Pakistan Journal Of Neurological Surgery
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Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury Associated with Elevated ICP and Brain Edema
Get PDFObjective: The aim of this study was to analyze the outcome of decompressive craniectomy in patients of traumatic head injury done in MTI, DHQ teaching hospital.Materials and Methods: 189 patients with head injury were operated in a period of 15 months (April 2018-June 2019). Among 189 patients only 50 (32 men and 18 women) were treated with decompressive craniectomy (DC). We analyze only 50 cases that were treated with DC. Demographic details, GCS, time of DC and complications were recorded. Glasgow Outcome Scale was used as a measure of clinical outcome.Results: Out of 50 patients, 18 (36%) showed a complete recovery, mild disability was found in 10 (20%) patients. The percentage of severe disability was observed in 7 (14%) patients asexual condition existed in 5 (12%) patients and the mortality rate was 12% (6 patients). 4 (8%) patients did not report us back. We excluded them from our final result analysis. A good result was presented in 28 patients (56%). Age was found to have a statistically significant association with clinical outcomes (p = 0.002). Moreover, the patients experiencing DC within 18 hours had an improved result (p = 0.001). The better GCS score before surgery was associated with good results (p = 0.001).Conclusion: Decompressive craniectomy is associated with better clinical outcomes in patients with traumatic brain injury associated with refractory cerebral edema and elevated intracranial pressure
Analysis of Head Injuries Due to Motorcycle Accidents Attended in Medical Teaching … 182 Institute (MTI), DHQ, Gomal Medical College (GMC), Dera Ismail Khan, Pakistan
Get PDFObjective: The consumption of motorbike is increasing in Asia. The aim of this study was to analyze the head injuries due to motorcycle accidents attended in the District Headquarter (DHQ), Dera Ismail Khan. Material and Methods: All the age groups from both genders were part of our study. All the patients show reduced GCS with some sign of having abnormalities on Computed tomography (CT) brain were included in our eligibility criteria. Pedestrians, those died before hospital arrival, complain about any other type of injury other than a head injury, and not have proper admission in the hospital was excluded from the study.Results: 478 patients were included in the current study. More than 44.14% of accidents were reported in patients aged 20 – 29 years. 441 (92.25%) were men, and 381 (79.7%) were driving themselves. Among 478 only 71 (14.85%) were wearing a helmet. Almost 47.48% of the accidents occurred on the weekend. 274 (57.32%) patients reached the hospital within 5 hours after the accident. 218 (45.6%) patients had a head injury. Brain edema was the most common CT abnormality 214 (44.8%).Conclusion: Mainly, the males were affected by a motorcycle accident and face head injury in the third decade of their life. The CT scan indicates brain edema as the most common findings. 45.6% of patients have a severe head injury and a mortality rate of 13.4% was reported. 
Pakistan Journal of Neurological Surgery
Get PDFDear ReadersOur Journal had complete 21 years of Publications. Pakistan Journal of Neurological Surgery achieved multiple miles stones for its up-gradation. Currently, it is recognized by The Higher Education Commission (HEC), Islamabad and Pakistan Medical & Dental Council (PMDC) Islamabad. I am extremely thankful to my editorial team for their efforts and cooperation. We have been indexed in multiple International agencies like ICI (Index Copernicus) Master List, ISSN France, BASE Germany, Asian Digital, www:citifactor.org, PASTIC and PakMediNet.I am glad to inform you that the journal ‘PAKISTAN JOURNAL OF NEUROLOGICAL SURGERY’ (ISSN: 2409-5567, 1995-8811)” has passed the evaluation process positively and is indexed in the ICI Journals Master List database. All submission of articles will be via online on our email [email protected] and [email protected] then it is processed for plagiarism, peer review etc. We hope our readers will benefit from its online Website: http:www.pakjns.orgForeign 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
Proximal Migration of Lumboperitoneal Shunt Catheter Up To Cervical Spine
Get PDFLumboperitoneal (LP) shunt had been in use as an internal cerebrospinal fluid (CSF) diversion for a variety of different indications, namely benign intracranial hypertension, communicating hydrocephalus, slit ventricle syndrome and CSF fistulas. Generally considered to be a simple surgical procedure but certain potential complications are associated with this technique, including chronic subdural hematoma, subarachnoid haemorrhage, acquired Chiari malformations and migration of the shunt tubing.1, 2 Proximal intrathecal migration of LP shunt catheter tip, high up in the cervical spine is a rare reported complication.3, 4, 5, 6, 7, 8 If doubtful on X-rays, Computed Topography (CT) scan confirms the diagnosis. Although multi factorial, this proximal migration is usually because of a faulty technique when anchoring sutures are loosened or cut. Measures employed to avoid this potential complication include appropriate technique for securing the LP shunt tube at the proximal lumbar and the distal peritoneal insertion sites with suture collars, thus enabling fixation of the tube. We report a case of an obese middle age female who developed proximal migration of the lumbar tube up to cervical spine, after having undergone LP shunt for pseudotumor cerebri
Clinical Outcome of Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia at a Tertiary Care Hospital.
Get PDFBackground: - Trigeminal neuralgia is a disease typically characterized by involuntary attacks of lancinating pain in the distribution of the trigeminal nerve that are activated by non-noxious stimuli. Numerous anticonvulsants, either alone or in combination, remain the first choice in the medical treatment of trigeminal neuralgia.3If the disease becomes non responsive, there are numerous surgical options like micro vascular decompression or minimally invasive percutaneous lesioning of the trigeminal nerve, such as glycerol rhizolysis, Radiofrequency Rhizotomy, and balloon compression. Objective: - To determine efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of early pain relief in a tertiary care hospital. Methods: - 62 patients with refractory trigeminal neuralgia or lancinating, recurrent episodes of pain in the distribution of Ophthalmic (V1) and Mandibular (V3) branches of trigeminal nerve, not responsive to 6 months of conservative treatment were included. Study was completed in one year i.e. from March 2015 to Feb 2016. Result: - In our study population, 62 included patients were had mean age 56.08 ± 7.39 years. 44 patients (71%) were male. Our treatment was effective in 58 patients (93.5%) while there was recurrence among 4 (6.5%) only. Conclusion: - It is concluded that the efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of complete relief of pain with intact sensations in treated branch region is excellent (93.5%)
Outcome of Endoscopic Repair of CSF Rhinorrhea with Endonasal Endoscopic Approach in terms of Success of Repair.
Get PDFObjective: This descriptive case series conducted to evaluate the outcome of CSF rhinorrhea repair with the Endonasal Endoscopic approach in terms of success of the repair.Materials and Methods: The study was conducted at Neurosurgery department, Unit II, Punjab institute of neurosciences, Lahore. This study involved 40 patients aged between 3-80 years of both genders diagnosed of CSF rhinorrhea with presented with in 1 week after trauma and spontaneous and postoperative cases.Results: The age of the patients ranged from 5 years to 53 years with a mean of 22.75 ± 15.59 years. Total 30 (75%) male and 10 (25%) female patients are included in the study. The underlying etiology was found to be post-traumatic (67.5%) 27 cases, followed by post-operative in 7 (17.5%) and spontaneous in 6 (15.0%) cases. Successful repair was observed in 36 (90.0%). No significant difference was found in the frequency of successful repair among various age groups; 5-20, 21-36 and 37-53 years (95.7%, 83.3% and 81.8%; p = 0.381), gender groups; male verses female (86.2% and 100.0%; p = 0.194) and etiological groups; post-traumatic vs. post-operative vs. spontaneous (92.6% vs. 71.4% vs. 100.0%; p = 0.169).Conclusions: The frequency of successful repair was found to be 90% in patients of CSF rhinorrhea treated through Endonasal endoscopic approach. No statistically significant difference was found in successful repair frequency across patient’s gender, age and underlying cause of CSF rhinorrhea
Evaluation of Midline Shift and GCS as an Outcome in Severe Traumatic Brain Injury
Get PDFObjectives: We determined the frequency of mortality in patients with traumatic brain injury and to compare frequency of midline shift and poor motor response in traumatic brain injury patients with and without mortality.Materials & Methods: Total 108 patients with severe TBI aged between 18 to 60 years were included. Admission GCS and motor response of post-nonsurgical resuscitation were recorded, along with midline shift on initial CT-scan. All patients were followed for the mortality up to 2 weeks. Chi square test applied for the frequency comparisons of ‘midline shift’ and ‘poor motor response’.Results: Mean age was 38.88 ± 8.94 years. Out of the 108 patients, 68 (62.96%) were males and 40 (37.04%) were females. Mean admission GCS was 3.39 ± 1.87. Mean motor response was 3.12 ± 1.68. Mean midline shift was 7.37 ± 2.09 mm. Mortality was found in 66 (61.11%) patients, whereas, there was no mortality in 42 (38.89%) patients. High mortality percentage (60%) was found in age group: 20-30 years. In male patients, high mortality percentage was found (63.24%) as compared to female patients. Comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’ in patients with mortality.Conclusion: The frequency of mortality in patients with severe TBI was found high. The ‘motor scores’ and ‘midline shifts’ can predict the outcome of severe TBI, because, comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’
Surgical Outcome of Anterior Cervical Discectomy and Fusion (ACDF) with Autologous Bone Graft from Iliac Bone and Miniplate Application Over It
Get PDFObjectives: To know the surgical outcome of ACDF with autologous bone graft from iliac bone and miniplate application over it.Materials and Methods: This prospective study was conducted in the Department of Neurosurgery, Hayatabad Medical Complex and Lady Reading Hospital Peshawar from 1st June 2017 to 31 December 2018. Only those patients having prolapsed intervertebral cervical discs or cervical stenosis were included while those with multiple level involvement, trauma, fracture and previously operated patients for any cervical pathology were excluded. Pre-op and postoperative data were documented. For all patients, tricortical iliac bone autograft and rigid plate instrumentation was used to optimize fusion cervical collar was not used post op. Acquired data were analyzed with SPSS v20.Results: Total 83 patients fulfilled the inclusion criteria and enrolled in the study. Out of these, 48 patients were males and 35 were females. The age range was from 17 to 63 with a mean age 52 years ± 2.5.The C5 – C6 was the commonest site for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. Odom’s criteria was applied to determine the outcome of the procedure. Excellent results were noted in 70 (82%). Ten (12.05%) patients had good results. Conclusion: The ACDF with the tricortical iliac bone autograft and mini plate application is the choice treatment in appropriately selected patients. It increases chances of fusion and abates the need for post op cervical collar. 
Analysis of Efficacy of Depo-Med Role Injection in Post-Operative Pain Relief for Lumbar Discectomy Patients
Get PDFObjectives: The main objective of the study was to analyze the efficacy of Depo-medrole injection in post-operative pain relief after lumbar discectomy. Material and Methods: This study was conducted in the Neurosurgery department of Mayo Hospital KEMU, Lahore during March 2018 to September 2018. The data was collected from 50 patients of lumbar discectomy randomly into two groups. One was operated patients and in group 2 patients were injected with local Depo-med role after lumbar discectomy. We studied the efficacy of Depo-med role injection in the second group. Pain intensity was measured using VAS from the whole sample at two weeks, four weeks, three months and last at one year post operatively.
Results: Data were collected from 50 patients. These patients were divided into two groups, 25 in group one and 25 in group two. The mean age of group one was 30.14 ± 8.15 and for group two was 29.82 ± 7.16. Both groups neither contrasted by age (p = 0.187) nor as indicated by term of side effects (p = 0.639) at the season of operation.
Conclusion: The usage of low dose Depo-med role decreased an abrupt lumbago and pain leg after surgery effectively. But it needs more observations due to small nonrandomized sample. 
FORTHCOMING NEUROSURGICAL EVENTS
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