Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Pure Endonasal Transsphenoidal Approach for Pituitary Tumors
Get PDFObjective: To determine the frequency of complete tumor excision by endoscopic skull base (transsphenoidal) approach in pituitary adenoma patients presenting to a neurosurgical department.
Materials & Methods: This descriptive case series was conducted at the Department of Neurosurgery Unit II, Lahore General Hospital Lahore from May 2019 to November 2019. The study included60 patients with pituitary adenoma from the outpatient department who qualified for the inclusion criteria. All patients went through the endoscopic binarial transsphenoidal approach for pituitary adenectomy. All patients were treated according to the department protocols and were followed for 6 weeks to determine the outcome i.e. no residual tumor left as determined by Magnetic Resonance Imaging.
Results: The mean age of pituitary adenoma patients studied was 50.02 ± 8.2 years. 43 patients (71.7%) were male.56 patients (93.3%) showed complete resection on MRI using the endoscopic binarial transsphenoidal approach. The outcome was not affected by patients' gender and age. Tumor size significantly affected the outcome i.e. complete resection.
Conclusion: It is concluded that the endoscopic skull base (transsphenoidal) approach for excision of pituitary adenomas gives desirable results as depicted by 93.3% success rate in terms of complete resection of the tumor. We did not observe a significant effect of patients' gender and age on the clinical outcome in the studied sample of the population
Single Burr Hole Evacuation of Extradural Hematoma in Pediatric Population: An Experience from the Biggest Children Hospital of Pakistan
Get PDFObjective: To observe the outcome of single burr hole evacuation of EDH in a pediatric population.
Material and Methods: We included 52 children who had had a head injury and were diagnosed with EDH on a CT scan. Over three months, they were all admitted to the pediatric neurosurgery ward. Serial CT scans and neurological evaluations were performed on all of the youngsters regularly to monitor their progress.
Results: 52 pediatric and adolescent patients were included. The age range was 6 months to 18 years. There were 30 male and 22 female patients. All of the children have EDH as a result of head injuries sustained in various accidents. All of the youngsters underwent surgery to remove EDH through a single burr hole. On the second postoperative day, five infants underwent reoperation owing to neurological deterioration, and two children died. The result was good (mRS 0) in 44/52 (84.6%) instances, mild deficits (mRS 1–2) in 4/52 (7.6%), and severe impairments (mRS 3–5) in 2/52 (3.84%) cases six months after the event.
Conclusion: Although, EDH is a life-threatening surgical disease if not treated promptly, EDH evacuation by a single burr hole has a satisfactory prognosis in the juvenile population, with fewer complications and recurrences
Success Rate of Endoscopic Third Ventriculostomy (ETV) in Non-Communicating Hydrocephalus in Pediatric Age Group
Get PDFObjective: To evaluate success rate of the endoscopic third Ventriculostomy (ETV) in non-communicating type of hydrocephalus in pediatric age group.
Material and Methods: This study was carried in the department of neurosurgery at Liaquat university hospital, Jamshoro in which an endoscopic third Ventriculostomy procedure was performed in patients (n = 55) with non-communicating hydrocephalus from October 2016 to April 2017. Post-operative follow-up was done on the 15th day post-operative to assess clinical and radiological improvement.
Results: 55 patients were included in this study, 26 (47.27%) males and 29 (52.73%) females. The mean age was 3.96 years. The most common etiology was aqueductal stenosis 28 (50.90%) patients followed by posterior fossa tumors in 18 (32.72%) patients. The operative technique was successful in 41 (74.55%) patients. Out of 41 successful patients, 34 (82.92%) patients had clinical as well as radiological improvement whereas 7 (17.07%) patients had clinical improvement only.
Conclusion: The success rate of ETV was 74.55% in the non-communicating hydrocephalus in the pediatric age group in our study. Endoscopic third Ventriculostomy is an effective treatment for non-Communicating hydrocephalus in pediatric age groups by diversion of CSF intracranially. This procedure provides shunt freedom and can be used alternative to shunts in pediatric age groups with non-communicating hydrocephalus
Recurrent Cervical Neurofibrosarcoma: A Rare Case of Malignant Peripheral Nerve Sheath Tumor of Head and Neck Region
Get PDFNeurofibrosarcoma is a malignant peripheral nerve sheath tumor (MPNST). The cervical location of the neurofibrosarcoma is very rare and is less than 1% in the literature. MPNSTs are often associated with neurofibromatosis type 1 (NF1). We are presenting a case report of 31 years old female, with huge recurrent cervical neurofibrosarcoma on the right side of the neck. To date, surgical excision followed by chemotherapy and radiotherapy is the treatment of choice which requires a multidisciplinary approach. We excised the above-mentioned cervical neurofibrosarcoma in a piecemeal fashion and discharged the patient on follow-up with the oncology department
Role of Decompressive Craniectomy in severe Traumatic Brain Injury: An Institutional Experience
Get PDFObjective: The present study was designed to assess the outcome following the Decompressive Craniectomy procedures performed in our setup for patients presenting with severe traumatic brain injury.
Materials and Methods: This was a retrospective study wherein the medical records of adult patients that presented with an initial Glasgow Coma Scale (GCS) ? 8 and in whom decompressive craniectomy had been carried out for severe traumatic brain injury were retrospectively analyzed. Patients in whom decompressive craniectomy had been carried out for causes other than trauma and patients with initial GCS ? 9 were excluded from the study. The studied parameters included age, sex, initial GCS, computed tomography (CT) brain diagnosis, and the outcome according to the Glasgow coma outcome scale (GOS).
Results: The study included 12 patients, and of these 12 patients operated with Decompressive Craniectomy for severe traumatic brain injury only 2 survived. The mortality was 83.3%. The initial GCS and age were not statistically different between the survivors and the non-survivors. Based on the Glasgow Outcome Scale (GOS) only 1 patient had a good outcome. Overall, an unfavorable outcome based on the GOS score was seen in 91.7% of patients.
Conclusion: Our study concludes that Decompressive Craniectomy is associated with high mortality in patients presenting with severe traumatic brain injury and does not seem to offer a better alternative to standard medical management
Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis
Get PDFObjective: To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis.
Material and Methods: The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score.
Results: Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value<0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value < 0.0001) observed only in male patients between two surgery groups for the back pain scores.
Conclusion: Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis
Early Neurological Outcome of Surgical Repair of Lipomyelomeningocele in Infants
Get PDFObjective: A prospective cohort study was aimed to evaluate the early neurological outcome of surgery among infants having lipomyelomeningocele.
Material and Methods: The study was conducted at the Department of Pediatric neurosurgery, Children Hospital &The Institute of Child Health, Lahore from January 2019 to June 2019.A total of 50 pediatric patients, both male and female, aged 3 months to 1 year, with lipomyelomeningocele (symptomatic or asymptomatic) who presented to the out-patient department were included in the study. Group A included those cases who were aged <6 months and Group B were aged >6 months. All patients underwent standard surgical procedures for the treatment of lipomyelomeningocele.
Results: Out of a total of 50 infants, there was 32 (64.0%) female. Overall, the mean age was 7.39 ± 2.63 months. The lumbar area having mass on the back was the most frequently seen in 23 (46.0%) infants. Group A included 20 (40.0%) infants while Group-B had 30 (60.0%). Low lying cord was the commonest neurological finding noted among 25 (50.0%). Complete Excision of Lipoma was done among 48 (96.0%) infants. Post-surgery, no significant difference was found on day-3 and day-10 between study groups (P > 0.05). Early outcome at 6-months intervals was found to be associated with significantly improved neurological function grades in Group-A (p = 0.030).
Conclusion: Surgical management of lipomyelomeningocele is a safe procedure. An early treatment approach even in asymptomatic infants is recommended to reduce neurological deterioration
The Gross Total Resection and Molecular Markers in Grade II Glioma
Get PDFObjective: The study determined the importance of gross total resection in grade II Glioma and evaluated the importance of tumor markers as prognostic factors.
Material and Methods: We included the 240 patients aged 13 – 65 years with supratentorialsuspected low-grade Glioma. Craniotomy was done in all my patients under general anesthesia and excised the tumor safely with the help of a microscope and CUSA without causing any focal deficit or hemodynamic instability. The 3D conformal radiotherapy and or Temozolomide chemotherapy was started as advised by the oncologist, postoperatively. The 5 and 10 years’ overall survival and progression-free survival were evaluated in my study.
Results: Median age of the patients was 45 years. The 46.66% patients were IDH mutant Astrocytoma, 39.1 6% patients were IDH mutant Oligodendroglioma with loss of heterozygosity at I p/l9q levels, and 14.16% patients had IDH wild type Astrocytoma. The gross total resection was done in 113 patients, subtotal in 53 patients, partial resection in 45 patients, and biopsy in 29 patients. Postoperative radiotherapy was done in 170 patients and Temozolomide chemotherapy in 67 patients. The 5 and 10 years’ progression-free survival was 80% and 49% and overall survival was 86.3% and 67%. The 10 – year overall survival for Oligodendroglioma, the IDH mutant Astrocytoma, and IDH wild Astrocytoma were 93%, 61.6%, and 34.7% (respectively), and progression-free survival were 89.2%, 48%, and 34% (respectively).
Conclusion: The gross total resection of IDH mutant Astrocytoma had a good outcome
Frequency of Extradural Hematoma in Patients with Skull Fracture after Head Injury
Get PDFObjective: To assess the frequency of patients with extradural hematoma who have a skull fracture on x-ray skull presenting with a head injury.
Material & Methods: A descriptive case series was conducted at the Department of Neurosurgery, RMU & Allied Hospital, Rawalpindi. 322 patients fulfilling the selection criteria were enrolled in the study from Emergency Ward. Patients with head injury having skull fracture undergone a CT scan for assessment of presence or absence of extradural hematoma. CT scan was done by a single senior radiologist for all patients.
Results: Mean age of patients in this study was 41.31 ± 14.67 years. Among the patients 259 (80.4%) were male and 63 (19.6%) were females. The mean duration of injury of the patients was 6.37 ± 3.40. Extradural hematoma was diagnosed in 104 (32.3%) patients. Age and site of fracture showed a statistically significant association for extradural hematoma. Whereas gender, duration of injury, and type of fracture did not show significant association for extradural hematoma.
Conclusion: Results of this study showed a low frequency of extradural hematoma in patients who presented with a head injury. Still, any patient suspected of head injury leading to skull fractures must be examined on CT scan to avoid and timely detect the intracranial bleeding in order to avert the complications and mortality after traumatic head injury
COVID-19 Pandemic: Influences on the Practice of Neurosurgeons all over Pakistan
Get PDFObjective: The aim of this survey was to observe the impacts of COVID-19 pandemic on neurosurgery practices during this pandemic, assess various types of adaptations taken by them, protective measures during patient examination and effects on their health, family and socioeconomic life.
Material & Methods: A Questionnaire comprising 32 questions was circulated among practicing Neurosurgeons of Pakistan by social media, e-mails for 8 weeks (January-February 2021) and their responses were analyzed.
Results: 108 participants were involved from all over Pakistan. 32% respondents stated reduction in clinical practice to a level of less than 25%. While, 10% reported complete closure of outpatient services during pandemic. There were varied responses on the use of protective measures and most used N95 mask only (31%). Pandemic also affected the research work, finances and leisure time activities.
Conclusion: Our study showed that neurosurgical practice was influenced by COVID-19 pandemic in many aspects in Pakistan. Proper method of protective measures and COVID testing of patients were lacking among them. Neurosurgeons should follow standard guidelines according to institutional directives in local neurosurgical practices so as to avoid being influenced by such crisis.