Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Sellar Suprasellar Brain Tumors through Retracterless Subfrontal Approach
Get PDFObjectives: The aim of this study is to see the surgical outcome of Sellar and Suprasellar brain tumors with retractorless modified subfrontal approach.
Material and Methods: We did cohort study of 15 patients who were operated in Neurosurgery Unit 2, PINS. Our study duration is 1 year and follow up duration is of 3 months. Clinical features were related to cranial nerves 2nd, 3rd ,4th, and pituitary gland, dural irritation and temporal lobe compression i.e., diplopia, decrease vision, CSF rhinorrhea, abnormal olfaction, headache, GTCS etc.
Results: In our study, age range was 8 – 62 years with mean age was 35 years. Our 5 patients were male and 10 patients were female. Surgery was performed in all patients through subfrontal approach with retractorless method. In Histopathological report of 2 patients’ findings was Craniopharyngioma, 12 were of pituitary adenoma and 1 was of sellar meningioma. Seven 46.67 percent patients operated successfully with no new neurological deficit. Three 20 percent patients operated but no post op improvement in clinical symptoms, no patients were re-explored postoperatively due to CSF Rhinorrhea. Diabetes Insipidus occurred in 5 (33.3%) patients post-operatively which was managed later on.
Conclusion: Surgery subfrontal approach with retractorless method is the safe corridor for treatment of sellar and Suprasellar brain tumors
Outcome in Normal Pressure Hydrocephalus after Ventriculoperitoneal Shunt in Tertiary Care Hospital
Get PDFObjective: To determine the outcome of the ventriculoperitoneal shunt in normal pressure hydrocephalus.
Material and Methods: This study was conducted at Jinnah Postgraduate Medical Centre, a tertiary care hospital in Karachi. Patients with idiopathic normal pressure hydrocephalus (NPH) were included. Gender distribution, presentation of symptoms and post-operative outcome based on the Stein Langfitt Scale were assessed. CSF was sent for microbiological and biochemical analyses. All patients were evaluated preoperatively and compared postoperatively during 6 months duration for improvement and any associated complication.
Results: In this study, we had 47 patients, 38 were male and 9 were female. 22 patients presented with dementia, 18 with urinary incontinence, 17 with gait disturbance 17, while 21 had headache based on Stein and Langfitt Scale. The 78.8% patients had an excellent outcome, 17% had a good outcome and 4.2% had poor results.
Conclusion: Ventriculoperitoneal (VP) shunt had promising results selected on history and examination of normal pressure hydrocephalus and improved radiological in Evan’s ratio CT brain scan.
Keywords: Normal Pressure Hydrocephalus (NPH), VP Shunt, Stein and Langfitt Scale
Functional outcome of anterior cervical discectomy and fusion for degenerative diseases of the cervical spine.
No full textBackground & Objectives: Discectomy followed by the fusion in the cervical spine is done for herniated cervical intervertebral disc causing neurologic symptoms when conservative management has failed. In our study, we assessed clinical presentation and functional outcomes after surgery through an anterior cervical approach.
Materials and Methods: This retrospective cohort study was conducted in the Neurosurgery division, Lady reading hospital Peshawar. We included 42 consecutive patients who underwent single-level anterior cervical discectomy and fusion for the herniated cervical disc. The mean follow-up was 14 months. Anterior cervical discectomy and fusion (ACDF) was done in all patients using standalone titanium or PEEK cage. Z scores and associated p values were calculated to see the difference of significance between preoperative reported symptoms and their improvements postoperatively.
Results: There were 37 male and 5 female patients. The mean age was 43 ± 9.8 years. Disc herniation mostly occurred at C4 – 5 and C5 – 6 levels (76.16%). Preoperatively, the Neck pain was present in 36 (85.7%), upper limb weakness in 20 (47.6%), numbness/paresthesias in 25 (59.5%), upper limb pain in 18 (42.84%), lower limbs spasticity in 14 (33.32%) and bladder involvement in 3 (7.14%) patients. Statistical significant postoperative improvements in (90-100%) were reported in symptoms. Postoperative complications were observed in 5 patients. Most reported complication, the dysphagia was noted in 9.52% patients.
Conclusions: A significant proportion of patients with herniated cervical disc showed an excellent recovery after anterior cervical discectomy and fusion (ACDF)
Source of Bleeding and Per-Operative Findings in Extradural Hematoma (EDH): A Three-Year Experience in a Teaching Institute
Get PDFObjective: The objective of this study was to analyze the main source of bleeding and operative findings in an extradural hematoma (EDH).
Material and Methods: A descriptive study was conducted at the Neurosurgery Department of Hayatabad Medical Complex Peshawar from March 2017 to April 2020.The study included 550 patients that met the criteria of inclusion well. Demographic profile, location of Extra-Dural hematoma, the source of bleeding, presence or absence of skull fracture and per operative findings were documented in structured proforma.
Results: 69% were male and 31% were female patients. The middle age group of 21 – 40 years mostly affected. Rupture or laceration of middle meningeal artery was the communal source of bleeding in 355 (64.5%) patients, followed by fracture bone in 285 (51.8%) of patients and dural venous sinus in 70 (12.7%) of patients. Preoperative findings in our study were linear skull fracture in 250 (45.4.0%), underlying contusion in 165 (30%), and contralateral hematoma in 70 (12.7%) of cases.
Conclusion: Rupture or laceration of a Middle meningeal artery (MMA) was the most communal source of bleeding in extradural hematoma. Therefore, per-operative cauterization of this vessel is important to prevent the chances of re-bleed and re-do surgeries
Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach
Get PDFObjective: In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach
Material and Methods: This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus.
Results: CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications.
Conclusion: Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications
Role of Dexamethasone in Recurrent and Residual Chronic Subdural Hematoma
Get PDFObjectives: To assess the effectiveness of dexamethasone in recurrent and residual chronic subdural hematoma as a monotherapy.
Material and Methods: A prospective Quasi-Experimental study was conducted at the Neurosurgery Department, Peoples Medical College Hospital, Nawabshah from July 2014 to June 2020.Patients were assessed by Markwalder’s neurological grading and intravenous dexamethasone was used as monotherapy and effects were monitored.
Results: Out of 280 patients100 patients had recurrent and 180 patients had a residual chronic subdural hematoma. Male n = 180, female n = 100 with male to female ratio 1.8:1. Patients with Markwalder Grade 0, 1, and 2 were included and Grade 3 & 4 with marked midline shift on plain Computed tomographic scan brain were excluded. Intravenous dexamethasone of 12 mg in three divided doses for 24 hours given for first 2 weeks then shifted on oral dexamethasone and gradually tapered in next 2 weeks. During this period patient was evaluated for fluctuation in blood sugar or epigastric pain. Serial follow-up of patient was done, 16.07% improved from Markwalder Grade – 2 to 0, Markwalder Grade 1 to 0 in 12.14%. Complete resolution of hematoma occurred in 53.57%. Radiological deterioration with increased volume of hematoma in n = 40 and worsening to Markwalder Grad – 3 n = 15 and Grade – 4 n = 25. Death in n = 11.
Conclusion: Monotherapy with dexamethasone in recurrent and residual chronic Subdural Hematoma results in clinical improvement and reduces the rate of re-operation
Surgical Outcome of Transpedicular Fixation for Degenerative Spondylolisthesis in Terms of Relief from Backache
Get PDFObjective: To document the outcome of transpedicular fixation for degenerative spondylolisthesis in terms of relief from backache.
Materials & Methods: This retrospective observational study was conducted in Mardan Medical Complex, Mardan. Static and dynamic spinal X-rays were used to diagnose degenerative spondylolisthesis. This research looked at how patients' pain levels, neurological state, and union improved after surgery. Patients with grade 5 spondylolisthesis, having congenital spinal anomaly, or who had previous spinal surgery were excluded from the study.
Results: In total 35 patients were included, 54.3% were male and 45.7% female. The primary reason for surgery was severe backache with 24 individuals having normal neurological status and 11 patients having some neurological abnormality. L5–S1was the most commonly involved level in 24 patients. Meyerding grades were used to determine the slip grade. The average duration of follow-up was two years and five months, with a maximum of five years and a minimum of six months. 83 percent of patients had pain reduction, whereas neurological improvement was achieved in 64 percent of instances and surgical union was achieved in 91 percent of cases. There was no neurological impairment in the patients treated with transpedicular fixation. Significant differences exist between preoperative and postoperative GRS scores in the following pain categories: no pain, mild, server and excruciating.
Conclusion: Transpedicular fixation is a protected, simple, and successful procedure for patients with spondylolisthesis for pain relief in backache. It also contributes to surgical union and improvement in the neurological status of the patients
Isodense Acute Epidural Hematoma in an Anemic Patient – Diagnostic and Therapeutic Trap: A Case Report
Get PDFPost-traumatic acute epidural and subdural hematoma is a common neurosurgical emergency. Epidural or extradural hematoma is an accumulation of blood between the skull and dura mater, mostly appears asa hyperdense biconvex shape on computed tomography (CT) scan. In our present study, weencountered a case of an eight years old malechild brought to the hospital with head trauma in aroad traffic accident. Initial CT scan revealed an epidural hematoma, which appeared isodense rather than the usual hyperdense presentation. This unusual presentation was due to low hematocrit (HCT). Thisparticular presentation poses a diagnostic dilemma and can compromise patient managementultimately leading to treatment failure. Here, we present a case report about diagnosing and managing an anemic patient with traumatic isodense acute epidural hematoma
Outcome of patients operated for depressed skull fracture with dural tear
Get PDFObjective: The objective of this study was to determine the outcome of patients operated for depressed skull fracture with a dural tear.
Material and Methods: A descriptive case series (n = 155) was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months.
Results: The mean arrival GCS was 10.64 ± 2.33. About 21.9% (n = 32) patients presented with a GCS of ? 8, while the remaining 78.1% (n = 123) presented with a GCS of ? 8. About 8.4% (n = 13) patients died due to the complications of the brain injury. The most common postoperative complication was found to be progressive neurologic deficit (PND) occurred in 21 (13.5%) patients. Penetrating injury to the head was also associated with unfavorable outcomes after surgery (p = 0.046), which shows that penetrating injury is associated with increased brain damage and hence consequently poor outcomes.
Conclusions: The neurologic status as denoted by the Glasgow coma scale is one of the most important factors which predicts the outcome. Surgical management of depressed skull fractures with dural tear has favorable outcomes in about two-thirds of patients. The remaining one-third patient remains in the severely disabled group. Every effort should be made to reduce the occurrence of complications as they are directly related to postoperative functional outcomes
Emergency Department Outcome of Patients with Traumatic Brain Injury – A Retrospective Study from Pakistan.
No full textIntroduction: Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality in both adults and children. As with other severe injuries, the outcome of TBIs is also gravely related to the quality of emergency care. Effective emergency care significantly contributes to reduced morbidity and mortality. This study was ensued to evaluate the characteristics of TBIs in Pakistan and their outcomes in the emergency department (ED).
Methods: This retrospective review included records of all TBI patients seen in the Neurosurgical ED of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 1st September 2019 till 7th December 2019.
Results: During the study period, 5,546 patients with TBI were seen in the ED; an estimated 56.5 patients per day. There were 4,054 (73.1%) male and 1,492 (26.9%) female patients. Most of these (26%) were of age <10 years. The most common culprit of TBI was road traffic accidents (RTAs) (n=2,163; 39%) followed by accidental fall (n=1,785; 32.2%). Head injury was mostly mild (n=4,034; 72.8%) and only 265 (4.7%) had a severe injury. Only 10% (n=549) patients were admitted for further treatment, 16% were managed in the ED then discharged, and 67% were immediately discharged from the ED after the first examination and necessary management. The ED mortality rate of TBIs was 2.2% (n=123/5,546) in our study. All of these cases had severe head injuries.
Conclusion: Major culprits of TBI are RTAs and accidental falls. TBIs are mostly mild-to-moderate and the ED mortality rate is low