Pakistan Journal Of Neurological Surgery
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Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity
Get PDFIntroduction: Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachnoid cyst is formed after some neurological insult like head injury, tumor, meningitis, or brain surgery. In 60 – 90% of cases, the primary type predominates and presents with pressure symptoms before the age of 20 years. The adjudged incidence is 1.4% in adults, the least frequent being intraventricular location.
Clinical Case: A 23-year-old male presented with a long-standing left-sided cranial vault headache, right-sided focal seizures, and progressive right- hemiparesis. Neurological evaluation revealed upper motor neuron signs on the right side of the body. A computerized axial tomography raised the suspicion of an arachnoid cyst for which magnetic resonance imaging was done which revealed a large intraventricular cyst of lateral ventricles causing mass effect over the ipsilateral hemisphere and mild obstructive hydrocephalous. Surgical intervention was required as per symptomology (intractable headache, seizures, and hemiparesis) and large cyst size.
Conclusion: Cerebrospinal fluid accumulation in the brain's arachnoid layer causes non-cancerous arachnoid cysts. Larger cysts may push on brain tissue and cause neurological difficulties. MRI may diagnose arachnoid cysts, and treatment options include cystoperitoneal shunt, craniotomy, and neuro-endoscopic fenestration, the least invasive. Cyst size and location determine therapy. In this example, endoscopic treatment reduced symptoms and consequences
Effect of drain placement on postoperative radiology following burrhole drainage of chronic subdural hematoma
Get PDFObjective:
The effect of drain placement on postoperative radiology following burrhole drainage of chronic subdural hematoma (ChSDH) is a topic that has been rarely addressed in literature. The present study was designed to study the effects of postoperative drain placement on different radiological parameters following ChSDH evacuation.
Materials & Methods
We studied the data of 117 patients operated with burrhole drainage of ChSDH and divided the patients into two groups. In the first group a postoperative subdural drain had been placed while the second was the no drainage group. The pre- and postoperative CT brain of the patients were analyzed and the change in the hematoma width and midline shift was noted.
Results:
In the drainage group 12 (18.2%) patients had recurrence. In the no drainage group also 12 (23.5%) patiens had recurrence. The difference in recurrence wasn’t significant (p=0.4775). The mean change in the width of the hematoma was 0.95 ± 0.37 mm in the drainage group, while in the no drainage group this was 0.51 ± 0.37 mm. This difference was very significant (p < 0.0000001). The mean change in the midline shift was 0.51 ± 0.21 mm in the drainage group, while in the no drainage group this was 0.26 ± 0.22 mm and this difference again was very significant (p < 0.0000001).
Conclusion
The placement of a subdural drain following burrhole evacuation of ChSDH leads to significantly decreased postoperative hematoma width and mass effect providing the radiological corroboration for drain placement
Outcomes of Microsurgical Resection of Low-Grade Cerebral Arteriovenous Malformations: A Descriptive Observational Multicenter Study from a Low-Middle-Income Country
Get PDFObjective: To appraise the overall outcomes of microsurgical resection of low-grade arteriovenous malformations (AVMs) in a low-middle-income country.
Materials and Methods: Data was collected from three different neurosurgical centers in Pakistan for this study and it lasted for two years. Patients who had been diagnosed with cerebral AVMs were categorized into three groups, A, B, and C, using the Spetzler-Martin (S-M) grading system. AVMs of grades 1 and 2 were included in Class A. Class B contained grade 3 AVMs, while Class C contained grade 4 and 5 AVMs. All male and female patients in Class A were eligible for this study.
Results: There were a total of 22 patients. The mean age was 36.41 ± 14.32 SD years. There were 12 (54.5%) male patients and 10 (45.5%) female patients. 13 patients (59.1%) presented with spontaneous intracerebral hemorrhage, while 9 patients (40.9%) presented with seizures. 14 patients (63.6%) had S-M grade 1 and 8 patients (36.4%) had S-M grade 2. All patients underwent microsurgical resection. We discovered 4.5% morbidity in our study. There was no postoperative mortality. According to the Glasgow outcome scale, an excellent functional outcome of 95.5% at 6 months and a 100% cure rate were noted.
Conclusion: Regarding morbidity, mortality, and cure rates for low-grade AVMs in our nation, microsurgery is a secure and efficient therapeutic option
Incidence and Outcomes of Diastematomyelia in Spina Bifida Patients
Get PDFObjective: To determine the prevalence of diastematomyelia in spina bifida patients and to assess the efficacy of surgical intervention.
Material and Methods: This prospective research study was conducted at the Jinnah Postgraduate Medical Center in Karachi in the Neurosurgery department. We included 55 patients after fulfilling the inclusion criteria. All of the patients had craniospinal MRI, and the results, as well as any anomalies discovered, were noted for future reference during their therapy. Patients suffering from these diseases were treated surgically, which included sac excision and repair, cord detethering, and ventriculoperitoneal shunting. Throughout the postoperative period, all of these patients' outcomes were documented and assessed.
Results: The majority of patients were under 1 month old (29 patients, 53.70%), whereas 13 patients were between one month and 1 year old. The patients were 2.8 years old on average. There were 23 males (42.60%) and 32 females (58.18%). Dermal sinuses, hypertrichosis, and skin dimples (signs of spina bifida occulta), with prevalence rates of 5.55 percent, 3.70 percent, and 1.85 percent, respectively. Spina bifida occulta was less frequent (17 cases) than spina bifida aperta (37 occurrences). 33 patients (61.11%) have myelomeningocele, followed by meningocele in three (5.5%), lipomyelomeningocele in six (10.9%), diastematomyelia in six (10.9%), dermal sinus in two (3.70%), along with spinal lipoma in one (1.85%) instance.
Conclusion: The overall prevalence of Diastematomyelia in patients with spinal dysraphism is low. However vigilant assessment and management is crucial for optimal surgical benefit.
Keywords: Diastematomyelia, Spina Bifida, Spinal Dysraphism
The Text Neck Epidemic: Unveiling the Hidden Burden of Neck Pain among Medical Students
Get PDFObjective: Text neck syndrome, caused by prolonged mobile device use, is increasingly common, especially among teenagers. Neck pain is a significant public health issue, affecting 40% of the population. Little research has focused on musculoskeletal pain in children and adolescents, including medical students. A cross-sectional study is needed to investigate text neck syndrome among medical students and provide effective prevention and treatment strategies.
Materials & Methods: This cross-sectional study (n=508) utilized an online self-designed questionnaire incorporating the Neck Disability Index and the Nordic Musculoskeletal questionnaire. Descriptive and inferential statistics, including chi-square tests and p-value calculations using SPSS version 25, were employed. The study aimed to examine neck pain prevalence and consequences to inform interventions for improved health outcomes.
Results: Among the 508 participants, 69.4% reported past neck pain. Females, those with higher stress levels, individuals using laptops/tablets for four or more hours, and medical students studying for 4 to 6 hours daily had higher neck pain prevalence (52.0%, 88.2%, 61.9%, and 57.5% respectively). Prevalence remained consistent between pre-clinical and clinical-year medical students. Multivariate analysis revealed a significant association between neck pain and longer mobile phone use, extended study hours, and lack of exercise. Only 16% sought treatment from a chiropractor/physiotherapist for their neck pain.Conclusion: The study emphasizes the importance of better education on neck pain prevention and seeking professional help. Adding exercise to daily routines can also be extremely helpful in preventing neck pain. To fully understand the effect on medical students and develop effective intervention
Significance of Correlation Between Spinopelvic Parameters in Patients of Chronic Low Back Pain
Get PDFObjective: To determine the significance of the correlation between spinopelvic parameters in patients with chronic low back pain.
Materials and Methods: 129 patients with chronic low back pain of a minimum of 03 months duration were included in our study from September 2020 to February 2023. Sagittal standing spinopelvic radiographs were done on all patients. Various spinopelvic measurements were done including PI, PT, LLA, SLA L1 – L3, SLA L3 – S1, LSA, SHA, and SIA. Pearson correlation was used to determine the correlation coefficient.
Results: The mean age was 36.45 ± 9.54 years. Males were 59 and females 70. Mean and SD of spine pelvic measures were LLA = 57.32 ± 12.45, SLA L1-L3 = 15.31 ± 3.75, SLA L3 – S1 = 42.46 ± 8.34, LSA = 8.94 ± 4.72, SHA = 38.10 ± 7.94, SIA = 52.42 ± 6.84, PT = 11.21 ± 5.83, PI = 48.72 ± 8.90. PI has a significant positive correlation with LLA ( r= 0.492 and p-value < 0.001).
Conclusion: PI and LLA are important spinopelvic parameters and have significant correlation with other spinopelvic parameters and derangement of one of them can affect the overall spine sagittal balance resulting in chronic low back pain
Relationship between postoperative pneumocephalus and recurrence following chronic subdural hematoma evacuation
Get PDFObjective: Postoperative pneumocephalus has been reported as one of the possible causes of increased recurrence following burrhole evacuation of chronic subdural hematoma (ChSDH). The present study was designed to assess the relationship between postoperative pneumocephalus and recurrence following chronic subdural hematoma evacuation.
Materials and Methods: The medical records of sixty eight patients that had been operated for ChSDH evacuation with burrhole drainage were retrospectively analyzed. The area of the pneumocephalus was measured in the slice where the size of the pneumocephalus was the biggest. The patients were then divided into the recurrent and the non-recurrent groups and compared for their association with the postoperative pneumocephalus. Patients with a pneumocephalus size of > 4 cm2 and those with a size ? 4 cm2 were also compared with each other for recurrence.
Results:
Fourteen (20.6%) patients had recurrence following burrhole evacuation of ChSDH. The mean size of the pneumocephalus in the recurrent group was 7.88 ± 5.12 cm2 and in the non-recurrent group was 6.56 ± 5.56 cm2.The size of the pneumocephlus was not statistically different (p=0.42) between the two groups. We also compared patients with a pneumocephalus size of > 4 cm2 and those with a pneumocephalus size of ? 4 cm2 and again found that the relationship with recurrence was not significant (p=0.288).
Conclusion:
We conclude that postoperative pneumocephalus is not associated with recurrence following burrhole evacuation of chronic subdural hematoma.
Keywords: Postoperative pneumocephalus, burrhole evacuation, recurrence, chronic subdural hematom
Sub Temporal Trans Tentorial Approach in Excision of Mid Brain Tumor: A Case Report
Get PDFThis case report presents a rare case of a 28-year-old male diagnosed with mid-brain glioma and managed through sub temporal trans-tentorial approach. She was presented to the Neurosurgery department with clinical features suggestive of raised intracranial pressure such as nausea, vomiting, diplopia, and headache from the past 2 months. The patient had a history of undergoing ventriculoperitoneal shunt two years back. The examination findings revealed that the patient had bilateral ptosis with the inability to open their eyes. He was bedbound. When examined in standing the patient demonstrated symptoms of instability when moving the limbs and loss of balance. MRI brain confirmed the diagnosis of mid-brain glioma. Right Sub temporal trans-tentorial approach was performed to excise the mid-brain glioma. Mid-brain gliomas although rare, are brainstem tumors that can present in adults with symptoms of increased intracranial pressure, the management of which can be done through radiotherapy, chemotherapy, surgical resection, or a combination. Focal and low-grade glioma can be successfully resected through the Sub temporal trans-tentorial approach with improved clinical outcomes
Assessment of the Association between Hypovitaminosis D and Chronic Low Back Pain in South Punjab
Get PDFObjective: To assess the relationship between hypovitaminosis D and chronic low back pain in South Punjab.
Materials and Methods: Retrospective research was done from January 2021 to June 2022. 173 chronic nonspecific low back pain patients presenting in outpatient clinics were included in our study. Two groups were made of all patients, one was vitamin-D level deficient, and the other was a vitamin-D normal group. The blood level of 30 ng/ml of vitamin D was taken as normal. Chronic Low back pain status was analyzed by VAS score. All the demographic data of patients were recorded. The relationship between vitamin D and VAS score was assessed by the spearman coefficient and p <0.05 was taken as significant.
Results: The majority of patients had a mean age of 36.45 ± 21 years, were female preponderance, married, and vegetarians with a mean sun exposure time of about 2 hours. In group 1, the vitamin D level was 13.41 ± 3.8 and in group 2 vitamin D was 38.71 ± 5.8 with p value< 0.0001. Spearman rho coefficient was used to assess the relationship between vitamin D and pain score. The result was a negative correlation between these 2 variables (r=-0.572) and p <0.0001.
Conclusion This research work showed the significant probability of association between vitamin D level and patients having nonspecific chronic low back pain. There was a negative association between vitamin D level and VAS score of patients having chronic low back pain.