Pakistan Journal Of Neurological Surgery
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Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop
Get PDFObjective: To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop.
Material and Methods: This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief on a Visual Analogue Scale (VAS) after 1 month and then after 6 months.
Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery, power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ? 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40).
Conclusion: Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits
Brain Death Islamic Perspective
Get PDFWestern world has well defined criteria for declaring the patient brain dead and discontinuation of life support treatment. However in the Muslim world these methods and practices are seen with skepticism as to their acceptance from Islamic and Sharia point op view, which in fact is incorrect and is due to lack of knowledge and absence of Institutional guidelines on this matter. Islamic law permits the withdrawal of futile treatment, including life support, from brain dead patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in brain dead patients. Euthenesia is however unacceptable in Islam. Although debate continues about the details of brain death criteria within Islamic scholars, brain death is accepted as true death by the majority of Mulim scholars and there is concensus on discontinuation of life support treatment in brain dead patients
Navigating Brain Lesions Via Craniometric Points of Human Skull. Effectiveness in Targeted Craniotomy
Get PDFBackground and Objectives: Navigating brain pathologies via external landmarks helps in guiding neurosurgeon to perform and plan brain surgeries without feeling compromised in their competence, when modern neuronavigation is not available. We assessed the navigating art of human craniometry in brain surgery, in terms of accuracy and safety, of our patients.Materials and Methods: A descriptive study was in Department of Neurosurgery Quaid-e-Azam International Hospital on utilizing the art of Craniometry in navigating brain lesions and to see how effective this art is in the execution of neurosurgical procedures.Results: Total of hundred patients were subjected in our study, who were according to inclusion criteria. Mean age calculated was 44 years with STD ± 6, with minimum age of 8months and maximum age of 83years. There were 61% male, and 39% female patients. Supratentorial lesions were 72%, ventriculoperitoneal shunts 11%,and 17% were infratentorial.In 89 surgeries, we were exactly on the target according to our external skull landmarks, in 4 cases we slightly deviated about 0.3 cm, and in 7 surgeries we encounter some difficulty in navigating lesions.Conclusion: Modern navigating technology is very much helpful in neurosurgery, and this fact is undeniable, but because of resources restrained is not always available. Mastering the art of craniometery of human skull guide neurosurgeons to perform/plan neurosurgical procedure of brain without feeling compromised in theircompetence
Insular Glioma Esoteric Precinct
Get PDFBackground and Objective: The complex insular anatomy and its proximity to eloquent areas make this area almost inaccessible for safe surgical resection of Glioma. Aim of our study is to determine outcome assessment after surgical resection.
Materials & Methods: This was a retrospective analysis of 59 patients over a period of 5 years from July 2013 till June 2018. All patients of insular Glioma were included in our study irrespective of age and sex. Degree of surgical resection, Post-operative neurological deficits and complications were assessed. They were followed in the outpatient department at 3, 6 and 12 months.
Results: Total 59 patients were included 38 (64.40%) male and 21 (35.59%) females. 36 (61%) patients had right sided insular Glioma and 23 (38.98%) have left sided. Seizures were main presentation in 46(77.96%) patients. Trans-sylvian route adopted in 34 (57.6%) patients followed by transcortical route. Near total Resection was Possible in 30 (50.84%) patients and partial in 29 (49.15%) patients. Focal neurological deficits the motor weakness & dysphasia were main post-operative complications in 18 (30.5%) patients. Three (5.08%) patients died. In all grade II and grade III Gliomas no increase in size was discovered on MRI Brain at 6 and 12 months.
Conclusion: Maximum safe resection of insular Glioma with acceptable morbidity is possible with improved overall survival and disease free interval
Evaluation of Nurses Competency about Surgical Hand Scrubbing
Get PDFObjective: Hands play a significant role in organism transmission. Poor hand hygiene practices in health care settings lead to nosocomial infection. Aseptic practice is the cornerstone of current surgery, thus rigid adherence to prescribed sterile techniques in the operating room is essential.The objective of this study was to evaluate nurses’ competencies regarding surgical hand scrubbing.
Material and Methods: Cross sectional observational design was used. The study was conducted in operating rooms in a tertiary care hospital, Lahore, Pakistan.This setting contains total seven operating rooms with 250 registered nurses. Sample size calculated through Slovin’s formula. Sample size was 154. Convenient sampling technique was used. An adopted checklist was used for observing the nurses’ practices of hand scrubbing. Data was analyzed in Statistical Software of Social Sciences (SPSS) version 25.
Results: Majority of nurses (72.7%) were between 21-30 years age group. Only 38.3% participants wore a face mask and surgical cap correctly and 61.7% did not wear correctly. Majority participants, 76% had short nails.All participants (100%) removed nail polish, artificial nails, and jewelry before scrubbing. Majority of participants applied a proper amount of Povidone iodine.
Conclusion: Operational hand scrub is very vital component of operative procedure. Results of this study showed inadequate practices of nurses in the operating room, which was overall 77%. There is a need to improve nurses’ practices so, periodically audit, manager supervision and feedback, workshops should be organized
Outcome of Essential Tremors with Stereotactic Thalamotomy: Noble Art of Lesioning
Get PDFObjective: Objective of study is to identify the effects of Stereotactic thalamotomy of the nucleus ventral intermediate (VIM) for treatment of essential tremor.
Material and Methods: This is a descriptive study.It was performed at NCCI, Karachi, duration of study was 7 years, from 2-10-2012 to 7-10-2019. Those patients were included who were with tremors refractory to medication, their duration of disease was > 3 years, and with grade 4 tremors. The thalamotomy was performed in all cases, and follow-up was conducted at 3, 6, and 12 months respectively. The success of the surgery was measured in the form of a reduction in medication number and reduction in dose >50% and by calculating the Essential Tremor Rating Assessment Scale (tetras).
Results: Total of 26 patients were included. All patients showed remarkable improvement post-procedure at 12 month follow-up. 20 (77%) patient required no medications. In 6 (23%) patients, the dose of medication was reduced to less than half post-treatment. The tetras score showed marked improvement in all a patient; 4 (15%) patients who had grade 4 tremor, showed the symptoms of minimal tremors graded 0.5 on last visit 3rd visit. Side effect post-procedure were mild transient numbness on the contralateral side was observed in 11 (42.3%) patient, 1 (3.8%) patient had dysarthria.
Conclusion: We concluded that stereostatic Ventral intermedius nucleus thalamotomy was effective in reducing tremor grades and improved all functionality with few mild side effects
Craniosynostosis: Clinical Presentation and Outcome of Surgical Treatment
Get PDFObjective: Craniosynostosis presents sclerosis cranial sutures, ossification and fusion involving the vault of the base, sutures involved can be one or more sutures. This study aimed to determine the surgical outcome of craniosynostosis.
Material and Method: The prospective study was conducted at the neuro spinal and cancer care institute, Karachi. Patients presented with sagittal, metopic, unicoronal, lambdoid, bicoronal craniosynostosis were included in the study, while patients with coagulopathy, previously operated cases were excluded from the study.
Results: We had 26 children in our study, age range about 1–3 years. Patients were cleaved into groups depending on their age. Most of the children 15 (57.6%) were in 1–2 years age group and 11 (42.3%) were in 2-3 years of age. Boys were 18 (69.2%) and girls were 8(30.7%). Coronal 11 (42.3%) was the most common suture involved, followed by sagittal 9 (34.6%). Lambdoid suture 3 (11.5%), metopic 2 (7.6%) and 3 (11.5%) case presented with raised intracranial pressure with multiple sutures closed involved. Strip craniectomy was done in all cases. We did bicoronal flap and Scalp flap turned into a supraorbital region while in metopic suture Fronto-orbital advancement and remodeling approach were used. No major complication was observed.
Conclusion: Cases which are managed early age have given good acceptable results in follow up, proper surgical expertise, perioperative management of temperature, blood loss, relieving the restriction of sutures and normalizing raised intracranial pressure can decrease the morbidity and mortality
Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management
Get PDFObjective: To know the incidence of CSF leak and role of tincture benzoyl in the management of CSF leak after the repair of congenital spinal deformities like myelomeningocele, meningocele and tethered cord syndrome.Materials and Methods: All patients who were operated for congenital spinal surgeries in the form of MMC, Meningocele and TCS by a single surgeon were followed for a minimum of 3 months. Patients with already CSF leak/ruptured MMC prior to surgery were not part of the study. The particulars like gender and type of surgery, days since first surgery, associated infection, hydrocephalus and type of management were noted on a proforma.Results: A total of 73 patients with spinal dysraphism were operated during the study period and of them about 13 patients returned with problems of the CSF leak. The mean duration and duration since the CSF leak was from 6 days to 16 days. Among them, 10 patients had an MMC repair and one patient had TCS release, while 2 patients were having meningocele repair. The patients were stitched and one patient was re-operated two times for repair of CSF leak. Two patients had a CSF leak along with post op signs of HCP that settled by placing a shunt along with primary repair of the wound reinforced with tincture benzoyl in a single setting. Conclusion: CSF leak is a common complication following repair of spinal dysraphism and most patients can be managed with the application of tincture benzoyl alone or after simple skin reinforcement
Operative Technique and Complication Avoidance in Supraorbital Endoscopic Keyhole Craniotomy
Get PDFObjective: The aim of the current study is to describe the technical details of the endoscopic supraorbital keyhole craniotomy and how to avoid complications related with it.Material and Methods: In this cross sectional observational study nine preserved human cadavers from TheSkull Base Lab of Weill Cornell Medical College, Cornell University, New York, USA were used. Total number of18 endoscopic supraorbital keyhole craniotomies were performed. Distances between the different targetedanatomical constructs were looked at and measured.Results: A supraorbital craniotomy was performed with details on the technique of the surgery. The secondmajor part of the results comprised of per-operative complications and how to avoid these complications.Conclusion: To treat anterior and middle skull base pathologies, the endoscopic supraorbital keyholecraniotomy is an effective, valuable and minimal access surgical choice
Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease
Get PDFObjective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage.
Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22.
Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months.
Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc diseas