Pakistan Journal Of Neurological Surgery
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Clinical Manifestation of Brain Abscess
Get PDFObjective: To determine the clinical presentations of brain abscess.Study design: Descriptive study.Place and Duration of Study: Hayatabad Medical Complex Hospital Peshawar Khyber Pakhtoonkhawa from 1st February 2001 to 31st July 2011.Material and Methods: A total 31 patients with symptomatic brain abscess confirmed on CT scan were included in this study. Both gender (male and female) and patients in the age range of 01 – 70 years were included in this study. The patients’ demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11.Results: Out of 31 patients, there were 17 (54.8%) males and 14 (45.2%) females. The age of patients ranged from 01 to 70 years. In this study the overall mean age was 32.38 years. Majority of patients 13 (41.9%) were in the age range of 31 – 40 years. Most common clinical presentation of patient were headache in 29 (93.5%) vomiting 22 (71%) and fever 13 (42%) patients.Conclusions: Brain abscess commonly occurred in the third decade of life. Headache vomiting and fever were the most common clinical presentation of brain abscess
To Evaluate the Outcome of Endoscopic Removal of 3rd Ventricle Colloid Cyst
Get PDFObjective: To analyze the outcome of 3rd ventricle colloid cyst removal by endoscopic approach. Material and Methods: It is a prospective observational case series study. About 11 patients of third ventricle colloid cyst were included. Site of the study was Neurosurgery B department, Lady Reading Hospital, Peshawar. Study duration was from July 2015 to June 2017. All routine investigations were done including CT brain and MRI .The clinical presentation, radiological findings, post-surgery outcome was analyzed. Endoscopic approach was applied in all cases using a rigid endoscope through right pre-coronal burr hole. Results: our study consisted of total 11 patients. Headache and giddiness were the most common presentations (n = 9). 5 patients had change in vision. 2 patients suffered ataxia. One patient presented with urinary incontinence. Post-operative hydrocephalus was observed in only one patient.no recurrence was noted on follow-up visits, Conclusions: Endoscopic approach to colloid cyst treatment is safe and effective with low complications rate
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
FORTHCOMING NEUROSURGICAL EVENTS
Get PDFWe 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
Surgical Outcome of Chiari-I Malformation
Get PDFObjective: To determine outcome in patients operated for Chiari-I Malformation.Study: Descriptive case series.Materials and Methods: Patients admitted in the Department of Neurosurgery, Bolan Medical College/ Hospital Quetta Pakistan from January 2013 to June 2017 with Chiari-I Malformation diagnosed on MRI and candidates for surgery based on consistent symptoms. MRI findings regarding cerebellar tonsillar termination in mm were recorded. Surgical Intervention consisted of suboccipitalcraniectomy, C1+/- C2 laminectomy(ies), reduction/ resection of cerebellar tonsil and expansion/augmentation duroplasty. Patients were followed-up after 6 months and outcome was determined by Chicago Outcome Scale for Chiari Malformation.Data Analysis: SPSS version 20 software was used.Results: Out of total of 39 patients 30 (77%) were females and 9 (23%) were males with Female to Male ratio of 3.3:1. Age ranged from 21 to 42 years. 35 (90%) patients presented with Valsalva headache, 34 (87%) with neckache, 25 (65%)with ataxia, 25 (65%) with paresthesia/numbness, 17 (44%) with sleep apnea, 16 (40%) with dysphagia, 15 (39%) with weakness, 12 (31%) with dizziness, 11 (27%) with visual disturbances, 9 (24%) with nausea/vomiting while 7 (18%) with tinnitus. 34 (88%) patients had tonsillar herniation more than 5mm while 5 (12%) had tonsillar herniation more than 10mm. Out of total of 39 patients 30 (77%) had good outcome while 9 (23%) had worse outcome.Conclusions: Surgical decompression in Chiari-I Malformation should be offered to only those patients who are consistently symptomatic and their symptoms correlate with CM1. Surgery has favorable outcome in patients without significant cord damage and less severe neurological deficit before surgery
A High Grade Diffuse B Cell Lymphoma Patient Presented with Isolated Large Space Occupying Lesion in the Frontal Lobe Mimicking High Grade Glioma or Fungal Granuloma Case Report and Review of Literature
Get PDFPrimary high grade B-cell-type cerebral lymphoma is a rare subtype of primary central nervous system lym-phoma. We herein report an unusual case of diffuse B-cell lymphoma in a young lady who presented with a large intracerebral space occupying lesion without extracranial involvement. The notable aspects of this case include the patient was having a short clinical history of symptom onset, rapid neurological deterioration having severe midline shift on imaging and a final histopathological diagnosis was consistent with high-grade diffuse B cell lymphoma after subtotal surgical resection. Extracranial extension of the disease was unremarkable on PET scanning. This case highlights the challenges neurosurgeons face, especially in the emergency setting, when the disease manifests in varied presentations. 
Role of Endoscopic Assisted Microsurgery for Pituitary Tumors
Get PDFObjective: To determine the outcome of endoscopic assisted microsurgery for pituitary tumors in terms of gross tumor removal and visual field improvement. Materials and Methods: This Descriptive case series conducted at Department of Neurosurgery, Lahore General Hospital Lahore over a period of six months from July 2012 to December 2012. Sixty five patients were included through non-probability purposive sampling technique. All cases of pituitary tumor diagnosed on MRI/CT scan of either gender having age 18 – 80 years and patients with recurrent cases, sellar and with suprasellar extension (assessed on CT and MRI findings). Informed consent was taken from the patients. All laboratory tests were done in hospital laboratory and reported by hospital pathologist Shaukat Khanum Memorial Hospital Lahore. Pre- and post-operative visual field status (at least 3 months after surgery) was analyzed. Surgery was performed by a single team of surgeons. Surgical procedure involves introduction of 4-mm to 2.7mm endoscope to visualize the sphenoethmoid recess. The bilateral sphenoid Ostia are entered. The posterior nasal septum was incised at middle turbinate and it was patients resected. All the data was entered and analyzed by using SPSS 20. Fre-quency and percentages were calculated for all qualitative variables like gross removal rate and visual filed improvement. Results: The mean age of the patients was 50.46 ± 17.80 years. There were 64.62% male patients and 35.38% female patients. Gross removal of tumor was observed in 56 (86.2%) and visual field improvement was found in 92.31% patients. 56 patients were those in which gross removal of tumor was observed in which 34 were males and 22 were females, similarly in 9 patients them was subtotal resection of tumor in which 8 were males and only 1 was female. Conclusion: In this study, gross removal of tumor as well as visual field improvement was found in maximum number of patients and it is concluded that endoscopic assisted microsurgery for pituitary tumors is a better technique for such surgeries. 
Early Treatment of Craniosynostosis by Using Endoscopic – Assisted Minimally Invasive Techniques
Get PDFObject: The conventional calvarial remodeling procedures are being replaced by minimally invasive endoscopic-assisted suturectomies across the globe. The object of the study was to evaluate the efficacy of these minimally invasive techniques of strip craniectomies in our population.Material and Methods: A total of 70 patients, below 4 months of age, with metopic, coronal or sagittal suture premature fusion were treated during a period of three years from Nov. 2009 – Nov. 2012, using minimally invasive endoscopic-assisted techniques.Results: The sagittal suture synostosis group consisted of 28 patients, 19 males and 9 females with a mean age of 3 months. The group with coronal synostosis consisted of 17 patients, 8 males and 9 females with a mean age of 3.2 months. Metopic group consisted of 25 patients, 17 males and 8 females with a mean age of 2.3months. All these patient were chosen for minimally invasive strip craniectomies with the help of rigid neuroendoscope instead of conventional suturectomy. There were 4 intra-operative and 3 post-operative blood transfusions (10%). The mean surgical time was 55mins. All but 3 patients were discharged on 1st post-operative day (96%).Complications included 3 dural tears, 2 sagittal sinus injuries and 2 pseudo-meningoceles (10%). 2 cases had superficial wound infection of the skin and there was no mortality. Using anthropometric measurements and photographic assessment, excellent results were obtained in 78%, good results in 14% and poor in 8%.Conclusion: Coronal, metopic and sagittal synostosis can be treated at a very early age satisfactorily with minimally invasive endoscopic-assisted technique with good cosmetic results and limited blood loss
Different Treatment Modalities for the Management of Spinal Tuberculosis
Get PDFObjective: To study the rationale of different treatment modalities of caries spine, anti tuberculus therapy (ATT), abscess drainage, spinal cord decompression and stabilisation.Materials and Methods: In this descriptive study number of patients were 132 conducted in the department of neurosurgery Lady Reading Hospital, Peshawar. From Dec.2008 to Dec. 2012.Results: Local spinal pain was relieved in 98.5%, tenderness improved in 97.7%, Paresis and plegia in 81.1%, Kypotic deformity reduced in 43.2%, approved sphincter functions improved in 40.6% cases. Morbidity was 2.3% and mortality (0.8%). Surgical procedure was abscess drainage in 8% and anterior decompression and stabilization was in 61% cases. All patients were treated with standard ATT regimen 4 drugs for 2 to 3 months and 3 drugs for 10 – 16 months and analgesics and followed for 18 months. Male were 83 (62.9%), female 49 (37.1%) minimum age 3years, maximum 70 years and mean ± SD 30 ± 15 years. Inclusion criteria: Patients hav-ing spinal TB. Exclusion criteria: Spinal pyogenic infection, metastasis and metabolic bone diseases. Informed consent and ethical committee approval was taken. Diagnosis was made on history and clinical examination of local tenderness, kyphotic deformity, paraparesis / plegia, tetraparesis / plegia and sphincter dysfunction. Investi-gations were x-ray chest, spine 3D CT and MRI. Erythrocyte sedimentation rate (ESR) and biopsy of the necrotic materials were done. Patients were treated with stanandard ATT, neurological improvement and radiological stability was assessed. Patients were divided in Group – A: Only ATT or abscesses drainage and ATT. Group-B: Spinal decompression and stabilisation with ATT. All information were recorded on a proforma. Data was analyzed using SPSS version 19.Conclusions: Early diagnosis and treatment had excellent outcome. Dorso-lumbar spine involvement and young age was common. Advanced cases needs multimodal therapy (medical, surgical and supportive). Some degree of kyphotic deformity still remained
Postoperative Rise in Serum Sodium Level, an Indicator of Diabetes Insipidus after Pituitary Adenoma Surgery
Get PDFoai:ojs2.pakjns.org:article/8Objective: To study the efficacy of post operative rise in serum sodium level as indicator of diabetes insipidus after pituitary adenoma surgery.Materials and Methods: The study was randomized control trial. It was conducted in Department of Neuro-surgery and Biochemistry from March 2016 to December 2017 (22 Months) Punjab Institute of Neurosciences/ Lahore General Hospital/Postgraduate Medical Institute/Ameeruddin Medical College. Ethical approval was obtained from hospital Ethics Committee. Total no. of 169 patients were enrolled for transsphenoidal surgery of their pituitary adenoma. Sample size was calculated from the reference study conducted by Schreckinger M et al10. Non probability consecutive sampling technique was used to collect the sample size. Data was calculated from all the patients regarding age, gender, duration of transsphenoidal surgery, postoperative evidence of diabetes insipidus by measuring rise in serum sodium level < 145mEq. Mean and standard deviation were calculated for demographic variables like age and gender while frequency and percentage were calculated for outcome variables like type of diabetes insipidus and sensitivity and specificity of serum sodium > 145mEq test. Chi square test was applied and analysis was done using computer software SPSS version 23. P value less than 0.05 was considered significant.Results: Overall, 100% (n = 169) patients were enrolled in this study, both genders. Gender distribution showed there were 68% (n = 115) males and 32% (n = 54) females. The mean age of the patients was 40.88 ± 4.95 years. Post-operative transient noted in 13.6% (n = 23) patients. Serum sodium level (specific) observed in 92.9% (n = 157) patients. While, > 145 mEq sensitive was observed in 88.2% (n = 149) patients (Table 1). The main outcome variable of this study was diabetes insipidus permanent, in our study, it was noted in 9.5% (n = 16) patients (Table 2). There was no association between diabetes insipidus permanent and effect modifiers (Table 3).Conclusion: From this study we conclude that level of sodium > 145mEq is very sensitive and specific test which can be used to predict the outcome after pituitary adenoma surgery in the form of Diabetes Insipidus