Pakistan Journal Of Neurological Surgery
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Clinical Outcome of Cortical Venous Thrombosis in Stroke Patients at a Tertiary Care Hospital of Southern Punjab
Get PDFObjective: This study was determined to find out the clinical Outcome of Cortical Venous Thrombosis (CVT) in Stroke patients at a Tertiary Care Hospital of Southern Punjab.
Material & Methods: A total of 100 patients with cortical venous thrombosis were included in this descriptive case series study, which was conducted at Department of Neurology, Nishtar Hospital Multan. Outcome of patients in terms of partial recovery or complete recovery, any recurrence, any complication, indication for Surgery and any disability in terms of focal deficit, prolonged hospital stay and Mortality was followed.
Results: Our study included a total of 100 patients with cortical venous thrombosis (CVT), 35 (35%) were male and 65 (65%) were female patients with their mean age was 37.69 ± 16.52 years, ranging from 20 – 83 years (51.37 ± 17.44 in males versus 30.32 ± 10.15 years for females). Headache was noted in 80%, focal deficit in 57%, nerve palsy in 30%, coma in 22% and disability was noted in 35%. Partial recovery was noted in 65%, whereas complete recovery was noted in 35% while, complications were noted in 12 (12%) of these patients with CVT.
Conclusion: Cortical venous thrombosis was more prevalent in females in their younger age groups and it was associated with poor prognosis as high frequency of partial recovery was noted in our study.
Keywords: Cortical venous thrombosis, Stroke, headache, recovery, outcome
Effects of Magnesium Sulfate Therapy on GCS Scores in Patients with Severe Traumatic Brain Injury
Get PDFObjective: Traumatic brain injury (TBI) is the number one cause of death under 44 years of age; in spite of this fact, there is no standard available pharmacological agent for the treatment of brain injury. We evaluated the effectiveness of magnesium sulfate treatment for the management and outcome of TBI.
Material and Methods: The prospective cases (n = 60) of TBI were included with non-probability consecutive sampling. They received standard protocol treatment for TBI and magnesium sulfate as an add on therapy. GCS was noted on two occasions, at the time of admission and on the 3rd day. T-test was used to compare the results and for identification of significance/insignificance results.
Results: Mean age of the patients was 37.12 ± 13.25 years. Majority were male (68.3%), while females were 31.7%. Mean duration of an elapsed post traumatic brain injury was 5.06 ± 2.32 hours. Mean GCS before magnesium sulfate treatment (on admission) was 5.46 ± 1.521; mean Glasgow coma (GCS) after magnesium sulfate treatment (on 3rd day) was 8.03 ± 2.56. There existed a significant difference between the GCS scores at the time of admission and on 3rd day (p value < 0.0001). Mean GCS was 7.69 ± 2.55 in age < 30 years and it was 8.29 ± 2.57 in age > 30 years, but this difference was not statistically significant.
Conclusion: A significant improvement was found in the GCS after magnesium sulfate therapy in patients with TBI
Efficacy of Prophylactic Intraoperative Povidone-Iodine Solution Irrigation in Preventing Surgical Site Infection Following Spinal Surgery
Get PDFObjective: Deep wound infection can worsen clinical outcome and increase costs following spinal surgery. The bactericidal activity of povidone-iodine covers a broad spectrum of pathogens including methicillin-resistant Staphylococcus aureus. Our study aimed at evaluating the role that intraoperative dilute povidone-iodine solution irrigation could play in preventing post-operative wound infection following spinal surgery.
Material and Methods: The clinical data of 41 patients that had undergone posterior spinal surgery in the department of neurosurgery Allama Iqbal hospital Sialkot was retrospectively analyzed. We divided the patients into two groups. In group 1patients wounds were irrigated with 0.35% povidone-iodine solution prior to closure. In group 2 patients wounds were irrigated with normal saline only. The two groups were then compared for evaluation of efficacy of peroperative povidone-iodine solution irrigation in preventing post-operative wound infection.
Results: No infection occurred in the 16 patients in group 1 in whom wounds had been irrigated with povidone-iodine solution, compared to 3 deep infections developing in the 25 patients in group 2 in whom wounds had been irrigated with normal saline only. In the 3 patients that suffered from deep infections the duration of hospital stay was also significantly increased (P < 0.05).
Conclusion: Our study supports the notion that perioperative povidone-iodine irrigation is an effective adjunct measure for prevention of surgical site infection following spinal surgical interventions
Lumbar Spine Aneurysmal Bone Cyst: A Rare Entity
Get PDFAn Aneurysmal Bone Cyst (ABC) is a benign, locally aggressive, vascular, and expansile bony tumor of idiopathic etiology containing multiple thin-walled blood-filled channels, mostly diagnosed in pediatric and adolescent age groups. These lesions can cause local pain, pathological fractures, spinal deformity, and neurological deficits. The treatment of choice for ABC is highly debatable according to the literature. The treatment choices are simple curettage and grafting, complete surgical resection with or without prior selective arterial embolization, radiotherapy, or a combination of these procedures according to the case. Each modality is having different outcomes, technical requirements, and complications. We are reporting a case of Aneurysmal Bone Cyst of the lumbar spine in a young patient treated by surgery
Comparison of Low – Versus Medium-Pressure Shunts in Pediatric Hydrocephalus – A Study of the Children Hospitals, Lahore
Get PDFObjective: This prospective cross-sectional study was aimed to assess the effectiveness of low-pressure vs. medium-pressure shunts in children with hydrocephalus.
Material and Methods: 52 children with different types of hydrocephalus were admitted through OPD and Surgical emergency at The Children Hospital, Lahore. All Children were gone through Ultrasonography and CT Brain plain after admission. The pediatric hydrocephalus was resolved into two groups. All patients treated with Chhabra differential pressure VP (ventriculoperitoneal) shunt in either low pressure or medium pressure. CT scans were used to assess the postoperative clinical and radiological outcomes to monitor the ventricle hemispheric ratio (VHR).
Results: A low-pressure shunt was implanted in 26 individuals, whereas a medium-pressure shunt was implanted in 26 individuals. Patients varied in age from one day to thirteen years old. In group A, the average VHR was 57.58% preoperatively, but it dropped to 42.88% after surgery. Similarly, in group B, the pre-and postoperative VHR was 59.35% and 42.81%, respectively, which was statistically significant. In both groups, the incidence of shunt complications and redo shunt operation were not statistically significant.
Conclusion: In this study, individuals with pediatric hydrocephalus who had a low-pressure shunt or a medium-pressure shunt had similar outcomes
Acute Traumatic Subdural Hematoma: Series of Thirty Cases
Get PDFObjectives: Acute Traumatic Subdural Hematoma (ASDH) is one of the most dangerous and challenging neurosurgical problems faced by neurosurgeons. Road traffic accidents (RTAs) and falls are the most common causes of ASDH. This study focused to evaluate the incidence, mode, and severity of the injury, treatment options, and determine outcomes in patients with ASDH.
Material & Methods: Thirty patients with ASDH were studied over a period of three years. Detailed history, general and neurological examination including GCS were noted, CT scans were done and patients managed according to said protocol.
Results: Twenty-three (76.66%) were male and Seven (23.33%) were female. The common mode of injury were road traffic accidents (66.66%) and falls (26.66%). Out of 30 patients, 53.33% had GCS 3-5. Overall, the mortality rate was 60%. 23.33% of patients survived with severe disability and 10% of patients showed moderate disability and good recovery. The mortality rate was higher in patients above 50 years of age.
Conclusion: Acute traumatic subdural hematoma is still very fatal and has a high mortality. Early CT scanning emergency, surgery and good postoperative ICU care can play a role in improving the outcome in patients with ASDH
Frequency of Infected Healthcare Workers and Factors Leading to Infection in Emergency Neurosurgical Trauma during COVID-19 Pandemic
Get PDFObjective: The aim of this study was to know the frequency of COVID-19 infection in healthcare workers and to identify the risk factors leading to infection in emergency neurosurgical trauma during COVID-19 pandemic.
Material and Methods: This descriptive cross-sectional study was conducted in the Department of Neurosurgery, Ayub Teaching Hospital. A total of 99 healthcare workers with an age range from 22 – 55 years attending or carry emergency procedures with both male and female gender were included in the study. Age, gender, sign and symptoms, safety measures and COVID PCR reports were recorded.
Results: 12 (12.1%) out of 99 healthcare workers got an infection with COVID-19. 83.3% of the infected healthcare workers were male while 16.6% were females. A maximum of the healthcare workers infected with COVID-19 was in the age range 31 – 40 (50%). Most of them were Doctors (66.6%) followed by nursing staff (25%). Low-grade fever and cough were the most common symptoms. The most important factors which affect the transmission of infection to healthcare workers were improper use of personal protective equipment (PPE), masks, gloves by healthcare professionals, and inability to maintain social distancing with the patients.
Conclusion: To protect healthcare workers from getting infections, proper personal protective equipment should be used. Early recognition of the infected patient and prompt isolation should be done to prevent or minimize the chain of transmission
Hemorrhagic Stroke May Be the Sequelae of Brain Tumors
Get PDFObjective: Hemorrhagic stroke is a common neurosurgical emergency caused by multiple pathological conditions. Brain tumors can also present with acute neurodeficits secondary to hemorrhagic stroke. This study as case series was conducted to report the clinical presentation, radiological findings, causes and management of brain tumors presenting as hemorrhagic stroke.
Materials and Methods: Clinical assessment and radiological investigations were done, including CT brain and MRI brain with contrast. Surgery was done with evacuation of the hematoma and excision of tumor, and the tissue was sent for histopathology. Post operatively patients were shifted to the intensive care unit for monitoring and ventilator support if needed. Adjuvant treatment was guided according to histopathology report.
Results: Total number of patients who were diagnosed to have a bleed in brain tumor were thirteen (n = 13). There were 6 (46%) males and 7 (54%) females. Mean age was 55 years. Among 13 patients, 4 (31%) patients had metastatic brain tumors and 9 (69%) patients had primary brain tumors. Diagnosis was done on CT brain, MRI brain and confirmed on histopathology of tissue obtained during surgery. Out of 13 patients, 5 (38%) patients were asymptomatic prior to hemorrhage and 8 (62%) patients had neurodeficits before and recent episodes of bleeding, which caused deterioration of neurological state.
Conclusion: Malignant primary and metastatic brain tumors can present as acute focal deficits due to brain hemorrhage. Diagnosis is based on clinical presentation, radiological features and histopathology. 
Outcome of Deep Brain Stimulation (DBS) for the Treatment of Parkinson’s Disease in Terms of Improvement in MDS-UPDRS Scale Over 5 Years
Get PDFBackground & Objective: Parkinson’s disease (PD) is the second most common Neurodegenerative disorder after Alzheimer’s disease. There are several surgical procedures for advanced PD, but amongst all deep brain stimulation has proven to be safest and effective. The objective of this study was to see the outcome of DBS for the treatment of PD in terms of improvement in MDS UPDRS over 5 years.
Material and Methods: 44 patients were included in study from Oct 2014 to Sep 2019. History, examination was carried out, and preoperative MDS-UPDRS (Movement Disorder Society Unified Parkinson’s Disease Rating Scale) was recorded. Postoperative improvement in MDS-UPDRS score was assessed at first Programming, 2nd week, and 6th week and at 3rd month.
Results: At baseline the mean, the MDS – UPDRS (Part-I) score was 14.20 ± 0.61 and at the end of 3rd month, the mean score was 11.18 ± 0.47 respectively. At baseline the mean, the MDS – UPDRS (part-II) score was 18.99 ± 0.70 and at the end of 3rd month, the mean score was 13.01 ± 0.57, respectively. At baseline the mean, the MDS – UPDRS (part-III) score was 45.19 ± 0.90 and at the end of 3rd month, the mean score was 25.15 ± 1.20 respectively. At baseline the mean, the MDS – UPDRS (part-IV) score was 10.18 ± 0.87 and at the end of 3rd month, the mean score was 3.85 ± 1.03, respectively.
Conclusion: The Deep Brain Stimulation (DBS) is safe and effective in the management of PD
The Surgical Results in Pure Endoscopic Endonasal Trans-sphenoidal Surgeries in 403 Pituitary Adenomas: An 8-Years of Experience from a Single Neurosurgical Unit
Get PDFObjective: To review and report the results in pure endoscopic endonasal trans-sphenoidal surgery done at our unit for pituitary adenomas (PAs) in last 8 years.
Material and Methods: We reviewed 403 consecutive patients who underwent pure endoscopic endonasal trans-sphenoidal surgery for newly diagnosed pituitary adenomas between August 2012 and July 2020 at our neurosurgical unit. Endocrinological, demographic features and outcomes, their complications, and duration of stay in hospital were assessed in these patients who were operated in our neurosurgical Unit. The Mean Follow-up on average was 3.5 months.
Results: 403 consecutive cases were reviewed. Majority of cases were in the 4th decade of life at presentation. 227 (56%) were non-functioning pituitary tumors and 176 (44%) were hormone secreting pituitary adenomas. Thirty-one (7.7%) complications were observed in 28 post-operative patients. The most frequently observed complication was diabetes insipidus (temporary in 19 (5%) and permanent in 3 (0.7%) cases), cerebrospinal fluids leaks (5 cases) (5.7%), Syndrome of inappropriate antidiuretic hormone (1 case) (0.2%), internal carotid injury (1 case) (0.2%), Empty Sella syndrome (1) (0.2%) and post-operative cardiac complication (1 case) (0.2%). The Follow-up on average was 3.5 months.
Conclusions: The pure endoscopic endonasal trans-sphenoidal surgery of pituitary adenomas provides acceptable and reasonable results representing a safe alternative procedure to the traditional Trans-sphenoidal microscopic approach