Pakistan Journal Of Neurological Surgery
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Spectrum of Different Spinal Disorders Presenting to Neurosurgical Department of Public Sector Tertiary Care Hospitals of Peshawar
Get PDFObjectives: To assess the spectrum of different spinal disorders presenting to the Neurosurgical department of public sector tertiary care hospitals of Peshawar.Materials and Methods: This was a retrospective study carried out in the Neurosurgery departments of two public sector tertiary care hospitals in district Peshawar from January 2012 to December 2018. Our inclusion criteria comprised of all those patients who were having spinal abnormalities irrespective of age and gender, admitted either via emergency or OPD. We excluded those patients who were dead on arrival or whose data was lacking including those who did not do their follow up and those who were not given consent for the study.Results: Out of total 5,579 patients, male to female ratio was 1:1.7. The age range was from 6 days to 78 years. Elective cases were 63.61% (n = 3,549) and emergency were 36.37% (n = 2,030). TSCI were 35.01% (n = 1,953) and NTSCI were 3,626 (n = 64.99%). Out of all patients, 91.03% (n = 5,079) were treated surgically. About 79% (n = 4,406) had a good outcome.Conclusion: We collected data and made a survey of the spectrum of different spinal abnormalities resulting from various etiologies focused over the last 6 years. We found a variety of cases presenting to our departments of neurosurgery. Non traumatic spinal injuries are more frequent as compared to traumatic ones
Functional Outcome of Discectomy in Single Level Lumbar Disc Disease
Get PDFObjective: To know functional outcome of discectomy in single level lumber disc disease.Materials and Methods: This prospective study was conducted in the Department of Neurosurgeryunit B, Lady Reading Hospital Peshawar from July 2014 to July 2016. Patients with severe leg pain, progressive neurological deficit, positive nerve root tension signs and disc herniation confirmed on radiology were included and conventional open discectomy was performed. Follow up was done for 6 months after surgery.Results: Ninety patients who were operated for single level herniated disc were included. Most commonly, the involved level was L4–5 followed by L5-S1. Improvement in leg pain was observed in 91.02 % of patients.Conclusion: Good preoperative workup is necessary for excellent postoperative results in herniated lumbar disc surgery. Outcome for leg pain is good as compared to only back pain. The poor outcome in the form of failed back surgery is due to improper preoperative workup and patient selection
Community Awareness Level Regarding Brain Tumours and Reasons of Delay in Total Diagnostic Interval
Get PDFObjectives: This study was conducted to determine the awareness in the Pakistani community regarding Brain tumors and exploring the reasons for the delay in Total Diagnostic Interval (TDI).Material and Methods: The methodology used to determine community level of awareness by anonyms, questionnaire based descriptive study. The duration of the study was 4 months and data was taken from the patients operated in Neurosurgery Unit I of Punjab Institute of Neuroscience (PINS).Results: A total of 102 patients were recorded, of which sixty five (63.7%) were male patients and thirty seven (36.2%) female patients. Immense delay was noted in getting the first basic radiological investigation, i.e., more than one year in 33 cases (32.35%) after the appearance of their first symptom. The study revealed that 46 cases (45.00%) got treatment from Quack, 38 cases (37.00%) from spiritual healer/Hakeems and 8 cases (07.00%) had homeopathic treatment. It was noted that 35 (34.30%) of the patients were unaware of their disease, and 67patients (65.00%) were aware of their disease. The awareness group revealed that 28 cases (27.45%) know about their disease, but reluctant to get surgery, while 30 cases (29.00%) were considered quacks treatment. Seventy five cases (73.52%) presented after 12 weeks of their initial symptom in our series.Conclusion: Awareness regarding brain tumors is insufficient that is resulting in delay of Total Diagnostic Interval, moreover the scenario was further complicated by adopting alternative methods of treatment like Hakeems/quacks/homeopathic and spiritual healers
Frequency of Ventriculoperitoneal Shunt Infection in Infants on The Basis of Cerebrospinal Fluid Analysis
Get PDFObjective: To know the frequency of ventriculoperitoneal shunt infection in infants on the basis of cerebrospinal fluid analysis.Material and Methods: A cross-sectional study conducted at the LRH Neurosurgery unit, pathology department of KTH Peshawar and department of neurosurgery Gomal Medical College. D.I. Khan, from July 2016 to June 2018. All consecutive patients with suspected ventriculoperitoneal shunt infection were included in the study. The age of the patients was up to one year, irrespective of their gender. Infants with closed fontanelle and previous revision surgery for ventriculoperitoneal shunt were excluded from the study.Results: Total 204 patients. The age of the patients were under one year (infants). Infected cerebrospinal fluids were observed in 19.1% (39/204) infants. Female infants were slightly more common (51.3%) than male. Majority (64.1%) of the patients was having age less than 6 months.Conclusion: We conclude from our study that 19.1% of infants with cerebrospinal fluid shunts have infected CSF on laboratory analysis. Most of the infected shunts occur in female infants and in the first half of their age
Leukocytosis: Predictor of Radiological and Neurological Outcome of Patients of Traumatic Brain Injury Presented to Jinnah Hospital, Lahore
Get PDFBackground/Objective: Catecholamines and cortisol cause raised TLC (total leukocyte count) and brain inflammation after injury. We found out that weather leukocytosis is predictive for radiological and neurological outcome in patientswith TBI presenting to JHL.Materials and Methods: Blood samples of patients (n = 100) were collected on presentation in the emergency room, after 72 hours and on the 5th day for TLC count.CT Brain was obtained on presentation in emergency, after 72 hours and on the 5th day. The progression of imaging findings on CT scan were assessed and compared with TLC count. The outcome of these patients was assessed according to the Extended Glasgow Outcome Scale.Results: TLC after TBI is raised initially and then it declined afterwards in mild and moderate TBI, but remained on the upper limit in moderate TBI. In severe TBI, TLC was raised initially and then it progressed to higher limits afterwards.These results showed that there is a strong relation between TLC and TBI.Regarding the association between radiological assessment and severity of injury along with raised TLC, it was observed that the patients having EDH had raised TLC along with expansion of hematoma, while patients with contusions, T-SAH (traumatic sub-dural hematoma) SDH had TLC on upper limit, but there was no significant resolution of radiological severityConclusion: WBC count can be used as a predictor of radiological outcome, as it was found that patients with severe head injury had raised TLC. TLC count can be used to assess the severity of injury and prognosis
Incidence of Supratentorial Metastatic Tumors Study of 20 Cases
Get PDFObjectives: To determine the incidence of supratentorial metastatic Tumors in Balochistan.Material and Methods: Twenty (20) cases of both gender and different age group included in the study. This study was conducted at Neurosurgery Department, BMCH, Quetta from May 2010 to July 2014. Infratentorial metastases were not included in the study.Study Design: Prospective and Analytic Study.Results: Twenty patients of both genders were included in the group. The 12 patients were female and 8 male, age of patients range from 20 years to 65 years. The majority of patients were between 35 to 60 years. Debulking of tumor were done in 8 patients while Biopsy taken from the rest of the patients.Conclusion: Metastatic brain tumors usually occur in adults. Previously the diagnosis was very late, but now a days due to the availability of modern technology the diagnosis made early
Surgical Outcome of Subdural Hematoma by Single Vs Double Burr Hole Technique
Get PDFObjective: To determine frequency of a favorable outcome of chronic subdural hematoma patients by single vs. double burr hole technique.Materials and Methods: A randomized controlled trial was done in Neurosurgery Department, Pakistan Institute of Medical Sciences, Islamabad from 15th September 2016 to 15th August 2017. All patients in group A were operated through a single burr-hole technique either under general anesthesia or local. Group B patients were operated through double burr-hole technique.Results: One hundred patients were included in this study, divided into two groups. Group A had mean age 54 years with STD of ± 5.7 while in group B, mean age was 53 years with STD of ± 6.3. In group A there were 35 (70%) male and 15 (30%) female patients while group B had 30 (60%) male and 20 (40%) female patients. In group A, mean GCS was 12.78 with STD of ± 1.4. In group B, mean GCS was 12.64 with STD of ± 1.3. The favorable outcome after surgery was attained in 43 (86%) patients in Group A while 46 (92%) patients in Group B.Conclusion: Chronic subdural hematoma is a complication seen in older age after trivial trauma history. Single burr-hole drainage of hematoma is an effective method of treatment when compared with double burr-hole method which is more time consuming
National Neurosurgical Activities
Get PDFNeurosurgery is an inherently dynamic specialty, developing at a very rapid pace, more so because of the involvement of and its dependence on advanced technology. The international neurosurgical scene is full of cutting edge research presented in dramatic meetings, conferences, workshops and courses. The local neuro-surgical landscape is no exception. Its panorama is changing as the development of neurosurgery is gaining pace in Pakistan. Prospects look good considering the fact that the activity on the academic front is also getting richer. The following compilation of the individual events gives a flavour of this richnes
Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak
Get PDFObjective: To compare the frequency of postoperative cerebrospinal fluid (CSF) leak after decompressive craniectomy with wide dural flap duraplasty versus dural slits in patients with post traumatic acute subdural hematoma.Material and Methods: The study was conducted from August 2017 to February 2018 in the Department of Neurosurgery, PIMS, Islamabad. A total of ninety-two (n = 92) adult patients of either gender between age 15-55 years presented with isolated, unilateral traumatic acute sub dural hematoma (ASDH) with midline shift of 5mm were categorized into 2 groups; Group A (DC with open dural flap) and Group B (DC with dural slits). Patients were observed for CSF leakage for four weeks.Results: Results showed that the overall frequency of CSF leak was not significantly different in both groups and revealed that the CSF leak was observed in 10.9% (n = 5/46) in group A (DC plus open dural flap) and in 21.7% (n = 10/46) in group B (DC plus dural slits) (P = 0.158). The difference was not significant in terms of frequency of CSF leak in both groups when results were stratified with respect to gender, age, duration of trauma and baseline GCS. P value (chi-square) was found to be > 0.05 in all cases.Conclusions: The postoperative CSF leak was observed in higher percentages in patients who underwent DC with dural slits as compared to the patients who underwent DC with open dural flaps for surgical management of ASDH. The difference, however, was not statistically significant