Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Surgical Outcomes of Single-Level Stand-Alone Cage Use in Anterior Cervical Discectomy and Fusion
Full text linkObjective: To test clinical and radiological outcomes of single-level anterior cervical discectomy and fusion (ACDF) without anterior plating using polyetheretherketone (PEEK) cage as a stand-alone cage.
Materials and Methods: This retrospective study included 24 patients who underwent single-level ACDF between May 2024 and July 2025, with 12 12-month follow-up. All the surgeries were anterior, and PEEK cages were autologous bone-filled. They employed a team that measured the functional outcome of Neck Disability Index (NDI), the Visual Analog Scale (VAS), and Swallowing Quality of Life (SWAL-QOL). Fusion, subsidence, and alignment were the radiological results. An analysis involving 22.0 SPSS was used, and p < 0.05 was the cutoff point.
Results: A complete population was maintained for a period of 12 months. At radiograph- 100 percent in fusion. The NDI and VAS scores improved significantly (21.05, 8.10, and 2.25, 1.12, respectively). The assessment of the level of SWAL-QOL was low, and its expression was through dysphagia during follow-up. Subsidence >2 mm with clinical significance was observed in two patients (8.3%). One case (4.2%) of pseudarthrosis and two cases (8.3%) of transient adjacent level radiculopathy were recorded, and no infections were registered, with no reoperations being observed.
Conclusion: Single-level ACDF with the use of standalone cages gives good fusion, improved clinical results, and a low complication rate. Morbidity can subsequently be reduced after the surgery by foregoing anterior plating
Comparative Analysis of Complications in Meningitis Patient Tuberculous vs. Bacterial
Full text linkObjective: This comparative analysis aims to evaluate the patterns of radiological complications in bacterial meningitis against those seen in tuberculous meningitis.
Materials and Methods: A retrospective review of imaging and clinical data was conducted. The frequency of complications such as hydrocephalus, infarcts, tuberculomas, abscesses, and cerebritis was analyzed in both cohorts.
Results: Hydrocephalus was significantly more frequent in TBM (46.9%) compared to ABM (23%, p < 0.001). Tuberculomas were exclusive to TBM (57.3%, p < 0.001), while abscesses (6.3%) and subdural collections (8.4%) were unique to ABM (p < 0.05). Infarcts occurred at similar rates in both groups (27% vs. 28.1%, p = 0.88). Logistic regression identified TBM as an independent predictor of hydrocephalus (OR: 3.4, 95% CI: 2.1–5.8,p < 0.001) and tuberculomas (OR: 18.7, 95% CI: 11.4–30.9, p < 0.001). These findings emphasize the distinct radiological complication patterns in ABM and TBM, aiding in tailored management strategies.
Conclusion: The use of regression analysis provided new insights into predictors of complications; while cerebral infarcts are common in both ABM and TBM, TBM showed a greater burden of complications, particularly hydrocephalus and tuberculomas. The findings highlight the importance of early diagnosis and tailored treatment strategies to reduce morbidity and mortality in both forms of meningitis
Correlation of Radiological and CSF Patterns in Adults with Meningitis: A Retrospective Analysis from a Tertiary Care Hospital in Peshawar
Full text linkObjective: This study aimed to assess the correlation between radiological imaging findings and cerebrospinal fluid (CSF) parameters in adult patients with bacterial and tuberculous meningitis, to identify distinct diagnostic patterns that could enhance differentiation and improve clinical management.
Materials and Methods: A total of 97 cases, comprising individuals aged fourteen years and above, were retrospectively examined over a twelve-month timeframe following a confirmed diagnosis of meningitis. Data included clinical presentation, CSF analysis, and imaging findings from MRI and CT scans. Statistical tests, including chi-square, were used to evaluate the association between radiological and CSF patterns.
Results: Tuberculomas were exclusively associated with tuberculous meningitis (p = 0.013), while infarcts were more prevalent in bacterial cases (p = 0.002). Hydrocephalus was observed more frequently in bacterial meningitis, but it was not statistically significant (p = 0.155). CSF profiles highlighted elevated protein levels and lymphocyte dominance in tuberculous cases, contrasting with neutrophilic inflammation and variable glucose levels in bacterial meningitis. The integration of radiological and biochemical data enhanced diagnostic precision.
Conclusion: This study highlights the importance of combining radiological imaging with CSF analysis in diagnosing meningitis. The findings provide valuable insights into local patterns, improving differential diagnosis and patient outcomes. Prospective studies are recommended to validate these findings and refine therapeutic protocols
Comparison of the Efficacy of Peri-Operative Use of Bupivacaine with Corticosteroids Versus Bupivacaine Alone in Lumbar Disc Disease Surgery
Full text linkObjectives: To compare the efficacy of peri-operative use of bupivacaine with corticosteroids versus bupivacaine alone in lumbar disc disease surgery.
Materials and Methods: This randomized controlled study at PIMS Hospital (Nov 2023–May 2024) involved 76 patients (ages 25–65) undergoing lumbar disc surgery. Patients with prior surgery, epidural steroids, spinal trauma, or rheumatoid arthritis were excluded. Group A received Gelfoam soaked in 10 mL of 0.25% bupivacaine + 2 mL dexamethasone, while Group B received Gelfoam with 10 mL of 0.25% bupivacaine only. Efficacy was assessed over 24 hours.
Results: Patients in Group A and B had mean ages of 43.08 ± 10.50 and 42.11 ± 10.22 years, respectively. The majority of the 45 patients (59.21%) were in the 25–45 age range. The male-to-female ratio was 2.16:1, with 52 (68.42%) of the 76 cases being male and 24 (31.58%) being female. The mean baseline VAS score was 6.61 ± 1.03. The mean baseline VAS score in group A (corticosteroid and bupivacaine) was 6.47 ± 1.01 and the mean pre-therapy VAS score in group B (bupivacaine alone) was 6.74 ± 1.06. The efficacy of using bupivacaine and corticosteroids during lumbar disc disease surgery was found to be 30 (78.95%) as compared to 20 (52.63%) in the bupivacaine group only, with a 0.016 p-value.
Conclusion: The study concluded that the efficacy of peri-operative use of corticosteroid and bupivacaine is higher as compared to bupivacaine alone in lumbar disc disease surgery
Rare Brachial Plexus Tumor: Case Report and Surgical Management Insights from Pakistan
Full text linkA 40-year-old male presented with a six-month history of numbness, paresthesia, and progressive flaccid weakness that was localized to the right C5 dermatome. A large, lobulated, and encapsulated mass in the medial aspect of the right axilla was identified via imaging studies. The mass was associated with the superior and middle trunk of the brachial plexus and extended to the supra and infraclavicular fossa. The imaging studies were supported by the nerve conduction studies (NCS), significantly highlighting the involvement of the right upper trunk with signs of denervation. The transclavicular neurosurgical approach was effective in the removal of the tumor while preserving the normal neurological functions. Brachial plexus tumors are rare and often underdiagnosed due to nonspecific symptoms and overlapping features with other neuromuscular conditions. This case highlights the diagnostic value of MRI and nerve conduction studies in identifying tumor characteristics and planning surgery. A transclavicular approach enabled safe excision with preservation of neural function. Postoperative recovery was favorable, with improved motor and sensory function and no recurrence at two months. This case emphasizes the importance of early diagnosis, appropriate surgical technique, and multidisciplinary management in achieving optimal outcomes. This case report highlights the diagnostic and therapeutic challenges associated with brachial plexus tumors due to their complex anatomical location. However, Imaging studies, a multidisciplinary approach, and nerve conduction studies were important in achieving favorable outcomes. The transclavicular neurosurgical approach was meaningful in tumor excision while preserving normal neurological function
Meningitis in Children Presenting With First-Time Fits And Fever
Full text linkBackground: Seizures are among the most common neurological crises that children experience. Medical professionals are concerned that meningitis may be the underlying reason when youngsters experience convulsions and fever. This study aimed to determine the frequency of meningitis in children presenting for the first time with seizures and fever at a tertiary care hospital in Peshawar.
Materials & Methods: This descriptive cross-sectional study was conducted over six months at the Pediatric Medicine Department, Khyber Teaching Hospital, Peshawar. The study used a non-probability consecutive sampling method to select 135 children, ages 1 month to 12 years.
Results: The study included 135 children with a mean age of 7.44 years (SD ± 2.7). Age-wise distribution showed the highest proportion (31.1%) in children aged 11–12 years. Males comprised 41.5%(n = 56), and females 58.5%(n = 79). Meningitis was confirmed in 37%(n = 50) of cases. Fever was documented in 48.1% of cases. There was a statistically significant correlation (p < 0.001) between meningitis and the duration of symptoms, complicated seizures, and fever.
Conclusion: Meningitis is a serious medical issue that should be evaluated by medical professionals in children who are having their first seizures and fever, especially if they are young or have complicated seizure presentations. Meningitis may not show the classic symptoms, but a diagnosis can still be made in some situations
Determining the Occurrence, Predictors and Contributing Factors of Ischemic Versus Hemorrhagic Stroke Among Patients with Post Stroke Epilepsy; A Comparative Study
Full text linkObjective: To assess the occurrence, and contributing factors of post-stroke epilepsy in stroke patients and to compare the frequency of ischemic versus hemorrhagic stroke in patients presenting at Nishtar Hospital, Multan.
Materials & Methods: The patients with stroke, fulfilling inclusion criteria admitted to the neurology department of Nishtar Hospital, Multan were recruited in the study. A detailed history of the current illness as well as a history especially related to seizures was questioned. CT scan brain of all the patients was done and type of type i.e., ischemic or hemorrhagic was determined. Patients were followed for 3-month intervals for the occurrence of epilepsy.
Results: out of a total of 136 patients with stroke, ischemic stroke was found in 107 (78.7%) patients and hemorrhagic stroke in 29 (21.3%). Most patients were males 80 (58.8%) while 56 (41.2%) were females. The mean age of the patients was 55.55±10.17 years and the mean BMI was 25.26±5.54 kg/m2. The frequency of obesity, hypertension, diabetes, and smoking was 21.3%, 48.5%, 44.9%, and 44.1% respectively. Seizure was observed in 35(25.7%) patients with stroke, commonly in hemorrhagic stroke (12/17, 70.58%).
Conclusion: Old age, hypertension, and smoking significantly increase stroke risk. Epilepsy can complicate stroke with a higher incidence of hemorrhagic stroke
Institutional Experience of Microsurgical Clipping for Anterior Circulation Aneurysms with Mini Pterional Craniotomy: A Cosmetic and Pivotal Innovation
Full text linkObjective: To examine the functional outcome, complications, and aesthetic results with the mini pterional craniotomy for microsurgical clipping for anterior circulation aneurysms.
Material & Methods: This study was conducted at Neurosurgery Unit II of Punjab Institute of Neurosciences Lahore by a single neurosurgical team with 10 years of experience in vascular neurosurgery. A total of 107 patients who fulfilled the inclusion criteria were included in the study. Mini pterional craniotomy was performed in all the selected patients. Data was analyzed for age, gender, location of the aneurysm, and Modified World Federation of Neurological Surgery grade (WFNS) (pre-op, post-op at 3 months). Data was also analyzed for post-op complications along with a subjective assessment of wound scars by patients according to a modified cosmesis scale.
Results: Out of the total 107 patients, 64 (59.8%) were female while 43 (40.2%) were male. Aneurysm was located at the anterior communicating artery in 58 (54.2%) patients and at MCA in 39 (36.4%). The pre-op WFNS grade was 1 in 52 (48.5%) patients and grade 2 in 25 (23.3%) patients. The WFNS grade recorded at 3-month post-op follow-up was grade 1 in 66 (61.6%) patients and grade 2 in 11 (10.2%) patients. Seven (6.5%) patients developed hydrocephalus, 5 (4.6%) got meningitis and 4 (3.7%) developed neurological deficits.
Conclusion: Mini pterional craniotomy has proven itself as a safe and effective surgical procedure. It can be applied to a variety of aneurysmal locations and has a low rate of complications and good outcome
Gut–Brain Axis (GBA) and Neurosurgical Practice: Treatment Implications of Gut Microbiota Modulation
Full text linkTranspedicular Screw Fixation and Its Surgical Outcomes In The Management of Lumbar Instability: A Case Series of 107 Patients
Full text linkObjective: Lumbar instability is a predominant pathology characterized by excessive and abnormal movement between two or more segments and is a significant cause of disability. In recent years, the transpedicular screw fixation system has been found to be successful in the management of spinal instabilities. The study aims to find out the surgical outcomes of TPF in radiological lumbar instability.
Materials & Methods: This study was conducted on 107 patients at Ali Institute of Neurosciences, Irfan General Hospital, from June 2018 to December 2021, with a one-year follow-up period. Patients were recruited through non-probability convenience sampling. Inclusion criteria consisted of patients diagnosed with radiological lumbar instability evident on investigation findings. Exclusion criteria consisted of patients who were diagnosed with functional or non-radiological instability and those undergoing any procedure other than transpedicular screw fixation.
Results: A total of 107 patients were treated for radiological lumbar instability through transpedicular screw fixation, out of which the majority of the participants were males (62%), followed by females (38%). The majority of the participants (75%) stated that the back pain was diminished completely or had minor episodes. Mean improvement on the visual analogue scale was observed to be 6 points (Pre-op VAS=8, Post op VAS=2). Neurological symptoms, including sensory and motor, demonstrated improvement in 90% of the patients.
Conclusion: Transpedicular screw fixation (TPF) is a safe, effective surgical procedure associated with significant clinical outcomes. However, the procedure is associated with minor surgical and post-op complications. Postoperative physiotherapy may further enhance recovery in lumbar instability patient