Pakistan Journal Of Neurological Surgery
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Frequency of Improvement in Muscular Rigidity after Pallidotomy in Medically Refractive Parkinsonian Patients
Get PDFObjective: To find out frequency of improvement in muscular rigidity after Pallidotomy in Parkinsonian patients who are medically refractory.Material and Methods: This prospective descriptive study conducted in Neurosurgical Unit II, Punjab Institute of Neuro-Sciences, LGH, Lahore, during the period of one year from March 2015 to February 2016. They were evaluated before admission by history and thorough examination and then investigated with a CT scan and MRI of the brain. This study included patients as young as 30 years to as old as 65 years. Those patients who had trauma, stroke, demyelination or lesion in basal ganglia were excluded from the study.Results: 75 patients were included in the study with no lost to follow up. At the time of presentation, baseline rigidity graded as 3 in 37 (49.3%) and grade 4 in 38 (50.67%) patients. Reduction in rigidity at ? 25%, was considered significant improvement. At 3 months follow up 49 (65.3%) patients had UPRDS grade 1 while 26 (34.7%) had (Unipied Parkinson’s Disease Rating Score) UPRDSS grade 2 and no patient shown UPRDS grade 3 or 4. Out of 37 patients who had UPRDS grade 3 at baseline, 32 had grade 1 while 5 had grade 2 after Pallidotomy. Out of 38 patients, who had UPRDS grade 4 at baseline, 17 had UPRDS grade 1 while 21 had UPRDS grade 2 after pallidotomy. The difference was calculated to be significantly high (p < 0.001).Conclusion: Pallidotomy is one of the successful surgical procedures to reduce Parkinsonian muscular rigidity
Pakistan Journal of Neurological Surgery achieved multiple miles stones for its up-gradation
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Pakistan Journal of Neurological Surgery achieved multiple miles stones for its up-gradation. Currently, it is Higher Education Commission (HEC), Islamabad and Pakistan Medical & Dental Council (PMDC) recognized. I am extremely thankful to my editorial team for their efforts and cooperation. We had been indexed in multiple International agencies like ISSN France, BASE Germany, Asian Digital, www:citifactor.org, PASTIC and PakMediNet. All submission of articles will be via online on our email [email protected] then it is processed for plagiarism, peer review etc. We hope our readers will benefit from its online website
Outcome of Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy
No full textObjective: To asses’ surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-levels Cervical Spondylotic Myelopathy .
Methods: A total of 90 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between January 2017 and October 2018 were divided into three different groups, the 2-level group (65 patients), the 3-level group (20 patients) and the 4-level group (5 patients). The clinical and Radiographic outcomes like Neck Disability Index (NDI) score, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared between different procedures.
Results: At a minimum of 1-year follow-up, no statistical differences in NDI score, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups , and in terms of postoperative total ROM, the 3- level group was superior to the 4-level group and inferior to 2-level group (P,0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group.
Conclusions: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible
Outcome of Endoscopic Third Ventriculostomy: An Experience of 80 Treated Patients
Get PDFObjective: To examine the outcome of Endoscopic Third Ventriculostomy in 80 consecutive patients operated in Irfan General Hospital and Prime Teaching Hospital Peshawar.Materials and Methods: Prospective observational study was conducted in the neurosurgery department of Prime Teaching Hospital and Irfan General Hospital Peshawar. 80 patients (48 male and 32 female) were followed for 3 months. The inclusion criteria all patients with Third ventricular hydrocephalus were included in this study and the exclusion criteria unwilling patients and those who opted for VP shunting rather than ETV. Data was analyzed using SPSS version 22.Results: ETV was performed in 80 patients. With highest success rate inAqueductal stenosis and posterior fossa tumors 88% and 87% respectively. ETV had a lowest success score of 50% in patients with Hydrocephalus TBM. Common post-operative complications were seizures and CSF leakage.Conclusion: ETV is less invasive and effective treatment for non-communicating hydrocephalus.ETV is most effective in treating aqueductal stenosis and posterior fossa tumors. The overall success rate of ETV is 74%. Based on these findings, it is recommended that ETV should be attempted as first line treatment for patients with triventricular hydrocephalus due to various pathologies
Intra Ventricular Migration of External Ventricular Drain Tube
Get PDFMigration of the proximal end of the External Ventricular Drain (EVD) tubing in the ventricular system of a hydrocephalic brain is a rare complication. This event could be multi factorial; and measures, including appropriate careful nursing and securing of the anchoring knot are to be employed to avoid this potential complication. We report a case of an infant with intra ventricular hemorrhage, gross hydrocephalus and fits.After an initial management with anti-epileptic and repeated fontanelle tap, a Ventriculo. Peritoneal (VP) Shunt was placed which over drained the Cerebrospinal Fluid (CSF); resulting in subdural hygromas. The VP Shunt was replaced with an EVD. On the seventh post-operative day, the Computed Tomography (CT) Scan revealed the proximal intra ventricular migration of the EVD tube with no clinical signs of obstruction. The scalp dressing was removed to reveal that the non-absorbable anchoring knot of the tube had cut through the skin. The EVD tube was pulled till the desired length within the ventricle and was properly anchored. Post procedural CT scans showed the desired length of intra ventricular EVD tube. It is recommended for the neurosurgical nursing staff to be vigilant enough during feeding them and especially while changing posture for nursing to prevent such mishaps. Daily assessment of the wound dressing would assist in insuring a secured knot over the tubing on the scalp
Functional outcome of Microvascular Decompression for Trigeminal Neuralgia
Get PDFObjective: To know functional outcome of microvascular decompression in trigeminal neuralgia.Materials and Methods: This prospective study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from July 2014 to Dec. 2017. Patients with idiopathic trigeminal neuralgia with failed medical treatment were included in this study. A Barrow Neurological Institute pain score was calculated for all patients’ pre and post operatively. Microvascular decompression was done in all cases and follow up done in the outpatient department of all operated cases.Results: Thirty six patients were included in the study and operated for trigeminal neuralgia. Pre-operatively 20 (55.5%) patients had a score of 5 and 16 (44.4%) had a score of 4. Postoperatively, at the last clinic follow up, 18 patients (48.6%) had a score of 1 while 15 (37.8%) had a score of 3 and 3 (8.1%) had a score of 4. Complication developed in nine cases which included cerebrospinal fluid leak (3 patients), 1 patient hearing loss, 2 patients developed wound infection, 1 patient meningitis and cerebellar hematoma in 1 patient.Conclusion: Good preoperative workup in the form of history, physical examination, radiological workup and microsurgical techniques are pivotal for a successful outcome. Microvascular decompression is currently a safe and effective treatment option for patients having trigeminal neuralgia not responding to medical management
Surgical Outcome of Cerebellopontine Angle Tumors
Get PDFObjectives: The purpose of this study was to evaluate the clinical features and surgical outcome of CP tumors with retractorless method.Material and Methods: It is a retrospective study of 7 cases operated in Neurosurgery Unit 1, PINS/Lahore General Hospital, Lahore. Study span was 2 months and follow up duration was 15 days. Predominating symptoms were related to cranial nerves 5th, 6th, 7th, 8th and cerebellum.Results: Age range was 25 – 45 years with an average age of 35 years. 4 patients were male and 3 patients were female. In all patients, surgery was performed. Clinical presentation was tinnitus, decrease hearing, hearing loss, abnormal balance, headache, facial numbness, buccal numbness, ataxia and trigeminal neuralgia in one case. All patients were operated through retrosigmoid sub-occipital approach with retractorless method. VP shunt was inserted in 3 cases and EVD was done in all other cases just before surgery. Histopathology report was 4 patients were of vestibular schwannoma, 2 were of meningioma and 1 was of epidermoid cyst. Five patients operated successfully with no new focal neurological deficit. One patient died intraoperatively and one patient was re-explored postoperatively due to intracranial hemorrhage.Conclusion: It is concluded that surgery via the retrosigmoid approach with retractorless method is relatively safe corridor for the treatment of CP Angle Tumors
The Woes of Economic Burden of Traumatic Brain Injury (TBI) Cases Borne by Public Sector Hospital of Pakistan
Get PDFObjectives: To highlight the role of public sector hospitals in sharing the major burden of severely head injured patients in a resource constrained economically striving countryMaterials and Methods: The study was conducted in the Neurosurgery department of Jinnah Hospital, Lahore, Pakistan. 70 patients with moderate to severe TBI cases above one year of age were included. The data was analyzed for the cost estimation for the period of six months, for the following heads: 1) hospital cost per day, 2) ICU setup cost per day, and 3) salaries of hospital staff per day.Results: There were 53 cases of moderate injury and 17 cases of severe injury. Mean hospital stay was 14 days, minimum number of stay was 2 days and the maximum number of stay was 124 days in six months. Overall, in six months, per day cost of hospital bills head was Rs. 42,333/1130/€ 1016 per day. The salary head’s total cost was Rs. 2573/16.06/€ 14.44. The grand total of all heads, (bills, ICU setup & salaries) was Rs. 22,482,29/1409/€ 1270.Conclusion: We evaluated the cost effectiveness of the Neurocritical care unit of a public sector hospital who provides the best possible health care facilities at a cheaper rate as compared to developed countries. We are highlighting the economic burden borne by the developing country’s government
