Pakistan Journal Of Neurological Surgery
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Short-Term Complications of Microscopic Trans Nasal Transsphenoidal Pituitary Adenomectomy
Get PDFBackground/Objective: The commonest of pituitary gland tumors is pituitary adenoma which may be excised transcranially or trans nasal trans sphenoidal using either microscope or endoscope, in this study, the microscope was used. The objective was to see the short-term outcome of patients after microscopic transnasal trans-sphenoidal pituitary adenomectomy.
Material & Methods: This was a descriptive prospective study carried out from July 2019 to July 2021. 80 cases were included. All patients were investigated by contrast brain MRI, hormonal assay for pituitary gland & visual perimetry. Patients were evaluated for complications at 48 hours and 7 days.
Results: Mean age of the study population was 41.78 ± 11.75 years. There were 61 (76%) men & 19 (24%) women. 55 (68.8%) patients had functioning and 25 (3.3%) patients had nonfunctioning adenoma. Among 33 (41.3%) patients size of the adenoma was < 0.9 cm and 47 (58.8%) patients had adenoma > 1.0 cm. 12 patients had CSF leaks within 48 hours of surgery and 5 had a persistent leak on the 7th day. No statistically significant association was seen between age, gender, and size of adenoma and persistent CSF leak (P > 0.05). Diabetes insipidus was found in 9 patients. 3 had post-operative hematoma, 01 patient had meningitis and 2 patients died.
Conclusion: microscopic transnasal trans-sphenoidal surgery is a safe procedure yet associated with significant complications
Assessment of Outcomes of Myelomeningocele Repair and Early Post-Operative Complications
Get PDFObjective: To explore the result and frequency of different problems that occur in the early post-operative period and the incidence of these complications in our community. It will give insight and drive further development in the care of myelomeningoceles as well as the unique problems that emerge in these patients post-operatively.
Materials and Methods: At the Jinnah Postgraduate Medical Center in Karachi, the Department of Neurosurgery, this prospective, observational study was carried out over 12 months. Patients of both genders from 1 month to 2 years of age, diagnosed with myelomeningocele, and admitted to the ward for surgical repair were included in the study.
Results: Out of 94, there were 58.5% female patients, with the highest percentage of age group i.e. 48.9% in > 3 months to 9 months. Medium size of MMC (71.3%) at the lumbar side location (46.8%) was observed in the highest frequency among the study sample. The overall postoperative complication rate was 19.1%, with CSF leak being the most common (9.6%) followed by wound infection (5.3%). There was no association of the complications with the age, size, and location of MMC.
Conclusion: Myelomeningocele treatment may be delayed as a result of distant homebirths. Neurosurgeons who are trying to give prompt access to medical care for individuals born with MMC face various hurdles, including the family's desire to seek medical attention, their capacity to do so, and the availability of proper medical treatment
Osteomalacia in Neurosurgical Practice - A Review of 32 Cases
Get PDFObjectives: To assess the apparently neurosurgical presentation of patients suffering from osteomalacia which is potentially preventable and treatable metabolic disease, (mimicking discogenic disorder), osteomalacia.
Study Duration: January 2005 to December 2006, covering a period of two years in the department of Neuro-surgery Lady Reading Hospital, Peshawar and Department of Medicine Hayatabad Medical Complex Peshawar.
Study Design: Descriptive observational study.
Material & Method: This is a review study of 32 cases of osteomalacia presenting as discogenic disorder, collected from the Neurosurgery OPD. A separate Performa, which outlined, age, sex, marital status, gestational history, educational status, main presenting complaints, history of exposure to sunlight in the domain of urban and rural set up. The duration of the symptoms, history of medical and surgical treatment and procedures was used. This was supplemented by appropriate hematological and biochemical profile namely hemoglobin con-centration, ESR, serum calcium, phosphate and serum alkaline phosphates levels. A detailed note of the plain radiological findings mainly the looser zones and CT scan or MRI findings was also made to exclude the other diseases. All patients having biochemical profile and radiological evidence of osteomalacia were included. While patients having other orthopedic, neurosurgical and medical conditions not fulfilling this criteria were excluded. The available data was analyzed according to the set parameters and was later used for discussion and recommendation.
 
Titanium Cage Fixation in Thoracic and Thoraco-lumbar Anterior Inter-body Fusion
Get PDFnner by inter body fusion.
Study Design: Prospective Study.
Material and Method: The study was conducted at the department of neurosurgery Lahore general hospital Lahore.
Results: Thirty cases were included during period two years. All cases operated for decompression, fusion and instrumentation, cages of titanium mesh were used. Neurological status of the patients assessed before and after operation. Twenty eight (93.3%) cases improved neurologically. Two (6.7%) did not improved.
There were three infected cases which were treated and improved in the long run.
Conclusion: By using anterior interbody fusion (AIF) with cage we can mobilize the patient early. Improvement of the neurological status is excellent. Per operative infection rate is very low. Deformity can be corrected with more accuracy.
Key Words: Anterior cervical corpectomy, anterior dorsal inter body fusion, anterior, posterior and lateral, computed tommography, magnetic resonance imaging
Intracranial Fungal Granuloma Various Treatment Modalities Depending Upon The Anatomical Structures Involved
Get PDFObjective: To determine the efficacy and achievement of better results by applying different modalities of management, depending upon the anatomical structures involvement.
Material and Methods: This is a vast study including 50 cases of intracranial fungal granuloma presenting in the department of Neurosurgery PGMI Lahore General Hospital, Lahore. The study duration was ten year from August 998 to August 2008.
Prospective and retrospective and observational.
Results: A total of 50 cases were included in the study. Sex incidence revealed male 30 (60%) and female 20 (40%) patients. The ratio of male to female was 3:2. The age range revealed youngest patient was 10 years of age and oldest patient was 58 years of age. Most of the patients (80%) were in the 3rd, 4th, 5th decade of life.
Conclusion: I there is intradural extension of the disease then only Bur hole Biopsy should be performed if necessary, otherwise antifungal treatment can be given on clinical basis as well. Attempt to excise the lesion can flare up the disease process, hence should not attempted. If one has performed craniotomy for excision of tumor but per operatively surgeons had the impression of fungal granuloma, fungal stain should be sent immediately to confirm the diagnosis and antifungal should be started immediately. These patients had the tendency to deteriorate on 4th – 6th day post operatively, such patient should be subjected for selective hyper-ventilation for one week to 10 days or till the clinical condition of the patient improves significantly. 
Management of Depressed Skull Fracture: A Study of 93 Cases
Get PDFObjective: To determine the correlation of skull fracture with dural tear in head injury patients presenting to a tertiary care hospital.
Patients and Methods: This study was carried out at Lady Reading Hospital Peshawar from January 2008 to December 2008. All patients who were operated for depressed skull fracture during this study period ware included in the study. X-ray skull and CT scan brain were done for all patients; side and site of skull fracture were noted on imaging and during surgery. The incidence of dural tear associated with depressed skull fracture in various age groups and gender was noted. The results were analyzed using SPSS various 11.
Results: A total of 93 patients of depressed skull fracture were operated. There were 64 male and 29 female. Fall from the height was the main cause of trauma (61.3%). Most of the patients presented with moderate head injury. Dural injury was noted in 59.1% of the cases leading to neurodeficit in the form of hemeparesis/ hemiplegia in majority of cases. All patients were operated elevating the depressed fragments and dura repaired.
Conclusion: Dural injury is associated with morbidity in the form of hemiparesis / hemiplegia in patient having depressed skull fracture mainly at franto-patietal region for which prompt surgical intervention and dural repair are the procedures of choice.
Key Words: Depressed skull fracture, head trauma, duroplasty
The Radiological Outcome of Thoracolumbar Spine Fracture Fixation in Short Vs Long Segment
Get PDFObjectives: The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures.
Materials and Methods: A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level.
Results: In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%).
Conclusion: Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation.
Keywords: Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome
The outcome of Endoscopic Supraorbital Eyebrow Approach: A Case Series Reported from PINS, Pakistan
Get PDFObjective: The study was conducted to evaluate the technique and results of the endoscopic supraorbital eyebrow craniotomy for resection of extra-axial skull base lesions.
Material and Methods: A case study of 70 patients who underwent the endoscopic supraorbital eyebrow approach was conducted. The patients' lesion location, the extent of excision, hospital stay, complications, and cosmetic results were all examined. A 48-hour postoperative CT scan was conducted, followed by a 6-week MRI to check for residuals. Total resection (complete), near-total resection (>90 percent), and subtotal resection (< 90 percent) were the three types of resection rates. At the follow-up appointment, the wound was evaluated for aesthetic reasons as well as any neurological impairment.
Results: There were 39% male patients and 61.4% female patients. The mean age of the patients was 37 years. Craniopharyngioma (88.57%) was reported in most of the patients. In the majority (93%) of the cases, total resection was performed. No complication was observed in 70% of the patients. 14% of patients reported Diabetes insipidus. No intraoperative complications like bleeding or tissue injury were observed. 88.57% of patients were satisfied with the surgical management.
Conclusion: With outstanding aesthetic outcomes, the endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive Keyhole method to remove extra-axial anterior skull base and sellar, suprasellar, and parasellar lesions
Efficacy and Role of Intrathecal Fluorescein for Detection of Defect Site for Treatment of Cerebrospinal Fluid Rhinorrhea
Get PDFBackground/Objectives: Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant mortality and morbidity. 90% of post-traumatic rhinorrheas stop conservatively, 10% of post-traumatic, spontaneous, and post-operative rhinorrhea need surgical repair. Fluorescein is helpful in the detection of CSF rhinorrhea peroperatively.
Material and Methods: A descriptive case series was conducted at the Department of Neurosurgery, PINS Lahore in a single unit by a single surgical team. 62 patients were enrolled who met the inclusion and exclusion criteria. The lumbar drain was passed at L4 – L5 level and 0.1 ml of 25% sodium Fluorescein was diluted in 10 ml of CSF. The endoscope passed through the nostril and the leakage point was detected by yellowish-green fluid coming out of the rent under endoscope. After surgery, the patients were followed up after two weeks to observe the efficacy. Post-stratification was done through a chi-square test.
Results: The mean age of the patients was 42.85 years. The most common leakage was found from cribriform plate followed by lateral lamella & sphenoid sinus. Gender difference, leakage site, and age of the patients did not have significant effects on the results of using fluorescein dye for detecting the rent. The benefit of using the dye was 79%.
Conclusion: This study indicated that intrathecal fluorescein is a highly effective and beneficial approach for pinpoint localization of CSF defect, particularly very minute defects, and plays an important role in the successful treatment of CSF rhinorrhea
The Management options for Post Traumatic CSF Rhinorrhea: A Case Series study
No full textObjective: A descriptive case series study was aimed to evaluate management options for traumatic csf rhinorrhea and develop a better option
Materials and Methods: The study was conducted at Neurosurgery department, Bahwal Victotoria hospital Bahawalpur . This study involved 80 patients aged between 20-55 years of both genders diagnosed of CSF rhinorrhea presented with trauma.
Results: In the department of Neurosurgery BVH, Bahawalpur 2000 patients were admitted with head injury in two years from April 2021 to February 2022. A total of 80 patients of these had cerebrospinal fluid (CSF) rhinorrhea. This study was conducted to evaluate the management options of CSF rhinorrhea in the patients with head injury. CSF rhinorrhea was stopped in 70 patients with conservative management. In 10 patients cerebrospinal fluid rhinorrhea continued after the conservative management of 2-6 weeks and surgical repair of Dural tear at the base of skull was done in these patients. Site of CSF rhinorrhea leakage was located in these patients with the help of CT Scan and MRI skull.In all these patients Dural tears was repaired with a graft of fascia Lata or periosteum, pasted on the site of defect with fibrin glue.
CONCLUSION:We concluded that all post traumatic C.S.F rhinorrhea cases should be managed conservatively because most of the C.S.F leaks stop spontaneously with proper conservative management. So surgical repair should be delayed for 2-12 weeks after a leak has been identified