Pakistan Journal Of Neurological Surgery
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Isolated Sacral Metastasis Mimicking a Chordoma Presenting as a First Manifestation of Thyroid Malignancy: Case Report
Get PDFFifty-nine years old female presented with the clinical manifestations of lumbosacral plexopathy. MR imaging revealed a large destructive pelvic mass of sacral origin, mimicking a sacral chordoma. Histopathological findings are suggestive of follicular variant of papillary carcinoma of thyroid origin. There was no clinically palpable thyroid lesion or any clinical feature suggestive of thyroid dysfunction. This report describes an isolated sacral metastasis of thyroid origin without prior clinical features of thyroid malignancy.
Keywords: Sacral metastasis, Thyroid metastasis, sacral chordoma, spinal metastasis, sacral tumor, pelvic tumors
Anterior Cage Fixation in Spinal Injuries
Get PDFMethods: The study comprised 121 patients (98 men and 23 women) between ages 15-70 years with one spinal fracture with two or three column destruction, who underwent with expandable cage placement, between January 2005 to January 2009. Neurological status was classified using American Spinal Injury Association (ASIA) impairment scale and motor index. The fusion status and spine alignment were examined by radiological imaging.
Results: All patients in this study achieved solid fusion with significant neurologic improvement. Mean follow up time was 6 months. Neurologic status in 41 patients (pre op: ASIA-E post op-unchanged). 30 patients (pre-op: ASIA-D, post-op improved to ASIA-E). 6 patients (pre op: ASIA-B, 2 patients improved to ASIA-D and 5 patients improved to ASIA-D). Pain improved in all case and sensations were last to recover.
Conclusion: The TMC is an effective adjunct in restoring and maintaining sagittal plane alignment after thoracolumbar vertebrectomy to achieve canal decompression and in this context it provides an effective method for anterior column reconstruction. It has been found to be a rapid and safe procedure for lumber spine fusion, with a high fusion rate and clinical success with rare serious complications.
Key words: Thoracolumbar spinal trauma, Titanium Mesh Cage, Anterior Column Reconstruction of spine, Spinal stability
Clinical Presentation and Surgical Management of Brain Abscess
Get PDFObjectives: To determine the clinical presentation, surgical management and outcome of patients with Brain Abscess in our locality.
Study Design: Descriptive study.
Place and Duration of Study: Bolan Medical complex, Sandeman Provincial Hospital and Akram Hospital, Quetta. Duration from January 2003 to July 2004.
Subject and Methods: Study conducted on twenty patients with Brain Abscess confirmed on CT Scans. Patients of both gender and all age group were included in the study. Those managed conservatively were excluded from the study.
Results: Surgery was performed on all patients with the mortality rate of 20% (4) in this study.
Conclusion: Appropriate microbial coverage and surgical management of Brain Abscess reduced the mortality and neurological deficits.
Key Works: Brain Abscess, Neurological deficit, Mortality
Frequency and Progression of Gliomas in Pregnancy in Population Presenting at Lahore General Hospital, Pakistan
Get PDFObjective: To study the frequency and progression of gliomas in pregnant patients in our population.
Materials and Methods: A retrospective study of 30 pregnant patients between 18 to 40 years of age with confirmed gliomas from July 2015 to July 2020 was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. Time of diagnosis, grade of glioma, the outcome of pregnancy, and mode of treatment were studied in these patients.
Results: Out of 30 patients, 29 were freshly diagnosed during pregnancy. All patients underwent cesarean section. If the patient presented before 30 weeks of pregnancy, irrespective of the outcome of the baby, the caesarian section was done. If a patient presented after 7 months, in case of low-grade glioma, the patient was in-house transferred and operated for tumor after delivery. A total of 17 patients had low-grade glioma and 12 patients had high-grade glioma. One patient had a recurrent disease during pregnancy, with the progression of tumor from low grade to high grade.
Conclusion: There is an association between pregnancy and the incidence of gliomas. They can be both high or low grades. The mode of delivery is preferably the caesarian section because the stress of labor causes an increase in the frequency of seizures. There is the possibility of recurrence as well as progression to higher grade during pregnancy
The Prevalence of Low Vitamin D3 Levels in Patients with Lumbar Disc Herniation and Its Relationship with Different Patient Parameters
Get PDFObjective: To determine the prevalence of low vitamin D3 levels in patients having proven lumbar disc herniation and its relationship with different patient parameters.
Materials and Methods: This is a prospective study carried out on 100 patients at the Neurosurgery department, Jinnah postgraduate medical center from Feb 2018 to April 2019. Serum Vitamin D levels and other characteristics were assessed in patients with prolapsed lumbar intervertebral discs. Low levels of Vitamin D were defined as insufficiency (10 ng/ml – 30 ng/ml) and deficiency (< 10 ng/ml).
Results: Out of 100 patients in the study, only 21% had optimal serum vitamin D3 levels, and 79% had hypovitaminosis (57% insufficient and 22% deficiency). Low vitamin D levels were prevalent in all age groups, with deficiency more prevalent in the older age group (p-value = 0.004). The BMI (body mass index) of the patients showed a linear correlation with vitamin D levels.
Conclusion: Decreased vitamin D levels are prevalent in patients having herniated lumbar discs. The study showed that older-aged patients and high BMI exhibited severe vitamin D deficiency. As a result, recommendations are that preventive initiative for this specific hypovitaminosis target a broader population to intercept the occurrence of low vitamin D levels and the associated repercussions
Results of Conservative Management of CSF Rhinorrhea in Post Traumatic Patients
Get PDFObjectives: We aimed to see the results of conservative management of CSF rhinorrhea in post-traumatic patients.
Material and Methods: An observational study was conducted on 50 patients for 3 months from 1st November 2021 to 31th Jan 2022. Patients presented to neurosurgery unit II, PINS. All patients had a history of road traffic accidents (RTA).
Results: The age range was 10 – 50 years. The mean age was 25 years. All patients were managed conservatively for one week. We advised complete bed rest to all patients for 2 weeks. Head ends of all patients were slightly inclined from 15 – 30 degrees to reduce pressure in basal cisterns. We gave acetazolamide, mannitol, antibiotics, and anti-epileptic medication to all patients. CSF rhinorrhea in our 43 (86%) patients was stopped completely. In our 5 (10%) patients, CSF rhinorrhea was cured completely after doing a lumbar puncture with drainage of CSF and with the placement of a lumbar drain at a rate of 10 ml per hour. In our 2 (4%) patients, CSF rhinorrhea was not cured. We have to do surgery either by trans cranial or endoscopic repair of CSF rhinorrhea.
Conclusion: CSF rhinorrhea is best cured by conservative management except in 4% of cases
Outcomes of Acromegaly Patients Treated with Sandostatin LAR after Surgical Excision of Pituitary Adenoma
Get PDFObjectives: An observational study to evaluate the outcomes of Acromegaly patients treated in the department of Neurosurgery III, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan.
Materials and Methods: This study was the analysis of a case series of 20 patients (mean age: 30 years) of both genders with acromegaly due to macroadenoma who had endonasal excision and postoperative treatment with Sandostatin LAR.
Results: This study consisted of a total of 20 patients out of which 11 (55%) were male and 9 (45%) were female. All 20 Patients (100%) had a headache as their main symptom and 13 patients (65%) had visual field deterioration. 19 patients (95%) had complete resection of the tumor whereas 1 (5%) had a subtotal resection. After surgery and treatment growth hormone levels improved in 19 patients (95%) and remained elevated in 1 patient (5%), IGF-1 (Insulin-like growth factor – 1) levels improved in all 20 (100%) patients. Following consecutive octreotide injections vision of 11 patients (84%) out of 13 improved and in 2 (16%) patients, it remained the same as of Preoperative status whereas Headache improved in all 20 (100%) of the patients. None of the patients had any complications related to the procedure or the injection of octreotide LAR.
Conclusion: Acromegaly due to macroadenoma responds well to treatment with octreotide LAR after endonasal resection in terms of hormonal levels and symptoms of the patients. It is a safe treatment with very less side effects and complications
Incidence of Development of Hydrocephalus after Excision and Repair of Spina Bifida Aperta in Infants
Get PDFObjective: To find out the incidence of hydrocephalus after excision and repair in infants presenting with Spina Bifida Aperta.
Materials & Methods: This prospective cohort study was conducted at the Pediatric Neurosurgery Department, Children Hospital & The Institute of Child Health, Lahore, Pakistan, from January 2021 to October 2021. A total of 62 infants of both genders presenting with spina bifida Aperta undergoing repair were included. Data of the patients, i.e., name, age, gender, head circumference, location, and width of the defect, accompanying bladder, limb anomalies, radiological, laboratory findings, and diagnosis (meningocele or meningomyelocele) were noted. Patients were followed postoperatively for 1-month, and the incidence of post-surgery hydrocephalus was noted.
Results: Out of 62 children, 36 (58.1%) were male and 24 (41.9%) female. The mean age was noted to be 138.82 days. Most children, 36 (58.1%), were found to have meningocele. The most frequent local meningocele/meningomyelocele was noted to be lumbosacral, 22 (35.5%). Post-surgery hydrocephalus was noted among 11 (17.1%) cases. No significant association of gender, age, head circumference, defect size, the maximum dimension, diagnosis (meningocele or meningomyelocele), or location was noted with post-surgery hydrocephalus among study cases (p > 0.05). No mortality was reported.
Conclusion: Meningomyelocele and lumbosacral location of the defect were among the prominent factors affecting the incidence of post-surgery hydrocephalus.
Keywords: Spina Bifida Aperta, Meningiocele, Myelomeningocele, hydrocephalus, lumbosacra
Common Histopathological spectrum of Posterior Fossa Tumors in Pediatric Age Group
Get PDFObjective: To know about the common posterior fossa tumors in the pediatric age group on basis of Histopathology in Neurosurgery Department, Hayatabad Medical Complex Peshawar.
Material and Methods: This descriptive cross-sectional study was conducted in the department of MTI Hayatabad medical complex Peshawar from January 2017 to January 2020. We included a total of 52 patients who operated for posterior fossa tumors and biopsy reports were observed to know the histological pattern of the tumor. We included all those patients who have posterior fossa tumors except those tumors which involved or arise from brain stem and infections. The data was collected and analyzed using SPSS version 21.
Results: Our study shows that the mean age was 6 years with a standard deviation ± 2.81. Fifty-eight percent of children were male and 42% of children were female. Histopathologic patterns were analyzed as 48% of children had Medulloblastoma, 25% of children had Astrocytoma, 19% of children had Ependymoma, 8% of patients had other histopathologic patterns.
Conclusion: Our study concludes that common histopathologic patterns of posterior fossa tumors in children were medulloblastoma (48%), Astrocytoma (25%), ependymoma (19%) respectively
Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively
Get PDFObjective: To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI).
Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0.
Results: Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035).
Conclusion: Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes.
Keywords: Midline shift, CT scan, Glasgow Coma Score, Head Injury