Pakistan Journal Of Neurological Surgery
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Assessment of Frailty Preoperatively and Loss of Independence in Elderly Surgical Patients
Get PDFObjective: This study was aimed to determine preoperative frailty assessment screening on postoperative morbidity and postoperative loss of independence (LOI).
Materials & Methods: A total of 100 patient’s age 65 years and older were included in this study. Edmodium Frail Scale (EFS) was used for the assessment of frailty. The surgical procedure was categorized on operative severity score, and Hierarchical Condition Category (HCC). The Chi-square test was applied to see the significant/insignificant differences between different stratified groups of patients.
Results: The mean age of the patients was 68 years. There were 63% male and 37% female patients. Maximum patients (78%) who had no LOI were in age less than 80 years. 11% of patients who had LOI were only 11%. There existed a significant difference (p-value: 0.004) between age groups (greater than/less than 80 years) of patients and presence/absence of loss of independence (LOI). After EFS assessment, 32% of patients had limited mobility, 22% had weight loss, 19% reported depression, 9% of patients were socially dependent and 18% reported cognitive impairment.
Conclusion: The results suggest that frail patients older than 78 years and OSS > 3 had a more increased risk of postsurgical LOI. The patients with EFS >5 and OSS >3 had more LOI. EFS analysis explained that those patients with restricted mobility, depression, and dependent socially had increased LOI. 
Outcome Comparison of Endoscopic (Endonasal Trans-Sphenoidal) Repairs of CSS Leak vs. Transcranial Approach
Get PDFObjective: To compare the effectiveness of Endoscopic (Endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications like infection, recurrence and hospital stay.
Material and Methods: The comparative experimental randomized study was conducted in the Department of Neurosurgery Unit I, PGMI, Lahore General Hospital, Lahore. After approval from ethical committee this study was carried out in our unit. 40 subjects with the history of CSF leak were randomly divided into two groups; one was treated with endonasal trans-sphenoidal repair and another was treated with trans-cranial approach, the subjects were followed up for 1 year. Detailed history, neurological examination, preoperative CT and MRI scans were performed in all patients.
Results: The mean age of patients with CSF leak was 25.58 ± 14.38 years. Among the patients, 17 were females and 23 were male. The mean age of the female was 31.70 ± 14.29 years. The mean age of the male was 21.04 ± 12.95. The recurrence was observed in 2 (10%) of the patients treated with endoscopic technique and 1 (5%) of the patients treated with trans-cranial approach. Those patients were successfully repaired in a second operation. Overall success rate was 92.5%. One patient (2.50%) among the trans-cranial approach develops infection which was treated successfully.
Conclusion: The endoscopic repair of CSF leak is both safe and effective and should be considered as the standard procedure of choice in most of the cases
Importance of Simpson/Shinshu Grading in Meningioma’s Excision, Outcome and Recurrence
Get PDFObjective: The study was aimed to determine the recurrence rate and recurrence-free survival of meningioma surgery with reference to Simpson grading of excision.
Material and Methods: The study was conducted in the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. Total 325 patients both male and female of age (13 – 70 years) with supratentorial grade I meningioma operated. The craniotomy with maximum safe excision of the meningioma was done in all patients under general anesthesia. All patients followed-up to one year clinically and radiologically. MRI brain plain and IV contrast were done at 6 months and then annually. The extent of resection was determined with the help of operative notes and post-op MRI and recurrences were studied with help of follow-up MRI.
Results: There were 227 female and 98 male patients in ages 13 – 70 years. The mean age of patients was 53.5 years. 227 (70%) skull base meningioma, 71 (22.0%) convexity meningioma, and 26 (8%) falx or tentorium meningioma were operated. We achieved Simpson grade I excision in 55 (17.45%), grade II in 208 (64%), grade III in 23 (7%), and grade IV in 36 (11%) cases. The median recurrence free survival (RFS) with reference to Simpson grading of excision was 250, 120, 98, 80 months for grades I, II, III, and IV excision; it was statistically significant according to the grading of excision.
Conclusion: Excision of meningioma up to grades I and II had an excellent outcome with minimum chances of complications
Anxiety and Depression in Parents of Children With Cerebral Palsy: A Case-Control Study
No full textObjectives: To assess the occurrence of anxiety and depression in parents caring for a child with Cerebral Palsy.
Material and Methods: A case-control study took place at the Gambat Medical Center and Jinnah Postgraduate Medical Centre from January 2019 to April 2021. There were two group categories; Group A served as the control group while Group B consisted of parents of children with cerebral palsy. Either the mother or father of the children was included and those parents who had more than one child were excluded from this study. They were screened for anxiety and depression using the Hospital and Anxiety and Depression Scale (HADS).
Results: 112 participants were included with 56 in each group. A parent with a cerebral palsy child had significantly higher levels of depression score on HADS compared to the control group (depression; 16.67 ± 5.24 vs. 8.39 ± 4.01; p < 0.001). Similarly, anxiety was higher in parents who had a child with cerebral palsy (p<0.001). Most of the parents with cerebral palsy had severe depression i.e., 19 (33.9%) (p < 0.001). The most common type of CP was spastic diplegic and the mean depression score for different types of CP varied between 14.33 ± 6.727 and 17.67 ± 3.055 however, the difference was not statistically significant (p = 0.65).
Conclusion: The parents of children with cerebral palsy were more likely to suffer from depressive symptoms as compared to those with healthy children
Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country
Get PDFObjective: To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC).
Materials and Methods: A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes.
Results: 85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates.
Conclusion: Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously. 
Comparison of Surgical Outcome of Anterior Circulation Aneurysms With and Without Proximal Temporary Artery Occlusion
Get PDFObjective: To compare the outcome of the TAO vs. no TAO during aneurysm surgery in terms of clinically significant postoperative ischemic changes due to vasospasm.
Material and Methods: A quasi-experimental study was conducted at Lahore General Hospital wherein 82 patients were enrolled. This study was conducted when the first author was working as PGR at LGH Lahore during 2015 to 2017. Patients were followed from admission to three-month post-op. During the follow-up, patients with clinical substantial post-op ischemic changes were calculated on CT Angiography for the presence of vasospasm.
Results: Mean age of the patients was 45.23 years. Proximal TAO was done in 30% (n=25) patients. Clinically significant post-op ischemic changes were seen in 29.3% (n = 24) patients. Of the patients who underwent proximal TAO, longer occlusion time (> 10 mins) was significantly associated with ischemic changes (p-value 0.015). Age > 50 years also showed a statistically significant association with clinical vasospasm (p-value < 0.001).
Conclusion: Temporary proximal artery clipping when employed within a limited duration appears to be safe and has no significant impact on clinical vasospasm. Since vasospasm is multifactorial, avoiding a longer duration of proximal TAO in patients with advancing age could decrease the frequency of post-operative ischemic changes due to vasospasm in such patients
Management of Post Traumatic Epilepsy in Pediatric Population in Pakistan
Get PDFObjective: To investigate the efficacy of seizure prophylaxis in the prevention of early and late-onset seizures after the traumatic brain injury known as post-traumatic epilepsy (PTE).
Material and Methods: A retrospective study was performed on children aged 0 to < 12 years who were presented to a level 1 trauma center during the six months with the diagnosis of mild to severe TBI. Data included is of 66 patients from Children’s Hospital, Lahore. It was analyzed according to a patient’s demographic data, mechanism of injury, clinical and radiological presentation, management, and follow-up. History of seizures was tracked through guardian referral or staff witnesses.
Results: Among 66 pediatric cases of acute brain injury from June 2019 to December 2019, 45 were males (68%) and 21 were females (32%) with a male to female ratio of 2:1. The mean age in our study was 3.8 years. 60% of children were managed under observation, 30% of children required medical pharmacological treatment, 9% of children needed surgical intervention, and 13% of children required artificial ventilation. Overall mortality is 4.5%. In our study, we found a considerable relationship between residual neurological deficits and severity of injury (p = 0.3), there is no noteworthy relationship between mechanism of injury and outcome (p = 0.5). The mean length of stay was 3.9 days but 60% of patients had stayed less than 3 days.
Conclusion: Analyzing the underlying mechanisms of post-traumatic epilepsy can lead us to propose effective treatments to prevent seizures following traumatic brain injury
Incidence of Depression and Anxiety among Patients with Acute Myocardial Infarction during COVID-19 Pandemic
Get PDFObjective: This study aimed to assess the incidence of anxiety and depression among AMI patients during COVID-19 pandemic in Pakistan.
Material & Method: This cross-sectional study was conducted from February 27 to June 2, 2020, at the Cardiology ward of Dera Ghazi Khan Teaching Hospital. Total 611 patients selected through convenience sampling. The patients were requested to respond to Hospital Anxiety and Depression Scale (HADS) and demographic information. An independent samples t test was applied for comparisons.
Results: Patients’ age was ranging from 41 to 79 years, with a mean age of 52.35 ± 5.12. There was a high frequency of anxiety (51.72%) and depression (34.86%) among AMI patients. A significant difference was observed in the level of anxiety (p = 0.001) and depression (p = 0.000) among male and female patients.
Conclusion: The present study findings affirmed that increased level of anxiety and depression are prevalent in AMI patients. Additionally, both anxiety and depressive symptoms were more common in female patients.
Keywords: COVID-19, Anxiety, Depression, Acute Myocardial Infarction (AMI)
Pattern of Skull Fractures and Its Outcome in Pediatric Head Injury Patients
Get PDFObjective: Skull fractures are common in pediatric age group. The surgical management of paediatric patients with a skull fracture differs among institutions and surgeons. Our object of this study was to assess the pattern of skull fractures and outcome in paediatric population.
Material and Methods: This study was conducted in the department of neurosurgery of a tertiary care hospital from June 2018 to April 2020. We included 152 children between ages 5 to 11 years who were brought with the head trauma and diagnosed to have skull fracture on computerized tomography (CT) Scan brain.
Results: The mean age of patients was 6.91 + 1.84 years. There were 59.8% males and 40.1% females. The most common type of fracture at presentation was depressed fracture in 42% patients, followed by linear (35%) and compound fractures (23%). Parietal fractures were the commonest (63.1%) in our study. Associated intracranial hematomas were seen in 37.5% patients, epidural hematoma being the most common. Surgically treated patients were 36%. Good recovery was seen in 73% patients while mortality was 10.5%.
Conclusion: Isolated skull fractures are overall benign conditions. Linear parietal skull fractures have good outcome amongst all fracture types
The Outcome of Subaxial Cervical Injury in Adult Patients Managed Surgically Through an Anterior Approach
Get PDFObjectives: We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours.
Material and Methods: A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months.
Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%).
Conclusion: The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction.
Keywords: Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring