Pakistan Journal Of Neurological Surgery
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Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan
Get PDFObjective: The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan.
Materials and Methods: This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion.
Results: 80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale.
Conclusion: Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern.
Patterns of Head Injuries in Pediatric Patients Treated in Emergency Department of Children Hospital and Institute of Child Health Lahore
Get PDFObjective: To analyze the pattern of head injuries along with characteristics and outcomes among pediatric age group presenting in The Children hospital Lahore, Pakistan.
Material and Methods: A cross-sectional study was conducted and a total of 384 children of both genders aged up to 12 years presenting with head injuries were included. After initial review and resuscitation by the trauma unit or neurosurgery unit, children were evaluated clinically and radiologically and the plan was decided for further treatment. Gender, age, place of injury occurrence, etiology of injury, Glasgow coma score (GCS) at the time of enrollment, the interval between injury and admission, management, outcome, and total duration of hospital stay were recorded on a predesigned proforma.
Results: In a total of 384 children, 249 (64.8%) were boys. Overall, the mean age was 5.8 ± 3.3 years. Falls were the commonest etiology in 210 (54.7%) children while motor vehicle accidents were the cause of head trauma among 78 (20.3%) children. The mean interval between injury and presentation was noted to be 3.2 ± 2.1 hours. Mortality was reported in 56 (14.6%) children and it was observed that a significant association was noted between outcome and GCS at the time of presentation (p < 0.0001).
Conclusion: The majority of the pediatric head injury cases were male and aged above 5 years. The most common etiology of head injuries was falls followed by motor vehicle accidents. GCS ? 8 at the time of presentation was significantly linked with poor outcomes
Neurosurgery with Artificial Intelligence
Get PDFThe safety and efficacy of surgery are the surgeon’s priority. With the help of artificial intelligence (AI) tools, with learning algorithms based on millions of patients’ records, the outcomes can be predicted following different types of surgeries. 1 According to the Journal of the American Medical Association by the Neurosurgical Simulation and Artificial Intelligence Learning Centre at The Neuro, McGill University, AI can enhance technical performance and learning outcomes during simulated brain tumor removal. 2 According to a study published in Nature partner journal Digital Medicine, an open-source smartphone app for meningioma has allowed surgeons and physicians to interactively with patients. The app helps doctors and brain tumor patients predict survival and help make better treatment decisions. Researchers have also created a machine-learning system to categorize tissue using a deep convolutional neural network (CNN).3 New research also showed that machine learning can diagnose brain tumors at a fraction of the time it takes human pathologists. The new method streamlined the practice of analyzing tissue samples while the patient is still on the operating table. As per new findings in Nature Medicine, the new AI system can accurately diagnose a brain tumor in two minutes4. We should place a high value on research based on anticipating neuropathologies, surgical outcomes, and choosing neurosurgical techniques in advance
Clinical outcome and complication of anterior cranial Fossa meningiomas in tertiary care Hospital Peshawar
Get PDFObjectives: We examined the surgical outcome and complications of anterior cranial Fossa meningiomas.
Materials and Methods: A prospective study was conducted at the Department of Neurosurgery Prime Teaching Hospital, Peshawar, KPK, Pakistan from June 2019 to June 2021. A total of 31 patients were selected through non-probability consecutive sampling. After clinical examination and radiological findings, the patients were diagnosed with anterior cranial Fossa meningiomas. Microsurgical Trans cranial approaches did. Clinical outcomes and complications were documented. Tumor anterior cranial fossa meningiomas. A low Karnofsky performance scale index was used to analyze the functional impairment of the patients.
Results: 9 (29.03%) were male and 22 (70.96%) patients were female. The mean age of presentation was 42 ± 5 years. Headache 25 (80.6%) and Visual loss were the main presenting symptoms 24 (77.5%), and Tuberculum sellae meningioma patients 08 (25.08%). The most common approach was Bifrontal craniotomy for OGM in 9 patients and two small OGM were operated on utilizing frontolateral craniotomy. The rest of the cases were operated through Pterional craniotomy. Tuberculamsalle meningiomas surgery results in a visual improvement in 6 patients (75%), Complete tumor resection was achieved in 22 (70.9%) patients and subtotal resection is achieved in 6 (19.3%) patients. In a few patients 03 (9.67%) only safe debulking and biopsy were taken. Postoperative hemorrhage was in 4 (12.9%) patients.
Conclusion: Transcranial approach for microsurgical resection of anterior cranial fossa meningiomas is an effective and feasible approach in terms of visual outcome and extent of resection.
Keywords: Anterior cranial Fossa Meningioma, Bifrontal Craniotomy, Front-lateral craniotomy
Comparison of Short Segment Percutaneous Transpedicular Fixation With and Without Inclusion of Fractured Vertebrae in Thoracolumbar Fractures
Get PDFObjective: To compare the outcome of SSPF (Short Segment Posterior Fixation) with and without the inclusion of fractured vertebrae in thoracolumbar fractures in terms of visual analog score and vertebral column stability.
Materials and Methods: The study enrolled 96 patients who were divided into two groups. Group A treated by SSPF (four screws: one level above and below the fracture), and Group B was treated by PSFFV (six screws: including fractured vertebrae). Assessment of parameters related to clinical and radiological aspects was recorded at 3 – 6 months.
Results: Mean ages of patients were 36.96 and 37.41 years with an M:F ratio of 1.8:1 and 1.4:1 in groups A (SSPF) and B (PSFFV), respectively. Mean VAS preoperatively, and postoperatively, at 3 and 6 months were 8.78 vs. 9.01, 4.98 vs. 5.01, 2.08 vs. 2.11, and 0.47 vs. 0.67 in groups A and B, respectively. Mean Kyphotic angle preoperatively, postoperatively, at 3 and 6 months were 21.76 vs. 22.91, 11.13 vs. 10.16, 13.59vs. 11.16 and 14.88 vs. 12.87 in groups A and B respectively. Mean AVH preoperatively, and postoperatively, at 3 and 6 months were 19.11 vs. 18.72, 20.01 vs. 22.71, 20.61 vs. 22.87, and 20.02 vs. 22.67 in groups A and B, respectively.
Conclusion: The results of this study favor PSFFV (Group B) over SSPF (Group A) in terms of vertebral column stability which was better achieved in PSFFV. PSFFV was also found superior with no implant failure which declares it safer and more effective than SSPF. None of the techniques was found superior in terms of pain. Radiologically, PSFFV, showed significant improvement in achieving anterior vertebral height, while there was no important distinction in kyphotic angle between the two
Pediatric Posterior Fossa Brain Tumor Surgical Outcome
Get PDFObjective: The study analyzed the complications and satisfactory surgical outcomes of posterior fossa brain tumor surgery in Lahore Medical City Lahore.
Materials and Methods: A prospective study was conducted and included 40 children who were diagnosed with posterior fossa brain tumors by history, physical examination, and later radiologically were admitted and operated on at the Pediatric Neurosurgery Department in Lahore medical City Lahore between the period of March 2021 and March 2022.
Results: There were 26 (65%) male and 14 (35% females) individuals among the 40 patients. The average age was 12.5 years. This study found that great surgical outcomes were observed in 10 instances (25 percent), good outcomes in 20 cases (50%), and bad outcomes in 10 cases (25%). The most frequent clinical manifestations were headache (38%), vomiting (30%), ataxia (10%), blurred vision (10%), and cranial nerve palsy (12.5%). The best prognosis is shown in children with Pilocytic astrocytoma, followed by ependymoma, while the poorest outcome is seen in children with medulloblastoma.
Conclusion: Pediatric neurosurgeons continue to face particular difficulty in the surgical treatment of posterior fossa brain tumors. Our study compares the outcomes, complications, and surgical outcomes to prior clinical investigations
Incidence and Surgical Outcome of the Intracranial Epidermoid Cyst at Punjab Institute of Neurosciences Lahore, Pakistan
Get PDFObjectives: The incidence and microsurgical outcomes of intracranial epidermoid cysts in the Department of Neurosurgery III, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan, are described in this case series.
Materials and Methods: This study was a data analysis of a case series of 15 patients (mean age, 40 years) of both gender with intracranial epidermoid cysts who had microsurgical surgical excision over five years.
Results: This study comprised 11 (73.3%) male and 4 (26.7%) female patients, 11 (73.3%) cases were infratentorial and 4 (26.7%) cases were in supratentorial region. The epidermoid was located in the CP angle in 11 (73.3%) patients, 3 (20%) in the midline supra sellar region, and 1 (6.66%) in the frontotemporal region. The presenting complaints were mainly headache in 11 (73.33%), cranial nerve palsy and cerebellar signs in 8 (53.3%) patients, Trigeminal neuralgia in 3 (20%) patients, Fits and hydrocephalus in 2 (13.3%) patients. There were 14 (93.3%) patients with GTR (gross total resection), 1 (6.6%) patients STR (subtotal resection). According to Karnofsky's performance scoring (KPS), 3 (20%) patients improved, 11 (73.3%) patients had the same KPS, and 1 (6.6%) patient had a lower KPS.
Conclusion: The epidermoid cysts in the brain are usually found in the infratentorial region rather than the supratentorial region. Infratentorial lesions typically cause cranial nerve deficits, whereas the supratentorial area symptom is a headache
Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons
Get PDFIntroduction/Objective: Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills.
Materials & Methods: Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa.
Results: The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above.
Conclusion: Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery
Lumbar Canal Stenosis Decompression Using Bilateral Interlaminar Versus Classic Laminectomy Technique
Get PDFObjective: The study compared the postoperative back pain VAS score in bilateral interlaminar and classic laminectomy techniques in patients with lumbar canal stenosis.
Material and Methods: This randomized controlled experiment was carried out at Ayub Teaching Hospital's Neurosurgery Department. 30 patients were in the bilateral interlaminar (BIL) group (A) and 30 were in the traditional laminectomy group (B). The bilateral interlaminar decompression technique was carried out utilizing the operating microscope. Both groups employed facet joint undercutting to reduce the 61-facet joint excision. All patients had postoperative CT scans to assess how well the decompression went. Postoperative VAS score was stratified to age, gender, duration of complaints, and duration of the procedure.
Results: In group A, the mean age of patients was 51.10 years while in group B, the mean age was 54.500 years. There was a male dominance of male patients in both groups. The baseline mean VAS score was 7.9 in group A and group B both. The duration of the procedure was 71.2 minutes in group A, and 104.7 minutes in group B. Mean postoperative VAS score was 5.4 in group A and 3.3 in group B. There existed a significant difference in mean postoperative VAS scores between groups concerning gender, the duration of complaints, and procedures.
Conclusion: In patients with lumbar canal stenosis, bilateral interlaminar allows for safe and adequate spinal canal decompression.
Keywords: Lumbar canal stenosis (LCS), Bilateral Interlaminar (BIL), Classic Laminectomy, Visual Analog Scale (VAS)