Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Percentage Difference in Angiographic Findings Vs Per-operative Findings and Their Implications in Surgical Management of Sub Arachnoid Haemorrhage
Get PDFObjective: To determine the frequency of different treatment modalities used for the exclusion of aneurysms from circulation, to determine the percentage difference between the angiographic findings and per-operative findings related to aneurysm and its surroundings and to determine the outcome of our surgical management.
Results: Out of 25 cases, maximum cases were recorded in 4th and 5th decade. Male to Female ratio remained (1:1.08). Hypertension is involved significant number of cases. The most common aneurysm was of anterior communicating artery aneurysm (55%). Percentage difference in angiogram and per-operative findings about the appearance of perforators was maximum i.e. in 6 (24%) cases. In 18 (72%) cases clipping was done while remaining 4 (16%) cases were treated with clipping and reinforcement and 1 (4%) each with wrapping, trapping and carotid ligation. At admission Twelve (48%) patients in Grade-I; according to WFNS scale and 10 (83.33%) made good recovery while 2 (16.66%) died. In Grade-II; we had 7 (28%) patients out of which 3 (42.85%) had good recovery, 3 (42.85%) in the state of moderate disability and 1 (14.28%) expired. In Grade-III; we received 6 (24%) patients out of which 4 (66.66%) made good recovery while 2 (33.33%) expired. 
Lumbar Discectomy Using Lagenbech Retractor, A Cost Effective Minimally Invasive Technique. Study of 520 Cases
Get PDFObjective: Conventional disc surgeries though have good results, may result in subsequent damage due to trauma to erector spinae, ligaments and bones.
Materials & Methods: A total of 520 patients who underwent lumbar discectomy were studied. 388 were male and 132 were female. The mean age in this study was 35 years. Only patients with symptomatic posterolateral disc prolapse were included in the study. All patients were investigated with MRI or CT scan of lumbar spine. Only ten patients were investigated with myelography. The followup period was up to two years. Oswestry Disability Index of low backpain disability was also used as specific parameter in some of the cases.
Results: Overall success rate for pain relief was 93.8%. Only 13% had occasional pain on exertion. The hospital stay was < 2 days. The most common complication was recurrent sciatica (5.7%), and these patients reported within six to eight months postoperatively. Other complications encountered were operation on wrong level (1.34%) discitis (0.76%), dural tear (0.19%), nerve root injury (0.19%) and failed back syndrome (2.30%).
Conclusion: Author concludes that lumbar discectomy performed through a small (< 2.0 cm) incision using manual retraction with Lagenbech retractor, headlight and magnifying loupes is a safe and cost effective procedure with distinct advantages such as reduced hospital stay, minimal post-operative pain, early mobilization and good alternative to conventional laminectomy/discectomy procedures. 
Surgical Outcome of Anterior Skull Base Approach for Combined ENT and Neurosurgical Lesions
Get PDFObjective: To determine surgical outcome of Anterior Skull Base approach for combined ENT and Neurosurgical Lesions.
Material and Methods: This descriptive study was conducted at the departments of ENT, Head, Neck Surgery and Neurosurgery Postgraduate Medical Institute (PGMI) Lady Reading Hospital Peshawar from March 2003 to Feb. 2008, with a total duration of five years. All these patients were admitted in ENT department. These patients were evaluated in terms of detailed history, thorough examination and radiological investigations. Incisional biopsy of the nasal mass was taken in cases where angiofibroma was excluded clinically, and then proper approach for excision of the lesion was planned. A well informed consent was taken from patient explaining the procedure, its risks, benefits and associated complications. The intracranial lesion was completely excised by neurosurgeons with help of microscope while the extracranial portion of the lesion was excised by ENT surgeon .The specimen of the lesions was examined by Histopathologist.
Results: This study included 23 patients in the age range of 12-51 years, mean age 25 years. Eighteen patients were male and five were female with female to male ratio of 1:3.6. These patients presented mainly with complaints of nasal obstruction, epistaxis and headache. CT scans were performed in all 23 cases (100%) while MRI in 5 cases (21.73%). These patients presented with advanced disease on radiological findings and they were treated by combined approach by Neurosurgeons and Otorhinolaryngologists. On histopathology of the specimen angiofibroma was on top. Two patients were subjected to radiotherapy postoperatively. There was no mortality and no recurrence of the disease.
Conclusion: The anterior skull base approach has good surgical outcome in terms of complete clearance of the disease and minimum morbidity for combined neurosurgical and ENT lesions irrespective of the nature of the lesion
The Prevalence of Chiari II Malformation in Neonates with Myelomeningocele at Ayub Teaching Hospital, KPK
Get PDFObjective: Neural tube defects (NTDs) are common in northern areas of Khyber Pakhtunkhwa (KPK) and need a lot of community education for the parents regarding this disease, which impaired the patients for their whole life. The study aimed to assess the contribution of a family history of myelomeningocele and the resulting incidence of Chiari II malformation.
Materials and Methods: A total of 131 patients were observed to determine the frequency of the Chiari II malformation in patients with myelomeningocele who presented in Ayub Teaching Hospital, Abbottabad. All neonates were sent to the radiology department for MRI. A repair procedure for meningomyelocele was done.
Results: The mean age was 16.56 days. In 53.4% of neonates, there was a familial history of spinal dysraphism, while in 46.6% there was no familial history. Chiari II malformation was present in 23.7% of patients who presented with myelomeningocele. A significant difference (p-value < 0.00001) existed between the presence/absence of a family history of myelomeningocele and Chiari II malformation out of the total.
Conclusion: Early surgery, along with a multidisciplinary approach, provides the best opportunity for improved results and survival.
Keywords: Meningomyelocele, Neural Tissue, Maternal Folate Intake, Meningomyelocele (MMC) Repair
Perceived Stress and Emotional Exhaustion among Undergraduate Medical Students of Gujranwala Medical College, Pakistan
Get PDFObjective: To determine a student's performance. A survey of undergraduate medical students was done to determine the factors linked to increased stress and emotional tiredness among medical students at Gujranwala Medical College (GMC) Pakistan.
Material and Methods: Data was collected using a structured questionnaire collected from undergraduate medical students. Information related to stress, nervousness, being upset, daily life restlessness, being irritated, being focused, satisfaction with the lecturing, financial strains, family-related stress, living problems, and career, was collected from the respondents via proforma with permission.
Results: 40.4% of students felt they had often faced stress during their last month with 37.1% facing unexpected events. Often students (34.4%) found restlessness during their last month with 39.1% of subjects feeling irritated by things happening around them. Some 35.8% of subjects had given thoughts to the future, 26.5% felt worthless and 33.1% forgot simple things or tasks. 39.1% felt they had difficulty focusing on the tasks given to them. Financial strain was always there in 3.3% and was rarely felt in 33.8% of subjects. Family-related problems were always there in 7.3% of subjects. 33.1% always felt dissatisfied with the quality of food in the mess. 29.8% of subjects felt they were unable to fulfill their parents’ expectations while 22.5% felt they face stress about their career.
Conclusion: 40% of students are experiencing various forms of stress and emotional exhaustion. 33 percent of students always felt tension due to messed-up food, and 26.5 percent felt they always felt alone to deal with their problems.
Efficacy of Posterior and Posterolateral Approach for Decompression and Fusion for Thoracolumbar Tuberculosis
Get PDFObjective: To study the efficacy of the posterior and posterolateral approach in thoracolumbar tuberculosis.
Material and Methods: 60 patients with thoracolumbar TB spine were enrolled in the study from 2015 to 2021. These patients had single-level disease with low back pain and neurological compromise in lower limbs. The diagnosis was made on an MRI of the spine and elevated ESR levels. All patients were started with antituberculous treatment. The pain was measured on the VAS score, and neurological status was assessed on the ASIA score. Kyphosis angle was calculated on a lateral x-ray of the spine. All patients were operated on by posterior and posterolateral approaches with decompression and fusion. At follow-up, fusion was assessed on every visit by x-ray along with neurological status and pain score.
Results: The mean age of patients was 45.8 years (25 to 66 years). 59.5% patients achieved radiological fusion on follow-up x-rays. There was a significant improvement in VAS score preoperatively mean and SD6.38 ± 1.24to postoperatively 4.45 ± 1.09. The mean and SD of kyphosis in patients preoperatively was 22.3 ± 3.06 to post-operative 22.3 ± 3.06 with a p-value < 0.05 which shows significant improvement.
Conclusion: Posterior and posterolateral decompression and fusion of thoracolumbar tuberculosis is a good surgical approach in respect of neurological outcome, correction of kyphosis, and pain improvement
The Outcome of Multidisciplinary Treatment of Spinal Tumors: Institutional Experience of a Tertiary Care Hospital
Get PDFObjective: Spinal metastatic tumors are mostly extradural. Intradural extramedullary tumors include neurofibromas and meningiomas while intramedullary tumors are mostly astrocytoma and ependymoma. The purpose of this study was to share the experience of managing these patients as a multidisciplinary team (neurosurgeons, general surgeons, thoracic surgeons, ENT surgeons, plastic surgeons, and oncology) in selected cases where the tumors grow into the surrounding structures.
Material and Methods: This study was conducted at the Neurosurgery Department at Jinnah hospital Lahore from January 2021 to September 2022. 50 patients admitted to the Neurosurgery Department from OPD/emergency with the diagnosis of a spinal tumor confirmed on MRI were included in the study. Those patients who were unfit for surgery were not included in the study. Data was analyzed for gender, region, and location of the tumor, histopathological diagnosis, and multidisciplinary team involvement.
Results: Out of 50 patients, 28 (56%) patients were male and 22 (44%) patients were female while ages ranged from 14 to 63 years. Extradural location was the most frequently encountered location, i.e., 50%. Metastatic tumors were the commonest. A multidisciplinary treatment board was conducted in 31 (62%) patients whereas adjuvant treatment was done in 15 (30%) patients.
Conclusion: Multidisciplinary treatment of spinal tumors should be encouraged at tertiary care hospitals and routine multidisciplinary treatment boards conducted before and after surgical excision
Lipoma at Conus Medullaris without Spinal Dysraphism causing Neurological Deficit: A Rare Occurrence
Get PDFIt's uncommon to have an intradural lipoma without spinal dysraphism. The majority are asymptomatic, however, neurological impairments might occur. For the past six months, a 35-year-old man had been experiencing growing weakening in both lower limbs. The L1 intradural space-occupying lesion was detected during a clinical examination and radiological workup. The patient underwent surgery to address a worsening neurological impairment. The patient had fully recovered neurologically after a six-month follow-up. If the neurological damage is progressive, intradural lipomas should be surgically removed. The surgical treatment produces positive results
Types of Non-Acute Headache and Neuroimaging in the Evaluation of Patients with this Type of Headache
Get PDFThe aim of this study was to find the type of non-acute headache and to estimate the frequency of significant intracranial lesions in this type of headache. Non-acute headache was defined as any type of headache that had begun at least four weeks before. All the patients aged > 15 years attending the neurology and neurosurgery clinics of Post Graduate Medical Institute (PGMI), Lady Reading Hospital (LRH) Peshawar with non-acute headache were included in the study. The pregnant women and patients with facial pain alone were excluded from the study. They were followed prospectively for over a year. Detailed history and through neurlogic exami-nation was performed. The headache was classified according to the International Classification of Headache Disorder (ICHD) second edition of the International Headache Society (IHS). Every patient was investigated by neuroimaging studies. The computed tomography (CT) was done in all patients. Magnetic resonance imaging (MRI) was done in 86 patients to improve their diagnosis. Neuroimaging results were classified as “significant abnormalities”, “non-significant abnormalities” or “normal”. Significant abnormalities included neoplastic disease, hydrocephalus, vascular malformations, chiari malformation, large aracnoid cysts, intracranial hemorrhage and acute cerebral infarcts. The total number of patients was 1200; 795 women and 405 men. Their mean age was 38 years (15-75 years). Neuroimaging studies detected significant lesions in 18 patients (1.5%). The proportion of patients with headache and intracranial lesions is relatively small but neither neurological examination nor the features in the clinical history permit us to rule out such abnormalities
Pattern of Various Neurosurgical Diseases and Their Surgical Management in a District Headquarter Hospital, A Study of 80 Cases
Get PDFObjectives: The objective of this study was to find out the pattern of Neurosurgical problems in a D.H.Q Hospital Kohat Road, Peshawar, which is a secondary care centre.
Study Design: Retrospective study.
Materials and Methods: This study was conducted in the D.H.Q Hospital Kohat Road, Peshawar from 15 May, 2008 to 15 Oct, 2008 with 1-3 months of follow-up. In these five months total 52 OPD days were attended in which total 1400 patients were treated. Out of these patients 80 patients were admitted for different Neuro-surgical procedures.
Results: 80 patients including 50 male and 30 female were operated upon for different Neurosurgical diseases. Out of 80 admitted patients for neurosurgical procedures 39 (48.7%) were of lumbar disc herniation, 10 (12.5%) had lumbar spinal stenosis, 3 (3.75%) patients had scalp lesions, 3 (3.75%) patients had myelomeningocele, 2 (2.5%) were operated for sciatic nerve repair, 07 (8.75%) were operated for carpal tunnel syndrome CTS, 02 (2.5%) were operated for tethered cord syndrome (TCS), 02 (2.5%) were operated for infra-orbital nerve avul-sion, 06 (7.5%) patients were shunted for hydrocephalus, 1 (1.25%) had ulner-nerve release and 01 (1.25%) pati-ent was operated for craniosynostosis.
Conclusion: Most of the Neurosurgical procedures except brain tumors don't need any sophisticated facilities, rather it is the will of neurosurgeon which counts. Most of spinal surgery, shunt for hydrocephalus, scalp lesions, craniosynostosis can be operated in the record care centre and depending upon the skill of the neurosurgeons