Pakistan Journal Of Neurological Surgery
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Neuro Endovascular Surgery in Pakistan, a Service Led by Neurosurgeons on the Horizon in Pakistan. A Turf War: Neurosurgery vs. Stakeholders for Pakistan’s National Stroke Centre
Get PDFClinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma
Get PDFObjective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia.
Material & Methods: A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days.
Results: The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients.
Conclusion: Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma.
Keywords: CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery & Subdural drain
Incidence and Trends of Neural Tube Defects in Babies Delivered at Dera Ghazi Khan Tertiary Care Center
Get PDFObjective: A cross-section study was conducted to determine the incidence and trends of neural tube defects in babies delivered at a tertiary care center. And those babies who were delivered elsewhere and were brought to a tertiary care center for treatment.
Material and Methods: The Study was conducted at neurosurgery and pediatric surgery departments, Ghazi Khan Medical College and Teaching Hospital. Two thousand (n = 2000) women delivered their babies at a tertiary care hospital were enrolled, out of them 52 women who delivered babies with neural tube defects (NTDs) were further assessed. Women were interviewed and history of folic acid intake, previous baby with NTDs and family history were recorded. Tests of significance were applied to assess the significant results.
Results: Folic acid intake was occurred in n = 298 (14.9%) subjects. Association of folic acid on neural tube defects. Odds ratio showed that if a baby without intake of folic acid had 7.8 times at risk to suffer from a neural tube defect. The association was also significant (p = 0.000).
Conclusion: Neural tube defects are common in tertiary care centers its incidence was 2%. Increased incidence of NTDs was observed in babies who delivered by folic acid deficit mothers. Early childhood marriages in rural areas and cousin marriages are the main contributing factors.
Keywords: Neural tube defect, Anencephaly, Spina bifida, Hydrocephalus, Meningocele
Brain Abscesses in Children: A Study of Microbiological Spectrum and Outcome of 80 Cases
Get PDFObjective: Brain abscess is a focus of pus in the brain due to infection somewhere else in the body. It is common in males than females and the average age in children ranges from 4 to 7 years. It develops by skull trauma or contiguous or hematogenous spread of infection. The study aimed to identify the pattern of microbiological involvement in the etiology of pediatric brain abscesses and the outcome so as to enable us to ensure definitive treatment with the appropriate and specific antimicrobial regimen.
Materials and Methods: A prospective study was conducted in 80 pediatric patients of brain abscess admitted to the Pediatric Neurosurgery Department, Children Hospital, Lahore, Pakistan.
Results: The median age was 5.2 years with a predominance of males (60%). The most common presentation was fever (72.5%) and then fits (35%). Congenital heart disease was the commonest factor in 32% of cases. Streptococcus was a commonly isolated pathogen in 17% cases out of 70% of culture positive cases. Recovery was seen in 70% of cases and the mortality was 7.5%.
Conclusion: Congenital heart disease is the most common causative factor in pediatric brain abscesses and most of the abscesses were found culture negative. There is a pressing need to carry out multicenter studies over a large sample size over extended study duration in developing countries to help establish guidelines in treating pediatric brain abscesses
Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain
Get PDFObjective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement.
Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ?3) was considered after 12 months.
Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement.
Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF
Anterior Cervical Corpectomy with Cage Fixation for Cervical Spondylotic Myelopathy
Get PDFObjective: This study aimed to report the clinical outcome of anterior cervical corpectomy with cage fixation in patients with cervical spondylotic myelopathy.
Material and Methods: This observational retrospective study included 36 patients from the Neurosurgery department of Lady Ready Hospital MTI, Peshawar from 2014 January to 2015 December. After performing surgery, the patients were followed up for six months for neurological outcome and various post-operative complications such as infection, transient recurrent laryngeal palsy, screw displacement and improvements in paresthesias and gait ataxia.
Results: Most of the patients have no post-operative complications. Seventy-five percent (n = 27) of patients reported an immediate improvement in paresthesia and fine hand movements and gait. The major reported complications were implant failure (5.55%) and recurrent laryngeal nerve transient palsy in two patients (5.55%) each.
Conclusion: In patients with cervical spondylotic myelopathy, with anterior compression, cervical corpectomy with cage fixation is less invasive and an effective procedure with acceptable outcomes
Post-Operative Complications of Surgery for Chronic Subdural Hematoma (SDH) and Prevention: A prospective study
Get PDFObjective: The study aimed to determine the rate and type of complications during surgery for treatment of chronic subdural hematoma and assess ways for their prevention.
Material and Methods: A total of 50 patients of chronic SDH were selected from the Neurosurgery Department of Bahawal Victoria Hospital. Patients were treated surgically with a single burr hole evacuation under local anesthesia, introduced a subdural drain, nursed in a head-down position for 24 hours, and given plenty of fluids orally and intravenous route. The surgical technique involved a formation of a single burr hole at the point of maximum density.
Results: Out of 50, 43 patients recovered smoothly postoperatively and discharged on the 7th postoperative day. Two patients were re-operated due to inadequate evacuation or reaccumulation. One patient developed subdural empyema post-operatively and expired in spite of good antibiotic cover. In one patient subdural drain penetrated the brain parenchyma resulting in dysphasia. Another patient formed an intracerebral hematoma due to irrigation of the cavity with pressure. One patient with GCS 4/15 developed seizures postoperatively and expired after one hour. One patient developed gross subdural tension pneumocephalus after removing the subdural drain was re-operated and recovered.
Conclusion: Single burr hole evacuation of chronic SDH under local anesthesia is the most accepted surgical treatment. Using proper aseptic surgical techniques, the introduction of the minimum necessary length of the subdural catheter to avoid penetration into the brain parenchyma, followed by careful irrigation of the subdural cavity can help prevent complications
Comparison of Early vs. Late Tracheostomy in Subdural Hematoma Operated at GCS Six or Below
Get PDFObjectives:To compare the outcomes of early tracheostomy vs. late tracheostomy in post-operative patients after acute subdural hematoma at receiving GCS (Glasgow comma scale) of six or below.
Method: A quasi observational study was conducted on 30 patients with acute subdural hematoma after RTA (road traffic accident) and were operated in The Department of Neurosurgery Unit 2, Punjab Institute of Neurosciences, LGH, Lahore. The age range was 20 – 65 years. All patients were operated upon within 12 hours of RTA.
Results: In Group A, 12 (40%) patients, decompressive craniectomy with the evacuation of acute subdural hematoma and early tracheostomy were performed. In Group B, 8 (26%) patients’ craniotomy and evacuation of acute subdural hematoma were done along with early tracheostomy. In 6(20%) patients, decompressive craniectomy and evacuation were done and their tracheostomies were done at the 10th post-operative day. In 4 (13.33%) patients’ craniotomy and evacuation of hematoma done and their tracheostomies were also done at 10th post-operative day. In Group A, on 5th postoperative day GCS of 16 (53.33%) patients with early tracheostomies and fewer comorbidities improved, they were extubated, while 2 (6.67%) patients did not improve and 2 (6.67%) patients died. In Group B, in 30 patients with late tracheostomies, only 4 (13.33%) patients were improved. On 10th post-op day, GCS of 4 (13.33%) patients improved, GCS of 3 (10%) patients not improved and 3 (10%) patients died.
Conclusion: Early tracheostomy in patients with acute subdural hematoma yields good results as compared to late tracheostomy
Single Burrhole Craniostomy with Subdural Placement of Foley Catheter for Drainage of Chronic Subdural Hematoma
Get PDFObjective: Chronic subdural hematoma (CSDH) is a common neurosurgical condition of the elderly. The lack of consensus over a single standard surgical procedure for the management of CSDH urges neurosurgeons to evaluate different techniques in terms of a better outcome.
Material & Methods: In this prospective study forty cases of CSDH who had undergone single burr-hole craniostomy and subdural placement of Foley catheter were analyzed. The observations were made concerning clinical, radiological findings, postoperative complications, and mortality rate.
Results: The study included 26 males and 14 females with a mean age of 67 years. The most common presenting symptom was hemiparesis (n=18, 45%). Recurrent hematoma and recurrent evacuation rate was 10%. There was no case of newly developed postoperative seizures, pneumocephalus, intracranial hemorrhage, and wound infection. The mortality rate during the study was 0.0%. The mean Glasgow outcome score (GOS) at the time of discharge was 4.8.
Conclusion: We concluded that single burr-hole evacuation of CSDH with Foley catheter placement appears to be an effective procedure with a significant reduction in postoperative pneumocephalus. Factors such as sudden decompression of hematoma, the air in the subdural cavity, misplacement of drainage tubes, and damage to blood vessels during surgery can be reduced with this technique
Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan
Get PDFObjectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS).
Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years.
Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy.
Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature