Pakistan Journal Of Neurological Surgery
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Endoscopic Discectomy versus Microscopic Discectomy
Get PDFObjective: A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease.
Material and Methods: A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI).
Results: There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group.
Conclusion: Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain
Outcome of the Traumatic Extradural Hematoma on the Basis of Size of Extradural Hematoma
Get PDFObjective: This study aimed to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma.
Materials & Methods: A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months and included 188 patients. The detailed history and clinical examinations were noted through a pre-designed proforma. Patients were followed post-operatively till the time of discharge and for either favorable outcome or unfavorable outcome according to the GOS.
Results: 73% of patients had extradural hematoma volume between 25 – 50 mL, while 27% patients had extradural hematoma >50 mL. 12% of patients had Glasgow Outcome Score (GOS) scores 1 – 3, while 88% of patients had GOS scores: 4 – 5. The mean GOS was 3. Patients with favorable outcomes were 88% while 12% had an unfavorable outcome.
Conclusion: The size of the extradural hematoma has a strong correlation with outcome. The greater the size of the hematoma, the poorer the outcome
Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.
Get PDFObjective: To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan.
Material & Methods: A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions.
Results: 85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p<0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months.
Conclusion: Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability
Incidence of Epilepsy and Drug Dependence after Post Traumatic Contusions Managed Conservatively
Get PDFcontusions managed conservatively.
Material and Methods: A prospective observational study was carried out in, Punjab Institute of Neurosciences, Lahore. A total of 97 patients, from 15-65 years, who were diagnosed with cerebral contusions and being managed conservatively were enrolled from July 2019 to December 2019. They were followed-up for 12 – 18 months.
Results: A total of 23% patients developed early post-traumatic seizures (PTS) and 11% of patients developed late post-traumatic seizures with mild to moderate brain injury.6% of patients with early PTS used antiepileptic drugs (AED) for at least three months during follow up and 7% with late PTS used AED. 8% of patients developed late PTS without any early PTS. The results of our study show that among 23% early PTS and 11% late PTS only 3 % actually required to use AED for at least 6months. To prevent this, 3% of the population 44% were using AED supplementary.
Conclusion: In our study, the incidence of early and late PTS is comparable to the other studies. The non-judicious use of the anti-epileptic drug is common in our country which leads to an increase in the risk of drug resistance and cost-intensive for poor patients in developing countries as prophylactic and excessive use of anti-epileptics does not affect the PTE
COVID-19 Vaccination in Neurosurgeons
Get PDFIn a letter to President-Elect Josephs R. Biden on January 19, 2021, the American Association of Neurological Surgeons (AANS) emphasized the significance of COVID-19 immunization for neurosurgeons in order to reach the worldwide objective of vaccination. In a report, only one death is reported from 264,00,000 vaccinated people. In negative-vaccinated individuals, the death rate is 2-3% in younger adults, whereas 7-10% is reported in older people. COVID-19 was reported in less severity in those who were positive-vaccinated. According to a latest survey, 60% of Pakistani neurosurgeons were COVID-19 positive, mostly from the hospital environment. High level of acceptance and motivation is found in our neurosurgeons. 91% of our neurosurgeons have been vaccinated. Mostly received the SinoPharm and Oxford AstraZeneca
Recurrent Occipital Dermatofibrosarcoma Protuberans: Multidisciplinary Management of a Rare Case: Multidisciplinary management of a rare case
Get PDFDermatofibrosarcoma protuberance is a skin tumor arising from dermis, slow growing in nature and locally invasive. Most commonly present on extremities and rarely on head and neck region. We are presenting a case of 24 years old male with huge recurrent DFSP lesion in occipital region. We did wide local excision with tumor free skin margins of 2.5cm followed by excision of involved occipital bone and wound coverage with carotid artery flap. DFSP is challenging skin tumor with high recurrence rate and should be managed by multidisciplinary approach
Frequency of Post-Operative Cerebrospinal Fluid (CSF) Leak in Retromastoid Surgery for Vestibular Schwannoma: A Three-Year Experience of a Tertiary Care Hospital
Get PDFObjective: Descriptive study was aimed is to find out the frequency of CSF leak in retro mastoid surgery for Vestibular Schwannoma.
Material and Methods: From 2017 to 2020, 63 patients underwent microsurgical excision of Vestibular Schwannoma with retro sigmoidal approach in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. All patients of either sex underwent retro mastoid approach for Vestibular Schwannoma surgery, having complete dural closure per operatively were included in this study. Data was collected which included symptoms, clinical assessment, radiological findings, per-operative and postoperative findings. Patients were monitored for 30 days after surgery and checked for any CSF leaks.
Results: There were 36 male and 27 female patients. In our study, the postoperative CSF leak was present in 9(14%) of cases. There was no significant difference (p-value 0.097) whether the dura was closed with graft and without graft. Insignificant differences existed in CSF leak vs. different age groups (p-value 0.964) and gender (p-value: 0.917).
Conclusion: Our study found that after retro sigmoid approach for vestibular Schwannoma surgery, the frequency of CSF leak was 14%, which gives us insight into our complication rate and allows us to change our surgical procedure technique, such as using fibrin glue or less frequently artificial dura, to reduce this rate
Role of Rivaroxaban in Patients with Cerebral Venous Thrombosis
Get PDFObjective: Cerebral venous thrombosis is a common neurological disease. It has been treated so far with Warfarin that needs continuous monitoring of PT (prothrombin time) and INR (International Normalization Ratio) with potential complications due to this problem. Newer oral anticoagulants have been recommended for other thromboembolic events like pulmonary embolism and can be a good alternative treatment of CVT. We determined the effectiveness of new oral anticoagulant Rivaroxaban in patients with cerebral venous thrombosis.
Material and Methods: The study was conducted in the indoor department of Neurology, Punjab Institute of neurosciences for 1year. Magnetic cerebral venography (MRV) Brain was done at the start of Rivaroxaban, at 3 months and at 6 months where needed. The bias effect was removed by getting MRV done and reported from the same department.
Results: A total of 18 patients were enrolled in the study. One patient was lost to followup. Mean age of our patient data was 28.66 ± 6.66. 16 (88%) patients were females and 2 (11%) were males. 9 patients (50%) had clinical and radiological recovery based on MRV brain at 3 months.7 patients (38%) had recovery based on clinical and radiological parameters at 6 months. Only 1 patient had partial recanalization but that also improved clinically.
Conclusion: Rivaroxabancan is a very effective alternative for warfarin in cerebral venous sinus thrombosis which will avoid concerns commonly encountered with warfarin
The association of brain tumor and hydrocephalus in the patient managed with craniotomy and ventriculoperitoneal shunt – The single-centre study
No full textOBJECTIVE: To determine frequency of hydrocephalus in brain tumor perioperative and and need of perment VP shunt .
METHOD & MATERIAL: This was descriptive study, the ethical approval was taken from the hospital, study duration from 24-June-2014 to 30-september-2020 at JPMC, Karachi. Inclusion criteria were patient with brain tumor associated with hydrocephalus or postoperatively developed hydrocephalus within 3months of surgery and exclusion criteria were they had shunted previously due to some other reason, history of operation of brain tumor previously, history of trauma.
RESULTS: We operated 156 cases of brain tumor concomitant with hydrocephalus, these included pre-operative and post-surgery development of hydrocephalus, out of that 65 (41.6%) were adult and 91 (58.33%) were children, who had hydrocephalus due to brain tumor. 90 (57.6%) were male and 66(42.3%) were female. The mean age for an adult was 34.2±8years and 8.1±4years was for a pediatric population of the patient. Patients who had preoperative hydrocephalus were 34 (21.7%) adults and 55(35.25%) pediatric and post-operative development of hydrocephalus was 28 (17.9%) in adults and 41 (26.28%) pediatric patients,
CONCLUSION: The common brain tumor associate with hydrocephalus in children was craniopharyngioma and in adults it was CP angle tumor. Among 6026 cases of brain surgeries 2.6% required vp shunt dependency. Considering common cause of hydrocephalus in brain tumors, perioperative decision-making plays a pivotal role in the management of tumour-associated hydrocephalus.
 
Computerized Tomographic Based Study of Thoracic Spine Morphology in Relevance to Pedicle Screw Fixation in Pakistani Population
Get PDFObjective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography.
Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width.
Results: Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (21.2 ± 1.07 mm). Interpedicular (IPD) canal dimensions were minimum at T6 (19.18 ± 1.6 mm) and maximum at T3 (23.18 ± 1.2 mm). Anterior vertebral body height was minimum at T1 (16.9 ± 1.34 mm) and maximum at T12 (27.14 ± 1.34mm). Posterior vertebral body height was minimum at T1 (18.8 ± 1.13 mm) and maximum at T12 (29.76 ± 1.43 mm).
Conclusion: A detailed anatomy of the thoracic spine is essential for surgical planning to decrease postoperative complications