Pakistan Journal Of Neurological Surgery
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Positive Predictive Value of Magnetic Resonance Imaging in Intradural Spinal Tumors Taking Histopathology as Gold Standard
Get PDFObjective: To observe the positive predictive value of MRI, taking histopathology as gold standard in detecting spinal intradural tumors.Materials and Methods: Total 180 cases were included through non-probability purposive sampling, at Ganga Ram Hospital, Radiology department, Lahore. The radiological diagnosis obtained through MRI, was observed. The cases fit in inclusion criteria were underwent surgery and their histopathological findings were observed. Comparison between the outcomes of MRI and histopathology were undertaken, keeping histopathology as gold standard. Positive predictive value of MRI in the diagnosis of intradural spinal tumor was calculated andpresented in the form of percentages and frequency.Results: There were total 180 patients presenting in OPD with the mean age of 45.71 ± 13.57 years. There were 112 (62%) male. Male to female ratio was 1.6:1. There were 134 (74.4%) cases who were positive for malignant spinal intradural tumor on histopathology showing the PPV of MRI as 74.4%.Conclusion: Magnetic Resonance Imaging is very beneficial imaging tool for early diagnosis of spinal cord tumors
Multimodality Treatment of Craniopharyngioma: Aspiration of Cystic Contents and Placement of Ommaya Reservoir Stereotactically Followed by Gamma Knife Radiosurgery – Single Center Study of 81 Cases
Get PDFObjective: The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic 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 method
Patterns, Frequency and Gender Dominance in Paediatric Neuro-trauma in a Tertiary Care Hospital in Peshawar
Get PDFObjective: To determine the patterns, frequency and gender dominance in pediatric trauma presenting to Neurosurgery Department in a tertiary care hospital.
Material and Methods: This retrospective study was conducted in Department of Neurosurgery, Lady Reading Hospital, Peshawar. The medical records of all patients (0 – 15 years) with trauma admitted in our unit were analyzed retrospectively.Demographic details of the included subjects were noted down.
Results: A total of 448 patients were included in our study; 308 males and 140 females. Patients with 0 – 5 years were 40%, 6 – 10 years were 38% and 11 – 15 years were 22%. Extradural hematoma (28.12%) preceded depressed skull fracture (20.08%), followed by linear fractures (17.85), subdural hematoma (7.58%), contusions (5.80%) and subarachnoid hemorrhage (5.35%). Patients with diffuse axonal injury accounted for about 4.91%. Only 2 cases of cervical injury were noted.
Conclusion: The number of boys was comparatively greater than girls. Most of the patients were in the age group of 0 – 5 years. Ratio of extradural hematoma was the highest among all the injuries
Surgical Outcome & Cost Analysis of Single Stage Anterior Decompression and Cage Fixation in Patients with Thoracic and Lumbar Tuberculous Spondylitis: A Single Centre Experience Over Six – Years with Comprehensive Literature Review
Get PDFObjective: For Tuberculous spondylitis (TS) the optimal mode of management for extensive tuberculous spondylitis is still a subject of debate. We determined the outcome for single stage anterior decompression and cage fixation for dorso-lumbar TS.
Material and Methods: This prospective study was conducted between 2012 and 2018. Worsening or new onset neurological deficit, increasing deformity, large paraspinal abscess and those not responding to anti-tuberculous drug therapy were included. Patients with severe comorbidities (> ASA class III) and recurrent cases were excluded. Demographics, clinical features, radiological characteristics, intraoperative details, postoperative complications and follow-up condition were recorded.
Results: One patient with mean age of 45.6 ± 14.9 years with 17 (54.8%) males and 14 (45.2%) females. Mean symptoms duration was 71.9 ± 29.4 days. 41.9% had spasticity & 25.8% had sphincter dysfunction on presentation. Half (48%) of patients had a Frankel grade 3 or less bilaterally. Mean length of the procedure was 137.4 ± 19.9 minutes. 19.4% (n = 6) had postoperative pulmonary complications, 16.1% (n = 5) wound infection, 9.7% (n = 3) had worsening of neurologic deficit and one (3.2%) remained static. Graft extrusion and cage subsidence were noted in one (3.2%) patient each. Favorable outcome was observed in 83.9% (n = 26) while 16.1% (n = 5) had unfavorable outcome. Mean out-of-pocket cost was 164677.4 ± 11469.9 rupees (USD: 1187 approx).
Conclusion: Timely spinal decompression with stabilization at the onset of the Pott’s disease in patients who fulfil the criteria as surgical candidates carries a promising outcome
Comparative Study Regarding Efficacy of Radiofrequency Rhizotomy and the Microvascular Decompression in the Treatment of Trigeminal Neuralgia
Get PDFObjective: Trigeminal neuralgia is the lancinating electric shock like pain because of neurovascular compression in trigeminal nerve distribution. We compared the efficacy of radiofrequency rhizotomy with microvascular decompression in terms of complete pain relief.Material and Methods: The randomized controlled trial study was conducted in the neurosurgery department, LGH Lahore for a period of one year June 2017 to June 2018. A total of 110 patients were included and distributed into two groups, i.e. group-I who underwent radiofrequency rhizotomy (RFR) and group-II who underwent microvascular decompression (MVD). Follow-up of all the patients was assured up to six months. All the data were analyzed using S.P.S.S Ver. 23.0.Results: There were 38 (34.6%) male and 72(65.4%) female. Mean age was 51.25 ± 8.80 years. At the end of six months, in Group-I (RFR), Nineteen (34.5%) patients were completely pain free, 25 (45.5%) patients had significant pain relief, 7 (12.7%) had mild improvement in the pain and 4 (7.3%) patients had no improvement in the pain. In group-II (MVD), 30 (54.5%) patients were completely pain free, 14 (25.5%) had significant pain relief, 9 (16.4%) had mild improvement and 2 (3.6%) had no improvement in their pain (Chi-square = 6.49, p = 0.090).Conclusion: Microvascular decompression had better results than a radiofrequency rhizotomy in patients presenting with trigeminal neuralgia regarding excellent pain relief and fewer complications
Outcome of Laminoplasty in Patients with Multilevel Cervical Myelopathy
Get PDFObjective: To determine the outcome of surgical intervention in the form of laminoplasty in the patients with multilevel cervical myelopathy. Material and Methods: Descriptive case series, was conducted at NS-I, PINS, Lahore for 6 months. The patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All of the patients were assessed using JOA score before and after 2 months of surgery. General characteristics, including age, gender, other medical conditions and other risk factors were assessed prior to surgery. The total number of 35 patients was included with expected JOA percentage recovery rate of 75% + 21% after the procedure. Results: In this study 35 total patients were enrolled. The mean age was 55.68 + 9.92 years. Total number of male patients were 23 (65.71), while the female was 12 (34.29). The mean duration of degenerative cervical myelopathy was 3.90 + 1.3 months. The mean pre op value of JOA score was 7.08 + 2.7 (4 – 10) for the patients. The mean post op score was 13.00 + 2.30 (9 – 17). The mean recovery value calculated at two month interval was 62.12 + 17.39 (38.46 – 100). Statistically, there was a significant difference of outcome of pre and post op value of JOA scores i.e., p value = 0.00. Conclusion: Our study determined that, the open door laminoplasty is an effective and reliable technique with good outcome in the treatment of multi-level degenerative cervical spine myelopathy patients. 
Outcome of Endoscopic Discectomy in Patients with Lumbar Prolapsed Intervertebral Disc
Get PDFObjective: To determine the outcome of endoscopic discectomyin patients with lumbar prolapsed intervertebral disc in terms of back pain and leg pain using the visual analogue scale.Material and Methods: Descriptive case series, was conducted at, PINS, LGH Lahore for 6 months. 15 patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All patients’ low back pain and leg pain was documented using visual analogue scale before and after 2 months of surgery.On the basis of VAS we calculated % age improvement of low back pain and leg pain after endoscopic discectomy, while ? 5 scale improvement was considered clinically significant.Results: Patients mean age was 44.46 years. Among them, 9 (60%) were males and 6(40%) were females. On average, the basal metabolic index (Kg/m2) was 29.29 However, the BMI of females was 31.76 and male was 27.65 Kg/m2. On average, the duration of symptoms was 8.05 months. On average, the Straight Leg Raise was 24.7o at the time of treatment. A decreased sensation was observed in L5 of 3 (20%) and in S1 of 4 (26.67%) participants. Whereas Absent sensation was observed in L5 of 3(20%) and in S1 of 5 (33.33%). Mean preoperative back pain and as well as leg pain was 7.05 that improved to 0.41 and 0.86 4 weeks post operatively.Conclusion: Endoscopic discectomy is equally effective in alleviating the symptoms without notable difference in surgical outcome
Frequency of Discitis in Lumbar Discectomy Patients: A Two Year Study
Get PDFObjective: Aim of conducting the study was to evaluate the incidence of post op discitis in lumbo-sacral disc surgeries.Materials and Methods: This observational prospective study was carried out in Neurosurgery unit Hayatabad Medical Complex, Peshawar for 12 months (1st July 2017– 30thJune 2019).A total of 250 patients operated for lumbar disc surgeries were enrolled in the study, both genders and age range of 16-60 were in inclusion criteria.Patients with co-morbidities e.g., poorly controlled diabetics and immunosuppressed patients were excluded from the study. All patients were followed to calculate the frequency of discitis. Results: Among the 250 cases, 11 (4.4%) were diagnosed with discitis. 15% cases had slight sign and symptoms, pain and surgical scar tenderness not warranting the diagnosis of discitis. The mean age in this study was 37 years with Standard Deviation of 13.769. Male cases were 133 (53.2%) while females were 117 (46.8%). Discitis was more common at L4-5.Conclusion: From this data it was concluded that incidence of discitis is slightly higher in our setup than international discitis incidence/rates. The possible reason could be (to some extent) due to inefficient/poorly resourced infection prevention committee and partly due to less standardized OT system in comparison to international OT complex standards
Surgical Outcome of Chiari Malformation Type One in Adults
Get PDFObjective: To assess the post-operative outcome after Posterior Fossa Decompression (PFD) with duraplasty in Chiari-1 malformations.Study Design: Case series.Place and Duration of Study: Department of Neurosurgery, Medical Teaching Institution Lady Reading Hospital Peshawar, from January 2013 to June 2018.Materials and Methods: This study included 28 patients of Chiari 1 malformations admitted through OPD with the presentation of suboccipital headache, neck pain, dizziness/fatigue, numbness and paresthesias in upper limbs, gait problem, cerebellar dysfunction and or with syringomyelic syndrome. MRI whole spine and CT scan brain was done in all cases to confirm diagnosis and rule out other pathologies. Suboccipital craniectomy with C1 laminectomy and expansile duraplasty was performed in all cases and clinical outcome was assessed in follow-up clinic.Results: Among 28 patients, 16 were females and 12 males. Age ranged from 16 to 48 years with a mean of 26 years. Headache were present in 22, neck pain in 17, fatigue and dizziness in14, numbness and paresthesia of upper limbs in 12, loss of fine motor skills in 8, cerebellar dysfunction in 5 and sphincter loss in 4 patients. Mean time to diagnosis was 14 months. Syrinx was present in all patients. Posterior fossa decompression with duraplasty with an additional C1 laminectomy was performed in all cases. Syringo-subarachnoid shunt was placed in one patient. Pain was relieved in 78.5% of cases. Postoperative outcome was assessed as good, fair and poor based on pre and post-operative clinical and radiological parameters. Good outcome was noted in 22 patients and fair in 6 cases in this series. No patient suffered a in our series. Syringomyelia was improved in all except one case in which it improved after syringo subarachnoid shunt. Postoperative morbidity included CSF leak in 2 patients, superficial wound infection in 2patients.Conclusion: Posterior fossa decompression with C1 laminectomy followed by expansile duraplasty is the main surgical modality of treatment for Chiari-1 malformation. Better post-operative outcome is achieved with PFD in terms of symptoms, reduction in syrinx size, with minimum surgical morbidity and mortality
Outcome of Endoscopic Treatment of Intracranial Arachnoid Cysts
Get PDFObjective: To analyze the outcome of endoscopic treatment of intracranial Arachnoid Cysts.Materials and Methods: The study was conducted from July 2015 to September 2016 at the department of Neurosurgery Unit III, PGMI, Lahore General Hospital, Lahore. A total number of 13 patients were included in the study of both gender and age range of 05-45 years. Detailed history, neurological examination, preoperative CT and MRI scans were performed in all patients. Karl Storz (Lotta system) endoscope was used in all patients. Postoperative CT scan and follow up MRI scans were done in all patients.Results: Out of 13 patients, there were 08 (60%) male and 05 (40%) female patients. Their age ranged from 05 - 45 years. The majority of patients in our study were in their second and third decade of life. In this study, the symptomatic relief and reduction in cyst size was gained in most of the patients with minimal recurrence and fewer number of side effects.Conclusion: Endoscopic treatment 0f intracranial Arachnoid Cysts proved to be an effective and a very safe technique, provides the best results, avoids shunt dependency with minimal recurrence and fewer side effects