Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Posterior Cervical Foramenotomy
Get PDFObjective: Objective of the study was to evaluate the surgical outcome of posterior foraminotomy in patients with cervical spondylotic radicular symptoms.Material and Methods: This descriptive observational study was conducted at the department of neurosurgery lady reading hospital Peshawar from July 2012 to June 2018 (6 years). The author has personal experience of 29 patients during the study period. All consecutive patients who underwent posterior cervical foraminotomy for cervical spondylotic radiculopathy included in the study, irrespective of their age and gender. After approval from the hospital ethical committee, informed consent was taken from patients or their relatives. The patients were followed up improvement of symptoms and post-operative complications. The data was entered in a specially designed Performa. Patients’ data was analyzed using SPSS version 21.Results: We had total 29 patients during the study period who full fill the inclusion criteria. Most (65.5%) of our patients were men. Age of the patients ranged from 23-66 years with the mean age of 44.5% year. The most common level involved was C6-7 (41.4%) followed by C5-6 (37.9%). The most common operative indications for cervical radiculopathy was lateral soft disc herniation followed by osteophyte formation and foraminal stenosis. Post operatively arm pain relieved in almost all patients. Pins and needles, improved in 79.3% cases. Post-operatively neck pain and superficial wound infection was observed each in one (3.4%) case. One of our patients improved initially, but after 2 months had recurrent of symptoms and needed anterior cervical discectomy.Conclusion: We conclude from our study that cervical spondylotic radiculopathy patients respond well to posterior cervical foraminotomy. This procedure is having an acceptable complication rate. This is an effective and safe procedure. This approach can be an alternative treatment choice in patients with cervical radiculopathy secondary to lateral disc herniation, and or foraminal stenosis
Assessment of Nocturnal Pain Control Outcomes Following Open Surgical Release of Carpal Tunnel Syndrome
Get PDFObjective: To assess the Nocturnal Pain Control Outcomes of Open Surgical Release of Carpal Tunnel Syndrome.Study Design: Descriptive case series.Place and Duration of Study: Medical Teaching Institution, Govt. Lady Reading Hospital Peshawar from 3/5/2016 to 3/11/2016 (six months).Materials and Methods: Patients of tunnel syndrome (CTS) of both gender and age ranging from 20 to 60 years were included. Patients with recurrent carpal tunnel syndrome and those having previous wrist surgery done for other diseases were excluded. Diagnosis was done on history, clinical examination and electrophysiological studies. Open surgical release was done in all cases. Patients were followed after 10 days and were assessed clinically on visual analogue scale. Statistical tests with significance of P < 0.05 were utilized using statistical package of social sciences (SPSS version 17).Results: Mean age of the study participants was 39.90 ± 3.99. Twenty one percent (21%) patients were male and seventy nine (79%) patients were female. Fifty – eight percent (58%) of the patient had CTS in right hand while forty – two percent (42%) had in the left hand. Eighty two percent (82%) patients had controlled pain while eighteen percent (18%) patients had uncontrolled pain.Conclusion: Our study concludes that eighty two percent (82%) patients had complete relief of nocturnal pain in patients presenting with carpal tunnel syndrome after open surgical release
Visual Improvement after Endoscopic Endonasal Transsphenoidal Excision of Pituitary Gland Tumor
Get PDFObjective: To evaluate the frequency of improved visual acuity after Endoscopic Endonasal Transsphenoidal excision of pituitary gland tumor.Study Design: Descriptive case series.Materials and Methods: In our study, Pre-operative visual acuity was noted by using the Snellen’s chart. Then patients underwent pituitary gland excision though Endoscopic Endonasal Transsphenoidal approach under general anesthesia. After surgery, patients were shifted in postsurgical wards and then will be discharged from there and were examinedfor 3 months in OPD. Snellen’s chart was used to evaluate patents for visual acuity after 3 months by an experienced ophthalmologist having at least 4 years residency experience If visual acuity increased ? 1 line, then improved visual acuity was labeled.Results: Improved visual acuity after pituitary gland tumor excision was seen in 59(89.39%) patients. Age and gender of patients did not show any statistically significant association for improved visual acuity.Conclusions: Results of this study showed that pituitary gland tumor excision through Endoscopic Endonasal Transsphenoidal approach is effective in terms of visual acuity improvement. Our main objectives in pituitary surgery are protection and reinstatement of vision and this surgical approach give maximum cover to vision restoration
Outcome of Lateral Mass Fixation and Fusion – A Comprehensive Analytical Study of 205 Lateral Mass Screws in 35 Patients at Punjab Institute of Neurosciences
Get PDFObjective: To see outcome, accuracy and expected complications in passing lateral mass screws in patients with cervical spine injury, degenerative disease at the cervical spine level and neoplastic lesions.Materials and Methods: In this study, 35 patients were included and 205 screws passed in lateral mass patients’age ranged from 12-70 years (25 males and 10 females) with trauma to the cervical spine, degenerative disease at the cervical spine level and Intradural extramedullary benigntumors and extradural malignant neoplasm.Patients less than 12 years and more than 65 years of age,patients with traumatic ruptured disc causingspinal cord compression anteriorly and operated for cervical spine were excluded from our study.In all patients,we did lateral mass fixation with polyaxial screws and rods under fluoroscopic assistance.For assessment of screws trajectory and position, CT scan cervical spine with 3D reconstruction was performed on a first post op day to confirm screw orientation and direction and for fascet, foraminal, foramen transversarium violations.Results: All screws were passed by using Megrel’s trajectories. Not a single patient had nerve root, cord injury nor vertebral artery injury. One patient had screw pullouts requiring reoperation.12 to 14mm size screws were used under fluoro guidance. On postoperative CT cervical spine with 3D reconstruction shows no breach or violations of any foramen transversarium, nerve root injury or neural foramen penetration by screws. In all patients polyaxial screw/rod construct was used. Conclusion: Cervical spine lateral mass fixation with polyaxial screws is a safe and effective technique in expert hands under fluoroscopic assistance
Spontaneous Rupture of Intra Cranial Dermoid Cyst: A Case Report
Get PDFIntracranial dermoid cysts are benign, slow growing, congenital lesions that comprise less than 1% of all intracranial lesions. They are usually asymptomatic unless they get ruptured, either spontaneously or after head injury. We present a case of a ruptured intracranial dermoid cyst, at sellar/suprasellar region, in a middle aged male with multiple known comorbids. He presented in Accident and Emergency Department with severe headache, behavioral changes and vomiting. Radiological investigation were carried out showing ruptured intracranial dermoid cyst with dissemination of its contents into the ventricles and the sub arachnoid space causing hydrocephalus
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 academi
Editor Note
No full textDear ReadersPakistan Journal of Neurological Surgery achieved multiple miles stones for its upgradation. Now all submission of articles will be via online on our email [email protected] then it is processed for plagiarism, peer review etc. last 25 Issues are available online now. We hope our readers will benefit from its online website. We had been indexed in multiple International agencies like ISSN France, BASE Germany, Asian Digital, ESJI (Eurasian Scientific Journal Index) and www:citifactor.org. Few more are a process.Foreign Training ScholarshipsDuring the Neurotrauma Conference at Peshawar, PSN had meeting with Mr. Franco Servadei President WFNS. He agreed to provide short term training/visits of PGRs or young Neurosurgeons to the well established centers of the world. PSN is in contact with International Societies and many short term Visits 2/3 Months are available. All young Neurosurgeons/Senior PGRs should avail these opportunities. The International Candidates should apply to PSN Executive Committee VIA Dr. Muhammad Usman Publication. Secretary PSN or President PSN Prof. Salman Sharif.Need of Neurosurgery Institutes of Neurosciences in the CountryWorld over there is new concept of making institutes of Neurosciences. Similarly other institutes Like PIC, FIC, MIC (of Cardiology) and Children Hospital are delivering a great service to the patients. The Pakistan Society of Neurosurgeons demands establishment of Neurosciences Institutes all over the country which should be autonomous. PSN Executive Committee had approved a resolution for such Institutes among all Province of Pakistan and one at Islamabad by Federal Govt. of Pakistan. All members of PSN are requested to struggle for multiple neurosciences institutes in the country
Catheter Drainage for Chronic Subdural Hematoma
Get PDFObjective: To evaluate the functional outcome of patients having chronic subdural hematoma (CSDH) in terms of Glasgow Outcome Scale subjected to single burr-hole craniostomy and catheter drainage without prior subdural space irrigation.Materials and Methods: This study was performed in Neurosurgery Department, PGMI Lady Reading Hospital, Peshawar, Pakistan from January 01, 2016 to December 31, 2016. Through a Descriptive Case Series, 116 patients presenting with CSDH were included in the study in a consecutive manner, subjected to single burr hole craniostomy and catheter drainage and followed up for up to 06 weeks.Results: The mean age group of the sample was 37.31 +/- 10.74 years, of which 69% were male and 31%female patients respectively. At the presentation, there were 37.06% of patients in Class I group with GCS13-14, 47.41% of patients in Class II group with GCS 9-12 and 15.52% of patients in Class III group with GCS 3-8. On follow up, Glasgow Outcome Score of the sample was 4.04 +/- 0.75, with 84.48% favorable and 15.52% unfavorable outcome respectively.Conclusion: This study suggested that chronic subdural hematoma managed with single burr hole subdural catheter drainage is associated with a high frequency of a favorable outcome in terms of Glasgow Outcome Score. Admission Glasgow Coma Scale of less than 8 and advanced age are associated with lesser frequency of favorable outcome and more prone to unfavorable outcomes
International Neurosurgical Events
Get PDFFORTHCOMING NEUROSURGICAL EVENTSWe are delighted to publicise forthcoming events which may be of interest to our members. If you would like your event to appear on this page please send details to both Amy Pinchbeck – Smith and Lucinda Foster. Or Our Email: [email protected] 2019Comprehensive Endoscopic Endonasal Surgery of the Skull Base. UPMC Center for Cranial Base Surgery, UPMC Presbyterian Hospital, Pittsburgh, PA. Wednesday, July 31, 2019 - Saturday, August 03, 2019. Contact: Mary Jo Tutchko. Phone: 412.647.8186. Email:[email protected]
Prevalence of Post Traumatic Amnesia after Mild Closed Traumatic Brain Injury by Galveston Orientation and Amnesia Test
Get PDFObjective: We evaluated the frequency of post traumatic amnesia (PTA) in close mild traumatic brain injury (TBI) via. Galveston Orientation and Amnesia Test (GOAT).Materials & Methods: A total of 115 patients with mild TBI, both male and female, aged between 14 to 60 years and presenting within the first 6 hours were included. Assessment with the GOAT was performed within 6 hours of admission. Post traumatic amnesia was recorded.Results: Patients’ mean age was 39.21 years. Majority of the patients (64.34%) were between 36- 60 years of age. Prevalence of post traumatic amnesia (PTA) in closed mild TBI was found in 27.83% patients, whereas, there was no post traumatic amnesia in 72.17% patients. Mean admission GCS was 14.54 and the mean GOAT score was 83.89 in all patients GCS 14/15. There was more prevalence of PTA in age 36-60 years, in male patients and “time since injury” in >3 hours. Mean GOAT was 68.3 in patients (30.19%) with PTA with GCS 14, whereas, mean GOAT was 74.8 in patients (25.80%) with PTA with GCS 15.Conclusion: 30.19% patients with GCS 14, were positive for PTA (GOAT: 68.3). Overall, 28% patients were positive for PTA. This study concluded that prevalence of post traumatic amnesia in mild TBI is relatively high in our study as compared to other recent reports.Abbreviations: TBI: Traumatic Brain Injury. PTA: Post Traumatic Amnesia. GOAT: Galveston Orientation and Amnesia Test. GCS: Glaucoma Outcome Scale. LOC: Loss of Consciousness. CT: Computed Tomography