Pakistan Journal Of Neurological Surgery
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Assessing Nursing Practices Regarding Standard Approaches on Post-Operative Wound Care Dressing
Get PDFBackground and Objective: Post-operative delay wound dressing causes a wound contamination or delay wound healing process. Wound leakage and smell produce acute wounds changed into chronic wound conditions. This study assessed the nursing practices regarding standard approaches used for post-operative wound dressing and its care.
Materials and Methods: A cross-sectional observational study designed with study population n = 150 in female nurses of two intensive care units and three surgical wards units: I-II-III. Data was collectedusing an adopted, observation checklist. Reliability tested by Cronbach alpha, 0.92. The mean scorewas categorized following rules, less than (1.5) was considered low (L), from (1.5-2.5) considered moderate (M), and greater than (>2.5) was considered high (H).
Results: The results indicated that 55.3% of nurses had 32 – 38 of age and 48.7% were BS nursing education. According to the mean score majority of nurses had medium (M) and low (L) wound dressing practices observed. Plaster not present (52%) during dressing. 73.3% of nurses had not ensured privacy. The commonpractices were found, no handwashing before and after wound dressing.
Conclusion: The majority of the nurses were not following the standardized wound dressing checklist. According to the study, findings recommended the education sessions, seminars, frequent departmental observation, and psychomotor simulation practices that need to be discussed with clinical professionals
A Rare Case of Nasal-Orbital-Cranial Aneurysmal Bone Cyst
Get PDFcase of aneurysmal bone cyst involving ethmoidal sinuses, maxillary sinuses, frontal sinuses, sphenoidal sinuses, basisphenoid bone, and left orbit with intracranial extension in a 9 year old female. The diagnosis was confirmed using CT, MRI-brain, CT-angio brain imaging. The finding of nasal-orbital-cranial aneurysmal bone cyst was confirmed on Histopathology. Two staged surgical excision planned and done, i.e. trans-cranial and trans-nasal excision
Management of Type – II Odontoid Process Fracture by Anterior Odontoid Screw Fixation (AOSF) in Young Adults: Case Series
No full textodontoid fracture AOSF with lag screw is the reference technique in unstable fracture. Various other treatment modalities have been described in the literature; however author finds the ASOF technique to be reasonable with less intraoperative and post-operative complications. Moreover the rate of bony fusion is also high and post-operative mobilization in case of ASOF.
Material and Methods: This is prospective observational case series. Two cases of odontoid fractures (type II) are reported.
Results and Conclusion: Our cases illustrated that odontoid fracture type II can successfully be managed with AOSF with good post-operative outcome. Union rate of this fracture is high with lag screw fixation (AOSF technique). Nevertheless, due to a limited number of cases author would also like to add that outcome could be better assessed in a larger group of study
Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions
Get PDFObjective: To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute.
Material and Methods: We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach.
Result: Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage.
Conclusion: This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach.
Keywords: Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma
Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management
Get PDFObjective: To compare short term outcome of combined surgical and medical management versus medical management alone in caries spine.Material and Methods: This study was conducted from August 2015 to August 2018, on 68 patients randomly divided into two groups of 34 each. All were diagnosed cases of Caries spine based on history, clinical examination, ESR and imaging appearances. Group A underwent surgical intervention along with Anti-Tuberculous Treatment (ATT) while Group B received medical treatment (ATT) alone.
Results: There were 37 (54.41%) males and 31 (45.59%) females with mean age of 34.84 ± 10.6 years. The thoracic spine was the commonest site in 33 (48.5%) patients, followed by lumbar in 20 (20.8%), dorso-lumbar in seven (10.3%) and cervical in four (5.88%) patients. The ESR fell from 85mm/hr to 24.46mm/hr in Group A and to 41.92mm/hr in Group B (p = 0.0124). Overall improvement in Frankel grade was seen in 25 (73.5%) patients in Group A and 12 (35.3%) in group B. In group A, improvement seen from grade A in two (8%), grade B in three (12%), grade C in 12(48%), Grade D in seven (28%) patients, (p = 0.000) while eight (23.5%) patients remained same and only one (2.5%) deteriorated from baseline neurological status. In Group B, 16 (47%) patients remained same and six (17.6%) deteriorated. Conclusion: Surgery combined with antituberculous therapy was found to be beneficial in patients suffering from caries spine and to be recommended to patients desiring rapid recover
Surgical Outcome of Open Carpal Tunnel Release Using Global Symptom Severity Score
Get PDFObjective: Purpose of conducting this study was to evaluate the surgical outcome of open carpal tunnel release using Global Symptom Severity score (GSS) in our local setting.
Material and Methods: This prospective analytical study was conducted in the Neurosurgery Department Hayatabad Medical Complex, Peshawar. We operated consecutive 105 Carpal tunnel syndrome cases over a period of 2 years via open carpal tunnel release (OCTR) method. All of these cases were surgically indicated. All patients were evaluated preoperatively with clinical assessment and NCS. Cases were operated under local anesthesia as a day case surgery. Patients were evaluated at 3 months follow-up visit using global symptom severity score (GSS) and compared with pre operative GSS. The paired sample test was applied to obtain p value.
Results: Total 105 patients were operated during study period. 72 (69%) patients were women and 33 (31%) were men. The mean age of patients was 41 years. 70 (66.66%) procedures were done for the right hand and 35 (33.33%) were performed for left hand. Pre-op Mean GSS score was 27 ± 2.5 which decreased to 2.1 ± 0.43 postoperatively (P < 0.005).
Conclusion: Carpal tunnel syndrome is more commonly affecting the dominant hand of middle aged females. Open carpal tunnel release procedure is the safe and effective treatment for this compressive neuropathy
Comparison of Stereotactic Subthalamotomy and Ventralis Intermedius (VIM) Thalamotomy in Relieving Parkinsonian Tremor
Get PDFBackground/Objectives: Parkinson’s disease is a neurodegenerative disease with cardinal features of tremor, rigidity, postural instability and bradykinesia. Surgery is indicated for the patients not responding to medical management or who develop motor fluctuations and dyskinesia following prolonged levodopa therapy. Stereotactic Subthalamotomy and VIM (Ventralis Intermedius) Thalamotomy is cheap, safe and effective surgical options for the treatment of Parkinsonian tremor. The objective of the study was to compare Stereotactic Subthalamotomy with Ventralis Intermedius (VIM) Thalamotomy, in terms of improvement in Unified Parkinson’s Disease Rating Scale (UPDRS), for the treatment of Parkinsonian tremor.
Material and Methods: This is a randomized control trial (RCT) and 38 tremor predominant Parkinsonian patients were enrolled in the study. Half of the patients underwent Stereotactic Subthalamotomy and another half underwent VIM Thalamotomy. Patients were assessed pre-operatively, immediately post-operatively and followed up at three weeks, six weeks and three months by using UPDRS scores.
Results: The mean age of patients was 59.58 years and they were predominantly male. Post-operative UPDRS score was improved significantly in both STN and VIM groups. However, the improvement was significantly higher in STN lesioning compared to VIM lesioning.On the other hand, the improvement in tremor component score of UPDRS was comparable in the both groups. Moreover, post-operative complications were higher following Subthalamotomy (21.05%) which included dyskinesia, dysphasia, transient weakness and hematoma formation.
Conclusion: Both Stereotactic Subthalamotomy and VIM Thalamotomy are equally effective in relieving Parkinsonian tremor with a lower complication rate following VIM Thalamotomy
Intracranial CT Scan Findings in the Patients of Head Injury: An Early Experience at Dera Ghazi Khan Teaching Hospital
Get PDFIntroduction: Head injury patients constitute a major number to any trauma emergency. Every head injury patient whose level of consciousness seems to alter, must be checked for brain injury. With the help of Computed Tomography (CT), Radiological evaluation has experienced a drastic change because it precisely explores the location and nature of lesion(s).
Material and Methods: This study included 408 patients that were admitted to the emergency of Teaching Hospital Dera Ghazi Khan, from October 2017 to September 2019. In this study, the location as well as nature of lesions were evaluated with the help of CT.
Results: CT results expressed that there was skull fracture (28.4%), extra dural hematoma (20.6%), diffuse intra cerebral hematoma (18.6%), brain contusions (18%), subdural hematoma (5.9%), diffuse axonal injury (DAI) (4.4%), subarachnoid hemorrhage (2.5%) and pneumocranium (1.5%). It was also noted that the males having age group between 20 – 35 years were mostly involved in head trauma and the reason for this was a road accident.
Conclusion: CT scan explained the location and nature of brain and skull lesions.
Keywords: Computed Tomography (CT), Road Accident, Head Trauma
Middle Cerebral Artery Aneurysm Coiling without Assisted Techniques – A Good Alternative, Single Venture Experience
Get PDFObjective: To evaluate the result of a coiling of middle cerebral artery aneurysms without auxiliary techniques.
Material and Methods: This study was conducted from June 2010 to September 2019 in the Department of Neuroradiology, Punjab Institute of Neurosciences, Lahore. There were a total of 500 patients with unilateral and bilateral cerebral aneurysms at the MCA level that have been included in this study which comprise of both sexes.
Results: There was a total of 500 patients, which comprised of 200 (40%) men and 300 (60%) women. Their ages ranged from 22 to 65 years. The majority number of patients was in their fifth 180 (30%) and sixth decade 150 (30%) of life. In our study, a successful coiling was performed in 490 (98%) patients with minimal re-canalization of MCA aneurysms. In 10 (2%) procedure was unsuccessful due to vasospasm.
Conclusion: The conventional coiling in middle cerebral artery aneurysms can be effective and safe without auxiliary techniques
5 Years Mortality of Severe Traumatic Brain Injury during the Establishment of Closed System Neurocritical Care Unit in a Resource Constrained Developing Country
Get PDFBackground & Objectives: Severe traumatic brain injury is one of the leading causes of mortality and morbidity.Efficient management of severe traumatic brain injury demands a specialty driven focused intensive care. We developed our model of closed ICU driven by Neurosurgical Neurointensivist and the corollary to thiscommitment is a TBI patient centered Neurocritical care with the capacity and capability to deal with most of the neurological illnesses.Materials & Methods: A prospective study was conducted to find out the impact of the establishment of closed system of neurocritical care on 5 year mortality of severe TBI. Total 1288 patients met the inclusion criteria, which were enrolled. Tabulation was done for gender, age range, Glasgow outcome scale and mortality.Results: It was observed that mortality reduced from 47% to 35% over a span of five years. The most common age range was 30-40 years, which is the most productive group of any population. Bed sore incidence is always on rise in any ICU. After the implementation of SOPs based management and increase in nursing staff theincidence of bedsore also showed a detrimental pattern from 35 % to 19%.Conclusion: Neurocritical care unit is proven to be an integral part of any neurosurgical unit and this closed system of NCC unit provide best SOP based care with significant reduction in mortality of patients with STBI