Pakistan Journal Of Neurological Surgery
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Our Experience of Posterior Fossa Tumors Surgeries
Get PDFObjective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes.
Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically.
Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery.
Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies
Anterior Cervical Discectomy and Fusion Surgery: Results with Zero-Profile Spacer/Cage
Get PDFObjective: Study provides proof to support the promised benefits of employing stand-alone zero-profile cages in multilevel ACDF procedures, as the stand-alone zero-profile device has proven safety and a reduction of the risk of dysphagia in single-level ACDF surgeries.
Materials and Methods: This is a retrospective descriptive study, conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan. Data of 36 patients evaluated for post-operative dysphagia and fusion, who had multi-level ACDF surgery employing stand-alone zero-profile cages.
Results: Total of 36 patients underwent ACDF surgeries. 86.1% (31/36) patients operated for 2 levels and 13.9% (5/36) patients operated for 3 levels. Dysphagia developed postoperatively in 2 (5.6%) patients in which zero-profile stand-alone cages were used. Fusion was achieved in 94.4% (34/36) patients.
Conclusion: Stand-alone zero-profile cages in multi-level ACDF surgeries have a good outcome in terms of post-operative less dysphagia and higher fusion rates.
Keywords: Anterior Cervical Discectomy (Decompression) And Fusion (ACDF), Zero-Profile Cages, Cervical Spondylotic Myelopathy
Outcome of Transpedicular Fixation in Thoracolumbar Fractures
Get PDFObjective: The purpose of this study was to assess the clinical improvement in the post-op period in patients with thoracolumbar fractures who underwent transpedicular fixation.
Materials and Methods: A retrospective study was conducted for 6 months in the Neurosurgery departments of private hospitals in Quetta. A total of 34 patients with trauma were included in the study who underwent Transpedicular screws and rods fixation (Including both long and short segment fixation). American Spinal Injury Association (ASIA) impairment scale was used to describe the individual’s functional impairment from spinal cord injury. Preoperative and postoperative comparison within 6 months.
Results: There were 22 male and 12 female patients. The patients were between 18-45 years of age. There were 16 cases of the following vertebral fractures: D9, D10, D12, L1 in ASIA-A and ASIA-B grades. There were 6 cases of the following vertebral fractures: L1, L2 in ASIA-C grades. And 12 cases of L2, L3 vertebral fractures in ASIA-D and ASIA-E Grades. In ASIA Grade A, 25% of patients improved to ASIA C and 12.5% of patients improved to ASIA D postoperatively. In ASIA Grade B, 25% of patients improved to ASIA C, and 25% of patients improved to ASIA-D post-operatively. In Asia-C Grade, 16.6% of patients improved to ASIA E, and 50% of patients improved to ASIA D postoperatively.
Conclusion: In a considerable proportion of individuals, surgery resulted in superior clinical results. ASIA Grades A and B should also be operated early for greater clinical improvement.
Keywords: Transpedicular Fixation, Thoracolumbar fractures, ASIA Scores
Surgical Outcome of Traumatic Posterior Fossa Extradural Hematoma in Paediatric Population: Our Experience at UCHS, The Children’s Hospital, Lahore
Get PDFObjective: Most common location for Extradural hematoma (EDH) is within the supratentorial region. The incidence of Posterior fossa extradural hematoma (PFEDH) is1.2% to 12.9% of all EDH. The purpose of this study is to evaluate the management, clinical outcomes, and epidemiological features of posterior fossa EDH.
Materials and Methods: A cross-sectional study was conducted at the department of pediatric neurosurgery Children Hospital and the University of child health sciences, Lahore from September 2021 to December 2021. Thirty patients presented with posterior fossa extradural hematoma in the pediatric age group were included. A plain CT scan Brain with the bone window was done for initial diagnosis to assess any injury in the posterior fossa including volume of hematoma and any associated fracture. Glasgow Coma Scale (GCS) was used to evaluate the outcome.
Results: Twenty-five patients were surgically treated, and five patients were managed conservatively. There was no mortality observed and the overall results were good in all the patients.
Conclusion: As compared to supratentorial extradural hematoma the Posterior fossa epidural hematoma is uncommon. For all suspected cases early and serial CT scans must be carried out. There was an excellent prognosis in pediatric patients who underwent surgical management
Frequency of SCF Leakage in Post-operative Patients of Tethered Spinal Cord in A Tertiary Care Hospital
Get PDFObjective: The study aimed to report the incidence of CSF leakage in patients with a tethered spinal cord, post-operatively.
Materials and Methods: A total of 75 individuals aged more than 2 years and of either gender who were hospitalized for surgery for tethered cord syndrome were included. All patients had a preoperative MRI of the spine, and those above the age of 6 had urodynamic tests. Clinical evaluations were performed until hospital release, then again at 3, 6, and 12 months. Urodynamic tests and spine MRIs were redone one year following surgery. Under general anesthesia, all patients had microscopic untethering procedures to release tethering materials and heal the thecal sac.
Results: 52% of patients fall under TCS type ‘simple’, whereas, 48% of patients found with complex TCS. The frequency of CSF leakage in post-operative patients with a tethered spinal cord was found in 17.33%. No CSF leak was reported in the majority of patients (49%) patients in the age group 2-30 years. 52% of patients with simple TCS reported no CSF leak, whereas, only 13(18%) patients with complex TCS reported CSF leaks. 40% of patients reported no CSF leak who was diagnosed with complex TCS. There existed a significant relationship between the types of TCS (simple/complex) for CSF leak distribution.
Conclusion: This study concluded that the frequency of CSF leakage in post-operative patients with tethered spinal cord was found in 17.33% of patients.
Keywords: Tethered Spinal Cord (TCS), CSF Leakage, Lipomyelomeningocele
Results of Endoscopic Septostomy in Isolated Lateral Ventricular Hydrocephalus
Get PDFObjective: To determine the success of endoscopic septostomy in the management of isolated lateral ventricular hydrocephalus.
Material and Methods: A retrospective analysis of data was done and records of all patients who underwent endoscopic septostomy for isolated lateral ventricular hydrocephalus due to any cause for the last 4 years, December 2017 to December 2021 at Punjab Institute of Neurosciences, Lahore. Radiological and clinical outcomes and complications were recorded. A total of 60 cases were reviewed.
Results: Out of 60 patients, 95% were in the age group of 3 – 25 years and 5% were in the age group of 26 – 71 years. There was 54% male whereas 46% were female. Septostomy was successful in relieving hydrocephalus in 75% of cases.
Conclusion: Endoscopic septostomy is an effective procedure for the management of isolated lateral ventricles.
Keywords: Septostomy, Hydrocephalus, Isolated Lateral Ventricles
11 Years Old Female with Synergistic Presentation of Cranial and Spinal Pathologies: Myxopapillary Ependymoma with Hydrocephalus - A Rare Entity
Get PDFThe correlation between hydrocephalus and spinal cord tumor was first described by Kyrieleis et. al. 1% concomitant presence was documented by Mirroni et.al. Moreover, the understanding of the pathophysiological association between these two conditions is still lacking. 11 years old girl presented in the outpatient department of Jinnah hospital Lahore with complaints of difficulty in walking for the last 2 years, numbness of right leg for the last one year, and severe bilateral sciatica for 2 months. On further inquiry, she told that she is also suffering from headaches and blurred vision for the last 6 months. Her neuroimaging revealed hydrocephalus and mixed density heterogeneously enhancing intradural lesion at the conus. She underwent ventriculoperitoneal shunting for hydrocephalus and laminoplasty followed by excision of spinal tumor reported being myxopapillary ependymoma grade II. The presence of headache along with signs & symptoms of raised intracranial pressure in these patients warrant cranial imaging. CSF diversion for hydrocephalus and gross total excision of the spinal lesion is the standard acceptable treatment
Frequency of Functional and Non-Functional Pituitary Adenomas in Patients Presented at Ayub Teaching Hospital, Abbottabad
Get PDFObjective: Pituitary lesions cause morbidity and mortality in all age groups due to their hormonal hypersecretion, its mass effects, and post-surgery complications. The present study determined the frequency of functional and non-functional pituitary adenomas.
Materials & Methods: The study included patients (n = 114) presenting with functional and non-functional pituitary adenoma. Pituitary adenomas were diagnosed based on MRI brain with contrast and the size of the tumor was noted a tumor having a size of 10 mm or more was labeled as macro adenoma and a tumor having a size less than 10 mm was labeled as microadenoma. Pituitary adenomas were stratified among age, gender, duration of symptoms, types of adenomas, types of functional adenoma, and type of the tumor on a size basis.
Results: Most of the patients had TSH- secreting adenoma (21.9%). 52.6% were found with microadenoma and 47.4% had macro adenoma. Patients with functional adenoma were 30.7% and with non-functional adenoma 32.5% were male while patients with functional adenoma were 26.3% and with non-functional adenoma 10.5%were female (p = 0.018). Patients with functional adenoma (43.9%) and non-functional adenoma (8.8%) were found to have microadenoma, whereas patients with functional adenoma (13.2%) and non-functional adenoma (34.2%) were found to have macroadenoma (p = 0.000). Patients with functional adenoma having a duration of symptoms below 1 year were 11 (9.6%), 1 to 3 years were 25 (21.9%), 17 (14.9%) were 4 to 6 years, and 12 (10.5%) above 6 years duration of symptoms.
Conclusion: Patients with pituitary adenomas should be diagnosed early to receive successful therapy
Surgical Outcome of Endoscopic Third Ventriculostomy in Patients Having High ETV Success Score: One-Year Experience at a Tertiary Care Hospital
Get PDFBackground & Objective: Endoscopic third Ventriculostomy (ETV) is an accepted alternative to VP shunt in patients with obstructive hydrocephalus. We will share our experience and outcome.
Materials & Methods: Thirty consecutive ETV cases performed by a single surgeon during 1 year in patients with an ETV success score of 60 or higher were included in this study. Patients’ demographics, outcomes, and complications are reported.
Results: (60%) were male and 12 (40%) were female. The mean age in our study was 6.1 years ± 9 (mean ± SD). Posterior fossa tumor was the most common etiology in our series (46.6%) followed by aqueductal stenosis (23.3%). Eighty percent of our patients did not experience an ETV failure. The complication rate was 20%. Inadequate ventriculostomy in 6.6% of the patients was the commonest complication.
Conclusion: ETV is safe and effective in patients with high ETV success scores
Incidence and Predisposing factors of Brain Abscess in Children at a Tertiary Care Center Dera Ghazi Khan
Get PDFObjective: A cross sectional study was aimed to investigate the incidence and predisposing factors of brain abscess in children.
Material and Methods: The study was conducted in the departments of Neurosurgery and Pediatric Surgery, Ghazi Khan Medical College and Hospital DG khan. Thirty two children with brain abscess were enrolled in the study. A diagnosis of brain abscess was made on clinical and radiological basis. T-test and chi square were applied to see the association between variables.
Results: Most common location of Abscess was found as frontal in 21.9% patients, temporo parietal in 53.1% patients and occipital in 25.0% patients. Streptococci was the most common microorganism on culture reported, noted in 46.9% patients. Major predisposing factors (p = 0.000) and location of abscess (p = 0.003) were the effect modifiers for microorganism on culture reports.
Conclusion: Streptococci was the most common abscess causing microorganism causing about 47% of total abscess causing pathogens. Main predisposing factors were: otitis media, cyanotic heart disease and post head injury otorrhea.
Keywords: Brain abscess; Children; Otogenic brain abscess; Otitis media, Seizures; Streptococci