Pakistan Journal Of Neurological Surgery
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The outcome of Posterio-lateral Decompression and Transpedicle Fixation for Thoracic Spine Tuberculosis
Get PDFObjective: The study assessed the outcome of posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis.
Materials and Methods: An observational, cross-sectional study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. All those patients who had undergone posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis were included. Both genders with ages more than 14 years were included in our study. Ethical committee approval was taken. Pre-designed proforma was used for data entry. Patients’ data were analysed through SPSS software.
Results: A total of 31 patients with tuberculous spondylodiscitis were studied. The age ranged from 15 – 57 years with a mean of 37.74 ± 10.07 years. Most of the patients with thoracic TB were male 54.8% (17/31). Pain improved in all the patients and neurology improved in most of the cases. The dural tear was in one patient and one patient had a wound infection. There was no mortality.
Conclusions: We conclude from the study that posterior-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis is a safe procedure. It has good results in terms of pain relief and neurological improvement. This procedure has an acceptable complications rate. Therefore, it can be considered as a better alternative to other surgical procedures for thoracic spine tuberculosis
Comparison of Outcomes of Early and Late Surgical Interventions in Lipomeningomyelocele (LMMC) and Lipomeningocele (LMC)
Get PDFObjectives: The study compared the signs and symptoms of post-operative complications in early vs. late intervention lipomeningomyelocele (LMMC) and lipomeningocele (LMC).
Materials and Methods: We compared the clinical and surgical data between two groups i.e., lipomeningomyelocele (n = 189) and lipomeningocele (n = 64), and their early vs. late surgical interventions for 3 years from January 2018 to July 2021. We included patients of both genders (n = 253) with lipomeningomyelocele or lipomeningocele aged up to 7 years. A detailed neurological exam i.e., sensory, motor, and cerebellar signs was performed to evaluate the patients.
Results: The presentation of LMMC (74.7%) was very high compared to LMC (25.3%). 74.7% underwent detethering of the spinal cord, as they had cord tissue coming out of the defect. 25.2% had only meninges coming out of the bony deficiency and performed dural repairs. 47 patients had incontinence which was improved postoperatively. Sixty-nine patients had hydrocephalus which was treated with VP shunt or ETV. 23 patients had diastematomyelia which is a bony spur duly repaired intra-operatively. 50 presented with paraplegia and 19 cases with club feet. The majority of patients in both groups, reported for Power would fall between 3/5-4/5. For patients who underwent late intervention, 7 presented with post-operative incontinence, 12 with hydrocephalus, 12 with CSF leakage, and 13 with paraplegia.
Conclusion: If performed on time, surgical intervention in lipomeningocele and lipomeningomyelocele yields good results. Early intervention is substantially better for managing post-op CSF leakage and incontinence than late intervention
Role of Anterior Cervical Decompression Fusion (ACDF) and Plating in Patients with Lower Cervical Caries Spine
Get PDFObjective: We assessed the neurologic status of patients with cervical spine caries after anterior cervical decompression fusion and plating in terms of muscle power measured by MRC (medical research council) grade and functional status measured by Nurick grade.
Materials and Methods: A descriptive case series study was conducted and 36 subjects with lower cervical spine (C3 – C7) were included with cervical spine caries who needed anterior cervical decompression and plating operated by the department of Neurosurgery, KEMU/Mayo Hospital. The cervical spine TB was confirmed using an MRI plain and contrasted cervical spine. Post-surgical neurological examinations were performed on the 1st, 7th, 21st, and 42nd days and the 3rd and 6th months after surgery. The neurological state was measured in terms of muscle power measured by MRC grades and functional outcome was assessed from Nurick grades.
Results: The mean age of the patients was 37.0 ± 14.4 years. The majority of patients had C5 caries spine (28%) and the least had C7 caries spine (14%). Most of the patients had pre-operative MRC grade 3 (41.7%). The majority had Nurick’s grade 5 (55.6%). 17% of patients had post-operative hoarseness of voice. 31% of the patients had post-operative dysphasia which improved by 3 weeks. 3% developed a new neurological deficit in the form of deterioration of muscle power measured by MRC grade during 6 months’ follow-up time.
Conclusion: All follow-up improvements were statistically significant in terms of pre-operative status
The Surgical Treatment of Carpal Tunnel Syndrome
Get PDFObjective: To evaluate the clinical outcome of surgical treatment of carpal tunnel syndrome. This study was conducted in Neurosurgery unit LRH from March 2006 to May 2008. Fifty patients including 45 female and 5 male with 19 female to male ratio were included in the study. The age range was 35-60 years. In 75% cases, right hand was affected while 25%, left hand was affected. Bilateral involvement was only in 3 (6%) cases. Pain and paraesthesia was there in all cases in the distribution of median nerve. Phallen test was positive in 85% cases and tenil's sign was positive in 64% cases. Thenar wasting was found in 12 cases (24%). Nerve conduction studies were positive in 45 patients (90%) carpal tunnel stenosis and the entrapment of transverse carpal ligament was found in all cases. All underwent surgical release of median nerve under local Anesthesia. The patients were followed for 4 months. The surgical outcome was excellent in 90%, good in 6% and fair in 4%.
Key words: Carpal tunnel syndrome, Median nerve decompression
Basal Ganglia Infarct in Young Female Patient: in Consideration with D.V.T and Paradoxical Emboli
Get PDFTwenty four years old female presented on the 20th postnatal day with painful swelling of her limbs (more in the lower limbs) along with headache, nausea, and right sided weakness. On the basis of the history, relevant physical examination and investigations (C.T scan brain and echocardiography) she was diagnosed to have a paradoxical emboli from D.V.T (deep venous thrombosis) of her legs that reached her brain through patent foramen oval causing a basal ganglia infarct. Based on her serum albumin and ascetic albumin, her diagnosis was made which was in the favor of nephrotic syndrome. She was heparinized and anti-platelets aggregating therapy was initiated for her deep venous thrombosis. She was advised to get physiotherapy for the weakness she had on her right side. Because of timely diagnosis and early treatment her weakness had a gross improvement and she was able to start moving her limbs by herself at the time of hospital discharge.
 
Comparison of Cerebrospinal Fluid Leakage in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma with and without Sellar Floor Reconstruction
Get PDFObjectives: This study aimed to compare CSF leak in endoscopic endonasal TSS of pituitary adenoma with and without reconstruction of the sellar floor with no intraoperative CSF leakage.
Materials and Methods: It was a randomized controlled trial of 116 patients of both genders diagnosed case of pituitary adenoma who underwent endoscopic endonasal TSS over 1 year. The cases were randomized into 2 groups. In Group A endoscopic endonasal TSS and the sellar floor, reconstruction was done while in Group B only endoscopic endonasal transsphenoidal surgery was done without reconstruction.
Results: The patient’s mean age in group A was 40.7 ± 9.56 years, and in group, B was 41.9 ± 10.5 years. The gender distribution, for group A, males and females were 29 each (50%) and in group B, the males were 36 (62%) and females were 22 (38%). There were 52 (89.7%) cases of macroadenoma and 6 (10.3%) cases of microadenoma in each group. On the 1st postoperative day, CSF leakage was noted in 2 (3.4%) patients of group A, and CSF leakage was observed in 2 (3.4%) patients of group B. Results revealed no difference in CSF leakage between both groups. There were minor nasal complications in both groups.
Conclusion: There is an equal chance of success with endoscopic endonasal transsphenoidal surgery (TSS) of pituitary adenoma with and without reconstruction of the sellar floor, concerning post-operative CSF leak, in patients who have no intraoperative CSF leak which enlarges the pool of options for treatment
Comparison of the Efficacy of Multi Dural Stab Craniectomy with Open Dural Flap Craniectomy in Patients Having Acute Subdural Hematoma
Get PDFBackground/Objective: We compared the efficacy of multi-dural stab craniectomy with open dural flap craniectomy in patients having acute subdural hematoma.
Materials and Methods: A randomized controlled trial was conducted in the Department of Neurosurgery, Allied hospital, Faisalabad. 70 patients having acute subdural hematoma were included. All of the patients were randomized in two groups: group A received a multi-dural stab craniectomy, while group B received an open dural flap craniectomy. Efficacy was assessed after 3 months of treatment in terms of a good recovery.
Results: Out of 70 patients, the mean age was 34.51 ± 8.712 years. Because of similar age and presenting GCS, the data show a non-significant difference in clinical outcomes between patients undergoing multi dual stab and open dural flap operations. However, a significant difference between the clinical results occurred at 3 months after the surgery (p-value 0.004). The efficacy of the multi-dural stab procedure was significantly higher from the open dural flap surgery (p-Value 0.006). The efficacy of the multi-dural stab surgery was significantly higher in the under 35 years age group of patients compared to open dural flap surgery. The results highlight those better results were seen in both surgeries when the presenting GCS of patients was higher (GCS= 6 – 8) compared to poor outcomes in patients with GCS of less than 5/15.
Conclusion: Multi-dural stabs are a safer alternative to the open dural flap for removing acute SDH with satisfactory recovery
Transpedicular Fixation via Posterior Approach for Dorsal and Lumbar Spine Tuberculosis
Get PDFObjective: To determine the outcome of Transpedicular Fixation via Posterior Approach for Dorsal and Lumbar Spine Tuberculosis.
Material/Methods: This study was cross-sectional and conducted from 01/02/2015 to 30/7/2020 in the department of neurosurgery. A total of 36 patients with dorsal and lumbar spine tuberculosis were operated on for transpedicular fixation. Assessment scores were used pre-operative and post-operative and patients were kept on follow-up till six months after the surgical procedure. Variables like age, gender, spinal level, preoperative, and follow-up clinical status were calculated.
Results: There were 19 (53%) male and 17 (47%) female patients with a mean age of 27 ± 8. Thoracolumbar was the commonest segment involved in 17 (47%) patients, followed by lower thoracic in 8 (22%) and lumbar in 7 (19%). There were 7 (19%) patients on the preoperative American Spinal Injury Association (ASIA) impairment scale in grade B, 12 (33%) in grade C, 15 (42%) in grade D, and 2 (5%) in grade E. The follow-up assessment at 6 months showed that ASIA grade B was seen in 3 (8%), grade C in 4 (11%), grade D in 16 (44%), and Grade E in 13 (36%) patients. Preoperative and follow-up scores on the ASIA impairment scale, COBS ANGLE, and ESR showed a significant difference (p-value < 0.05).
Conclusion: We concluded that transpedicular fixation can restore the stability of the spine in thoracic and lumbar tuberculosis. The procedure is important for the improvement of clinical symptoms, correction of kyphosis, and stabilization of the spinal column
Outcome of Manual Traction in Patients with Cervicogenic Dizziness and Neck Pain
Get PDFObjective: Symptoms of cervicogenic dizziness include instability, unsteadiness, confusion, neck soreness, and limited cervical range of motion (ROM). We evaluated the outcome of manual traction in patients presenting with dizziness and neck pain.
Materials and Methods: 50 patients included who had dizziness and neck pain with a reduced range of cervical motion. Patients had sessions of manual traction after pre-treatment evaluation. Patients included in the study after history and physical examination were sent to the otorhinology department to rule out the vestibular cause of dizziness. Patients were sent to the Physiotherapy department for manual traction. Pain and dizziness were assessed from VAS and DHI scores.
Results: There were 28 male and 22 female patients. The mean age of the patients was 23.92 ± 11.39 years. The mean VAS scores (dizziness) were 46, 31, and 14 before treatment, at one week, and at one month, respectively. The mean VAS scores (pain) were 40, 21, and 8 before treatment, at one week, and at one month, respectively. The mean DHI scores (for dizziness disability) were 47.5, 34, and 21, at one week and at one month, respectively. There existed a significant difference (p < 0.00001) between the VAS and DHI scores before the treatment and post-treatment of follow-up at one week and at one month.
Conclusion: Patients with cervicogenic dizziness who were treated with manual traction improved considerably in terms of dizziness severity, pain relief, and a low score on the dizziness handicap index, indicating better psychological and functional well-being.
Keywords: Cervicogenic Dizziness (CGD), Dizziness Handicap Inventory (DHI), Manual Traction Protocol