Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Role of Early Tracheostomy in the Management of Severe Head Injury
Get PDFObjective: The objective of this study was to compare the role of early and late tracheostomy in patients presenting with severe head injuries.Material and Methods: This randomized controlled trial study was conducted in the department of neurosurgery, Lahore General Hospital Lahore from March 2018 to August 2018, after taking approval from the ethical committee. A total of one hundred and thirty patients was divided randomly into early (within three days) and late(after three days) tracheostomy groups. After tracheostomy, data regarding acute physiology, age and chronic health evaluation II (APACHE II), the total number of days since ventilation, tracheostomy, weaning, discharge from ICU and hospital, complications and mortality were noted. All the data was entered and analyzed with SPSS23.0. Quantitative variables were presented as mean and standard deviation, qualitative variables were presented as numbers and percentage. The Chi-square test was applied. A p-value of ?0.05 was considered significant.Results: The mean age of the patients was 33.13 ± 2.53 years. There were 84 males (64.61%) and 46 females (35.38%) in the study. The duration of mechanical ventilation, ICU stay and stay in hospital for early and late tracheostomy groups were 25.68 ± 2.94 vs. 33.37 ± 3.32 days, 29.42 ± 2.97 vs. 38.54 ± 3.80 days and 37.20 ± 2.98 vs. 47.15 ± 3.84 days respectively. Four patients (3.08%) and seven patients (5.38%) suffered from mortality.Conclusion: Early tracheostomy among the patients presenting with severe head injuries was associated with a better outcome than late tracheostomy
Neuroendoscopic Management of Hydrocephalus in Children
Get PDFObjective: To determine the Neuroendoscopic management of hydrocephalus in children.Materials and Methods: The study was conducted at the Department of Neurosurgery, Peoples University of Medical and Health Science for women Nawabshah from January 2014 to May 2015. All of the patients with hydrocephalus diagnosed on history, clinical examination and CT scan included in the study. Subjects with co–morbidities such as uncontrolled diabetes, cardiac diseases or uremia were excluded. Patients with age of 6 months to 13 years either gender were included in the study. Aesculap rigid rod lens neuroendoscope with 0 degree was utilized. Warm ringers were utilized for irrigation, a Fogarty embolectomy catheter was utilized for ETV. Hemostasis was accomplished with irrigation, tamponade or coagulation. Endoscopic third ventriculostomy (ETV) was labeled successfully when characteristics of intracranial hypertension (ICP) clinically improved and the size of ventricular decreased on post-operative CT scan. All the data was recorded in the Proforma.Results: Thirty patients with male to female ration 2.5:1 were administered. Age ranged between 6 months and 12 years with a mean of 22.03 months. There were 15(%) cases of Tri Ventricular Hydrocephalus, 10 cases of Tetra Ventricular Hydrocephalus. Two cases of Dandy Walker Hydrocephalus, one case of Asymmetrical Ventricles Hydrocephalus and postoperative fever occurred in two subjects. CSF leak appeared in one patient who was managed conservatively. No operative mortality was found.ETV worked effectively for Hydrocephalus treatment in 99.9% patients included in the study
Outcome of Microvascular Decompression (MVD) for Trigeminal Neuralgia
Get PDFObjective: To assess the outcome of patients of Trigeminal Neuralgia after Microvascular Decompression (MVD).Design: Case Series.Place and Duration of Study: Bolan Medical Complex Hospital, Quetta from July 2008 to July 2015.Materials and Methods: Patients of all age group and both gender were included. Those patients were included in study that was not relieved by conservative treatment.Results: 40 patients included in study, 30 patients were male and 10 patients were female. Male to female ratio 3:1. The majority of the patients were over 50 years of age. Duration of symptoms in all the patients was more than one year. All of patients were not responding to medical treatment (Anticonvulsant, Antispasmodic and Pain Killers) after one year treatment. All of patients were operated. Procedure was microvascular decompression. They were followed for the period of one year. Most of the patients were pain free after surgery and few patients develop minor complications.Conclusion: Micro vascular decompression is treatment of choice in those patients who stop responding to the conservative treatment
Study of Risk Factors in the Management of Epilepsy – A Study of 100 Cases
Get PDFObjective: Epilepsy is one on of the commonest neurological problem seen in neurology and the ultimate aim is to manage the fits. Despite giving various medicines, fits are not controlled in some patients. This study has been carried out to define various factors which account for poor control of fits in these patients. These include incorrect diagnosis of epilepsy, under dosage, improper selection of the drugs, noncompliance of the patient, lack of education, etc. If proper emphasis were given to all these factors while treating the patient of epilepsy, fits can be effectively controlled in the majority of the patients.Material and Methods: It was a retrospective and prospective study. The duration of study was six months from 1st January to 31st Dec 2016. The study has been carried in the department of neurology, Gujranwala medical college/DHQ teaching hospital Gujranwala.Results: A total number of hundred patients were entered into the study. This was a heterogeneous group according to gender and age. There were a total of 62 (62%) males, and 38 (38%) females. Out of total 100 patients, 86 had idiopathic epilepsy which constitutes 86% of total patients. Four (4%) had fits following meningitis. There were no patients with a history of fits following trauma. There were four (4%) patients who had a brain tumor.Conclusion: It is concluded from our study that: Idiopathic Epilepsy is the commonest among etiology of fits almost (86%). Tonic clonic generalized epilepsy is the commonest type of presentation for Epilepsy (76%). The control of seizures can be improved by education/councelling of the patients
Incidence & Management of Delayed Cerebrospinal Fluid Leaks after Lumbar Spinal Surgery-Analysis of 10 Cases
Get PDFObjectives: Cerebrospinal fluid (CSF) leaks in degenerative lumbar spine surgery are common, however, delayed cerebrospinal fluid (CSF) leaks are quite rare in neurosurgical practice. Literature regarding its incidence and management is scant.Our aim was to describe the incidence & management of delayed CSF leaks after degenerative lumbar spine surgery. Material & Methods: This was a prospective study where all patients operated for lumbar disc or stenosis, who presented with the delayed CSF leak (> 1 week postoperatively) without intraoperative record of incidental durotomy were included. Data was collected about demographics, diagnosis, operative detail, postoperative course & management issues. Results: Ten out of 1128 patients developed delayed CSF leaks (0.89%). Mean age at the time of diagnosis was 52.1 ± 6.9 years with 6 (60%) males & 4 (40%) female. The most common spinal level was L5-S1 (50%). Eighty percent (n = 8) patients underwent primary surgery while 20% (n = 2) were revisions. Clinical features were headaches (80%), dizziness (70%) and altered sensorium in 20%. Mean time of the leak was 17.3 ± 2.2 days. Two patients resolved with bed rest and compression dressing while the lumbar drain was placed in 80%. Three (30%) patients of the 8 needed open repair of the dural defect. Complications of the CSF leak included wound infection in 60%, and meningitis in one (10%) patient. There were no cases of neurologic deficit. One case eventually developed infective discitis
Peripheral Neuropathy in Newly Diagnosed Cases of Type II Diabetes Mellitus
Get PDFObjective: Diabetes mellitus linked to severe macrovascular and the microvescular complications. Diabetic peripheral neuropathy is the challenging complication of the diabetes mellitus, which is linked to the morbidity, mortality, and big economic burden. We determined the frequency of peripheral neuropathy in newly diagnosed cases of type II diabetes mellitus.Materials & Methods: The current descriptive Cross Sectional study took place in Services Institute of Medical Sciences, Lahore, From June 2014 to January 2015. All the patients, those were newly diagnosed with diabetes mellitus, aged 30-60 years and both genders were included. Detailed history regarding diabetes was taken. Patients underwent for the evaluation of peripheral neuropathy by taking physical examination, previous history and vibration perception test. All the data was recorded in the Proforma.Results: Total 150 cases were studied, out of them, 42.67% were aged 30-45 years while 57.33% were in the age range of 46-60 years and their overall mean age was 46.35 ± 9.52 years. Males were 54.0% and females were 46.0%. Frequency of peripheral neuropathy for newly diagnosed type II diabetic subjects was noted 20.67%, with insignificant association of age and gender.Conclusion: It was concluded that the peripheral neuropathy was 20.67% among patients newly diagnosed with diabetes mellitus
Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms
Get PDFObjective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient
Six Months’ Analysis of Head Injury due to Motor Bike Accidents in Punjab Institute of Neurosciences (PINS), Lahore
Get PDFObjectives: To analyze the head injury with special emphasis on motor bike accidents, different age groups affected and its impact on society. The study was conducted at the Neurosurgical unit 1 PINS, Lahore, for six month duration.Material and Methods: This is a prospective study. In this study 1600 cases of head injury due to motor bike accidents who presented in thecausality department of Neurosurgical Unit 1 were studied.Results: A total of 1600 cases were included caused by motor bike accidents from May 2018 to October 2018. Most common age group was 12 to 45 years 1056 (66%) of cases, above 45 years 448 (28%) cases, children 0-11 years 96 (6%) cases. In gender distribution 1280 (80%) males and 320 (20%) females. There were only 256 (16%) wearing helmets and 1344 (84%) without helmets. Severity of injury sustained in all cases was: GCS = 13-15 in 1088 (68%) cases; GCS = 9-12 in 368 (23%) cases and GCS = 3-8 in 144 (9%) cases.Conclusion: Head injury due to motor bike accidents is involving the most productive age and increasing the burden on family and health care system. Strict implementation of traffic rules and use of helmets can reduce the incidence
Surgical Outcome of Traumatic Brain Injury: A Retrospective Experience of 2 Months at Lahore General Hospital Lahore
Get PDFIntroduction: Traumatic head injury is a common cause of death in the young population. It is important public health care problem in Pakistan and equally pandemic in developing countries. By knowing prognostic factors, proper management, and avoiding the cause, and also by public awareness we can decrease mortality and morbidity.Material and Methods: A retrospective study conducted in the Neurosurgery department of Lahore general hospital Lahore, from 1st Nov. 2018 to 31st Dec. 2018 and data collected from 30 patients. All patients were of traumatic head injury after that they suffer from ICH/SDH/EDH. All patients who had brain death or suffer from poly-trauma were excluded from research. Prognosis was assessed from GCS, age, CT scan findings. Patients having GCS less than 4 were considered having poor prognosis. Serial imaging were taken to see the progression of the disease.Results: Out of 30 patients, 5 patients are female and 25 patients are males. Mean age of patients is 34 years. Age group 30 – 45 have maximum numbers of patients. RTA is a major cause of mortality in our study, particularly for those patients having low GCS i.e., 4. In this study nearly 66.7% patients had post traumatic fits. 46.7% patients had skull fractures. 16.7% patients had EDH 33.3% patients had SDH and 50% patients had contusion/DAI/TSAH.Conclusion: Prognosis in the severe head injury is determined by the age, mode of the injury, CT findings, resuscitation, and GCS
A Study of Risk Factors of Stroke in Department of Neurology at GMC/DHQ Teaching Hospital Gujranwala
Get PDFObjective: To evaluate pattern and risk factors of strokes admitted in the department of neurology GMC/DHQ teaching hospital Gujranwala. Materials and Methods: This study was conducted at GMC Gujranwala during January 2018. Results: During the month of January 2018 total number of admitted patients were 400. Out of these one hundred were of stroke. Males were 61, females were 39. Mean age was 57 years while the mean hospital stay was 6.2 days. Among these 100 cases, cerebral infarction were in 54 patients and hemorrhagic in 46 patients. We observed that most of cerebral infarction were in territory of middle cerebral artery, and intracerebral hemorrhages were mostly thalamic region followed putamen. It was further seen that hypertension was the most common risk factor in 56 patients, ischemic heart disease (IHD) 28, and diabetes in 10 patients. The mortality was 20% more in patients of hemorrhagic strokes. Glasgow coma scale was an important determinant of outcome of stroke. Conclusion: Our study concluded that Ischemic Strokes are slightly higher than Hemorrhages stroke. GCS is an important determinant in the outcome of stroke. 33% of intracerebral bleeds die shortly after admission.