. Surgeons may use these findings to make informed decisions about the best treatment plan
The Comparison of Outcome of Ventriculoperitoneal Shunts vs. Endoscopic Third Ventriculostomy in Patients with Idiopathic Normal Pressure Hydrocephalus
Get PDFObjective: To compare functional outcomes in terms of INPGHS score and overall improvement in patients of iNPH treated with ETV vs. VP shunting.
Materials & Methods: A Randomized control trial was conducted for 6 months at the Department of Neurosurgery, Rawalpindi Medical University and Allied Hospitals, Rawalpindi. 62 patients (31 in each group) were enrolled & allocated into two groups. In group A patients ETV was done and in group B VP shunting. Post-operatively, Patients were followed up for 1 month.
Results: The mean age of the patients in the ETV & VP shunting groups was 63.19 ± 6.95 & 63 ± 6.82 years respectively. Males were 64.5% (n = 20) in both groups. Improvement was noted in 9 (29%) patients in the ETV group & 15 (48.4%) patients in the latter group (p-value = 0.118).
Conclusion: Ventriculoperitoneal shunts are superior to endoscopic third ventriculostomy in terms of functional neurological outcomes and improvement in symptoms.
Keywords: Endoscopic Third Ventriculostomy, Ventriculoperitoneal Shunt, Idiopathic Normal Pressure Hydrocephalus Grading Scale (iNPHGS), Aqueductal CSF Stroke Volume (ACSV)
Metallic Foreign Body in the Neck – a Rare Incidence
Get PDFPenetrating injuries of the neck comprise upto 10% of all cases of trauma.We report the case of a 19 years old female who was admitted in Neurosurgery department of Lahore General Hospital with complaints of upper and mid back pain for 3 weeks, numbness of legs, abdomen and chest for 2 weeks and weakness of legs for 10 days. There was no preceeding history of trauma, major surgery or systemic illness. Her neurological examination suggested upper motor neuron signs in both lower limbs. She underwent a series of extensive investigations to rule out the differential diagnosis of myelitis, arteriovenous malformation and caries spine. In parallel to ongoing investigations, she received symptomatic treatment and empirical antituberculous therapy. Her MRI report showed a photon deficient area at the level of T1, which was also seen in chest Xray but was overlooked as artefact. Later on it was found to be a stray bullet which was causing the symptoms
incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital
Get PDFObjective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment.
Materials & Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &dislocations), ligamentous injuries & SCIWORA. The primary outcome was the functional status at 6 months following treatment.
Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery.
Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality
Re-Operation Rates after Burr-Hole Aspiration of Brain Abscess
Get PDFObjectives: To determine the re-operation rates after burr-hole aspiration of brain abscess.
Materials & Methods: The cross-sectional study was conducted from August 2022 to January 2023 at Jinnah Postgraduate Medical Centre (JPMC). A single burr-hole aspiration was used to treat a total of 64 cerebral abscess patients. Demographics, clinical presentation, predisposing variables, abscess location on imaging, and clinical outcomes were examined in medical records.
Results: The study included 64 patients with 60.9% males and 39.1% females. Patients most commonly presented with headache (90.6%) and fever (81.2%) with the majority of patients (92.1%) aged less than 30 years. The commonest source of infection was congenital heart disease (29.6%) in both aspiration and re-aspirations (46.6%). The parietal region was the most common location in both aspiration (32.8%) and re-aspiration (40%) of abscesses with the majority (40%) of re-aspirations done in the 3rd postoperative month.
Conclusion: Single burr-hole aspiration is a safe and effective method for the management of brain abscesses. It is a less invasive procedure and is associated with minimal complications. The learning curve is short and safely be performed by neurosurgeons in training.
Keywords: Brain abscess, Burr-hole aspiration, Re-aspiration, Infection, Meningitis
Impact of Intracranial Pressure-Monitored Therapy on Mortality in Patients with Severe Traumatic Brain Injury
Get PDFObjective: To assess the impact of intracranial pressure (ICP) monitored therapy on mortality in patients with severe traumatic brain injury.
Materials and Methods: A randomized controlled trial was conducted at the Department of Neurosurgery, Jinnah Hospital Lahore. Forty patients of both genders, aged between 15 to 60 years were randomly selected and divided into two groups (Control & Experimental). Patients injured within 24 hours with a Glasgow Coma Scale (GCS) of 8 or less and showing radiological evidence of raised intracranial pressure were included. Patients with extradural hematoma, penetrating injury, or those requiring any surgery were excluded from the study. Data were analyzed using SPSS version 20.
Results: No significant difference was found in mean age and gender among the two groups. The GCS of the control group was 6.2 ± 1.6 while that of the experimental group was 6.7 ± 1.6. The mean of the maximum ICP of the experimental group was 25.31 ± 8.48 mm of Hg. There was a significant difference in the mean duration of ventilation between the two groups. In the control group, 10 (50.0%) patients expired whereas in the experimental group, 8 (40.0%) patients expired. The proportion of mortality was higher in the control group but the difference was not statistically significant between the two groups (P value: 0.525).
Conclusion: Intracranial pressure-monitored therapy was effective but statistically showed no significant superiority over unmonitored management. 
Computational biomarkers for the decision of neurosurgical treatment for brain tumors
Get PDFComputational biomarkers are a promising area of research for the decision of neurosurgical treatment for brain tumors. These biomarkers can help to predict the biological behavior of tumors, such as their growth rate, invasiveness, and response to treatment. Computational biomarkers can play an important role in the decision-making process for the neurosurgical treatment of brain tumors. These biomarkers provide quantitative and objective measures of tumor characteristics that can help inform the choice of treatment and predict patient outcomes
Microvascular Decompression in Trigeminal Neuralgia: Analysis of the Effectiveness of the Surgical Technique and Intraoperative Neuroanatomy-7 Years of Institutional Experience
Get PDFObjective: The study analyzed the effectiveness of microvascular decompression based on BNI score improvement and interpret the anatomy of offending vessels.
Materials and Methods: A total of 57 patients were included in the study. Data was collected and analyzed for age and gender distribution, the severity of pain, affected division of trigeminal nerve, duration of symptoms, type of petrosal vein, offending vessel, pre-op BNI score, one month & one-year post-op BNI score and major & minor complications of the procedure.
Results: The most common indication for patients to undergo microvascular decompression was side effects of pharmacological treatment, i.e., 36.8%.The most common combination of affected divisions involved was V1 & V2, i.e., 26.3%. BNI score was evaluated 24 hours after surgery and it was observed that 56 (98.2%) patients had a BNI Score of 1. After one year, 46 (80.7%) patients had a BNI Score of 1. So, an effective outcome of microvascular decompression was observed in 80.7% of patients. The most common offending vessel was arterial compression, i.e., 47 (82.4%). Among them, a superior cerebellar artery was found in 40 (85.1%) patients and an anterior inferior cerebellar artery in 7 (14.8%) patients.
Conclusions: Microvascular decompression is a safe and effective procedure for classical trigeminal neuralgia and arterial compression is found in the majority of patients. The BNI score is an effective tool for assessing and categorizing the patient's pre and postoperatively.
Keywords: Trigeminal neuralgia (TGN), Microvascular decompression (MVD), Barrow Neurological Institute (BNI) pain score, Cerebellopontine (CP) angle