Pakistan Journal Of Neurological Surgery
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Spinal Extraosseous Extradural Ewing’s Sarcoma: A Systematic Review
Get PDFObjective: The objective of this systematic review was to state and analyze all the case reports published on extraskeletal extradural Ewing’s Sarcoma to date.
Material and Methods: We searched PubMed, MEDLINE, EMBASE, and Google Scholar using the following search term, including Boolean operators AND and OR. We only included published case reports and series about Ewing's Sarcoma that were Extra-skeletal and Extradural. We excluded the intradural EWS cases and those that did not have both components, i.e. extraskeletal and extradural. Conference articles, commentaries, and unpublished articles were also not included. A PRISMA flowchart was also formed.
Results: After the first case of EES in 1969, around 40 case reports and series have been reported, which sheds light on the rarity of this disease. Age of presentation varies from as early as two months, with the oldest report being 49 years of age, and most cases presenting in adolescents and young adults. Spinal Epidural extraskeletal Ewing's sarcoma has been more frequently reported in males. The level of occurrence of the tumor also varies among cases, with cervical, thoracic and lumbar regions being more frequently affected than sacral regions.
Conclusion: Extraskeletal extradural ES is an exceedingly rare anomaly. Multicentric collaborative work is the need of the hour for such orphan illnesses, to optimize treatment paradigms as a single-center is exceedingly unlikely to amass cases
Stereotactic Thalamotomy – A Conventional But A Valuable and Effective Surgical Strategy for Parkinsonian Tremors
No full textObjective: To determine the frequency of improvement in tremors in Parkinsonian patients after stereotactic thalamotomy.
Material & Methods: A descriptive case series was conducted in the department of Neurosurgery Unit II, Lahore General Hospital from January 2016 to March 2020. The study included65 patients of Parkinson’s disease with tremors refractory to medicines for 6 months who fulfilled the inclusion criteria. Outcome and possible complications were explained before taking informed consent. An outcome like reduction in tremors was used as a research instrument. It was determined by a modified unified Parkinson's disease rating score (UPDRS). Patients were diagnosed based on history, clinical examination, and MRI brain by a team comprising of neurologists and neurosurgeons. Thalamotomy was done by one surgical team. Patients were examined and scored post-operatively at 3 weeks and 3 months. Improvement was labeled as a reduction in tremors upto grade 1 or more from baseline after thalamotomy.
Results: Improvement in tremors after thalamotomy was observed in 58.5% of patients whereas there was no improvement in tremors after thalamotomy in 41.5% of patients. There was no significant association between age and improvement in tremors after thalamotomy (p-value = 0.786). No significant association was found between the duration of medical treatment and improvement in tremors after thalamotomy (p-value = 0.681).
Conclusion: Improvement in tremors after thalamotomy was observed in 58.5% of parkinsonian patients. Effect modifiers like age and duration of medical treatment were not significantly associated with improvement in tremors after thalamotomy
Sub arachnoid hemorrhage and vasospasm
Get PDFSpontaneous sub arachnoid hemorrhage develops vasospasm in the 3-8 days. It should be dealt with conservative symptomatic treatment in this risky phase. Commonest presentation of vasospasm is headache. Usually headache increases with the onset of vasospasm at day 3 and diminishes as the vasospasm subsides after 8-10 days. Surgical interventions like clipping and coiling should be avoided in this period and patients should be given plenty of fluids (hemodilution, hypervolemia and hypertension). This triple H therapy holds good for asymptomatic vasospasms but were found less effective in symptomatic patients of SAH. Constipation should be avoided. Grade is supported by evidence from placebo-controlled study. There are some guidelines available for the prevention and the treatment of cerebral vasospasms with Nimodipine (oral). The use of triple H treatment as a preventative measure is a grade B recommendation. The treatment of symptomatic vasospasm with therapeutic hypertensive hypervolemia hemodilution is advised, however no prospective trials are available (grade C recommendation). There is no evidence that antifibrinolytics, steroids, or anticonvulsive prophylaxis should be used routinely. Current prophylaxis and treatment of cerebral vasospasm are still insufficient, according to clinical data, and vigorous triple-H-therapy is linked to an increased risk of sequelae
Assessment of Nursing Care Skills in Neonatal Unit: A Cross Sectional Observational Study
Get PDFObjective: Increased hospital treatment is required to reduce neonatal mortality in low/middle-income (LMIC) countries. Nurses are vital for providing safe and efficient treatment, but a shortage of nurses and high patient workloads can lead to missed treatment. We aimed to evaluate thecare provided to newborns and finding missing care using direct observation methods.
Material and Methods: Cross sectional observational study. The sample size was 133 which were calculated through Slovin’s formula. An adopted research tool was used which contain two sections. Section I included demographic data of nurses and neonates admitted in the ward. Section IIwas an Observational checklist on neonate’s care with “Yes” “NO” which include 5 main themes that had sub points.
Result: Handing over the baby was less fifty five percent. Member not assesses the patient at the end of shift 54.1% nurses done this and 45.1% missed this task. Intravenous drug administration with a septic technique was 42 percent. Counselling of kangaroo mother care was 45.9 percent done and 54 percent missed.
Conclusion: Research addresses a significant gap in global literature regarding quantification of nurse’s treatment using direct observational methods. We found considerable variability in the implementation of the task with potentially significant consequences for well-being and health of patients. The concentration of nursing tasks in babies was less than 60% on average. Tertiary care setting environment lacks a large proportion of nursing care with potentially serious effects on patient health and outcomes
Factors Affecting Decision Making Process on Spine Surgery: Patients’ Perspective
Get PDFObjective: To determine the factors that affects the decision making process of the spine surgery from a patient’s perspective.
Material and Methods: The study was carried on 264 patients admitted for spine surgery in the Department of Neurosurgery, Khyber Teaching Hospital, Peshawar, Pakistan. Data was collected from patients on questionnaire using a Likert scale. Reliability was ensured by Cronbach alpha.
Results: The results for regression analysis revealed that there is a significant negative relationship between previous experiences and decision for spine surgery in patients (? = -0.156, p = 0.001 < 0.05). There is a significant positive influence of emotional and social state (? = 0.193, p = 0.002), information & counselling (? = 0.097, p = 0.011), socioeconomic status (? = 0.131, p = 0.004), severity of disability (? = 0.602, p = 0.000), ineffective conservative treatment (?9 = 0.082, p = 0.013) and intensity of pain (? = 0.527, p = 0.000) on decision for spine surgery in patients. The independent variables, including physical health, gender role and age were found to have an insignificant effect on the decision for spine surgery (p > 0.05).
Conclusion: It is concluded that the factors affecting the decision of patients on spine surgery included previous experience, emotional & social state, information & counselling, socioeconomic status, severity of disability, ineffectiveness of previously taken conservative treatment and intensity of pain
Assessment of Efficacy of Hayman Suture Technique in Management of Intraoperative Atonic Postpartum Hemorrhage
Get PDFObjective: To assess the efficacy of the Hayman suture technique in the management of intraoperative atonic postpartum hemorrhage thus reducing maternal morbidity and mortality.
Study Design: Simple Descriptive study.
Materials and Method: A simple descriptive observational study was conducted at Farooq Hospital and AIT, Lahore. The study included all patients with intraoperative atonic PPH after elective and emergency caesarean sections, during the study period, in whom medical management of PPH failed and Hayman suture was applied.
Results: Hayman suture was 97.5% successful in controlling primary PPH due to intraoperative uterine atony. It failed in only one patient (2.5%) and that patient needed a hysterectomy.
Conclusion: Hayman suture is an effective and quick technique in controlling primary PPH due to intraoperative uterine atony. It is an effective surgical technique after failure of conservative medical management. It is easy to apply and can be applied by Postgraduate trainees and registrar in emergency as lifesaving procedure
Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease
Get PDFObjective: To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF).
Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level.
Results: The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05).
Conclusion: Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome
Midline Posterior Fossa Tumors in Young Adults: Evolution of Thought and Practice
No full textObjective: The aim of our study was to evaluate the surgical outcome of posterior fossa lesions and to find out the relation between surgical skill and post-operative outcome and to determine how evolution in surgical skill dictates post-operative outcome.
Material & Methods: This was a retrospective analysis of 207 patients with midline posterior fossa lesions over a period of 10 years from Jan 2009 till December 2018. The degree of surgical outcome was assessed by degree of surgical resection, Post-operative neurological deficits and complications, Stay in ICU and duration in hospital.
Results: 207 Midline posterior fossa tumors were operated. Headache was leading symptom in patients followed by vomiting and balance problem. Medulloblastoma was a most common pathology in 133, Ependymoma 32, Astrocytoma in 28 Choroid Plexus Papilloma in 3, dermoid cyst 3,arachnoid cyst 4 and Hemangioblastoma in 4 patients. Gross Total resection was possible in 110 patients. Post operatively gag reflex was impaired in 36 and facial palsy in 5 patients. Chest infection was the most common complication in 84 patients, followed by wound infection, CSF Leak and Meningitis. Mortality was 11.59% as 24 patients died within one month, while 28.5% patients stayed in ICU.
Conclusion: Post-operative mortality and morbidity is relatively high among post fossa tumors. Improvement in surgical skills better instruments revealed better outcome over a period of 10 years due to better understanding of microsurgical anatomy and utilization of modern therapeutic strategies for resection
Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan
Get PDFObjective: To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population.
Material and Methods: Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis.
Results: Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases.
Conclusion: Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism
Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus
Get PDFObjective: To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus.
Material and Methods: The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death.
Results: Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%).
Conclusion: Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes