Pakistan Journal Of Neurological Surgery
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To Document The Clinical Presentation and Outcome of Open Neural Tube Defect at Teaching Hospital, Dera Ghazi Khan
Get PDFObjectives: To study clinical presentation and to determine outcome of open Neural Tube Defects at ourrespected institution. We took a review of all cases of open neural tube defects seen at the Neurosurgery Unit of hospital in the last years to document their medical patterns, assess their neonatal outcome.Materials and Methods: This retrospective study included 74 patients, admitted to the Department ofNeurosurgery, D. G. Khan Medical College and Hospital, Dera Ghazi Khan. The procedure for history takingand clinical examination was completed to measure Folic Acid Intake in first trimester, ultra sound abdomen,pre-natal diagnosis, hydrocephalous, CSF leak from swelling, sphincter involvement, weakness of lower limb,previous baby affected, type & location of open neural tube defects along the cranio-vertebral axis. Spine X-rays,neurosonograms, MRIs were carried out to find associated irregularities and complications if exist.Results: Out of 74 children born with open neural tube defects, 9 (12%) mothers received antenatal care only, 7(9%) get folic acid regularly. Prenatal diagnosis was made in 11 (14.8%) mothers whose antenatal abdominalultrasound was done. The most common type of myelomeningocele was lumbosacral 58 (79%). Forty-four(59.4%) babies have hydrocephalous while five babies were microcephaly. Increased risk of rupturedmyelomeningocele was linked with vaginal delivery. Sphincter disturbance and limb paralysis was present in 35(47%) and 32 (43.7%) of babies respectively. The mortality was in 12% patients.Conclusion: We suggest that efforts should be made in this respect to prenatal diagnosis of such lesions to getbetter neonatal outcom
Postoperative Wound Pain and Hospital Stay in Patients of Open Lumbar Discectomy (OLD) Versus Endoscopic Lumbar Discectomy (ELD) in Lumbar Disc Herniation (LDH)
Get PDFBackground: Endoscopic lumbar discectomy is also beneficial regarding relieving wound pain, less hospital stay and smaller incisions. We compared visual analog scores (VAS) and hospital stay in patients treated with either endoscopic lumbar discectomy or open lumbar discectomy postoperatively.Material and Methods: Half patients underwent open lumbar discectomy – OLD (group A) and half operated with endoscopic lumbar discectomy – ELD (group B). The pain was quantified through visual analog score (VAS) observation in all patients. A preoperative medical management included prescribing a combination of an analgesic and a muscle relaxant along with physiotherapy with an avoidance of lifting heavy loads. Mann- Whitney (U) tests were applied for the comparison of postoperative VAS and hospital stay between groups.Results: 85% patients were having left sided prolapsed paracentral disc, and 15% were having right sided prolapsed paracentral disc. The mean postoperative VAS was 4 in patients treated with ELD and it was 1.32 in patients treated with OLD. The mean hospital stay was 1.5 days in ELD treatment, whereas, it was 2.5 days in OLD treatment. A significant difference (p=0.037) was found in the comparison of mean post-operative VAS between two vertebral levels (i.e., L4-L5 & L5-S1). The post-operative VAS and hospital stay (days) in ELD group were statistically significantly higher than the OLD group (p values 0.000).Conclusion: ELD procedure was effective as compared to open lumbar discectomy in terms of postoperative wound site pain and hospital stay. Endoscopic Lumbar discectomy is a minimally invasive procedure for discectomy
Cervical Spine Discectomy, Osteo-facetectomy by Noble Art of Cloward Procedure and Its Modification- A Single Centre study
Get PDFObjectives: To analyze the surgical outcome of cervical spine osteo-facetectomy discectomy, and modified Cloward procedure.Materials and Methods: A prospective study was conducted at the Neurospinal & cancer care institute, Karachi. The duration of study was from 1st June 2017 to 25th November 2019. Patients having prolapsed intervertebral cervical discs included in the study, while those with trauma, cervical radiation, previous cervical surgery andmultiple level involvement were excluded. Pre and post-surgical data was collected. Titanium Hashmi cage was used in all operated patients at single level instrumentation.Results: A total of 113 patients satisfied the inclusion criteria and were considered in the study. Among them, 77 patients were male and 36 were female. The age range from 26 to 65 with a base age of 53 years ± 2.5. C5 – C6 was the commonest level for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. For the outcome of theprocedure Odom’s criteria, was followed the results showed excellent improvement in 88 (77.87%), Good results in 18 (15.9%), fair in 5 (4.42%) and 2 patient had Poor (1.76%) results. Fusion was seen in 86 patients, superficial infection in two cases.Conclusion: Patients with single-level degenerative disc and treated with modified titanium Hashmi cage provided a good fusion with the relief of upper limb pain without donor site morbidity at anterior iliac spine
Subspecialization, a Cause of Concern for Neurosurgeons in Pakistan, an Opinion Piece and Open Discussion
Get PDFSpecialization is a process of becoming an expert. In medicine, it was a long and gruelling journey that medical graduates embarked upon in their chosen field with pride and enthusiasm to become leaders. The specialists seen as the culmination of years of hard work and the marker of prestige. In the old days this distinction was very apparent between the barber surgeons who had little to no formal education and trained as an apprentice and the physicians, who had a university education, went on to become fellows of one of the Royal Colleges and were treated as experts. Eventually, as knowledge expanded, 65 specialities fragmented from medicine and surgery and as of today 31 subspecialties are recognized by the general medical council in the UK.
Magnetic Resonance Spectroscopic and Histopathological Findings in the Supratentorial Brain Space Occupying Lesions
Get PDFObjective: Diagnosis of supratentorial space occupying lesion is a frequent dilemma in neurosurgical practice. MR spectroscopy that is an advanced MR imaging sequence can prove to be decisive in such cases. The objective of the study is to determine diagnostic accuracy of MRS in differentiating supra-tentorial brain space occupying lesions taking histopathology as gold standard
Material and Methods: The cross sectional study was conducted at Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from August 2018 to July 2019. A calculated sample size of 156 patients aged between 18-50 years after informed consent. All patients underwent MR Spectroscopy pre-operatively. Surgery was performed and histopathological findings were compared with spectroscopic findings.
Results: The average age of the patients was 32.41 ± 10.02 years. There were 84 (53.84%) males and 72 (46.15%) females. The sensitivity of MRS was 90.69% with a specificity of 97.34%.
Conclusion: MR Spectroscopy is an accurate diagnostic tool for establishing pre-operative differentiation between neoplastic and inflammatory lesion. It should be performed in all cases where contrast MRI is inconclusive in establishing the diagnosis.
Keywords: , Brain Abscess, Supratentorial lesion, Brain Tumo
Comparison of Mean Glasgow Outcome Score in Patients with Traumatic Brain Injury after Magnesium Sulphate Therapy and Placebo. A Prospective Study of Shaikh Zayed Hospital Lahore
Get PDFObjective: We evaluated the effectiveness of magnesium sulphate treatment for the management and outcome of TBI.
Material and Methods: The prospective cases (n = 112) of TBI were included from Department of Neurosurgery, Shaikh Zayed Hospital, Lahore. Patients were split into two groups. Magnesium sulphate treatment group (n = 56) and placebo group (n = 56). Detailed history of patients was taken along with comprehensive examinations with CT scans.56 TBI patients were given standard treatment plus magnesium sulphate and remaining 56 patients received just standard treatment.
Results: Mean age of the magnesium supplement therapy group was 36.83 ± 13.45 years while in the placebo group was 33.64 ± 12.88 years). Majority 28 (67.9%) were male in the magnesium sulphate group while 37 (66.1%) were in the placebo group. Mean duration passed between hospital presentation and traumatic brain injury was 4.98 ± 2.32 hours in the magnesium sulphate group while it was 5.05 ± 2.48 in the placebo group. Mean Glasgow outcome score was 3.57 ± 1.33 in the magnesium sulphate group while 2.78 ± 1.23 in the placebo group and this difference was statistically significant.
Conclusion: There is significant improvement in GOS after magnesium sulphate therapy in patients with traumatic brain injury versus placebo group as noted in the results
Pakistan Journal of Neurological Surgery
Get PDFDear ReadersI am glad to announce that Pakistan Journal of Neurological Surgery has been upgraded in Y category from Z category in the list of HEC recognized journals. Moreover, it has been included in the list of HJRS (HEC Journal Recognized System) after an evaluation. I am extremely thankful to my editorial team for theirefforts and cooperation. We have been indexed in multiple International agencies like ICI (Index Copernicus), ISSN France, BASE Germany, Cross Ref, Eurasian Index, Asian Digital, PASTIC and PakMediNet. Each article has its DOI Number as well via Cross Ref
Pakistan Journal of Neurological Surgery
Get PDFOur Journal had complete 21 years of Publications.Pakistan Journal of Neurological Surgery achieved multiple miles stones for its up-gradation. Currently, it is recognized by The Higher Education Commission (HEC), Islamabad and Pakistan Medical & Dental Council (PMDC) Islamabad. I am extremely thankful to my editorial team for their efforts and cooperation. We have been indexed in multiple International agencies like ICI (Index Copernicus) Master List, ISSN France, BASE Germany, Asian Digital, www:citifactor.org, PASTIC and PakMediNet
Anterior Cervical Discectomy and Fusion: Operative Technique and Post-Operative Complications – An Experience in a Tertiary Care Hospital
Get PDFBackground and Objective: The most common spinal procedure in our set up to address various disorders of the cervical spine like prolapsed intervertebral disc, trauma, and degenerative disc disease is an anterior cervical discectomy and fusion (ACDF). As there is no technique without complication, this procedure is also related with certain important complications. We evaluated post-operative complications of ACDF in our institution.Material and Methods: The preoperative data of 148 patients who were operated in last 3 years for ACDF isincluded in the study. Patients with previous neck surgery are excluded.Results: The most commonly performed surgical interventions is single level ACDF (65%). Dysphagia is mostsignificant (16%) complication. After which neurological deterioration (9%) with equal incidence of RecurrentLaryngeal Nerve Palsy and wound infection that is 8% each.Conclusion: The most common post-operative complications are dysphagia and worsening of preexistingneurology and multilevel ACDF is identified as the most common risk factor. Early recognition of complicationsand management may help to reduce mortality and morbidity
Comparison of Frequency of Recurrence after Burr Hole Evacuation of Chronic Subdural Hematoma with or without Subdural Drain.
Get PDFChronic subdural hematoma (CSDH) is known to have a significant recurrence rate. The rate of recurrence of chronic subdural hematoma after surgery ranges from roughly 5% to 30%. Burr hole evacuation without drainage is performed as a first line of treatment for CSDH. As there is controversy in literature regarding the use of drainage after burr hole evacuation, the results of my study may be helpful for selecting a proper treatment modality as a first line of treatment for CSDH in terms of recurrence.
The objective of this study was to compare the frequency of recurrence after burr hole evacuation of CSDH with and without subdural drain. It was a randomized controlled trial conducted in Department of Neurosurgery, Allied hospital, Faisalabad form Aug 2016 to Aug 2018
RESULTS:In our study, out of 130 cases(65 in each group). 84.62%(n=55) in Group-A and 76.92%(n=50) in Group-B were between above 40 years of age whereas 15.38%(n=10) in Group-A and 23.08%(n=15) were between 18-40 years of age, mean+sd was calculated as 64.03+7.61 years in Group-A and 62.28+7.83 years in Group-B, 78.46%(n=51) in Group-A and 72.31%(n=47) in Group-B were male while 21.54%(n=14) in Group-A and 27.69%(n=18) in Group-B were females, comparison of frequency of recurrence after burr hole evacuation of CSDH with and without subdural drain shows 10.77%(n=7) in Group-A and 27.69%(n=18) in Group-B, p value was 0.01 showing a significant difference.
CONCLUSION: We concluded that the frequency of recurrence after burrhole evacuation of CSDH is significantly lower with drain when compared without subdural drain