Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Microvascular Decompression for Trigerminal Neuralgia in Terms of Pain Control Using Visual Analogue Scale
Get PDFObjective: The aim of conducting this study was to evaluate the outcome of a Micro vascular Decompression procedure for the definitive treatment of Trigeminal Neuralgia in our setup.
Material and Methods: This observational prospective study was carried out in Neurosurgery unit Hayatabad Medical Complex, Peshawar. A total of 50 patients operated for micro vascular decompression surgeries were enrolled in the study, both genders and any age were in inclusion criteria. Patients previously operated for trigeminal neuralgia were excluded from the study. Post operatively all patients were followed for 1year to calculate the outcome in terms of pain control using visual analogue score (VAS). Immediate pain relief during the first post-operative week and trigeminal neuralgia pain at 1 year post op were recorded and graded into three categories based on Visual Analogue Scale (VAS) such as Excellent: 0-2 , Good: 3-6, Fail/Poor: 7 – 10.
Results: 50 patients fulfilled the inclusion criteria. 22 were male & 28 were female with an age range from 42-78 years. Average duration of disease was 5 years. In 30 patients, clinically v2-v3 were predominantly involved, in remaining 14 patient v1-v2 were involved & only in 6 patients all three branches were involved. Among all operated 50 patients 18(36%) had excellent pain relief, 26 (52%) had good pain relief & 6 (12%) had fail/poor pain relief.
Conclusion: From this data it was concluded that micro vascular decompression is an effective surgical procedure in relieving pain of trigeminal neuralgia in patients who are refractive to medical treatment
Outcome of Retinaculotomy for Carpal Tunnel Syndrome
Get PDFObjective: To evaluate the results of a minimally invasive technique performed for the most prevalent diseasewhich is not dependent on sophisticated instrumentation and results in early return to work.Material and Methods: A total of 52 patients was operated and included in the study. The record of thesepatients was collected on specified proforma.We used the retinaculotomy method performed by 3 surgeons of the same competence level.Results: Total number of patients operated was 52 Male 8 (15%) Female 44 (85%). A total of 48 (92%) patientsimproved (by 4th week in terms of VAS from 6 to 1 or 0). 9% of patients had scar tenderness which improved by 4th week in 100 % patients. Almost all the patients resumed their daily life activities by 4th week.Conclusion: It was concluded from this study that using the mini technique of retinaculotomy the complicationsassociated with the use of the classic open technique can be avoided and patients successfully treated can have an early return to their normal daily life activities
Transaxillary Transthoracic Approach to Upper Dorsal Spine Lesions: An Anatomical Corridor with Muscle Preservation
Get PDFObjective: Conventional methods for anterior upper dorsal spine are not devoid of intra-operative complications due to anatomical constraints, a major blood vessel and vital organs. We analyzed the details of Trans- axillary approach without muscle cutting in tuberculosis, tumor, and traumatic lesions of T2 to T6 and upper limb causalgia.Materials and Methods: A prospective quasi-experimental study was conducted for 3 years included 30 patients presented with dorsal myelopathy due to D2 to D6 vertebral body involvement. Right and left sided approaches were utilized. Medical Research Council grading was used to assess neurological status.Results: Mean age was 32 ± 15 years, which included male 18.60% and female 12.40%. T4 vertebrae were commonly involved. Others were T5, T3 and T6 respectively. The majority of lesions were tuberculosis of the spine (n = 14), tumor (n = 8), trauma (n = 5) and causalgia of upper limb (n = 3). No intra-operative complications occurred, estimated blood was 80-100 ml and operative time was 120-160 minutes. Postoperative complications included pneumonia (n = 1), superficial wound infection (n = 3), death (n = 1). Serial follow up was for 2 years, Patients were discharged with improved neurological status and causalgia patients got immediate post-operative relief.Conclusions: Transaxillary approach is a unique anatomical corridor which is safe, feasible with promising results. It provides optimal decompression, reconstruction with better fixation and alignment in various pathologies of upper dorsal spine
Framed Stereotactic Brain Biopsy Outcome – Single Center Study
Get PDFstereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi.
Material and Methods: After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided.
Result: The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case, and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient.
Conclusion: Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods.
 
Nurses Practices Regarding Medication Administration through a Central Venus Catheter
Get PDFObjective: The purpose of this study was to examine nurses’ practices related to medication administration through the CVC.
Material and Methods: A cross-sectional observational study was conducted at Tertiary Hospital. The study subjects were the female Nurses aged between 21 – 60 years (n = 133). A convenient sampling technique was used.Data collected through an observational checklist which contain two sections; demographic and 19 items of their practices. A pilot study was done on 20 participants to assess the reliability of the observational checklist. Data analyzed by using SPSS version 25.
Results: 82.7% participants’ ages were between 21 – 30 years, 13.5% were between 31 – 40 years and 3.8% were between 41 – 50 years. Participants’ education was as follows: general nursing diploma (84.2%), BS Nursing Post RN (registered nurse) (11.3%), BSN -Bachelor Science in Nursing (Generic) (4.5%). Only 41.4% participants performed hand hygiene before procedure and 58.6% did not perform. 34.6% participants remove gloves and perform hand hygiene; remaining 65.4% did not perform hand hygiene correctly. All participants 100% performed documentation on drug chart.
Conclusion: The significance of quality care, combined with good practices, particularly when medicines are administered through the Central Venous Catheter. Incorrect practices of medication administration through CVC increase the risk of blood stream infection. This research study shows 50% unsatisfactory practices
The Effect of Digital Media on The Younger Minds During the Pandemic: A Study in Pakistan,Jordan and Syria
No full textObjective: To evaluate the psychosocial impact of the use of digital media on young minds.
Material and Methods: A survey based cross sectional study was conducted by using questionnaires through google forms from diverse general, young population. A total number of 110 respondents from Pakistan, Jordan, and Syria, were included.
Results: 18 – 35 years age group showed Depression 53.4%, Anxiety 71.8%, Lack of Interest in Daily Activities 70.5%, Decreased Decisive Ability 10.5% and Insomnia 66.3%. While, the 36 – 54 years group showed Depression 46.4%, Anxiety 56.8%, Lack of interest in Daily Activities 61.8%, Decreased Decisive Ability 8.3% and Insomnia 47.5%. It was noticeable, that the younger age group of 18 – 35 years suffered more psychological effects.
Conclusion: We concluded that while digital media is affecting all age groups, but the younger age group was affected the most.
 
Microsurgical Resection of Intracranial Dermoid and Epidermoid Tumors
Get PDFObjective: To Ascertain the outcome of microsurgical resection of intracranial dermoid and epidermoid tumors.Materials and Methods: This prospective study was carried out in Neurosurgical Department, Lady Reading Hospital (LRH) Peshawar and followed for 3 years after microsurgical resection. All the patients with suspected intracranial Dermoid and epidermoid tumors (IDETs) on imaging study pre-operatively and later confirmedpostoperatively (after histopathology) were enrolled. Patients having recurrent tumor, opting for nonsurgical management and those deem unfit for surgery were not included in the study.Results: 27 patients were included in the study with 12 (44.4%) males and 15 (56.6%) female. Age of the patients rangefrom 11 to 58 years.Mean age was 38.6 years. Epidermoid tumors were 19 (70.3%) in number and dermoid 8 (29.7%) in number. The most common presentation was increased intracranial pressure (ICP) and cranialnerve deficit. The lesion was located in infratentorial location in 15 (56.6%) patients, 12(44.4%) were supratentorialy located. Gross total removal (GTR) was performed in 21 (77.8%) patients, while in six patients (22.2%) subtotal removal (STR) was attempted. 1 (3.7%) patient died while 2 (7.4%) patients had permanent morbidity post operatively, all other patients (89%) improved. Recurrence occurred in 9.5% of GTR patients while in STR patients, 33.3% patients were noted with increase in residual tumor on neuroimaging.Conclusion: Microsurgical resection with GTR is possible for most IDET and gives good results with minimalcomplications
Evaluation of Electrolyte Imbalance in Acute Stroke
Get PDFObjective: Electrolyte imbalance is common in acute stroke; it may cause severe morbidity and mortality, so timely management of electrolyte imbalance may improve morbidity and mortality in cerebro-vascular accident. The purpose of this study was to evaluate electrolyte imbalance in acute stroke and its effect on the outcome of patients.
Material and Methods: This study was prospective descriptive in nature and it is comprised of 106 patients of acute stroke after clinically diagnosis confirmed by CT scan brain plain admitted in Khairpur Medical College Hospital. Serum electrolyte along with the other baseline investigation was performed.
Results: Hyponatremia was comparatively more common in brain infraction than spontaneous ICH. Hypokalemia is also more common in brain infarction as compared to the hemorrhagic stroke patients of this study.
Conclusion: Incidence of Hyponatremia was more common than hypokalemia in patients with acute stroke.
Keywords: Hemorrhage, Infraction, Hyponatremia, Hypokalemia
Association of Cigarette Smoking with Thickness of Intimal Layer of Carotid Arteries on Color Doppler Ultrasound Study and Its Surgical Management
Get PDFObjectives: Aim of this study is to evaluate the intimal vessel wall thickness in smoker and their co-relation with non-smoker and also surgical management of stenosis.
Material and Methods: It is a prospective study of 55 cases. Study span and follow up duration were 4 months. Our patients were presented with the history of CVA (Cerebrovascular accident), hypertension, diabetes, and headache.
Results: In all patients, the carotid doppler ultrasound was done and their intimal vessel wall thickness was noted. Our 78% patients were smoker and non-smoker was 22%. In our study, 52% patients had CVA, 41% patients had hypertension, 30% patients had headache and 9% patients were also obese. Forty three smokers used to take 15 – 25 cigarettes daily. Among 43 patients, 5 patients were females. In carotid Doppler study, intimal thickness was increased in 87%, the plaque was observed in 49% and stenosis was observed in 38% cases. In 18 % patients, who had stenosis > 70%, carotid endarterectomy was performed and in rest of the patients medical treatment done.Patients who were chronic smokers and had medical co-morbidities showed greater thickness of intimal layer of vessels on carotid Doppler. In 6 patients, post-operative headache occurred.
Conclusion: Smokers had more thickness of intimal layer of carotid vessels. Carotid endarterectomy yields good results in case of stenosis more than 70%.
Keywords: Cerebrovascular accident, Intimal layer thickness, Carotid doppler ultrasound, Cigarette smokin