Pakistan Journal Of Neurological Surgery
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Complications of Microvascular Decompression in patients with Trigeminal Neuralgia
Get PDFObjective: To determine the frequency of complications of microvascular decompression for patients with trigeminal neuralgia undergoing surgical decompression.
Materials and Methods: A descriptive case study was carried out in the Neurosurgery Unit 1, Lahore General Hospital. The study included 80 patients who fulfilled the inclusion criteria. Informed consent was obtained and possible outcomes and complications of surgery were explained beforehand to the patients. Demographic details were noted. Surgical site infection, CSF leak, Facial numbness, Facial palsy, Hearing impairment, and Postoperative hematoma as complications were assessed. The presence of complications was recorded. Data was stratified for age and gender from. Chi-square was used as a statistical test, taking a p-value ?0.05 as the level of significance.
Results: The study included 80 patients. The mean age of the patients was 40.8 ± 11.7 years. Overall complications were reported in 21 (26.3%) patients. Distribution of complications was as follows; surgical site infection 2 (9.5%), CSF leak (19.0%), facial palsy 5 (23.8%), facial numbness 9 (42.9%), hearing impairment 2 (9.5%) and post-operative hematoma 5 (23.8%).
Conclusion: Microvascular decompression (MVD) is recommended neurosurgical procedure for medically refractory patients with trigeminal pain if there is no contraindication for surgery. Surgical complications can be minimized by meticulous surgery resulting in adequate tissue respect. Another means to get better and long-lasting results with fewer complications is by using an autologous muscle graft
The outcome of Titanium Mesh Cranioplasty
Get PDFObjective:The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma.
Materials and Methods:The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3–6 months later in the private hospitals of Quetta. The resulting complications were reported.
Results:There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15–40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure.
Conclusion:This study concludes that there are few patients (<20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process.Keywords:Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fracture
Early Outcome of Ventriculoperitoneal (VP) Shunt in Terms of Improvement and Complications
Get PDFObjective: To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications.
Material and Methods: This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study.
Results: A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year.
Conclusion: VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period.
Keywords: Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC)
A Bicentric Study of Psychiatric Illness among Pediatric Population Patients with a History of Sexual Abuse
Get PDFBackground: The present study assessed the psychiatric diseases in victims of childhood sexual abuse from intact and broken families.
Methodology: A cross-sectional study was conducted at the PMC hospital, Nawabshah and Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, GAMBAT between February 2020 to January 2022. 60 (30 in each group) children were included with the ages of 5-16 years,. Non-probability convenience sampling technique was used. Children with reported sexual abuse who fulfilled the inclusion criteria were included in this study. All children included in the study were screened for psychological disturbances through the Urdu version of SDQ. The severity of symptoms was assessed based on ICD-10 criteria.
Results: There was a significant relationship between the identity of the perpetrator with the stability of the family. In victims belonging to the intact family system, the perpetrator was mostly an outsider while, in cases of broken families, oftentimes, the abuser was a relative or known to the victim. 44.44% of individuals belonging to broken families were abused within the confinements of the home. 17.8% of children from unstable families had mixed anxiety and depression disorder, while the rate was lower among children who had intact families. Surprisingly, only five children altogether had post-traumatic stress disorder. Hyperkinetic disorder and conduct disorder was significantly more prevalent in victims belonging to a broken family system.
Conclusion: Childhood sexual abuse and its resultant psychiatric morbidity are equally common in children from intact and broken families. However further research with a greater sample size from multiple centers is needed.
Keywords: Childhood sexual abuse, Psychiatric morbidity, Broken family
The Efficacy of Surgery for Supra-Tentorial Gliomas in Preventing Seizures
Get PDFObjectives: The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution.
Material and Methods: A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender.
Results: The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender.
Conclusion: The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management.
Keywords: Seizures, Supratentorial gliomas
Extrusion of the Peritoneal Catheter of Ventriculoperitoneal Shunt Through the Rectum
Get PDFA ventriculoperitoneal shunt is a common procedure for hydrocephalus. It is a life-saving procedure but is not risk-free. Some of the most common complications are shunt blockage and infection but they can also present with uncommon presentations. We report A child who presented with extrusion of a shunt catheter through the rectum. It was treated as an infected shunt. Externalization of the shunt was done through the abdominal site and the exposed shunt was removed through the rectum by gentle traction. Once CSF was clear a new shunt was placed on the opposite side.
Keywords: VP shunt, shunt infection, anal extrusion.
Key Message: Exposure to a shunt catheter through the rectum is an uncommon presentation. It should be treated as an infected shunt. Most of these cases do not cause peritonitis or meningitis. The exposed shunt catheter should be removed through the rectum by gentle traction.
Abbreviations: VP-Ventriculoperitoneal, CSF: Cerebrospinal fluid. ETV -Endoscopic Third Ventriculostomy
Management and Outcome of Ozone Therapy in the Lumbar Spine Disc Disease with and without Use of Corticosteroids
Get PDFObjectives: To determine the Consequences and out-turn of ozone with and without the use of peri-ganglionic infiltration of corticosteroids in lumbar spinal generative disc disease.
Material and Methods: Comparative study was conducted in the Neurosurgery Department Pakistan Institute Of Medical Sciences Islamabad from December 2014 to November 2020. We included 338 patients with herniated lumbar disc with backache and radiculopathy. Randomly categorized in groups A and B. Group A was given 4 to 6 ml of intradiscal ozone along with 40 to 80 mg of peri-ganglionic methylprednisolone while group B only received 4 – 6 ml of intra-discal ozone. The visual analog scale was used to assess the degree of pain and modified Macnab criteria were used to assess the post-procedural outcome, periodic follow was carried out up to 6 months after the procedure.
Results: 169 patients were enrolled in group A with 70 females and 90 males. Group B had a total of 169 patents with 89 females and 80 males. In group A, a single procedure was required in 89 patients, twice in 27, and thrice in 10 patients to completely obliterate pain. While in group B, 71 patients had the single procedure, twice in 92 and thrice in patients. Data were compared by the Chi-square test, which was further confirmed by a significant P-value of 0.061.
Conclusion: The combination of percutaneous ozone chemodiscolysis along with the preganglionic injection of steroids as compared to single ozone therapy is the most effective, rapid, and long-lasting method of relieving backache and radiculopathy associated with lumbar disc herniation
Post-operative Status of Facial Nerve in Cerebello-Pontine Angle Lesion via Retro-Sigmoid Approach; Complications and Outcome
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Objective: To assess the post-operative status of Facial Nerve in cerebellopontine angle (CPA) lesion via retro-sigmoid approach and also its complications and outcome.
Materials & Methods: This prospective study was conducted at the Department of Neurosurgery, JPMC Karachi from a period of 10-12-2021 to 10-06-2022.The sample size of our study was 37 patients. All the patients were operated for CPA lesions and followed for three months to assess the outcome efficacy.
Results: Our study showed that the mean age was 37 years, with a range of 27 to 65 years, in which the males were 18 (48.6%) and the females were 19 (51.4%). Out of 37 patients, 28 (75.7%) were diagnosed with vestibular schwannoma, while 6 (16.2%) were meningiomas, and 3 (8.1%) were epidermoid cysts. Gross total resection was performed in 14 (37.8%) patients, while subtotal resection (STR) in 23 (62.2%). Facial nerve function in terms of House-Brackmann at 3 months was found to be grade I in 26 (70.3%), grade II in 9 (24.3%), grade III in 1 (2.7%), and grade IV in 1 (2.7%).
Conclusion: The CPA is a small corridor through which important neurovascular structures pass. Identification of CN VII is important in large CPA tumours to preserve facial motor nerve function. For all kinds of CPA lesions, gross total excision should be the aim of surgery
Outcome of autologous bone graft versus polyetheretherketone cages in anterior cervical discectomy and fusion surgery
Get PDFObjective:To compare the outcome of autologous bone graft versus PEEK cages in ACDF surgery in terms of clinical performance and radiographic features.
Methodology:This study was conducted at Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan from April 2020 to December 2022. In this study patients were randomized into two equal groups i.e. Group A (autologous bone graft) and Group B (PEEK cage).
Results: Total of 98 patients was included in the study. The mean age of cases was 49.88 ± 17.83 years. There were 58(59.18%) male and 40(40.82%) female cases. 25(25.51%) cases who had C3-C4 involved, 48(48.98%) patients had C5-C6 and 25(25.51%) cases had C5 region involved. The mean disc height at 6th months in PEEK group was 6.71 ± 0.46 mm and in bone graft group was 6.33 ± 0.47 mm, p-value < 0.05. The mean operative time in PEEK group (2.07 ± 0.42) was statistically less than bone graft group (3.23 ± 0.36), p-value < 0.05. The average blood loss was also statistically less in PEEK group as compared to bone graft. The mean hospital stay in PEEK group was 2.92 ± 0.61 days as compared to bone graft was 5.48 ± 1.90 days, p-value < 0.05.
Conclusion:Outcome of ACDF surgery PEEK cages are better than autologous bone graft in terms of clinical performance and radiological features. Hence PEEK cages can be opted in future to have better outcome and higher patient’s satisfaction.
 
Incidence of Primary Brain Tumors: A Hospital Based Study of 200 Cases
Get PDFObject: The main objective of this study was to determine the incidence of primary brain tumors. It’s a hospital based study, which was conducted in the department of Neurosurgery Nishtar Hospital, Multan between 1996 and 1999.
Patients of either sex were included in the study on the basis of history, clinical evaluation, laboratory and imaging investigations. The patients were admitted from outpatient department and by referrals from other medical units. After admission in the unit a uniform protocol of history taking, clinical and neurological examination, investigations and histopathological diagnosis was adopted for each patient. The information thus gathered was entered in a pro forma. The data analysed were age, sex, histological type, frequency and intracranial location of tumors.
Results: Among the 200 patients with primary brain tumors, there were 133 (66.5%) male and 67 (33.5%) female patients; the ratio being 1.98. The mean patient age was 33 years. The 31-40-year-old age bracket was found to be most highly represented, corresponding to 22.5% of total patients. In the younger age group, there were 34 (17%) male and 10 (5%) female patients, the ratio being 3.4 and the age mean of the patients was 7.6 years, with the range of 12 months to 15 years.
Conclusion: The overall results conclude that primary brain tumors are more prevalent in males, with the age range of 31 and 50 years. Astrocytic tumors are the most frequent type of brain tumors with overall predilection for supratentorial compartment. Meningiomas and acoustic neuromas are rare in children