Pakistan Journal Of Neurological Surgery
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The Frequency of Early Post Traumatic Cerebrospinal Fluid Rhinorrhea in Patients with Head Trauma
Get PDFObjective: To determine the frequency of early post-traumatic CSF (cerebrospinal fluid) rhinorrhea in patients with head trauma.
Materials and Methods: A prospective study was conducted in the Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from 13th December 2019 to 12th December 2020. This study comprised 155 patients who had suffered head trauma. All patients were followed for one week. If patients developed clear, watery discharge from the nose, this was documented as being CSF rhinorrhea. The frequency was then further divided into immediate and early.
Results: The ages of the patients were 34.28 ± 14.20 years on average. The prevalence of CSF rhinorrhea was observed in 3.2% (5/155) patients. In all the patients, the CSF leak presented within the first 48 hours i.e. it was immediate.
Conclusion: Although rare, this post-traumatic complication continues to be a challenge in terms of morbidity and subsequent mortality.
Key Words: Cerebrospinal fluid, Rhinorrhea, Head Trauma
Chiari Malformation with and without Syringomyelia: Surgical Technique and Outcome in 88 Adult Patients
Get PDFObjective: This study identified the relationship between posterior fossa craniectomy, expansion neuroplasty, and radiological appearances in patients with Chiari malformation with and without clinical syringomyelia with the surgical outcomes in an attempt to correct the lesion.
Materials & Methods: Eighty-eight patients with Chiari malformation (CM) were included in the study where 70 had associated syringomyelia. All underwent posterior fossa craniotomy, expansion duroplasty without fiddling with cerebellar tonsils. Patients were evaluated at 1 month, 3 months, and 12 months. The MRI studies were done at 12 months when symptomatic relief and radiological findings were evaluated and matched.
Results: Most of the patients were young adults between the age range of 25 – 40 years. The most common complication was pseudomeningocele (5.68%) formation followed by CSF leak (4.54%). Patients with a longer history of Chiari malformation or syrinx-related symptoms and signs had partial relief in symptoms and signs. The poor outcome as expected was seen in patients with atrophic changes in upper limbs and hypertonia in lower limbs, especially in patients with loss of joints position sense and poor balance. Patients showed maximum improvement in headaches both suboccipital as well as generalized. Syringomyelia was decreased in size in 49 patients and remained unchanged in 21. Dysesthesias were improved in 31 patients.
Conclusion: Clinical improvement was related to the expansion of the posterior fossa and subarachnoid cistern and reduction in the size of the syrinx. Surgical decompression of the posterior fossa should create adequate space for its contents and reduce the syrinx cavity. The relationship between symptomatic improvement and radiological findings is not always linear.
Keywords: Chiari Malformation, Tonsillar Herniation, Syringomyelia, Duroplasty
Outcome & Complications of Decompressive Craniectomy with Expansion Duroplasty in Severe Head Injury
Get PDFObjective: A descriptive case series was conducted to find the frequency of complications and complications of decompressive craniectomy with expansion duraplasty in severe head injury.
Material and Methods: 189 patients fulfilling the selection criteria were included. All patients had TBI which was confirmed by CT scan. Surgery was performed on the day of admission under general anesthesia and a large trauma flap. Patients were monitored daily by evaluators from the date of surgery until hospital discharge or death. Patients were followed up for 3 months and the outcome was assessed using the Glasgow outcome scale (GOS).
Results: Mean age of the patients was 36.57 years. There were 61.4% (116) males and 38.6% (73) females. 3.7% had CSF leakage. 1.6% had meningitis. Wound infection was seen in 7.4% of patients. Forty percent had a favorable outcome and 60% had a poor outcome. Fifty patients out of 111 patients between 18 – 40 years showed good outcomes. Twenty-six out of 78 from the 41 – 60 years age group showed good outcomes. Out of 189 total, 76 patients had a good outcome. The outcome was good in 63 patients out of 148 patients with GCS 5 – 8, whereas 13 (out of 41) patients had a good outcome with GCS below 5.
Conclusion: We discovered that the result was good in 40% of patients, with 11 percent of complications recorded. Therefore, we concluded that decompressive craniectomy with expansion duraplasty is an effective procedure for the treatment of the severe head injury
Micro-Endoscopic Discectomy versus Open Discectomy: A Struggle for Better Clinical Outcomes
Get PDFObjective: The objective of the current study was to compare the clinical outcomes of a micro-endoscopic discectomy with an open discectomy.
Materials & Methods: This Quasi-experimental study was conducted in the Department of Neurosurgery, Alrazi Healthcare, Lahore, and Ammar Medical Complex, Lahore. The sample consisted of 40 patients with lower back pain with radiation to the lower limbs. A lumbar disc single-segment hernia was diagnosed based on magnetic resonance imaging (MRI) findings. Independent sample t-test was used to explore the difference in outcomes and level of pain between group A and group B. Chi-square test was used to compare the recovery rate of patients in both groups.
Results: A significant difference between the two groups in terms of surgery duration (t = 15.977, P = .000), blood loss during surgery (t = -10.256, P = .000), length of incision (t = -58.355, P = .000), and hospital stay after surgery (t = -4.687, P = .000) was found. The overall recovery rate for the micro-endoscopic Discectomy group was 95% whereas, in the open discectomy group, it was 90%.
Conclusion: Micro-endoscopic discectomy is superior to open discectomy in terms of lesser surgical trauma, lesser blood loss, lesser hospital stay, earlier return to work, and higher pain resolution
Efficacy of Ventriculoperitoneal Shunt For The Management of Cerebellar Haematomas
Get PDFObject: To determine the role of ventriculoperitoneal shunt in the management of cerebellar haemotoma with obstructive hydrocephalus.
Result: A total of 10 cases were included in the study. Six (60%) were male and 4 (40%) were female. Age range was from 35 – 63 years. The clinical presentation was sudden severe headache, vomiting, loss of consciousness. Glasscow coma score was 6/15 to 13/15.. C T Scan brain revealed cerebellar haematoma compressing the fourth ventricle with obstructive hydrocephalus. The range of volume of cerebellar haemotoma was from 20 ml to a maximum of 80 ml. Various management plan were offered, decision was done case to case basis. Three (30%) patients with mean cerebellar haemotoma volume of 30 ml (range 20-40) obstructive hydrocephalus were managed by a ventriculoperitoneal shunt (V.P. Shunt) alone. All three patients had excellent post operative recovery within a period of 2 to 4 weeks. Seven (70%) patients were operated for removal of cerebellar haematoma alongwith external ventricular drain (EVD.), which was removed on 5th – 7th day but in one case V.P. shunt was inserted post operatively. Result were good in 3 cases, excellent in 2 cases, fair in one case due to persistant hydrocephalus and mortality in one case. The patient who died was operated for removal of cerebellar haematoma and external ventricular drain was passed He died due to chest infection post operatively. Thus out of 10 cases V.P. shunt was done in 4 cases
Surgical Decompression of Carpel Tunnel Syndrome
Get PDFObjective: To study the out come of surgical treatment of carpel tunnel syndrome, and to evaluate symptomatic improvement.
Material & Methods: This study was conducted in the department of neurosurgery saidu teaching hospital, swat from January 2006 to December 2007.All the patients were randomly selected irrespective of their age and sex from neuro surgical out door clinic. Patients responded to conservative treatment were excluded from the study. The age range was from 20-70 years. A total of 83 patients were included in this study. 72 (8.6.74%) were females and 11 (13.25) males.
Results: 83 patients with age ranging from 20-70 years, 72 (86.74%) females and 11 (13.25) males (6.5:1) were subjected to surgical decompression 30 (36.14%) patients had bilateral carpel tunnel syndrome. Excellent result were obtained in 71 (85.54%) patients, good in 9 (10.84%) while 3 (3.6%) patients had poor response.
Conclusion: Surgical decompression is more effective than conservative treatment
Comparison of One vs. Two Burr Hole Craniostomy in Chronic Subdural Hematoma Recurrence
Get PDFIntroduction/Objective: Chronic subdural hematoma (CSDH) is most frequent neurosurgical conditions. To find the recurrence rate of chronic subdural hematoma in patients who underwent one vs. two burr craniostomy.
Material And Methods: A randomized controlled trial was conducted at the Neurosurgery department, Ayub Teaching Hospital, Abbottabad. In the current study, a total of 76 (38 in each group) patients were observed. ASA-I, ASA-II, ASA III patients, symptomatic radiologically proven Chronic subdural hematoma. Patients were randomly allocated into two groups of 38 patients each. randomization with blocks. Group A was treated with intraoperative epidural methylprednisolone while Group B was treated with normal saline only. Clinical information was recorded on a pre-designed proforma.
Results: Mean age was 54 years in group A, and 56 years in group B. In group A, 74% were male and 26% of patients were female. In Group B, 76% were male and 24% were female. The group A, 5% of patients had recurrence while in Group B, 13% of patients had a recurrence. There existed a significant difference between effectiveness and not-effectiveness of one/two burr hole craniostomy among patients who were less than 40 years.
Conclusion: The recurrence rate of chronic subdural hematoma is higher in patients undergoing two burr hole craniostomy as compared to one burr craniostomy
Cerebellopontine Angle (CPA) Tumors Presenting with Trigeminal Neuralgia (TN): A Study from LRH, Peshawar
Get PDFBackground/Objective: The cerebellopontine angle (CPA) is the most prevalent site for brain tumors, accounting for 10% of all cases. CPA tumors can have a direct or indirect pathogenic impact on the auditory nerve and brain stem. The study aimed to quantify the prevalence of cerebellopontine angle tumors in patients with trigeminal neuralgia.
Material and Methods: A cross sections study was conducted and 100 patients were included from the Neurosurgery department of LRH, Peshawar. Magnetic resonance images (MRI) were used to look for CPA tumors. The data on CPA tumors were stratified for age and gender. Suboccipital retromastoid craniectomy was performed.
Results: The mean age of the patients was 43 years. 38 patients were male and 62 were female. CPA tumors were seen in three percent of trigeminal neuralgia patients. There existed a significant difference (p < 0.00001) between the presence and absence of CPA tumors. A maximum number of patients (n = 37) were not having CPA tumors from the age group of 51-60 years. An insignificant association was reported for CPA distribution concerning age and gender.
Conclusion: According to our findings, 3% of trigeminal neuralgia patients had cerebellopontine angle tumors. We urge more investigation and screening of trigeminal neuralgia patients for CPA tumors based on the findings of this study
The Outcome of Minimally Invasive Percutaneous Transpedicular Screw Fixation (TPSF) in Thoracolumbar Spine Fractures
Get PDFBackground & Objective: This study aimed to determine the outcome of percutaneous transpedicular screw fixation (TPSF) in patients with thoracolumbar fractures.
Material & Methods: A total of 157 patients with thoracolumbar fractures were included from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays, CT, and MRI scans. Neurological status was documented preoperatively and postoperatively. All patients were treated with Minimally Invasive Percutaneous Transpedicular screw fixation. Data for operative time and per-operative blood loss was obtained through the operative notes. The severity of postoperative pain and length of hospital stay were also documented.
Results: Out of 157 patients, 69.4% were male and 30.6% were female. The 141 (89.8%) were traumatic from road traffic accidents/falls, and 16 (10.2%) were pathologic. The 128 (81%) patients were discharged on the first day, 23(15%) were discharged on the second day, and 6(3.8%) on the third day. 79% of patients had a single level of spine fracture whereas, 20% had 2 spinal fracture levels. The average operative time for MIS percutaneous TPSF was 55 minutes. Postoperative pain was markedly reduced as compared to traditional open surgery and no patient had any new neurological deficit. The mean blood loss was 25 ml and none of the patients needed a postoperative blood transfusion.
Conclusion: Percutaneous transpedicular instrumentation is an ideal surgical approach for thoracolumbar spinal stabilization.
Keywords: Thoracolumbar Fractures, Percutaneous Transpedicular Screw Fixation, Minimally Invasive Spine Surgery, Road Traffic Accidents (RTA)