Pakistan Journal Of Neurological Surgery
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Comparison of Open Versus Percutaneous Transpedicular Screw Fixation in Thoracolumbar Fractures
Get PDFmeantime to return to work following percutaneous transpedicular fixation versus open pedicle screw fixation. We evaluated the average time required to return to work following percutaneous transpedicular fixation versus open pedicle screw fixation in traumatic lumbar spine injury.
Material and Methods: A randomized controlled trial included 60 patients. At study entry baseline demographics (age, gender, & duration of injury) were recorded. 30 patients were in the percutaneous transpedicular fixation group (A), while 30 patients were in the open pedicle screw fixation group (B). All the patients were followed every month time taken to return to work (TTRW) was noted on a proforma.
Results: Mean time taken by patients to return to work after surgery in Group A was 2.9 days, while in group B it was 5.1 days in group B. The difference between the two groups was significant (p-value 0.001). Within Group A, male and female genders showed a significant difference (p-value 0.032) in the TTRW after surgery. However, Group B did not show a similar difference between male and female patients. Duration of procedure had a significant effect on the TTRW (p-value 0.001).
Conclusion: We found ‘ time is taken to return to work’ was 2.93 ± 0.82 in group A and 5.10 ± 0.71 in group B (P-value 0.001). There was a significant difference in both groups. Percutaneous transpedicular fixation is a fast, safe and effective method as compared to other methods
The Frequency of Low Serum Cortisol Level in Acute Traumatic Brain Injury
Get PDFObjective: The study focused on evaluating the frequency of low serum cortisol levels in acute traumatic brain injury.
Material and Methods: Patients with Acute Traumatic Brain Injury of both genders between the ages of 2 and 70 years old with a GCS of 12 or below were included. Information including name, age, gender, pregnancy, GCS, serum cortisol level, history of steroid use, and hypothalamic-pituitary dysfunction were all recorded on a predesigned proforma. The results were stratified among age, sex, and GCS concerning outcome variables.
Results: The majority of patients (42%) ranged in age from 26 to 50. Male patients outnumbered female patients (77%). The GCS ranged between 9 and 12 in 63% of cases. Furthermore, 88 percent of patients had cortisol levels greater than 300nm/L. Hypocortisolemia was found in 13 people aged 26 to 50, 12 between the ages of 2 and 25, and only 7 between the ages of 51 and 70. There were 25 males and 7 women in the group. In 86 instances, GCS ranged from 9 to 12, while in 12 individuals, it varied from 3 to 8.
Conclusion: Although the majority of patients recovered, early hypopituitarism was common in severe TBI. It is required to identify concealed pituitary dysfunction in the course of the rehabilitation process of TBI patients.
Keywords: Cortisol, Traumatic Brain Injury, Hypocortisolemi
An Emerging Minimally Invasive Ozone Therapy for Spinal Disc Disease and Its Outcome
Get PDFObjectives: To analyze the effect and outcome of ozone therapy in herniated cervical and lumbar disc disease.
Material and Methods: A prospective study was conducted in the Neurosurgery Department of Federal Medical, Teaching Hospital Islamabad from March 2015 to December 2019. 310 patients with neck ache, and backache with radiculopathy were enrolled. Magnetic resonance imaging and the computed tomographic scan were done.4 to 6 ml of ozone were inserted in disc space. Periodic follow-up was done for up to 6 months of therapy. A single session of therapy was required in 55%, twice in 22.5%, and multiple in 13% of patients.
Results: Out of 310 patients, n = 220 were male and 90 females. Cervical herniated discs were 30 and lumbar 280, single cervical disc herniation was found in n = 26 and multiple in n = 4 while the single-level herniated lumbar disc was n = 220 and multiple in n = 60. Self-analysis of pain before intervention was assessed by visual analog, scored was VAS 4 in n = 80, VAS 5 – 6 in n = 120, VAS 7 – 9 in n = 70, and VAS 10 in n = 40 patients. Post-intervention prognosis according to Modified Mac nab was Excellent in 54%, good in 29%, Fair in 13%, and poor in 3.2% of patients.
 
Outcomes of Cranioplasty after Craniectomy
Get PDFObjective: Craniectomy is a widely used procedure in neurosurgery that results in more cranioplasties to repair skull defects. The complication rate after cranioplasties seems to be higher than elective craniotomies so this study was conducted to determine the outcome of cranioplasty after craniectomy.
Materials & Methods: The patients included in this study had craniectomy and cranioplasty for any indication. Patients included had variables, such as age, sex, underlying pathology, craniectomy and cranioplasty dates, the material used for cranioplasty (autologous bone or methyl methacrylate), and methods of cranioplasty flap fixation (sutures or titanium plates and screws) follow up period and complications.
Results: It was concluded that patients in the age group of 41 – 60 years (5 cases), males (7 cases), cranioplasty performed after 6 months (5cases) with autologous bone graft (8cases) were associated with more complications.
Conclusion: The overall rate of complications associated with cranioplasties is not negligible, however, early cranioplasty in young patients with the use of polymethyl methacrylate may be associated with less complication rate.
Keywords: Decompressive, Craniectomy, Cranioplasty, Autologous, Polymethyl Methacrylat
Neurological Improvement after Decompression for Dorsal Spine Tuberculosis (TB)
Get PDFObjectives: To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading.
Materials and Method: Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented.
Results: Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery.
Conclusion: Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization.
Keywords: Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization
Clinical Outcome of Hypoglossal-Facial Nerve Anastomosis in Severe Facial Nerve Paralysis: An Experience from Khyber Pakhtunkhwa
Get PDFObjectives: Facial nerve injury is one of the most devastating complications occurring as a result of any chemical, mechanical or ischemic insult. This study aimed to determine the surgical outcomes of limited experience in lower motor neuron facial palsy in the last decade.
Materials and Methods: A Prospective case series was done at Neurosurgery Department, Prime Teaching Hospital, MTI Lady Reading Hospital, and Irfan General Hospital Peshawar Khyber Pakhtunkhwa Pakistan. Patients were diagnosed after thorough clinical examination and radiological findings; conduction studies these as severe facial paralysis (House and Brackmann 4 – 6). Surgical treatment is done with end-to-end hypoglossal-facial nerve anastomosis. Outcomes and complications were documented. Entered data into specifically designed proforma.
Results: Out of 13 patients, who underwent a surgical procedure, 8 were male (61.5%) and 5 patients were female (38.5%). The mean age of presentation was 46 years. Patients were labeled on House and Brackmann scale. Improvement was defined as ? 1 grade improvement on the H&B scale, after 1 year of follow-up, 11 patients improved (84.6%) while 2 (15.4%) remained static. The complication was observed as hemiatrophy of the tongue without physiological weakness.
Conclusion: Hypoglossal-Facial nerve anastomosis is recommended treatment for severe facial paralysis, during the first year of insult.
Keywords: Facial Nerve Paralysis, Hypoglossal-facial nerve, House & Brackmann
Comparison of Transcranial and Extracranial Surgical Approaches For Orbital Lesions
Get PDFObjective: The objective of the study was to compare the utilization and results of various surgical procedures for the orbital and paraorbital lesions. Neurosurgeons are confronted to orbital pathologies, when either intracranial lesion extended into orbit or when a symptomatic orbital lesion is not confined to orbit. A wide variety of surgical approaches can be utilized to deal with lesions of orbit.
Study Design: Retrospective study.
Material and Methods: A study was conducted at Lahore General Hospital, Lahore to evaluate the operative results regarding the resectability and functional outcome, as well as to assess the advantages of various surgical approaches. This is a retrospective study with a study period of 10 years from Nov 1993 to Nov 2003.
Results: Forty cases were included in the study. Mostly patients were operated by transcranial approaches like Frontoorbital craniotomy 23 (57.5%), Frontal craniotomy with superior will orbitotomy 6 (15%) cases, Bifrontal craniotomy 2 (5%) case and Fronto-orbitozygomatic approach (OZA) 2 (5%) cases. Thus out of 40 cases 33 (82.5%) cases were operated by transcranial approaches. Extracranial approaches were utilized in 6 cases, most common approach was suprolateral orbitotomy 5 (12.5%), transethmoidal approach 1 (2.5%) case and anterior exenteration 1 (2.5%) case. Post operative recovery was excellent in 35 (87.5%), good in 3 (7.5%) and fair in 2 (5%) cases. All had excellent functional outcome. Complete resectability was possible, in 38 (95%) patients. Proper planning and selection of approach pave the way for successful excision and excellent outcome.
 
Management of Lumbar Spinal Stenosis by Laminectomy Experience with 80 Patients
Get PDFObjectives: To study the clinical results and complications of patients with lumbar spinal stenosis managed surgically by single or two level laminectomy.
Study design: Retrospective study.
Materials and methods: This study was conducted in Neurosurgery Department of Lady Reading Hospital and Hayatabad Medical Complex Hospital, Peshawar from Jan, 2005 to December, 2007 with 06 months follow up. Total number of patients were 80. Data was collected with the help of performa containing name, age, sex of patients along-with signs symptoms, investigations, complications and follow up findings. Patients of both gender operated for the first time for lumbar spinal stenosis were included in the study Patients below 50 years, patients with spinal stenosis of more then 2 level, patients with spondylolisthesis and patients above 75 years were excluded from the study.
Results: Out of 80 patients 46 (57.5%) were male and 34 (42.5%) were female. 49 patients had single level laminectomy and 31 patients with two level laminectomies. 85% patients showed clinical improvement in pain and claudication, 6 patients had dural tear during surgery, one patient had CSF leak, 3 patients had superficial wound infection and 4 patients had urinary retention.
Conclusion: Laminectomy for lumbar spinal stenosis appears to be effective procedure in which better overall outcome and improvement in claudication, lower limbs pain and low backache can be achieved, improving health related quality of life
Unilateral Facial Neuralgia A management Dilemma
Get PDFObjective: The objective of the study was to assess the significance of clinical examination in Diagnosis and management of Patient with unilateral facial neuralgia.
Study Design: Observational study.
Place and Duration of study: Out patient clinic and department of ENT and Neurosurgery PGMI LRH Peshawar from IST Nov 2005---31 Oct 2007 (2 years).
Material and methods: Patients presented with unilateral facial neuralgia were assessed in out patient clinic, record keeping about data was assessed during compiling of study. Related investigations were performed to exclude secondary causes of neuralgia.
Results: A total of 1207 patients who presented with unilateral facial pain in two years duration were scrutinized for idiopathic facial neuralgia. 182 (15.07%.) patient were referred to neurosurgeon who were suffering from trigeminal neuralgia.43(3.56)%) patient were subjected to microvascular decompression (MVD).Rest of the patients were treated accordingly.
 
Posterior Fossa Dermoid Cyst in a Child with Recurrent Meningitis
Get PDFIntra cranial dermoid cysts are rare brain tumors. Cutaneous punctum extending in cranial cavity as dermal tract or intermittent seepage from the cyst in subarachnoid space can be a source of recurrent meningitis. We report a 5 years child with posterior fossa dermoid cyst presented to pediatrician with recurrent episode of meningitis. Diagnosis was made on CT / MRI images. Safe total excision was performed and patient was sent home safely on 4th postoperative days without any complication