Pakistan Journal Of Neurological Surgery
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Clinical Outcome Following Surgical Evacuation of Spontaneous Cerebellar Hematomas
Get PDFObjective: debated. The present study was designed to analyze the clinical outcome of patients operated in our department for spontaneous cerebellar hematoma evacuation.
Method: The medical data of all the patients in whom spontaneous cerebellar hematoma had been surgically evacuated were retrospectively analyzed. The parameters of age, preoperative Glasgow coma scales (GCS), and the volume of the hematoma was studied and their relationship with clinical outcome based on the Glasgow outcome scale (GOS) was analyzed
Results: The study included twenty-four patients. Fourteen (58.3%) patients survived and ten (41.7%) patients expired. The mean age of the surviving patients was 57 years and the mean age of the expired patients was 57.2 years. The difference wasn’t statistically significant (p = 0.9612). The mean hematoma volume in the surviving patients was 23 cm3 and in the expired patients was 26.2 cm3. The difference didn’t reach statistical significance (p = 0.1614). The mean preoperative GCS of the surviving patients was 12.4 and of the expired patients were 8.3. This difference was statistically significant (p = 0.004). All the surviving patients had a favorable outcome based on the GOS score
Conclusion: Surgical evacuation of cerebellar hematomas leads to a good clinical outcome. Preoperative GCS is significantly associated with the clinical outcome. The age of the patient and the volume of the hematoma were not found to be significantly associated with the clinical outcom
The Surgical Management of Supratentorial Astrocytomas Study of Preoperative Functional Status and Grade of Tumour For The Final Outcome
Get PDFObjective: Thirty cases of supratentorial extraganglionic astrocytoma were studied pre-and post operatively to evaluate the surgical Mortality and morbidity in relation to preoperative Karnofskys performance scale and histopathology of astrocytoma study. Comparative observational study conducted Neurosurgery Unit II, PGMI / Lahore General Hospital, Lahore.
Results: Mortality was 26.6% (8 patients), 87.5% patients having KPS <70 and 12.5% patients having KPS >70, as the level of significance is 0.1, p. value is 0.14. Mortality was high in high grade astrocytoma; G IV 50%, G III 37.5% and low in low grade astrocytoma; G II- 12.5% and G I-0%. With 0.1 level of significance, p. value is 0.07. Surgical morbidity was 50% (15 patients), of which 60% was early morbidity. Delayed morbidity occurred in 13% and was mixed (early and delayed) in 27%. Morbidity was high in high grade astrocytomas; G IV 27% G III - 47% and low in low grade astrocytoma G II 26% and G I-0%.
Conclusion: Mortality depended upon pre operative functional status and histopathological grade of astrocytoma in this study. Quality of life after surgical excision also depended upon the pre operative neurological status
Current State of Neurosurgery Training in Pakistan, Results of a Nationwide Questionnaire Based Survey: Interdepartmental Variations Preclude Standardization
Get PDFObjective: To observe inter departmental variation in the availability of resources and academic activities; within various neurosurgery programs of Pakistan.
Material and Methods: This is a proforma based survey of Neurosurgery trainees and young neurosurgeons of Pakistan looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the countries. All centers are accredited for neurosurgery training in Pakistan.
Results: Out of 36 respondents, 30 were completing fellowship training (FCPS) and 6 were induced for Master in Surgery (MS) program. About 80% participants used Youman’s text book of neurosurgery as reference book. Only 40% candidates had access to more than one indexed neurosurgery journals. Structured academic sessions (journal clubs, neuroradiology meeting, and neuropathology meeting) were lacking in majority of training institutes. 95% trainees had no microsurgical laboratory. Modern neurosurgical tools (frameless neuronavigation system, neuroendoscopy) were in use at few centers only.
Conclusion: Neurosurgery training in Pakistan is not uniform and wide variations exist between centers. We recommend exchange programs between centers at national and international levels to allow the trainees to gain first hand exposures to facilities not available in their own center
Comparison of Surgical Outcomes of ventriculoperitoneal (VP) Shunt at Choudhary’s Point vs. Keen’s Point
Get PDFObjectives: The study compared the outcomes of VP shunt at Choudhary’s vs Keen’s point.
Material and Methods: A quasi-observational study was conducted on 50 patients who presented to NS-2, PINS, with the complaint of hydrocephalus. The study was conducted for 3 months from 1st November 2021 to 31th Jan 2022.
Results: Mean age was 40 years. In 25 (50%) patients, VP shunts were done through Choudhary’s point while in 25 (50%) patients VP shunts were done through Keen’s point. All patients were evaluated on day 3rd POD, 7th POD, 15th POD, and 90th POD. All patients were improved on 3rd POD. On the 7th POD, 15 (30%) patients deteriorated and showed signs of raised ICP. In these patients, the upper end of VP shunts is again revised due to blockage. On 15th POD, the upper end of VP shunts was blocked in 3 (6%) patients and their upper end was revised. On 90th POD, 2 (4%) patients were presented with upper-end blockage, and again shunt revision was done. VP shunts in all these patients were done through keen’s point approach. Blockage of the lower end of VP shunt occurred in 10% of patients in which 8% were operated through Keen’s point approach while resting 2% of patients were operated through Choudhary’s point approach.
Conclusion: VP shunts through Choudhary’s point approach yield good results as compared to Keen's point approach. This site is described by professor Muhammad Anwar Choudhary, as more convenient for insertion of VP shunt
Enhancing Knowledge of Family Caregivers and Quality of Life of Patients with Ischemic Stroke
Get PDFObjectives: A Quasi-Experimental study was conducted to determine the impact of Attend-trial-based interventions on the knowledge of the caregivers and the quality of life of Ischemic stroke survivors.
Material and Methods: The study was conducted in the acute care hospital located in the rural area, Khyber Pukhtoonkha. A sample of 115 patients and informal caregivers participated in a multifaceted intervention including educational sessions, training and demonstration, and post-training discussion via WhatsApp. A pre-post evaluation of the quality of life, stroke knowledge, functioning, and activities of daily living was completed using validated tools. All information was collected using predesign pro forma and questionnaire.
Results: The interventions significantly improved all four outcomes in caregivers and patients. The mean score for the WHOQOL-BREF pre-intervention was 2.91 ± 1.10 which was increased to 4.18 ± 0.86. The pre-knowledge scores were 34.00 which increased to 39.95. There was a statistically significant change between pre and post knowledge scores [t (114) = -3.394, p = 0.001].
Conclusion: The study contributed towards the usefulness of multifaceted education intervention to enhance the rehabilitation efforts of patients and their caregivers in community settings
Outcome of Severe Traumatic Head Injury in Children
Get PDFObjective: To determine the frequency of outcome of severe head injury in children.
Material and Methods: This study was a descriptive case series carried out in the neurosurgery department from 05-01-2018 to 04-07-2018. The study includes 89 child age group patients with severe head trauma within the last 8 hours. CT scan non-contrast done in all patients. Designed Performa was filled. Required surgical intervention was done after completing pre-operative care if indicated. CT scan was done after performing the surgical intervention. Glasgow outcome scale was calculated at 2 months to follow up.
Results: 11.27 ± 4.38 years was the average age. It includes 70 (78.65%) males and 19 (21.35%) females. 18 (20.22%) was the frequency of mortality, those who survived were 36 (40.45%) with a good outcome, moderately disabled 19 (21.35%), severely disabled were 7 (7.87%), and vegetative was 9 (10.11%). The relationship of outcome with gender and age was found insignificant (p-value > 0.05) while with a mode of injury it was significant (p-value < 0.05).
Conclusion: Low mortality in children with a severe head injury was reported in this study. The commonest mode of injury was a road traffic accident. The clinical criteria for admission, findings on CT scans, and standardized neurological examination may yield data that can be used to predict outcomes accurately in children.
Keywords: Traumatic head injury, Road traffic accident, Outcome, GCS, Children
Per-Operative External Ventricular Drainage Results in Children with Posterior Fossa Tumors and Hydrocephalus
Get PDFObjective: We determined the outcome of per operational external ventricular drainage in pediatric patients with posterior fossa tumors and hydrocephalus.
Material And Methods: 54 patients included presenting with posterior fossa tumors and mild to moderate hydrocephalous were considered for per operative external ventricular drainage. The external ventricular drain was then weaned off in one week. If it cannot be removed due to persistent hydrocephalous it was converted into a permanent ventriculoperitoneal shunt.
Results: In the study, the mean age was 7 years. Twenty-seven children had ependymoma, 19% of children had medulloblastoma, and 54% of children had pilocytic astrocytoma. Moreover, 67% of children had weaned off and 33% of children had converted to VP shunt. There existed an insignificant difference in the outcome (yes/ no) concerning age groups, gender, and tumor type.
Conclusion: Our study concludes that the outcome of per operative external ventricular drainage was weaned off (67%) and converted to VP shunt (33%) in pediatrics with posterior fossa tumors and hydrocephalous
Multidisciplinary Management and Outcome of Intradural Extramedullary Spinal Tumors
Get PDFIntroduction/Objective: About fifteen percent of the primary CNS tumors are intraspinal. About two-thirds of tumors are intradural extramedullary (IDEM). This study was conducted to review the outcome of operative management of intradural extramedullary tumors in correlation with the factors, both clinical & histopathological, influencing the neurology of patients & prognosis.
Materials and Methods: It was a multicenter study including 42 patients conducted from December 2018 to December 2020. All patients were diagnosed by MRI with and without contrast. Patients were surgically treated & analyzed for clinical features i.e., pain by visual analog scale (VAS) & neurology by modified McCormick scale both preoperatively & post-operatively. Clinical features & outcomes were correlated with tumor size & histopathology. p-value < 0.05 was considered significant.
Results: This study included 42 cases. The most common diagnosis was schwannoma (76.19%). The average intradural space occupied at presentation was 82%. The most common location was dorsal (90.4%). The visual analog score for pain (VAS) improved in all patients post-operatively from 7 ± 1.9 to 2 ± 0.8 (p = 0.003) & modified McCormick scale from 3.0 ± 1.3 to 2.0 ± 1.0 (p = 0.005). The preoperative symptoms were correlated with the only size of the tumor occupying the intradural space (VAS p = 0.021, modified McCormick scale p = 0.018).
Conclusion: All the tumors excised showed some improvement in neurological status. Therefore, all patients diagnosed with IDEM should be operated on even if present with prolonged symptoms or severe neurological compromise.
Keywords: Intradural Extramedullary, Meningioma, Schwannoma, Intraspinal
Impact of Bronchoscopic Lavage and Aggressive Chest Physiotherapy on Clinical Pulmonary Infection Score of Patients of Severe Traumatic Brain Injury
Get PDFIntroduction: Traumatic brain injury patients present in the emergency room with a variable conscious status depending upon the severity of the injury. The process of aspiration starts from the scene of trauma as the patients with Traumatic brain injury and chest trauma have higher rates of aspiration pneumonia.
Materials and Methods: We conducted a prospective study to assess the impact of bronchoscopy lavage and aggressive chest physiotherapy on the Critical Pulmonary Infection Score of Patients with Severe Traumatic Brain Injury in the Neurocritical Care Unit. Patients with severe traumatic brain injury who met the inclusion criteria were enrolled in the study. Patients of both genders, ages ranging from 05 – 70 years were included in the study.
Results: 48 patients who met the inclusion criteria were enrolled in the study. 8 patients expired before 7 days and were excluded from the study. 88% were male and 12 % were females. Out of 40 patients, 30 were ventilated and 10 were managed without ventilation. Brain contusion was the most common CT scan finding. Out of 40 patients, 18 underwent surgical intervention, with decompressive hemicraniectomy being the most commonly performed procedure. Out of 40 patients, 32 patients underwent bronchoscopy. 8 patients out of 32 had more than two sessions of bronchoscopy.
Conclusion: As Critical Pulmonary Infection Score is an important indicator for pneumonia in the neurocritical care unit, the importance of standardized chest care with the help of bronchoscopic lavage and chest physiotherapy in keeping the Critical Pulmonary Infection Score on the lower side can prevent patients from developing life-threatening pneumonia