Pakistan Journal Of Neurological Surgery
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Efficacy of Discectomy by Fenestration Technique in Lumbar Radicular Pain
Get PDFObjectives: To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc.
Material and Methods: This descriptive study was conducted in the department of Neurosurgery of Hayatabad Medical Complex, Peshawar, from October 2008 to September 2010. All those patients were included in whom straight leg raising (SLR) sign was less than 60 degree and prolapsed disc at L4 – 5 or L5 – S1 levels on MRI. Patients with multiple level discs, previous history of spine surgery, central disc, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in prone position under general anesthesia.
Results: One hundred and nine patients were studied. 66 (55%) were male and 59 (45%) were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The commonest level of involvement was L 4 -L 5 in 67 (61%) followed by L5 – S1 in 42 (89%). Sixty five patients had left sided while forty four had right sided symptoms. Majority of patients presented in Dennis pain scale 4 i.e. 67% (n = 73).
Conclusion: In selected patients with prolapsed intervertebral disc, surgical treatment provides quick pain relief. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater expertise, sophisticated instrumentation and techniques
The Surgical Outcome for Prolapsed Lumbar Intervertebral Disc Based on Visual Analog Scores
Get PDFObjective: To determine the surgical Outcome for a prolapsed lumbar intervertebral disc based on a visual analog score.
Materials and Methods: A prospective study was conducted in the Department of Neurosurgery at Jinnah Postgraduate Medical Centre, Karachi. A total of 55 patients were included in the study. Questionnaires were used to collect demographic data, presenting symptoms, and the level of the herniated discs. The patients underwent different surgical interventions and then these patients were followed for 2 weeks postoperatively and the surgical outcome was assessed using the Visual Analog Score (VAS).
Results: A total of 34 (61.8%) males and 21 (38.2%) females were included in this study. The average age of the patients was 36.14 ± 9.30 years. L5/S1 was the most commonly affected level. Laminar fenestration was the most common surgical procedure done in 23 (41.8%) patients followed by hemilaminectomy in 19 (34.5%) patients and bilateral laminectomy in 13 (23.6%). Post-operative pain was relieved in the majority of patients which is 43 (78.2%).
Conclusion: Medical management remains the mainstay in the majority of patients having lumbar disc prolapse. However, in cases where the pain is refractory to conservative management, surgery is considered after careful patient selection. It was seen that surgical intervention successfully reduced the intensity of pain and resulted in a symptomatically improved patient. Hence it is safe to conclude that surgery is an effective measure and ultimately enhances the quality of life
Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy
Get PDFBackground: Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF.
Objective: This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery.
Materials and Methods: It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage.
Results: A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population. The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002.
Conclusion: PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM.
 
Delay in Diagnosis of Brain Tumors: A Dilemma For Neurosurgical Community Due To Spirituality and Quackery In A Developing Country
Get PDFObjectives: Primary and metastatic brain tumors are a significant cause of mortality and morbidity. The complex pathway to a cancer diagnosis is not human error and the achievements of better outcomes solely depend on the early diagnosis and management of symptomatic tumors. The estimated time between the first presentation to any health care professional and diagnosis is approximately 3 times longer in the UK as compared to other developed countries.
Material and Methods: It was a descriptive study and included 52 patients who were admitted to the Neurosurgery department at Jinnah hospital Lahore. The required data were collected either directly from the patients or from the hospital record of discharged patients. Our study compares the time interval difference of presentation of a patient to a local care provider (Quacks, Hakeem, and spiritual healers) and Neurosurgeon as well as delay in surgical intervention even after diagnosis and radiological investigations.
Results: 54% of patients presented with supratentorial lesions and out of these, parietal lobe lesions were more common (39%) while 29% of lesions were infratentorial. Around 50% of patients presented to a Local Care Provider within 20 days. However, only 42% of patients presented to a neurosurgeon after 6-9 months of the onset of symptoms.
Conclusion: Public awareness is the key to timely diagnosis, proper management, and better outcomes. The availability of specialists in peripheral hospitals can bring a change in this regard
Results of Resection of Giant Pituitary Adenomas through Endoscopic Endonasal Approach
Get PDFBackground/Objective: A minimally invasive surgical method is in use to create endoscopic transsphenoidal surgery. Because of the intricate dissection of the sellar region, surgical treatment of large pituitary adenomas is challenging. The study focused to determine the frequency of complications after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas.
Materials and Methods: A descriptive case series study was conducted at the Neurosurgical Department of Lahore General Hospital, Lahore. A total of 70 patients fulfilling the selection criteria were enrolled. Major vascular injury was noted when there is an injury to the internal carotid artery or cavernous sinus. After discharge, patients were followed-up in OPD for 3 months. After 3 months, patients were evaluated for CSF leak and vision. The presence of complications was recorded. During surgery, operative time was noted.
Results: Mean age of patients was 55.7 ± 6.5 years. 45.71% of patients were male while the remaining 54.29% of patients were female Total of 41.43% of patients had disease < 2 years, whereas the duration of surgery was ? 3 hours in 64.3% of patients. A total 15.71% had complications which included diabetes insipidus (8.57%), infections (5.71%), pituitary dysfunction (4.29%), CSF leak (2.8%) and vascular injury (1.43%). The mortality rate was 1.43%.
Conclusion: The complication rate after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas was high.
Keywords: Endonasal Endoscopic, Transsphenoidal Resection, Pituitary Macroadenomas, Complication
Frequency of risk factors in patients with carpal tunnel syndrome
Get PDFObjective: This study aimed to ascertain the frequency of carpal tunnel syndrome risk factors.
Materials and Methods: A cross-sectional study was conducted at the Department of Neurology, Nishtar Hospital Multan, Pakistan. One hundred and twenty patients with Carpal Tunnel Syndrome (CTS) who attended the study site were enrolled. Baseline data, including age, gender, residential area, Duration of CTS, smoking, hypertension, diabetes mellitus, and obesity, were obtained. The blood samples were obtained for screening for hypothyroidism.
Results: It was observed that most of the CTS patients were males (63.3%). The observed mean age was 44.3 ± 12.1 years, and 65.8% of cases belonged to urban areas. The most common risk factor observed among the currently enrolled CTS patients was obesity (70.8%), followed by smoking (50.8%), diabetes mellitus (45%), hypertension (34.2%), and hypothyroidism (22.5%).
Conclusion: Our study shows that the most common risk factor for CTS was obesity, followed by smoking, diabetes mellitus, hypertension, and hypothyroidism
Success and Complications of Microsurgical Over-Top Decompression for Lumbar Spine Stenosis: Experience in a Limited Resource Center
Get PDFObjective: The overtop decompression is also called the outside-in technique or bilateral decompression from the unilateral approach. The objective of the study was to evaluate the success and complications of microsurgical over-top decompression for single-level lumbar spine stenosis.
Material and Methods: This observational study was conducted at the Neurosurgery unit at Lady Reading Hospital Peshawar from Jan 2018 to December 2021. All those patients who had undergone over-top decompression for single-level degenerative lumbar spine stenosis irrespective of age and gender were included in our study.
Results: We had a total of 187 patients who underwent microscopic over-top decompression for lumbar spine stenosis. Four patients lost their final follow-up. The mean age of the patients was 46 years (ranging from 18 – 68 years). Spinal stenosis was more common in men (58.3%) and at L4/5 (51.87%) level. The mean duration of surgery was 56 minutes (range 35-86 minutes). Leg pain improved in 83.1% of the cases with overall patient satisfaction after surgery in 82.5% of the cases. The most common (6.95%) complication of the procedure was iatrogenic durotomy. Most of the complications were minor and treated conservatively.
Conclusions: Overtop decompression is a safe and effective minimally invasive procedure for lumbar spine stenosis. It has good results in symptomatic improvement. There is minimal soft tissue and bony dissection. Therefore, mobility and stability of the spine are preserved. Moreover, the learning curve for microscopic overtop decompression is shallow and surgery time is short
The Outcome of Burr Hole Evacuation Without Drain for Chronic Subdural Haematoma
Get PDFObjective: To evaluate the feasibility of burr hole evacuation of Chronic subdural haematoma (CSDH) without drain in terms of functional outcome, morbidity & mortality.
Place & duration of study: Department of neurosurgery, postgraduate medical institute, Hayatabad medical complex Peshawar, from 1st July 2007 to 30th June 2008 with 3 months follow-up.
Patients & methods: This study included 65 patients who presented in our unit with Chronic subdural haematoma (CSDH) from 1st July 2007 to 30th June 2008.
Results: A total number of 65 patients presented to us with Chronic subdural haematoma (CSDH) in above mentioned duration with a male to female ratio of 3.2:1 (51/16). The age range was from 27 years to 81 years with a Mean age of 57.5 years. 5 (8%) patients were 40 years of age & below, 12 (18%) patients were 41-50 years of age 26 (40%) patients were 51-60 years of age 14 (22%) patients were 61-70 years of age 8 (12%) patients were 71 years of age & above-history revealed fall in 26 (40%), RTA in 9 (14%), while 28 (43%) had no history of trauma.
Conclusion: Single & double burr hole evacuation is a safe & effective treatment for Chronic subdural haema-toma (CSDH) with low complications rate. The mortality associated with Chronic subdural haematoma (CSDH) is mainly determined by neurological status of the patient at time of presentation
Surgical Outcome of Lumbar Disc Surgery in 250 Patients
Get PDFObjectives: To study the outcome of patients with Lumbar Disc Herniation managed surgically by fenestration discectomy and laminectomy.
Study design: Retrospective study.
Materials and Methods: This study was conducted in Neurosurgery Department, Hayatabad Medical Complex, Peshawar from Jan, 2006 to December, 2007 with 6 months follow up. Total numbers of patients were 250. Data was collected with the help of performa containing name, age, sex of patient along-with signs and symptoms, investigation, complications and follow up findings.
Results: We included patients of both gender with age ranging from 18 to 60 years with mean age 39 years including 147 (58.8%) male and 103 (41.2%) female ratio 1.42:1, 250 patients were operated upon for Lumbar Disc Herniation. 06 (2.4%) patients had superficial wound infection, 06 (2.4%)had dural tear with 2 (0.8%) postop CSF leak, 04 (1.6%) patients suffered discitis and 14 (5.6%) patients had reherniation of discs at same operative level. Patients with recurrent disc herniation, Disc herniation with spondylolisthesis, patients below 18 years and above 60 years and patient with Disc Prolapse above L3-4 were excluded from the study.
Conclusion: Lumbar disc surgery is safe and effective procedure in good and experienced surgical hands by which pain and neurological deficit of patients can be reduced and prevented giving them good quality of life. Proper patient selection is imperative in achieving successful outcome. By strict selection criteria we can reduce the complications of this procedure.
Key words: Lumbar Disc Herniation, Discectomy, Laminectomy