Pakistan Journal Of Neurological Surgery
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Spectrum of Spinal Dysraphism in Pediatric Patients in a Tertiary Care Hospital
Get PDFObjectives: To report the spectrum of spinal dysraphism presenting in pediatric patients admitted to the Department of Neurosurgery Lady reading hospital Peshawar.
Material & Methods: A descriptive case series was conducted and total of 89 patients (age between 2 months to 12 years) were included who underwent the surgical treatment. All patients were examined for clinical and radiological diagnosis of spinal dysraphism.
Results: The average age at treatment was 23 ± 39.77 months. The most recurring (52.8%) presenting symptom was the swelling on the back followed by lower limb weakness. Meningocele was reported in 11.2%, myelomeningocele in 47.2%, myelomeningocele & hydrocephalus in 12.4%, tethered cord syndrome in 25.8%, and diastematomyelia 3.4% of patients. Excision combined with the repair was done in 58.4%, release & repair done in 29.2% and endoscopic third ventriculostomy/ventriculoperitoneal shunts with the repair were done in 12.4% patients. Cerebrospinal fluid leak was reported in 3.7%, wound infection in 4.5% and mortality was reported in 3.4% patients.
Conclusion: Overall, a good outcome was reported in the majority of our patients. Surgical procedures like myelomeningocele’s excision & repair, tethered cord’s release & repair, and ETV/VP shunt in patients with hydrocephalus can lead to satisfactory clinical outcomes
The relationship between the grading of lumbar spinal stenosis and pain improvement after caudal epidural steroid injection.
No full textObjective: This study aimed to determine the relation of severity of lumbar spinal stenosis and pain improvement after caudal epidural injection.
Material and Methods: 70 patients of neurogenic claudication were included from July 2019 to June 2020. MRI lumbosacral spine was done of all patients to categorize the degree of spinal stenosis on T2-W axial. All patients were given caudal epidural steroid injection as a day case procedure. Follow-up was done at 3 & 8 weeks and pain improvement was assessed by using Ronald satisfaction score.
Results: Mean age was 37.9 ± 7.8 years. 48.6% patients were male and 51.6% were female. The improvement was observed in 28 patients (40%) at 3 weeks and in 46 patients (65.7%) at 8 weeks. There was no statistically significant relationship between lumbar
spinal stenosis and pain improvements at 3 weeks (p value 0.30) and 8 weeks (p value 0.32).
Conclusion: The grade of lumbar spinal stenosis has no significant effect on pain improvement after caudal epidural steroid injection.
Keywords: LSS (Lumbar spinal stenosis), caudal epidural steroid injection (ESI), neurogenic claudication, MRI (Magnetic resonance imaging), T2W (T2 weighted) images
Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion
Get PDFObjective: To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine.
Material & Methods: This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used.
Results: Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients.
Conclusion: The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion
Risk Factors and the Incidence of Diabetes Insipidus after Pituitary Surgery
Get PDFBackground: To improve patient care, determining the post-surgery risk factors for diabetes insipidus are extremely significant. We demonstrated the pre-operative factors and postoperative incidence of diabetes insipidus in pituitary surgery.
Materials and Methods: Patients of both genders with ages between 18-65 years having pituitary adenoma amenable to surgery were included. The sample size mainly constitutes macroadenomas and giant adenomas i.e., greater than 1 cm and equal to or greater than 4 cm, respectively. The Hosmer-Lemeshow test was used to measure model fit. The receiver operator characteristic curve was used to evaluate the model and variables such as preoperative serum sodium and urine specific gravity.
Results: Only 210 of 279 patients met the selection criteria. Most of the patients have lesions greater than 1cm, as a result of which a greater number of patients had undergone transcranial approach. Out of these patients, 27% have developed diabetes insipidus. The mean age was 53 years in the non-DI group, whereas, 47 years was the mean age in the patients with DI. 25% of females and 31% of males developed diabetes insipidus. 75% of females and 64% of males did not develop DI. The highest percentage (61%) of patients who developed DI came from giant adenomas.
Conclusion: Giant adenomas, aggressively primarily treated adenomas, and those lesions that were approached transcranially, showed an increased risk of diabetes insipidus and those who have undergone redo surgery have reduced incidence of diabetes insipidus
Hematological Profile of Patients with Dementia in South Punjab
Get PDFObjectives: A case-control study was conducted to find the prevalence of abnormal blood indices and electrolytes in patients with dementia.
Material & Methods: The levels of erythrocytes, leukocytes, platelets, electrolytes, and ESR were determined from the biochemistry lab. A t-test was applied to see the significance of the difference between each dementia patient group (Alzheimer Disease-AD, Parkinson’s Disease-PD, and Frontotemporal Dementia-FTD) with the control group for each CBC and electrolyte parameter
Results: In each patients’ groups (AD, PD, and FTD), the mean value of every erythrocyte was lower than the normal range. A significant difference existed for each erythrocyte between dementia patients and controls, except MCHC. Low levels were observed in neutrophils in all groups of dementia including control group. Very high levels were observed in ESR in all groups of dementia. Significant differences existed in the WBC levels between controls and AD as well as PD patients, in platelets between the control group and FTD patients, and in ESR in each group of dementia patients vs. control group. Normal values observed in all groups of dementia patients as well as in the control group.
Conclusion: We found low levels in erythrocytes in cases of Alzheimer disease, Parkinson’s disease, and frontotemporal dementia. Age-related changes to hematological indices especially related to RBCs, and inflammatory mediators like cytokines, hamper the microcirculation in the cerebral tissue leading to micro-infarcts or microbleeds which cause neuronal insults and parenchymal damage
Comparison of Surgical versus Conservative Management of Borderline Traumatic Extradural Hematomas Without Neurological Deficit
Get PDFObjective: To compare the outcome of surgical versus conservative treatment of traumatic extradural hematoma in the supratentorial regin.
Material and Methods: It was a prospective randomized controlled trial conducted in Departments of Neurosurgery, Allied Hospitals, Faisalabad between December 2019 to November, 2020. A total of 100 patients Supratentorial EDH; fulfilling the selection criteria were enrolled. All patients underwent clinical and radiological assessment of EDH volume by the same neurosurgical team. The patients were then divided randomly into two groups by using the lottery methods. Group A patients were conservatively managed. Group B underwent surgery. All surgeries were done by the same surgical team. Glasgow outcome scale was noted in 5 days after admission or surgery in both groups.
Results: The patients average age was 29.96 years, male to female ratio was 1.7:1. The mean volume of hematoma was 24.68 and 27.56 in group A (conservative group) and Group B (operated group) respectively. The favorable outcome was noted in all the patients and no mortality occurred in any patients.
Conclusion: Both surgical and conservative treatments are equally effective in terms of a favorable outcome and mortality occurrence in management of traumatic EDH <30ml without neurological deficit. The conservative treatment is safe and cost-effective in borderline patients
Teaching Emotional Intelligence to Undergraduate Students
Get PDFEmotional intelligence (EI) is how well we handle ourselves and our relationship. EI may be a social intelligence that will be learned, developed, and improved. Both IQ and EI are needed for success in life. But literature has proved that we need more EI to be successful. Therefore, it should be taught to undergraduate students in order to increase self-confidence, improve interpersonal and communication skills, improve empathy for better patient care, buffer stress, improve problem-solving skills, developed leadership quality and all these characteristics will lead to success in life. In the literature, there are twelve different strategies; a teacher can apply to students to teach the topic effectively. Problem based learning and role-play teaching strategies will be helpful to teach the Emotional Intelligence (EI) effectively and fulfill the four competencies of EI which includes self-awareness, self-motivation, empathy, and inter/intrapersonal skills development.
Keywords: Emotional Intelligence, Undergraduate Students, Competencies
First local Case Report of a Holocord Pilocytic Astrocytoma – An Uncommon Entity with Management Challenges
Get PDFHolocord tumors are defined as “Intramedullary spinal tumor extending through the spinal cord with extension from cervicomedullary junction to the conus.” They are uncommon tumors having variable presentation and histology.1,2 Pilocytic astrocytoma (PA) is a slow-growing tumor, mostly benign. It is the diagnosis in 5% to 6% of all intracranial gliomas.3 It is the most common tumor in childhood occurring rarely in the adult population.4 To date, 25 cases of holocord astrocytoma have been reported, of these, 4 were adults and 21 were children. The management of this unusual disease is challenging and debatable.1,5 In this case report, we are describing a case of 14 years old male with holocord grade 1 pilocytic astrocytoma along with its clinical management. To the best of the author’s knowledge, this is the first case of a holocord astrocytoma reported in the country
Surgical Outcome of Adolescents and Young Children with Tethered Cord Syndrome: A Retrospective Analysis
Get PDFObjective: In Spinal dysraphism, neural tube defect is one of the leading causes of congenital central nervous system disorders and contributes to a high proportion of disability and mortality. This study aimed to evaluate the outcome of the detethering of tethered cord syndrome.
Materials & Methods: The study was conducted at the Neurosurgery Department of Hayatabad Medical Complex Peshawar. A total of 110 patients were included in our study. Clinical examination was recorded for back swelling, dermal stigmata, scars, lower limb neurological function, sensory deficits, reflexes. Also, look for any deformities like kyphoscoliosis or limb deformities and the presence/absence of neuropathic ulcers. Imaging studies were recorded for diagnosis, the level of spinal tethering, presence/absence of syrinx, and spine deformities. During the surgical operation, the diagnosis of the lesion was confirmed and the interventional procedure was recorded.
Results: One hundred ten patients were admitted during the study period with 57 (52.2%) females and 53 (47.8%) males with a mean age of 9.3 years (SD ± 4.3). Most patients had presented with pain in lower limbs (60.9%) and backache was (34.8%). The most common operative complication was CSF leak in 29 patients (26.1%) while wound infection occurred in 14 (13%) cases.
Conclusion: Tethered cord syndrome due to occult spinal dysraphism is a rare disease with significant neurologic consequences for the younger generation. Early clinical diagnosis and good surgical treatment could prevent the development of these complications