Pakistan Journal Of Neurological Surgery
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Incidence of Ventriculoperitoneal (VP) Shunt Infection In Vancomycin-Drenched VP Shunts
Get PDFObjective: To determine the occurrence of infection in patients with VP (Ventriculoperitoneal) shunts that were drenched in vancomycin.
Materials and Methods: A descriptive case series study was done in The Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from 10 September 2019 to 31 December 2020 to ascertain the frequency of VP shunt infections in vancomycin-drenched VP shunts. The patients were followed for 06 months.
Results: A total of 100 patients were included in this study. There were 44 (44%) men and 56 (56%) women. Age ranged from birth to 18 years. Patients younger than 1 year were 44 (44%), older than 1 to 10 years were 33 (33%) and older than 10 years were 23 (23%). Congenital hydrocephalus was the most common type observed in 49 (49%) patients. Shunt infection occurred in 7 patients (7%) within 6 months after surgery. Staphylococcus aureus was the most common pathogen identified in 05 of 07 (71%) infected patients. P value <0.05 was observed in Vancomycin-soaked VP shunts and shunt infection, which is significant.
Conclusion: The rate of shunt infection was significantly reduced when 2 mg/mL topical vancomycin was used intraoperatively (intra- and peri-shunt) in conjunction with a multi-step shunt infection prevention program. This treatment may be less expensive than using an antibiotic-impregnated catheter (AIC)
Improvement and Complications after Two-Level ACDF Surgery at a Tertiary Care Facility: A Retrospective Study
Get PDFObjective: To assess immediate and long-term outcomes and complications of two-level ACDF in patients with degenerative cervical disc disease.
Materials & Methods: A retrospective study was carried out in the Department of Neurosurgery at Prime teaching hospital, Peshawar. Patients with symptoms of cervical radiculopathy and radiculomyelopathy with two-level cervical disc disease were included. Patients with trauma, single-level disease, and those who had cervical corpectomy were excluded. Age, gender, Nurick Grading, level of involvement, and post-op outcomes were recorded.
Results: 27 cases among which 18 were males and 9 females were studied. 21 patients had radiculopathy while 6 had radiculomyelopathy. The mean age was 46 years. Nurick grade was from 2 to 6. ACDF was chosen as the procedure of choice. Follow-up involved the immediate post-op period for dysphagia, hoarseness of voice, and any neurological deficit, at 6 months and one year for outcomes of pain relief, improvement in paresthesia, and spasticity.
Conclusion: ACDF is a safe and recommended procedure for 2-level cervical disc disease in terms of pain relief, paresthesia, and spasticity with acceptable complications
Stuttering As a Disability in Pakistan; Policies and Its Implementation
Get PDFObjective: Stuttering is a disorder of speech fluency not only includes academic and social consequences but also has emotional/behavioral outcomes. Stuttering leads to negative emotions and feelings i.e., low confidence, frustration, shame, embarrassment, poor self-image, and negative social identity. The present study was aimed at incorporating the definition of disability in Pakistan policy and determining the position of stuttering in it.
Materials and Methods: The nature of the current study is qualitatively conducted on 10 Participants approached through convenient sapling and exploring their responses through Thematic analysis. Participants falling in this category were recruited into the study from SLPs, Lawyers, disability advocates, and CSPs as per inclusion criteria. Common masses were excluded from the study. A Self-Developed Questionnaire/structured interviews were conducted. Questions developed by the Lawshe method. The tool was validated through content validity by 10“experts”.
Results: Thematic analysis was done and the findings of the study indicated an individual’s negative reaction towards association with any kind of disability and communication barriers are also the main source of not fitting disability as a definition. Results also showed that lack of assessment and screening tools are the main barrier, however, Visibility as per data in research publications also consider a barrier towards recognition of it.
Conclusion: The study has practical implications regarding stuttering as a Disability in Pakistan
Efficacy of Electromagnetic Based Neuronavigation-Guided Biopsy of Supratentorial Lesions of the Brain at Jinnah Hospital Lahore
Get PDFObjective: The study aims to establish the efficacy of electromagnetic-based neuro navigation-guided biopsy of supratentorial lesions (including deep-seated, multiple, and suspicious lesions) in selected patients.
Materials & Methods: After being admitted to the neurosurgery department, all patients who satisfied the inclusion criteria were recruited for the research. Patients received neuroimaging in the form of CT/MRI brain with contrast using the neuronavigation protocol, and the data was uploaded to the Medtronic neuronavigation system. Under general anesthesia, all patients had a biopsy. On the console, the surgical trajectory for the biopsy was planned. Following the AxiEM system's usual operating protocols, a Sedan needle was used to biopsy lesions after its stylet was replaced with an EM stylet.
Results: Out of 19 patients, 11 (60%) were male and 8 (40%) female while age ranged from 13 to 70 years. Out of 19 patients, 4 patients (21%) had parietal, occipital, and thalamic lesions respectively. 4 patients (21%) had low-grade glioma (grade 2) and 3 (15.7%) patients had Burkitt lymphoma, adenocarcinoma (likely from lungs), and blue cell tumor respectively. As regards complications, 2 patients (10.5%) developed hemorrhage, 1 patient (5.26%) developed postoperative cerebral edema, and 1 patient (5.26%) expired.
Conclusion: Electromagnetic neuronavigation using the biopsy needle (Sedan needle) is a safe and effective neuronavigation system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis and adequate treatment
Radiologic–Histopathologic: Correlation of Intracranial Tumors Operated in a Tertiary Care Hospital: A Prospective Study
Get PDFObjective: This study aims to Correlate the pre-operative MRI diagnosis with proven histopathological diagnosis of consecutively operated brain tumors.
Material and Methods: The study included 51 cases of brain tumors, evaluated and operated on during the 4 months study period at Jinnah Postgraduate Medical Centre, Karachi. Data of the cases were collected from all patients operated and tissue diagnosis was correlated with MRI brain with contrast (Radiological Diagnosis).
Results: We evaluated 51 cases of brain tumors with a male preponderance. The most common tumors were meningiomas (15 cases, 29.4%). The second most frequent brain tumors were Gliomas (13 cases, 25.4%). Other common tumors were Pituitary Adenoma (7 cases, 13.7%), Pilocytic Astrocytoma (3 cases – 5.8%), Colloid cyst (2 cases – 3.8%), Non-Keratinizing Squamous Cell Carcinoma (2 cases – 3.8%). Preoperatively, Initial diagnosis on MRIs was proven with histopathologic examinations in 14/17 Meningiomas (82.35%), 12/13 Gliomas (92.3%), 7/7 Pituitary Adenomas (100%), 2/2 Colloid (100%), 1/1 Abscess (100%,) 0/2 Fungal mass (0%), 1/1 Chondrosarcoma (100%), ½ Medulloblastoma (50%), 1/1 Pilocytic astrocytoma (100%), 1/1 Ependymoma (100%), 0/1 Hemangiopericytoma (0%), 0/1 Clival chordoma (0%), 0/1 Craniopharyngioma. Overall, MRIs had a fairly accurate rate to diagnose brain neoplasms (78.4%).
Conclusion: Most of the tumors in this study were benign. Meningiomas were the most frequent tumors followed by Gliomas, Pituitary adenomas, and Vestibular schwannomas. MRIs can help diagnose brain tumors preoperatively with fair accuracy
Effect of Age, Gender, and Trauma-Type in Distribution of Pediatric Spine Fractures
Get PDFObjective: The study focused on evaluating the effect of Age, Gender, and Trauma-type in the distribution of pediatric spine fractures.
Material and Methods: All pediatric patients admitted to the Neurosurgery department over 5 years were retrospectively analyzed. Patients were divided into three groups. Levels of vertebral fractures were tabulated. Correlations with age, gender, and trauma type were then established.
Results: Of the 2956 pediatric patients, 38 had vertebral fractures. The mean age of patients was 11.7 years. Of these, 17 were male and 18 were female. By trauma type, 28 patients had fallen and 10 had road traffic accidents. There was a significant association between trauma types in the distribution of vertebral fractures in pediatric trauma patients.
Conclusion: The upper cervical spine should be carefully evaluated in all pediatric patients, especially those who had fallen as trauma-type. Careful screening of the thoracic spine is required in car accidents. Gender and age do not specifically contribute to the distribution of pediatric vertebral fractures
Early Postoperative Complications of Endoscopic Endonasal Transsphenoidal Surgery for Resection of Pituitary Adenoma
Get PDFObjectives: To determine early postoperative complications of endoscopic endonasal transsphenoidal surgery for resection of pituitary adenoma.
Materials and Methods: This Descriptive Case Series was carried out at the Department of Neurosurgery, Lady Reading Hospital, MTI, Peshawar. 124 patients of either gender between the age of 16 – 60 were already diagnosed with cases of pituitary adenoma. Patients included in this study were surgically treated by Endoscopic endonasal transsphenoidal surgery. Patients were followed up for seven days after surgery and assessed for CSF leak, the incidence of diabetes insipidus epistaxis, and meningitis. Stratification was done for age and gender and p-value < 0.05 (chi-square).
Results: CSF leak was observed in 2.4% (n = 3) of patients, diabetes insipidus was found in 11.3% (n = 14), Epistaxis in 1.6% (n = 2), and meningitis in 1.6% (n = 2) patients. No statistically substantial difference for both postoperative complications was observed based on gender and age-based stratification.
Conclusion: Diabetes insipidus was a common early postoperative problem that was found in 11.3% of patients, CSF leak was found in 2.4%, epistaxis in 1.6% while meningitis in 1.6% of the cases following Endoscopic endonasal transsphenoidal surgery for pituitary adenomas. Though, there was not any statistically significant association found among different age groups and genders for complications studied
Management and Outcome of Severe Traumatic Brain Injury
Get PDFObjective: To assess the management of patients with severe traumatic brain injury and their outcomes.
Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. Our study included 279 patients in total. After meeting the requirements for inclusion, the patient's baseline information, such as age, gender, arrival GCS, and outcome, were noted. Three months of post-trauma observation were employed to assess the outcome. SPSS version 22.0 was used to evaluate the data obtained.
Results: According to our study out of the total, 118 (42.3%) patients with severe TBI showed good outcomes while 161 (57.7%) showed poor outcomes at 3 months. In our study, the arrival GCS and arrival pupillary reactivity were statistically significant outcome factors (p = 0.040 and 0.010 respectively). Overall mortality was 35.13% (98) at 3 months.
Conclusion: Patients presenting with severe TBI have high morbidity and mortality. Arrival GCS and pupillary reaction were important factors to significantly alter the outcome.
Keywords: Traumatic Brain Injury, Glasgow Coma Score, Head Trauma, Glasgow Outcome Score, Outcome
Postoperative Neurological Outcome in Spinal Tuberculosis Patients Presenting with Severe Neurological Deficits
Get PDFObjective: To determine the postoperative neurological outcome in spinal tuberculosis patients presenting with severe neurological deficits.
Materials and Methods: 57 patients of 22 to 65 years of spinal tuberculosis were included in this study from January 2018 to March 2023. Data was collected from the hospital records of the patients who were admitted and operated on for tuberculosis of the spine. All regions of the spine were taken for study. ASIA scoring was done and patients were labeled from ASIA scores A to E. All patients were operated and postoperative ASIA scoring was also done on follow-up visits. An Independent sample t-test was used to assess the difference in the mean of these variables.
Results: The mean age was 44.45 ± 8.54 years. Males were 39 and females 18. Preoperatively 27 patients had ASIA B, 28 patients had ASIA C and 02 patients had ASIA D score. All these patients improved postoperatively. The mean preoperative ASIA Score was 2.03 ± 2.4 and the mean postoperative ASIA score was 4.1 ± 1.3 withp-value of 0.02. Patients having old age, who present late and with poor grades in neurology had worse outcomes postoperatively.
Conclusion: Patients with spinal tuberculosis presenting even with severe neurological deficits had significant improvement in neurology postoperatively.
Keywords: Spinal tuberculosis (TB), American Spinal Injury Impairment Score (ASIA), Mycobacterium Tuberculosis, Potts disease, Trans-pedicular decompression and fusion, Laminectomy, Magnetic resonance imaging (MRI)
Comparative Study on the Effectiveness of Posterolateral Fusion vs. Interbody Fusion in Isthmic/Degenerative Spondylolisthesis
Get PDFObjective: To compare the effectiveness of posterolateral fusion versus transforaminal lumbar interbody fusion in degenerative/isthmic spondylolisthesis in terms of postoperative pain and postoperative complications.
Materials & Methods: A quasi-experimental study was conducted and 74 patients were included. Group A (n=37) patients underwent PLF, whereas Group B (n = 37) patients underwent TLIF. The pain was assessed with a visual analog scale (VAS), and for disability, the Oswestry Disability Index (ODI) was used.
Results: In Group-A, pre- and post-op back pain mean scores were 3.86 & 0.78, leg pain mean scores were 1.32 & 0.54 while ODI mean scores were 22.51 & 8.59, respectively(P ? 0.05). In Group B, pre- and post-op back pain mean scores were 3.41 & 0.46, leg pain mean scores were 0.84 & 0.30 and ODI mean scores were 19.89 & 6.59, respectively (P > 0.05). The prevalence of minimal disabilities in the TLIF (73%, 78%, 81%, 86%, & 91%) group was relatively more than in the PSF (70%, 75%, 78%, 81%, & 86%) group during pre-op, and post-op phases (2 & 6 weeks, 3 & 6 months). Relatively more patients (8.1% vs. 5.4%) with moderate disability were found in the PSF group as compared to the TLIF group.
Conclusion: The study concluded that TLIF is a safe and more effective procedure than PLF for isthmic/degenerative spondylolisthesis. It is a better surgical procedure for post-operative back pain, leg pain, complications, and disability