Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Surgical Outcome of Organised Chronic Subdural Hematoma With Internal Septae in a Tertiary Care Hospital
Get PDFObjective: This study presented the surgical outcome of craniotomy and membranectomy (outer membrane excision) for the organized Chronic Subdural Hematoma (OCSDH) which have already developed thick internal septations.Materials and Methods: We retrospectively reviewed a series of consecutive patients operated via.craniotomy method for OCSDH in Neurosurgery Department Hayat Abad Medical Complex. Patients with both genders and all ages diagnosed as OCSDH with septae either diagnosed preoperatively via imaging CT/MRI or intraoperatively while getting operated by single burhole drain or two burhole wash method were enrolled in the study and operated via craniotomy/outer membranectomy method. All data was recorded in pre-formed Performa and demographics, clinical data analysed to quantify outcomes statistically.Results: Total 30 patients were operated in the 3 years study duration. Post-operative Recurrence of symptomatic hematoma was seen in only one patient, i.e. 3.33% and hence 29 (96.66%) had excellent outcome and remained symptom free at 6month followup visit. Out of 30 cases, we operated 27 (90%) were males and 3 (10%) were females, most of the cases were in the elderly age group (sixty five years was the mean age). Six cases (20%) had postoperative new onset seizures, all these patients were seizures free at 1month follow-up. Our three patients (10%) had a superficial wound infection.Conclusion: Craniotomy and outer membranectomy is a safe procedure for the management of OCSDH offering good results and fewer/no recurrence, unless the adherent inner (cortical) membrane removal is attempted, which may result in new onset seizures and neurological deficits
Intracranial Low Grade Glioma: a Clinical Study of 35 Cases in a Teaching Institute
Get PDFObjective: To determine the clinical manifestation and surgical outcome of patients with low grade Glioma.Material and Methods: This descriptive (cross sectional) study was done at the Neurosurgery Department, Mardan Medical Complex Mardan. The study period was March 2017 to February 2018. Patient of any age and gender presented to outpatient department or referred from some other medical facility and diagnosed as low grade Glioma on clinical and radiological grounds and later confirmed by histopathology were included. Results: Out of 35 patients, 20 (57%) were male and 15 (42%) were female. 20 to 80 years was the age range and mean age was 46.36 ± 17.11 years. Frontal lobe was the most frequent area of location, followed by parietal 9 (25%) and temporal 8 (22%) lobe. Pre-operativeKarnofsky score was 90 in 16 (45%), 80 in 8 (22%), 70 in 6 (17%) and 60 in 5 (14%) of patients. Gross total resection was achieved in 13 (37%), radical subtotal resection in 10 (28%), subtotal resection in 10 (28%) and biopsy taken in 02 (5%) patients. histopathology revealed Astrocytoma in 15 (42%), mixed Oligoastrocytoma in 12 (34%) and Oligodendroglioma in 8 (22%) number of patients. Post operatively surgical outcome was measured by improvement in symptomatology, Karnofsky score and seizure control. Conclusion: Conscious level, Karnofsky Performance score, seizure control are important parameters for surgical outcome in patients with low grade Gliomas. Gross total resection of the tumor is a better option for good surgical outcome
Spectrum of Posterior Fossa Lesions: Experience at Tertiary Care Unit
Get PDFObjective: The objective of our study was to evaluate the frequency and surgical outcome of patients with posterior fossa lesions.Material and Methods: This observational, descriptive study was conducted in the department of neurosurgery at lady reading hospital Peshawar and PUMH Nawabshah from Jan 2014 - June 2018. A total of 163 patients were observed during the study period. All those patients who undergone surgery for intra-axial posterior fossa tumors were included in the study. We included patients of both the genders and all age groups. We took approval of the study from the hospital ethical committee and informed consent was taken from the patients or their relatives. The data was entered in a specially designed Performa. Patients’ data was analyzed using SPSS version 21.Results: We had total 163 patients during the study period who fulfilled the inclusion criteria. Most (80.4%) of the patients were in the pediatric age groups and male (57%). Age of the patients ranged from 1-65 years with the mean age 17.4 years. The most common tumors in our study were Medulloblastoma (33.1%), Ependymoma (22.7%) and Astrocytoma (19%) in descending orders. Hemangioblastoma and metastasis were seen in 6.1% cases each. The most common clinical features were headache (87.1 %) and vomiting (64.4%) cases. Most (74.8%) of the patients undergone sub-occipital tumor excision. The most common post-operative complications in descending orders were tumor bed hematoma (6.7%), wound infection (4.9%) and cerebrospinal fluid (CSF) leak (4.9%). Total mortality was observed in 12.3% cases.Conclusion: We conclude from our study that posterior fossa tumors are more common in male children. The most frequent tumors in posterior fossa are Medulloblastoma, Ependymoma and Astrocytoma. Tumors is excision (66%) is the main treatment option. The rest need CSF diversion procedures. The main post-operative complications are tumor bed hematoma, wound infection and cerebrospinal fluid leak. Mortality is high in such patients. Most patients had good and satisfactory outcome after surgery
Dysfunction of the temporalis muscle following pterional craniotomy: Analysis of 20 cases
Get PDFBackground & Objectives: Temporalis muscle dysfunction following pterional approach for skull base approaches is commonly encountered which is very discomforting for patients however, literature regarding its management is insufficient. This study presents 20 cases over the course of 4 years and discuss the pitfalls in the management of temporalis muscle dysfunction following pterional craniotomy for various lesions.Materials and Methods: Sixty patients were operated using the pterional craniotomy, out of which 20 patients were included in the study. In these cases we used three methods of temporalis muscle dissection namely, the submuscular, subfascial & interfascial. Postoperatively, patients were followed for a median of 8 months. Detailed description of the follow-up findings and their statistical associations is presented.Results: Twenty patients with 12 (60%) males & 8 (40%) females with mean age of 43.8 ± 10.9 years were operated. Twelve (60%) patients were operated using the submuscular approach, 6 (30%) by the subfascial method and 2 (10%) by interfascial technique of temporalis muscle dissection. Of the 20 patients, 8 (40%) reported trismus, 10 (50%) had temporal region and jaw pain and 14 (70%) complained of difficulty chewing. For these patients, we employed local heat therapy (n = 14, 70%), chewing exercises (n = 12, 60%) and oral range-of-motion exercises (n = 9, 45%). 78.5% of patients responded with resolution of pain after local heat therapy, 80% with jaw range-of-motion exercises. The temporal hollowing was assessed by plastic surgeon, but none of the patient pursued plastic surgery intervention.Conclusion: Temporalis muscle dysfunction following pterional craniotomy occurs in about one-third of patients. It is a cause of significant patient concern. Physiotherapy and oral analgesics can alleviate the common symptoms. Patients must be informed about this complication to avoid undue psychological distress. Early diagnosis & management leads to better patient response
Microscopic Discectomy Outcomes in Lumbar Disc Herniation Patients
Get PDFBackground: Radiculopathy due to herniated lumbar disc is one of the most common determinant of sciatica. Most patients with sciatica respond well to non-surgical treatment. Surgery is performed when there is an established neurological deficit or when conservative management is not successful in achieving positive results in pain.Objective: To evaluate the frequency of good outcomes regarding pain relief after lumbar microscopic discectomy in adult patients presenting with radiculopathy.Material and Methods: Current study includes 80 patients, both male and female between 20-70 years and admitted for herniated lumbar disc surgery. Microscopic discectomy was performed in all these patients. Outcome variable was frequency of good outcome in terms of post-operative pain ? 4/10. Informed consent in written was obtained from the individual patient.Results: In 73 (91.3%) cases good outcome was observed. No substantial difference was noticed in the frequency of good outcome according to the duration of herniated disc (p = 0.960), pre-operative pain score (p = 0.499), age (p = 0.851) and gender (p = 0.703).Conclusion: Good outcome was observed in 91.3% patients presenting with herniated lumbar disc undergoing microscopic discectomy regardless of patient’s age, gender, pre-operative pain and duration of disc herniation
Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound
Get PDFObjective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections
Steroid Induced Gastrointestinal Perforation in a Traumatic Injury. Atypical Complication to a Common Drug
Get PDFWe report this case of a male patient with cervical spine injury following shallow water diving. With power of 3/5 in all 4 limbs and grade 2 subluxation (C5/C6) the patient was operated on undergoing a 360 degree fixation and unlocking of facets; he was administered steroids and developed abdominal distention. An eventual CT scan showing a pneumoperitoneum revealed he had developed a gastrointestinal perforation. GI perforation is a less well recognized side effect of steroids. It can be difficult to diagnose, as the steroids can mask the symptoms of gut perforation by reducing the clinical expression of peritonitis, and a serious complication; been reported in the literature to have a mortality ranging from 27% to a 100%.1-3 We report this case as a clinical reminder of the risk of GI perforation from steroid use and to emphasize the role of a multi-disciplinary team in the management of trauma patients
Consequences of Streptococcal Pneumoniae Meningitis When it Remains Undiagnosed – Suggested Model of Investigational Process
Get PDFBackground: Whenever any patient presents with headache and slightly high total leukocytic counts, the pertinent question gets raised is either prompt lumbar puncture (LP) is indicated or not. Usually patients with bacterial meningitis characteristically exhibit fever, neck rigidity and deranged mental status or headache. In majority of cases the causes are non-infective. Whilst meningococcal meningitis has a distinctive non-blanching rash and is promptly diagnosable from the CSF. Our report describes disease presentation with merely one aspect of the triad for acute bacterial meningitis and it raises query regarding reliance on guidelines based on the triad
Post Traumatic Mask Face, Diagnostic Dilemma in Bilateral Traumatic Facial Palsy. Case Report
Get PDFTraumatic temporal bone fractures, most of the time presents with complications in the form of cerebrospinal fluid leak, facial nerve injury as it enters the petrous part of temporal bone and also sometimes hearing loss due to concomitant vestibulocochlear nerve injury.2,3,4 Second most vulnerable nerve in head injury is facial nerve, with olfactory nerve being the first, and one reason for this is the tortuous bony course in the skull base and temporal bone.8-12 Evaluating facial nerve injury in head injury patient start with an inspection of the temporal bone for any signs of injury, i.e. laceration or visible auditory cartilage or any hematomas or bruises over mastoid, which is called Battle sign.10-12 Functional testing of facial nerve should be recorded in head injury with temporal bone fracture as soon as possible.1, 3- D CT reconstruction of the skull and temporal bone should be carried out when there is suspicion of facial nerve injury.11,12 Complementary electro diagnostic testing should also be performed in order to assess the severity of facial nerve injury.2,3,4 These all helps in early detection and further management of facial nerve injury.5,6,7,11 We presented a case of 18years old male who had road traffic accident on 29.10.2018. This patient suffered with the head injury with bleeding from nose and right ear. 
Endoscopic Endonasal Excision of Pituitary Tumors Using a Mono-nostril Technique
Get PDFObjectives: The purpose of this study is to assess the effectiveness and advantage of endoscopic mono-nostril approach to the pituitary tumors.Materials and Methods: We analyzed 70 patients undergoing transsphenoidal mono-nostril excision of pituitary tumors from September, 2016 to March, 2018.Results: We operated 70 patients, out of which 51 were males and 19 were females; the age of the patients ranged from 15 years to 65 years.In our study, out of 70 patients, 61 (87.1%) patients had excellent results with total tumor resection, marked visual improvement, early discharge on the second post-operative day, resuming their daily activities within two weeks and recurrence free interval of 1 year. Nine (12.8%) of our patients had a partial excision of the tumor, whereby there was improvement of headaches in all of them while visual status remained at the pre-operative status. Five (7.1%) of our patients had a post-operative cerebral spinal fluid (CSF) rhinorrhea, 4 (5.7%) in total excision group and 1 (1.4%) in partial excision group. These patients of CSF leak were retained in hospital and their mean stay in hospital was 12 ? 4. Conclusion: We consider that endoscopic mono-nostril excision of the pituitary tumor is a relatively safer, effective, minimally invasive procedure; whereby there is a fast recovery, early discharge and good cosmetic results