Pakistan Journal Of Neurological Surgery
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Management of Brain Abscess Study of 45 Cases
Get PDFObjective: To evaluate the signs and symptoms, to diagnose the abscess early and to provide rational treatment and minimize the complications.
Results: In this study included 45 patients 32 (71.1%) were male and 13 (28.9%) female. In this study analysed the results of different surgical procedures performed in brain abscess and combined therapy. The male and female ratio was 2.5:1 and high incidence was found in young patients mainly in first two decades of life. Otitis media 14 (31.1%) and congenital heart diseases 12 (26.7%) were the commonest causes of cerebral abscesses. Headache (51%), vomiting (51%), fever (53%) and neurological deficits (22.2%) were important signs and symptoms. Computer Tomography Scan (CT) was the common radiological investigation. The most frequently involved sites were temporal lobe in cases 14 (31.1%), frontal in 11 (24.4%) and cerebellum in 10 (22.2%) patients. In 82.2% of cases the volume of pus aspirated was less than 100ml. In 35 (77.8%) cases the first choice of treatment was bur hole aspiration. The excellent outcome was found in 80% of cases.
Conclusions: The cerebritis stage of abscess formation needs rational use of antibiotics, complete abscess with cavity needs bur hole aspiration. Brain abscesses with retained foreign body, CSF leak, containing air and fungal abscess should be excised. Cerebeller abscesses needs early evacuation or excision. Abscesses larger than 3 cm needs drainage and smaller than 1,7cm can be treated conservatively
Management of Hydrocephalus in Posterior Fossa Tumors in Children. An Experience of 30 Cases at Govt: Lady Reading Hospital Department of Neurosurgery, Peshawar
Get PDFTreatment of hydrocephalus in posterior fossa tumors in children is debatable issue especially in developing countries like Pakistan where the patients present very late. It depends upon the clinical presentations of patients and duration of hydrocephalus. In this regard hospital records of all children with posterior fossa tumors treated in our center during 2005-2008 were reviewed. Patient’s demographic and diagnostic data were analyzed. Chai square test was applied to compare the frequencies of post operative complications in various groups. In our series of 30 patients, 15 were male and 15 were female with equal male to female ratio 1:1. Ten patients with hydrocephalus were treated with External ventricular drain (EVD) per-operative while fifteen patients were treated with pre-operative VP shunt. Five patients did not have any treatment for hydrocephalus. It was proved that in our setup, pre-operative shunting is the best way of management of hydrocephalus in posterior fossa tumors
Benefits of Lumbar Facet Joint Block For Persistent Backache After Lumbar Discectomy An Analysis of 58 Patients
Get PDFObject: The author evaluated the effectiveness of using facet joint block with local anesthetic agents and steroid medication for the treatment of persistent low-back pain in a medium-sized series of patients who underwent lower lumbar disc surgery.
Methods: Over a period of 2 years, the author performed 130 facet joint injections in 58 patients with persistent low-back pain after lumbar discectomies at L3/4, L4/5 and L5/S1 levels in Combined Military Hospital Rawal-pindi. All of the 21 women and 37 men (mean age 44 years, range 23 to 68) entered into the trial had low back pain for over one month localised to one side with tenderness and local muscle spasm over the facet joints. All had a negative straight-leg-raising test but 17 had slight pain radiating into the posterior thigh on the same side where surgery was performed. The main parameter for the success or failure of this treatment was the relief of the pain. For the first injection mainly a diagnostic procedure the author used a local anesthetic (1 ml bupivacaine 1%). In cases of good response, Depomedral 80 mg was injected in a second session to achieve a longer-lasting effect. Long-lasting relief of the low-back pain was reported by 43 patients (74%) during a mean follow-up period of 10 months. Nine patients (15.2%) noticed a general improvement in their pain. Six patients (10%), however, experienced no improvement of pain at all. There were no cases of infection or hematoma.
Conclusions: Lumbar facet joint block is a minimally invasive procedure to treat facet joint pain in post discec-tomy period. The procedure also seems to be useful for distinguishing between facet joint pain from postoperative pain due to inappropriate neural decompression after lumbar surgery
Serum Hormone Levels of Prolactin and Prolactin Content of Nonfunctioning Pituitary Adenomas and Normal Pituitary Glands
Get PDFObjective and Study Design: The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral prolactin (PRL) hormone. In addition, the pituitary PRL hormone has also been measured directly in the adenoma tissue following its surgical removal and in the normal pituitary glands.
Material and Methods: The present study is based on 19 patients (16 males and 3 females), 30-50 year of age, diagnosed for NFPAs on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls.
Results: The mean serum PRL concentration in male patients before removal of the adenoma were significantly higher (P<0.05) than values obtained after surgical removal of the adenoma and those of control subjects. In 5 of these 16 patients (PA1, PA10, PA14, PA28, PA30) serum PRL concentrations were markedly above the normal limit of circulating PRL levels (>17.0 ng/ml), the levels being ~ 2-fold of the mean control levels. The PRL levels returned to normal range following ablation of adenoma in these patients. The individual and mean serum PRL levels in the remaining 11 (68.75%) patients were in normal range before and after surgery.
Conclusions: Taken together, the present data suggest that a significant proportion of NFPAs may actively synthesize and secrete pituitary hormones such as PRL, in amounts that may not be sufficient to produce any overt clinical signs of hormone hypersecretion
Effects of Transshenoidal Surgery on Patients with Nonfunctioning Pituitary Tumours
Get PDFObjective: The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal.
Materials and Methods: The present study initially included 22 consecutive patients 18 men and 4 women, of 22-55 (44 ± 2.3) years of age operated for NFMA between 2005 and 2008 at Lahore General Hospital, Lahore. Three of these patients 2 men and 1woman died during the follow-up period and were excluded from the study.
Results: Radiological imaging revealed a macroadenoma in all patients, with suprasellar extension in 96% and parasellar/infrasellar extension in 32% of cases. Visual field defects were present in 95% of the patients and improved in 84% of cases after surgery (complete recovery 3/19 (15%); partial recovery 13/19 (68%). The results demonstrate that in a subset of 4 of the 16 male patients with NFPAs the presurgical serum FSH values (45.1 ± 0.7 mIU/ml) were markedly and significantly greater than those of the remaining 12 patients (7.9 ± 0.7 mIU/ml) and of control subjects (8.8 ± 0.6 mIU/ml).
Conclusions: The present study suggests that pituitary tumours diagnosed as NFPAs constitute a heterogenous group of adenomas with regard to their secretory activity of intact adenohypophyseal hormones. Whereas some of these adenomas activity may synthesize one or more pituitary hormones, peripheral concentrations may not be sufficient to produce overt clinical symptoms of hormone hypersecretion. 
Acute Extradural Hematoma in Pediatric Age Group: Factors Affecting The Outcome
Get PDFObjective: To identify the factors affecting the outcome of acute extradural haematoma in pediatric age group.
Subjects and Methods: This was a descriptive study carried out at the Department of neurosurgery, PGMI Lady Reading Hospital Peshawar from January 2007 to December 2007 on 50 consecutive patients of acute extradural hematoma operated and post-operative outcome including good recovery, moderate disability, severe disability, persistent vegetative state, and death recorded.
Results: Out of 50 cases, 80% were males and 20% females. Majority (48%) cases were in the age range of 6-10 years, 36% in age group of 11-15 years, 16% in the age range of 1-5 years. In 60% patients fall, in 26% road traffic accident (RTA) and in 14% physical assault was the mode of injury. Interval between injury and surgery of > 8 hours recorded in 78% cases, 4-8 hours in 20% patients, < 4 hour in 2% cases. On CT scan, parietal site was commonest in 40% cases, frontal site in 26% cases. In 80% cases craniotomy and in 20% cases craniectomy performed. Post-operative outcome, good recovery noted in 80% cases, moderate disability in 10% cases, death in 6% cases, and severe disability recorded in 4% cases.
Conclusion: Extradural hematoma is a common manifestation of head injury, affecting male children age range of 6-10 years and early surgical intervention is life saving
Role of Endoscopic Third Ventriculostomy in Congenital Obstructive Hydrocephalus
Get PDFObject: To improve the care of Obstructive Hydrocephalic infants, from six months to twelve months and to evaluate the efficacy and complications of Endoscopic Third Ventriculostomy (ETV).
Materials and Methods: The study was conducted in the Department of Neurosurgery PGMI, Lahore General Hospital, Lahore from July 2007 to June 2008. Total numbers of patients were 30, which were divided into two equal groups. Group A (15 patients) underwent Endoscopic Third Ventriculostomy (ETV) and Ventriculo-peritoneal VP Shunt were done in Group B (15 patients). Cases were selected randomly.
Results: The mean age for Group A was 9 months and for Group B was 8 months Endoscopic Third Ventriculo-stomy (ETV) procedure found successful in older than 8 months of age while ventriculoperitoneal VP Shunt procedure found successful in all age groups. Before procedure mean head circumference for Group A was 50.86 cm and for Group B was 50.84 cm. After one year follow up mean head circumference in Endoscopic Third Ventriculostomy (ETV) Group was 50.18 cm and in VP Shunt Group was 47.38 cm. Primary success in Endoscopic Third Ventriculostomy (ETV) Group was 53.3% (8 out of 15), whereas in VP Shunt Group it was 66.7% (10 out of 15).
Conclusion: Although results are same in both groups but Endoscopic Third Ventriculostomy (ETV) Group remain shunt free. Endoscopic Third Ventriculostomy seems to be an effective alternative than VP Shunt in the management of Hydrocephalus in infants provided careful patient selection is done and surgeon is competent enough with Endoscopic Third Ventriculostomy technique
Does Early Tracheostomy Improve Outcome in Severe Head Injury?
Get PDFObject: To determine if early tracheostomy reduces the duration of mechanical ventilation, Intensive Care Unit (ICU) stay and morbidities associated with it in patients with severe head injury.
Methods: This 5-yr retrospective review included 60 ICU patients with severe traumatic head injury requiring mechanical ventilation and tracheostomy. Early tracheostomy (ET) was defined as tracheostomy within 7 days, and prolonged endotracheal intubation (EI) as endotracheal intubation for more than 7 days. Among 60 patients, 30 underwent early tracheostomy and 30 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator associated pneumonia (VAP), ICU stay and Glasgow Outcome Score (GOS).
Results: The incidence of Ventilator Associated Pneumonia (VAP) was significantly higher in prolonged Endotracheal Intubation EI group, relative to Early tracheostomy ET group (63% vs. 43%, respectively). ET group showed significantly less ventilator days (9 days vs. 12 days), ICU stay (10 days vs. 13 days), complication rate (13% vs. 18%) and mortality (10% vs.25%). Clinical outcome assessed on the basis of Glascow Outcome Score (GOS) was better in ET group.
Conclusions: In severe head injury early tracheostomy decreases total days of ventilation and ICU stay. Tracheostomy is associated with a decrease in the incidence of Ventilator Associated Pneumonia (VAP). Early tracheostomy should be considered in severe head injury patients requiring prolong ventilatory support.
 
Outcome in Surgically Treated Patients with Dorsal and Dorsolumbar Spinal Tuberculosis: A Retrospective Study of 40 Cases
Get PDFObjective: To determine the influence of disease severity and surgical treatment in patients with dorsal and dorsolumbar spinal tuberculosis with severe neurological deficit.
Methods: In this retrospective study (2005 – 2009) medical records of all patients with dorsal and dorsolumbar spinal tuberculosis treated surgically by Zafar Iqbal were analyzed. The clinical features, disease severity, operative procedures and outcome and factors affecting outcome were analyzed.
Results: A total of 42 patients with dorsal and dorsolumbar spinal tuberculosis with severe neurological deficit were treated surgically during this period. Two patients had follow-up of less than 3 months and were excluded from this study. Their age ranged from 18 to 65 years, with a mean age of 31 years. Male to female ratio was 3:2. Presenting symptoms were local pain in 34 (85%), radicular pain in 5 (12.5%),
Conclusion: This study indicates that a significant proportion of patients with spinal tuberculosis and severe motor deficits get remarkable improvement after surgical decompression and hence should undergo surgery even though they may be suffering from paraplegia of considerable duration. We found that age less than 50 years, radical surgery and spasticity are favourable prognostic factors
Surgical Management of Intracranial Aneurysms and Subarachnoid Haemorrhage : An Overview
Get PDFEgas Moniz discovered an aneurysm by cerebral Angiography in 1933.1
Cushing introduced first aneurysmal clip in 1911, Mayfield modified the existing spring clip with cross leg (Schwartz) by making it a smaller, tweezer – like applicator.2
An intracranial vascular procedure was first repor-ted with aid of operating microscope which introduced simultaneously magnification and illumination.3
Dott in 1933performed 1st planned intracranial surgery for a saccular aneurysm.4
Dandy in 1937 clipped the neck of aneurysm with a metallic clip.5
Yasirgill of Zurich and Drake of London Ontario, published a lot onaneurysms of anterior & posterior circulation.6,7
An elaborated study of natural history of aneurysm was published by the pakarinen in 196.7