Pakistan Journal Of Neurological Surgery
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A Spectrum of Spina Bifida: A Study of Neurosurgery Department of DHQ Teaching Hospital, Gomal Medical College, DI Khan
Get PDFObjective: To pin down the spectrum of spina bifida in infants.
Materials & Methods: This prospective cohort study was conducted at the Neurosurgery Department, DHQ teaching hospital, Gomal Medical College, D.I Khan, Pakistan, from July 2021 to July 2022. A total of 100 diagnosed infants of spina bifida of either gender, who were undergoing surgery were included in the study. Demographics like; gender, name, age, cousin marriage, region, type of spina bifida (meningocele or meningomyelocele), associated with hydrocephalus, and width of the defect were noticed. Post-operatively the maximum follow-up was of 1 month for noticing the outcome and complications.
Results: Of a total number of 100 infants, 76 patients were male, while 24 were female. The mean age of the patients was 913.625 days. The majority of the children (n = 59) were having myelomeningocele. The lumbosacral spine was the most common location (n = 88) for myelomeningocele/meningocele. Post-operatively, there was the development of hydrocephalus in 12 patients.
Conclusion: The majority patients of with spina bifida were males. Meningomyelocele and lumbosacral location were the commonest findings. Furthermore, the lumbosacral location of the spina bifida and myelomeningocele were most commonly associated with the development of postoperative hydrocephalus
Surgery for Cubital Tunnel Syndrome: A Comparative Study of Small Incision with Classic Anterior Nerve Transposition
Get PDFObjective: To evaluate the clinical outcomes of ulnar neuropathy, and cubital tunnel syndrome (CuTS) surgery via a small incision with that of anterior transposition of the ulnar nerve.
Materials & Methods: In this comparative cross-sectional study, 108 patients were recruited from the Neurosurgery Department of Qazi Hussain Ahmad Medical Complex, Nowshera. Two Groups were made. Group A patients undergo either ulnar nerve anterior transposition or simple decompression via a small skin incision, while Group B patients undergo ulnar nerve subcutaneous anterior transposition through a classic skin incision.
Results: Totally 108 patients were enrolled. Males were 67 and females were 41 with a mean age of 45.6 ± 12.97 years. During follow-up visits, an increase in clinical outcome measures was noted, but no statistically significant difference was seen in both groups. Nevertheless, in comparison to the two groups, complications were more in group B, in terms of superficial infection, numbness of skin at the medial elbow, revision surgery, and painful scar.
Conclusion: It is concluded that keeping in view the stability/anatomical position of the ulnar nerve to undergo either simple decompression or anterior transposition through small skin incision is effective and an excellent procedure as compared to classic incision procedure in treating patients suffering from cubital tunnel syndrome
Effect of Lumbar Discectomy on the Quality of Life (QOL)
Get PDFObjective: Quality of life is an individual’s perception. Herniated lumbar discs badly affect quality of life due to lower back pain and neurological deficits. The purpose of the study is to see the impact of lumbar disc herniation (LDH) on the quality of life of individuals and to examine the effect of surgery on the quality of life in these patients.
Materials and Methods: A prospective observational study was conducted in the Department of Neurosurgery at Sir Ganga Ram Hospital / Fatima Jinnah Medical University, the data was collected through purposive sampling from LDH patients (N=159). The data was collected at three-point times; preoperatively (N=159) immediately postoperatively (n=125), and after 3 months post-operative (n=92). Quality of life was measured by the World Health Organization Quality of Life (WHO-QOL BREF scale) and the Aberdeen Lower Back Pain Scale (ALBPS).
Results: The quality of life in pre-operative patients was very poor and lumbar discectomy significantly (p<.05) not only improved the overall quality of life but with high significance reduced lower back pain at p<.001 hence showing the effectiveness of surgery among LDH patients.
Conclusion: For patients with recommended surgery for lumbar disc herniation, early intervention enhances quality of life. After surgery, significant pain improvement was seen as shown by ALBPS. WHO-QOL BREF assessment also highlights surgical impact on quality of life, before and after the procedure.
Keywords: Quality of life, Discectomy, Herniated Disc, Low Back Pain, Spine
Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma
Get PDFObjective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients.
Material & Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality.
Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were <40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery >4 hours post-injury had higher mortality (18.2%) vs. <4 hours (8.5%). 14/43 GCS <8 patients survived, with no deaths when GCS >12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness <10mm and only 1 survived with a thickness >16mm. 25/29 died with midline shift >11mm.
Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS>9, normal pupils, hematoma width <1.5cm, midline shift <1cm, and surgery within 4 hours
Surgical audit of ruptured intracranial anterior circulation aneurysm clipping in Neurosurgery Unit II, Punjab Institute of Neurosciences, Lahore.
Get PDFObjective:To review and document the rates of morbidity and mortality after surgical clipping for ruptured intracranial anterior circulation aneurysms in the department of Neurosurgery Unit II at Punjab Institute of Neurosciences, Lahore.
Methods:Retrospective observational study was done. Doctors’ and nurses ‘notes, and radiology were reviewed to analyze the outcome of patients after microsurgical clipping.
Results:180 patients were included according to non-probability, consecutive sampling. Mean age = 44.32±13.75 years, male to female ratio of 2.05:1. Fisher grade was: Grade I – 89.4%, Grade II-6.7% and Grade III- 3.9%. WFNS grade was: Grade I- 83.9%, Grade II – 11.1%, Grade III – 1.7% and Grade IV – 3.3%. Hunt and Hess grade was: Grade I- 47.4%, Grade II-25%and Grade III- 0.6% (p=<0.001)(Confidence Interval-CI=95%). Anterior Communicating Artery aneurysms were 47.22 % (p=0.50), Middle Cerebral Artery aneurysms 28.3% (p<0.001), Internal Cerebral Artery aneurysms 8.9%(p<0.001), Distal Anterior Cerebral Artery aneurysm 8.3% (p<0.001) and Posterior Communication Artery aneurysms 7.2%(p<0.001). , A temporary clip was applied during surgery in 13.3% only.The results showed the incidence of these outcomes as: Acute New onset Neurological Deterioration/Deficit was documented in 6.1%), Rebleeding 3.3%, Vasospasm 5.0%, Revision surgery 6.1% and Mortality in 8.3% (p<0.001).
Conclusion:T the outcome of patients who underwent surgical clipping of ruptured anterior circulation aneurysms in the department of Neurosurgery Unit II, Punjab Institute of Neurosciences, Lahore, is comparable to the results of the studies and trials in the published literature
Unilateral Laminotomy vs. Conventional Laminectomy: Which is Better for Degenerative Lumbar Spinal Stenosis?
Get PDFObjectives: To compare the outcomes of conventional laminectomy and unilateral laminotomy for lumbar spinal stenosis.
Materials and Methods: The results of our research were compared between unilateral laminotomy (Group A) and conventional laminectomy (Group B) for lumbar spinal stenosis using a sample of 60 cases (30 in each group) selected through non-probability convenient sampling. We calculated the sample size using OPENEPI and analyzed the data with SPSS 26.0. For qualitative and quantitative data.
Results: Mean age of participants was 49.7 years in both groups, The sample consisted of 37 male and 23 female participants made up the patient population. Dural tears (5%), progressive neurological deficit (0%), and surgical site infections (1%), among other postoperative complications, were all treated with antibiotics based on culture and sensitivity.
Conclusion: Bilateral decompression via unilateral laminotomy is a less invasive alternative to conventional laminectomy for lumbar spinal stenosis, with significantly improved pain scores and minimized hospital stay. This technique offers appropriate decompression of neuronal components at the affected level with no increased risk of complications.
Keywords: Degenerative, Spinal Stenosis, Unilateral Laminotomy, Conventional Laminectom
A Rare Presentation of Triplegia Resulting from Penetrating Brain Trauma by a Hand-Held Dagger
Get PDFPenetrating brain trauma is a devastating injury mode mostly seen in military settings. Its low-velocity counterpart resulting from objects such as knives, drills, daggers, etc. is relatively less common & rarely seen present mostly in isolated case reports. The neuropathological outcome can be disproportionately morbid in these cases with a varied clinical spectrum ranging from occult deficits to grave debilities reported. It is an anatomical insult whose course is free of clinical constraints & determined by the trajectory & velocity of the object. In this case report, an 18-year-old male ordeal is reported who suffered the injury from a hand-held dagger that involved both parietal cortices via midline traversing. GCS on presentation was 15/15 but the patient had triplegia in the form of paraplegia & contralateral upper limb monoplegia. The object was retrieved via craniectomy & cortectomy although no clinical recovery was seen post-up or on follow-up. It is a case intriguing & indicative of the unpredictable course of such injuries
Frequency of Ventilator-Associated Pneumonia among ICU Admitted Patients with Early Versus Delayed Tracheostomy
Get PDFObjective: Patients on mechanical ventilation in the intensive care unit (ICU) frequently develop ventilator-associated pneumonia (VAP), an acquired lung infection. The incidence of VAP varies highly in different setups. This study aimed to determine the incidence of VAP in the surgical ICU and the associated costs.
Materials & Methods: An observational cross-sectional study was conducted and included 116 patients who had a tracheostomy in the surgical ICU of Lahore General Hospital. They were observed for the occurrence of VAP, mortality, ICU stay in days, and cost of the ICU stay. Tracheostomies done before 7 days from mechanical ventilation with the expectation of needing extended ventilatory support were classified as early tracheostomies (Group E), whereas those performed after 7 days owing to failure to wean were classified as late tracheostomies (Group L).
Results: Patients in the early tracheostomy group had a mean age of 45.16 years, while those in the late tracheostomy group had a mean age of 50.00 years. Compared to the early tracheostomy group, the late tracheostomy group had a greater incidence of VAP, 8(25.8%) and 24(53.33%), and mortality, 8(25.8%) and 22(48.88%), respectively. Mean values like pre-tracheostomy ventilation were 4.70 & 12.17 days, ICU stay was 9.54 & 16.64 days and total cost in PKR was 796774.19 & 1438888, respectively among early tracheostomy & late tracheostomy groups.
Conclusion: The occurrence of VAP and mortality is significantly lower in patients who have undergone early tracheostomy
A Comparison of the Use of Tranexamic Acid versus Placebo in Patients Undergoing Excision of Intracranial Meningioma
Get PDFObjective: Complete surgical removal of intracranial meningiomas is curative but with significant blood loss. Tranexamic acid has been proven beneficial in reducing blood loss following major surgical procedures. Therefore, the purpose of the study was to evaluate how well tranexamic acid worked to stop blood loss in patients having an intracranial meningioma removed.
Objective: This study compares the effects of tranexamic acid and placebo on intraoperative blood loss, transfusion needs, and the frequency of surgical sites with good hemostatic quality in patients having an intracranial meningioma removed.
Materials & Methods: This clinical trial was carried out in the Department of Neurosurgery, unit II PGMI/ PINS, Lahore over 1 year. Two equal groups of 30 individuals each were formed from a total of 60 patients having an intracranial meningioma diagnosis. Group 1 was given TXA, whereas Group 2 was given a placebo (normal saline). Patients were assessed for intraoperative blood loss, transfusion needs, and a clean surgical area in terms of hemostasis.
Results: Mean blood loss in the TXA group was 803.0 ± 106.53mL while that in the placebo group was 1159.5 ± 101.79 mL which was statistically significant (p = 0.000). TXA also significantly reduced transfusion requirements (p = 0.000) and was associated with better hemostasis of the surgical field (p = 0.000).
Conclusion: This study concluded that TXA can reduce intraoperative blood loss and decrease the transfusion requirements in the postoperative period significantly as compared to placebo in patients experiencing surgical intracranial meningioma excision
PET-CT Guided Gamma Knife Radiosurgery for Recurrent Glioblastoma Multiforme Recurrent Cases in Pakistan
Get PDFObjective: The treatment of recurrent Glioblastoma Multiforme (r-GBM) poses a significant confronts to neurosurgeons. This study was conducted to assess the effectiveness of PET-CT-guided Gamma Knife radiosurgery (GKRS) in treating r-GBM. The purpose of the study is to determine the outcome of this treatment approach.
Materials and Methods: Retrospective descriptive research was supervised at the Neurospinal and Cancer Care Institute, Karachi Pakistan between June 2017 to August 2022. The study comprised patients with biopsy-confirmed Grade IV Glioblastoma Multiforme who experienced recurrence during follow-up. PET-CT and MRI brain with contrast were performed to determine the target volume of the tumor, and GKRS was carried out based on the scan findings.
Results: A total of 24 patients, ranging in age from 47 to 77 years with a median age of 50 years, were included in the study. The tumor recurrence occurred within a median interval of 10 months after diagnosis, ranging from 1 to 16 months. The median time for progression-free survival from GKRS was 5 months, ranging from 2 to 6 months. The median overall survival from GKRS was 11 months, ranging from 5 to 12 months.
Conclusion: GKRS is a tool in the multimodal treatment of r-GBM. By co-registering PET-CT-MRI, it becomes possible to plan the treatment more effectively by targeting the active tumor while preserving healthy brain tissue. This approach has the potential to improve overall survival rates and patient outcomes