Pakistan Journal Of Neurological Surgery
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Celebrating 25 Years of Excellence: The Silver Jubilee of Pakistan Journal of Neurological Surgery
Get PDFFrequency of Deranged Lipid Profile in Patients with Stroke
Get PDFObjective: This study aims to find out the frequency of patients with strokes at Lady Reading Hospital in Peshawar have abnormal lipid profiles.
Materials & Methods: The Department of Medicine at Lady Reading Hospital in Peshawar conducted this cross-sectional, descriptive study. There were 96 patients in all, both genders, who presented with a stroke between the ages of 30 and 70. Individuals with CRF (chronic renal failure), CLD (chronic liver disease), or medications that reduce cholesterol were not included. Blood samples were collected and transferred to the laboratory to measure the lipid profile.
Results: In this study, the age range was 30 to 70 years old, with a mean age of 53 years. The majority of the patients (54.17%) ranged in age from 51 to 70. There were 58.33% males and 41.67% females. 40 (41.67%) stroke patients had a disordered lipid profile. Of the stroke patients, 41.67% had abnormal total cholesterol, 53.13% abnormal LDL cholesterol, 25.0% abnormal triglyceride levels, and 21.88% abnormal HDL cholesterol.
Conclusion: This study concluded that the frequency of dyslipidemia in stroke patients is very high. With this knowledge, specialized statin drugs could be created, leading to better disease control. Patients with ischemic stroke were more likely than those with hemorrhagic stroke to have abnormalities in their lipid levels.
Keywords: Stroke, Cholesterol level, Dyslipidaemia, Lipid Profile, Cerebrovascular Accidents
Evaluation of the Outcome of Transpedicular Fixation for Thoracic and Lumbar Tuberculous Spine Disease
Get PDFObjective: Pakistan stands sixth in countries, contributing 60% of new TB cases worldwide. TB can involve a wide variety of organs including the spine which at times need neurosurgical intervention. This study aims to determine the overall clinical and radiological outcomes in patients with dorsolumbar spine TB managed by posterior transpedicular screw fixation. The study focused to evaluate the outcome of transpedicular screws fixation for the thoracic and lumbar tuberculous spine.
Materials and Methods: The study included a total of 60 patients were observed. A complete history and systemic physical examination was done. Pre-operative anteroposterior and lateral view radiographs were taken to measure the height of the vertebral body, kyphotic angulation, and sagittal plane index. Short-segment transpedicular fixation was done under general anesthesia by consultant neurosurgeons. All patients were asked for follow-up after one month. Post-operative anteroposterior plus lateral view radiographs were done to measure the height of the vertebral body, kyphotic angulation, and sagittal index.
Results: In our study mean age was 47 years. 58%patients were males and 42% of patients were female. The mean postoperative vertebral height was 18.93 mm ± 1.17 and the mean postoperative Kyphotic angle was 9.68 degree ± 4.03º. The mean postoperative Sagittal index was 5.83 ± 4.55.
Conclusion: The outcome of transpedicular fixation of vertebral height was 18.93 mm ± 1.17, Kyphotic angle was 9.68 degree ± 4.03º) and Sagittal index was (5.83 ± 4.55) for thoracic & lumbar tuberculous spine
Clinical outcomes of three Level Interlaminar Endoscopic Decompression Surgery in the Treatment of Multilevel lumber Spinal Stenosis
Get PDFThis is the first case report to test the efficacy of three-level endoscopic spine surgery for the treatment of lumber spinal stenosis. The patient was a 50-year-old entrepreneur with pain on standing and walking and all activities that compress the canal such as lumber extension. Three-level endoscopic surgery was performed at L3-L4, L4-L5, and L5-S1. Certain clinical and surgical outcomes were selected such as the Visual Analogue Scale for pain, Oswestry Disability Index score for level of disability and functional limitation, pain on certain aggravating activities involving extension like walking and moving downstairs, spinal and core stability using prone segmental instability test and patient satisfaction values taken at baseline and after the endoscopic surgery at two levels i.e. immediately after surgery and after one month follow up. Multiple-level interlaminar endoscopic surgery was successful in terms of reducing pain, improving score on the Oswestry disability index, improving daily life activities, increasing spinal and core stability, and increasing patient satisfactio
Head Injury Due to Fall from Heights in Pediatric Population of a Middle Resource Country
Get PDFObjective: One of the serious concerns for public health is unintentional injuries. Falls rank as the second most common cause of unintentional injury deaths globally, after injuries sustained in transportation accidents. The study's goals were to check the mechanisms and severity of the head injury from falls among children.
Materials and Methods: A non-randomized retrospective study was conducted and children aged 0 – 12 years (n = 228) undergoing cranial CT guidance for head injury were enrolled. All patients were treated under the supervision of the neurosurgery department. Detailed radiological evaluation was done and recorded on specialized proforma.
Results: Among the enrolled patients, mild head injury was noted in 49.1% of children while moderate head injury was noted among 40.4% of children. A total of 72 (31.6%) patients had skull fractures, of which 12 (5.3%) had a thin underlying subdural hemorrhage. Four cases of extradural hemorrhage complicated a skull fracture, and eight cases of isolated Subdural hemorrhage (SDH) were observed without a skull fracture. Of those 48 (21%), radiologically evident diffuse axonal injuries were present, and each of them included high-force injury mechanisms.
Conclusion: When children sustain minor trauma, skull fractures, and focal SDH are rather common, although most of the time there are no long-term neurological effects. On the other hand, patients with an equally severe cause of injury were the only ones who experienced diffuse brain injury with significant neurological disability that followed
Outcomes of Management of Pituitary Adenoma by Use of Octreotide Injections Preoperatively
Get PDFObjective: This study explored the effects of octreotide injections in patients with pituitary adenoma pre-operatively.
Material and Methods: A quasi-observational study was conducted on 12 patients in the Neurosurgery department of the Punjab Institute of Neurosciences (PINS) with a diagnosis of pituitary adenoma. To determine the size of the tumor, we did an MRI brain with pituitary protocol and after octreotide medication. The mode of diagnosis was clinical status, MRI brain, and biopsy of the tumor. We gave 14 short-acting octreotide injections to all patients before surgery and monitored their clinical and serum IGF levels. After the completion of 14 injections of octreotide, we planned surgery for the complete excision of the tumor. We performed IGF level 2 weeks after surgery. Then, we gave long-acting octreotide injections to all patients after every 28 days.
Results: The mean age was 43 years. 67% of patients were male and 33% of patients were female. 92% of patients presented with decreased vision. 17% of patients presented to us with complete loss of vision. In 17% of patients, the vision of the patients improved. Serum IGF levels significantly decreased after short-acting octreotide, surgical excision, and long-acting octreotide therapy.
Conclusion: With the use of octreotide therapy clinical status and outcomes of management of pituitary adenoma improve
Spectrum of Asymetrical Proptosis
Get PDFObjectives: To discuss different aspects of unilateral proptosis in our institutions.
Study Design: Observational study.
Place and Duration: Department of Neurosurgery/Head and Neck, PGMI, Govt Lady Reading Hospital, Peshawar. Pakistan from May 2004 – April 2008. All patients presented to outpatient clinic of Neurosurgery and ENT departments along with referred cases to these both departments were included in this study. These patients were analyzed in detail. Apart from local ENT examination and neurological examination, ophthalmological and systemic examination was also carried out. Relevant investigations were carried out to see the effects on anatomy as well as on physiology of globe. Patients with bilateral proptosis, relative proptosis due to crowzen's syndrome, Apart's syndrome and post traumatic proptosis were excluded. All these patients were managed surgically either individually or as team case by combined approach in the department.
Results: Thirty eight (38) patients with asymmetrical proptosis in this study were analyzed with regard to their sex, age, site of proptosis, origin and extent, surgical approach adapted, per operative and histological diagnosis. There were 22 male and 16 female patients with male and female ratio of 1.4 and 1. The age range was from 8-65 years with median age of 36.5 years. X-ray skull, PNS and CT brain including orbits and fronto nasal sinuses were done in all cases and MRI in 18 cases.
Conclusion: Variety of causes is responsible for unilateral proptosis which present in clinical practice to both ENT and Neuro surgeons. Team work helps a lot in making proper protocol
Pattern of Presentation of Spinal Dysraphism
Get PDFObjective: To assess the pattern of presentation of spinal dysraphism and compare with already available data on the subject.
Design: Prospective study.
Material and Method: This prospective study was done in the department of Neurosurgery, King Edward Medi-cal University (KEMU) Lahore, Pakistan from January 2008 to December 2009. Cases of spinal dysraphism admitted and managed in the department during this period were included in the study.
Results: Total patients admitted with spinal dysraphism during this period were 56. Of them, spina bifida aperta were 42 (75%) and occulta were 14 (25%). Age range of patients of spinal dysraphism was from 1 day to 27 years. Male to female ratio was 1.5 : 1. All the patients of spina bifida aperta had myelomeningocele i.e. 42 (75%). Of them maximum patients had myelomeningocele at lumbosacral region i.e. 18 (42%) followed by lumbar area i.e. 11 (26%). No patients had cervical spina bifida aperta. Hydrocephalus was present in 32 (76%) patient. Of 56 cases of spinal dysraphism, 14 (25%) had spina bifida occulta. Among spina bifida occulta, lipo-myelomeningocele and congenital dermal sinus were 5 (9%) each while 4 (7%) patients had meningocele. All patients had x-ray spine of the affected region. All patients of spina bifida occulta had MRI brain and whole spine.
Conclusion: All patients of spina bifida aperta presented with myelomeningocele, commonest at lumbosacral area. Age at presentation was relatively late. Of spina bifida occulta, Lipomyelomeningocele and congenital der-mal sinus were unusually equal. Meningocele was relative less
Review of Surgical Management of Supratentorial Extra Dural Haematoma at LGH
Get PDFThe Objectives: To review the surgical management of Supratentorial EDH, at our Department.
Study Design: Retrospective Review.
Setting: Department of Neurosurgery, Lahore General Hospital / PGMI, Lahore.
Materials and Methods: This is a retrospective case series of 1536 patients of Supratentorial EDH who were treated surgically between Jan 2005 and Dec 2009. Patients' medical records were reviewed to define variables associated with outcome at the time of discharge. Variables included in the analysis were time since injury, age, gender, severity of head injury, anatomical site of hematoma on CT scan and outcome at the time of discharge (Glasgow Outcome Scale). Patients harbouring extra-cranial injuries which required operative management by other departments, e.g. laprotomy, thoracotomy, chest intubation and cases having associated brain parenchymal injury requiring intervention, were excluded.
Results: In our study of 1536 patients the mean age was 20.46 years, the minimum age was 5 and maximum 60 years. The age range was 55 years. Out of the total 1536 patients 1068 i.e. 69.5% were male and only 468 i.e. 30.5% were females. Male to female ratio was 2.29 : 1. Patients presenting with Mild Injury was the largest group. 664 out of 1536 (n) i.e. 43.2% were having a score of GCS from 13 – 15.
Conclusions: The surgical management of EDH is a rewarding and life saving procedure and young male population seems to be a vulnerable population group.
 
Pattern and Practice of Paediatric Neurosurgical Procedures- An analysis of one year initial experience at resource challenged setup of Children Hospital, Faisalabad.
Get PDFpatients presenting to Children Hospital, Faisalabad.
Materials and Methods: Retrospective case series of 778 consecutive cases admitted in Pediatric Neurosurgery Department, Children Hospital, Faisalabad over one year (October 2019- September 2020). Patients of age less than 15 years, any gender, admitted in Pediatric Neurosurgery ward for management were included and studied for their demographic data hospital stay, a procedure done and outcome.
Results: A total of 778 patients who required some neurosurgical intervention were admitted, 725 underwent various types of procedures and the remaining were treated conservatively. 320 (44.14%) were male and405 (55.86%) were female. The age range was 20 days to 13 years. The most common diagnosis was hydrocephalous, and then was Meningomyelocele (MMC). The first three common procedures performed included monitoring of Cerebrospinal fluid (CSF) in 36% of cases, Placement of shunt (21%), and placement of external ventricular drain (EVD) in 13% of cases of cerebrospinal fluid (CNS) infections in patients of hydrocephalous.
Conclusion: Pattern of presentation of pediatric neurosurgical cases take in almost all types of diseases like neural tube defects, hydrocephalous, cranial trauma, tumors, cysts, and infections but surgical procedures in routine practice in Faisalabad district cover mainly hydrocephalous and its complications. Endoscopic or advanced procedures are not commonly practiced due to multiple factors but existing constraints do not prevent the best management of pediatric neurosurgery patients