Pakistan Journal Of Neurological Surgery
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Surgical Modality as a Determinant of Survival and Neurological Outcome Following the Evacuation of Acute Subdural Hematomas
Get PDFObjective: We designed the present study to compare the clinical outcomes of the craniotomy and the decompressive craniectomy procedures that we had performed in our department for evacuating traumatic acute subdural hematomas.
Material and Methods: We retrospectively analyzed the medical data of all the adult patients in whom a craniotomy or a decompressive craniectomy had been performed for evacuating acute traumatic subdural hematoma. The demographic data, the preoperative Glasgow Coma Scale (GCS), and the clinical outcome were studied.
Results: A craniotomy had been carried out in five patients for traumatic AcSDH evacuation while in twelve patients a decompressive craniectomy had been performed. The mean preoperative GCS was 9 in the patients that underwent a craniotomy, whereas the mean preoperative GCS in the decompressive craniectomy group was 6.8. The overall mortality was 47%. In the craniotomy group, 4 (80%) patients survived and 1 (20%) patient expired. In the decompressive craniectomy group, 5 (41.7%) patients survived and 7 (58.3%) patients expired. The outcome in all the 9 surviving patients was favorable based on the Glasgow Outcome scale and all of them were independent of follow-up.
Conclusion: Better clinical outcome was observed in patients who had undergone a craniotomy compared to those in whom a decompressive craniectomy had been performed. Patients that underwent a craniotomy were also in a better clinical status preoperatively compared to patients who underwent a decompressive craniectomy
Cosmetic Results By Utilization of Weber Ferguson Approach For Anterior Skull Base Lesions
No full textObjectives: To evaluate Weber Ferguson approach for dealing pathologies of the anterior skull base including maxilla, ethmoidal and frontal sinuses causing nasal blockage and then extending upwards into skull base.
Material and Methods: This study was done at Department of Neurosurgery at Lahore General Hospital Lahore and Department of Plastic Surgery, Services Hospital Lahore. Duration of study was eight years from Jan 2000 to Dec 2007.
Results: Ten cases were included in study. Six of them were females and four males. Age range was from 19 years to 52 years. Most of the cases were in second decade. All the cases had paranasal sinuses, nose and frontal skull base involvement. Two of the cases were that of ameloblastoma, two that of squamous cell carcinoma, two of mucormycosis, and one that of osteoidosteoma, angiofibroma, cystic bone disease and Schwan cell carcinoma each. Growth was successfully reached through this approach and all the cases had acceptable cosmetic results.
Conclusion: Weber Ferguson incision may provide excellent approach for anterior skull base lesions employing maxillotomy. Provided the incision lines respect the nasal subunits, nasolabial folds and skin relaxation lines it may gives excellent cosmetic results
Management of Cranio-vertebral Trauma: By Gallies Fusion One Year Experience at Lahore General Hospital
No full textCranio-vertebral trauma is rare entity faced in our Neurosurgical set up but estimated injuries may exceed 35% in some studies especially in road traffic accidents. After 1975 due to better on scene resuscitation the number of such injuries are increasing in our set up as well. To evaluate our data a study was conducted for one year from Jan. 2006 to June 2007 with six month/allow up of treated patients. This study was conducted in Department of Neurosurgery Lahore General Hospital Lahore Unit-1. Over one and half year. Five cases of Cranio-vertebral Trauma were recorded. Gender distribution revealed 1 (20.00%) Female and 4 (80.00%) Male patients. One (20.00%) patient was in pediatric age group and remaining were related to adult group. Main culprit was Road Traffic accident in 3 (60.00%) patients while one (20.00%) case of fall and one (20.00%) of assault were recorded. Patients were managed in a standard protocol and neurological out come -was measured immediate after operation then one, three and six months postoperatively using Frankel grading.
Conclusion: Out of all cases one case move from frankel grade C to B over the follow up of 6 months. In all cases Gallies fusion was done without any postoperative complication at least upto 6 months which confirm that Gallies fusion in Cranio-vertebral trauma is the best way of stabilization in cranio-cervical injuries which is simple, safer, cheaper and effective way affixing the spine posteriorly in devastating trauma of Cranio-vertebral region
Takayasu’s Disease: A Rear Case of Occlusive Vascular Disorder of Brain
Get PDFTakayasu’s Disease is a type of inflammatory disease which involve the vessels at different levels. This disease is important for remission and relapse. It usually affects the younger age group resulting in morbidity of the most valuable group of society. Its symptoms are non specific but it may present with the involvement of different organs of the body like heart, renal impairment, fibrosis of retroperitoneal area. Diagnostic tool is Ultrasonography but definitive diagnosis is achieved with the help of CT angiography at the level of aortic arch, neck and brain. Treatment includes both medical and surgical options. Most of the time relapse occurred but with various treatment we can prolong the remission span and improve the quality of life of the patient
Surgical Outcome of Posteriour Fossa Tumors in Children
Get PDFPosterior fossa tumors are most common in children than adults accounting for 54 to 70% of all childhood brain tumours. Out of them 30% are brain stem tumors. Most common posterior fossa tumors are Medulloblastoma, Astrocytoma, Ependymoma, and Brain Stem tumours. While dermoid, epidermoide and teratoma are the rare tumours. All focal and Cystic brain stem tumors in posterior fossa show better results with redical surgery than more diffused tumours that had stereotactic biopsy.
Key words: Posterior Fossa Tumors
Analysis of Patients Operated For Lumber Disc Herniation
Get PDFObjectives: To analyze different variables of patients operated for lumber disc prolapsed.
Study Design: Observational study.
Sample Size: Three hundred and twelve consecutive patients operated for lumber disc herniation.
Settings: Department of Neurosurgery, Postgraduate Medical Institute, Govt Lady Reading Hospital, Peshawar. Pakistan.
Duration: The study duration was nine months from January 2008 to sept; 2008.
Results: Out of 312 patients 208 were male and 104 female with male to female ratio of 2:1. Their ages ranged from 17 to 70 years. Majority (56.1%) of patients were from northern areas. Straight leg raising test was impaired in 295 cases. The ratio between contained and ruptured disc was 3:1. About 44.9% of patients (140 cases) had left side disc prolapse, while right side in 29.5% and bilateral in 25.6% cases. The common level affected was L4-L5. In 225{72.1%} patients modified fenestration Discectomy was suitable and in the rest Laminectomy was carried out.
Conclusion: From this study we conclude that Lumber disc herniation is common in male gender in 4th decade of their life, which occur commonly due to misuse of back. It usually occurs in Labourers and drivers. Left side and L4-5 level is involved in majority of patients. Sciatica with backache, and impaired straight leg raising test are important clinical features. Contained disc is more common than ruptured disc. Minimal invasive procedures like modified fenestration Discectomy gives good results. 
Importance of Serum Calcium and Uric Acid Levels in the Management of Neuromuscular and Skeletal Pains
Get PDFComparison of Dexamethasone Plus Metoclopramide, with Dexamethasone Alone in The Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Elective Craniotomy
Get PDFObjective: To compare the efficacy of combination of dexamethasone plus metoclopramide with dexamethasone alone for control of postoperative nausea and vomiting in patients undergoing elective craniotomy.
Study Design: Double blinded randomized controlled clinical trial.
Material and Methods: One hundred ASA I – II patients listed for elective craniotomy were randomized to two groups of 50 patients each. Group A received dexamethasone 8 mg (2 ml) plus metoclopramide 10 mg (2 ml) pre-pared in two different syringes, and group B received dexamethasone 8 mg (2 ml) and normal saline (2 ml), pre-pared in two separate received syringes just before induction of anaesthesia. Anaesthesia was standardized. All episodes of Postoperative Nausea and Vomiting (PONV) during the first 24 hours postoperatively were evaluated at 3 time periods : 2, 4, and 24 hours. The presence or absence of nausea and vomiting (by simply yes or no) was assessed by research nurses aware of the study but blinded to the group to which the patient belonged.
Results: The frequency of nausea and vomiting was clinically and statistically lower in dexamethasone plus metoclopramide group as compared to dexamethasone alone p-value 0.032 and 0.028 for nausea and vomiting respectively.
Conclusion: Combination of dexamethasone plus metoclopramide is more effective in preventing postoperative nausea and vomiting than dexamethasone alone when used for prophylaxis of Post-operative Nausea and Vomiting (PONV) before the induction of anaesthesia in patients undergoing elective craniotomy
Surgical Management and Outcome of Lumbosacral Disc Herniation (Study of 100 Cases)
Get PDFObjective: To discuss the surgical management and outcome of lumbosacral disc herniation.
Material and Method: The study was conducted in BMCH and Akram Hospital Quetta from April 2005 to November 2006, 100 patients of both gender included in study. Age range was 30 – 25 years. MRI lumbosacral spine done in all cases.
Results: Excellent result was observed in 80% of patients while fair result in 12% and results were same in 6% of patients. Poor result in 2%.
Key word: Lumbosacral Disk, Herniation.
 
Predictors of Surgical Outcome Following Cerebral Contusion in Severe Head Injuries
Get PDFObjective: There are controversies regarding the management of Cerebral Contusion. The study sought to identify parameters influencing the surgical outcome of individuals suffering from a brain contusion.
Methods: A quasi-experimental study was conducted at the Department of Neurosurgery, Mayo Hospital Lahore, and 37 patients were included. The information on the mode/mechanism of injury, time of presentation, clinical presentation, and contusion type/location was collected. GCS (at 1st, 2nd and 6th weeks) and GOS were used for the neurological assessment of pre-operative and post-operative status.
Results: The average age of presentation was 42.57 years. There were 21.6% female and 78.4% male patients. 64.9% presented with road traffic accidents. 4% of patients presented to the hospital within 12 hours of injury, 16.2% between 12 to 24 hours, and 5.4% between 24 to 48 hours. 29% had seizures and upgoing plantar. 18% had hemiparesis or hemiplegia. Light reflex was absent in 40.5% of patients. The GCS kept improving postoperatively. GCS at admission was averaging 8 which improved to 10, 12, and 13 after surgery. The presenting mean GCS at 1st-week, 2nd-week, 6th-week, and mean GOS at 30th PAD. Counter coup injury improved to 15/15 right in 1st week. Mean GOS was 5 at 30th PAD. The most improvement was seen in the frontoparietal, temporoparietal, and fronto-temporo-parietal locations. The mean GOS at 30th PAD was 4.
Conclusion: The outcome following cerebral contusion depends upon the initial presenting GCS and GOS. Therefore, the better the presenting GCS and GOS better is the prognosis of the patient