Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Cerebellopontine (CP) Angle Tumors
Get PDFObjective: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of CP angle tumors.Material and Methods: This is a retrospective study of 10 cases admitted in the Department of Neurosurgery, Shaikh Zayed Hospital, Rahim Yar Khan during the last 8 years. The predominating symptoms here related to the seventh and eighth cranial nerves and headache.Results: Study included 10 cases of CPA Tumour clinical presentation was hearing loss, tinnitus, abnormal bala-nce, headache, facial numbness and buccal numbness, ataxia and trigeminal neuralgia. We had 10 patients, came with above clinical presentations. All cases were operated through retromastoid sub-occipital craniectomy. VP shunt was inserted in 1 case. Histopathology report was four patients vestibular schwanoma three tentorial meni-ngioma, two epidermoid cyst and one patient had choroid plexuses papilloma.Complications: One patient developed meningitis due to cerebrospinal Fluid leakage at operative site. Lumber drain was placed to control leakage and infection was controlled by aggressive treatment. There was no mortality in our study. One patient developed recurrence of epidermoid cyst at the same site after seven and half years. None of the patients developed further cranial nerve deficit as compare to preoperative deficit. The maximum period of follow-up of one patient was seven and half year.Conclusion: It is concluded from this study that the retrosigmoid corridor is the safe surgical approach for CPA tumors. In case of CP angle epidermoid, there was no recurrence symptoms on the immediate follow-up. At ope-ration, the root entry zone of TN should be examined for evidence of additional vascular compressio
The Role of Intracranial Pressure (ICP) Monitoring in Severe Traumatic Brain Injury (TBI)
Get PDFThe management of patients with severe head injury is a prodigious task for any neurosurgical team. After the initial life support, the management plan of patient with traumatic brain injury rest on the findings of a cranial CT scan. The treatment options of TBI differ with severity of trauma. Osmotic diuretics in the acute phase can be helpful. Hyperventilation is a method to be used in conjunction with other options in certain situations. Normal values of intra cranial pressure (ICP) vary with age, being 10 to 15 mm Hg in an adult. Intra cranial pressure (ICP) values of 20 to 30 mm Hg shows mild intracranial hypertension, while sustained intra cranial pressure (ICP) values more than 40 mm Hg indicate life-threatening malignant intracranial hypertension which should be lowered immediately. Measuring the intra cranial pressure of severe traumatic brain injury patients is now mandatory as it allows an effective and control way of lowering the raised ICP with very good outcome results.Objective: To adjust the ICP lowering mechanics according to the reading obtained via the ICP monitor in patients after severe head injury so as to minimize the need of ventilatory support and decrease the patients’ stay at hospital.1. To measure the value of ICP by using ICP monitoring in severe head injuries (GCS score below or equal to 8).2. To assess the outcome of the conservative measures in patients in whom ICP was monitored, on the basis of Glasgow Outcome ScaleStudy Design: Prospective descriptive study.Setting: Department of Neurosurgery, Lahore General Hospital, Lahore.Duration of Study: One year from July 2012 to July 2013.Materials and Method: Thirty patients of traumatic brain injury were included in this study. ICP monitoring was done via Integra intra parenchymal Camino bolt and Integra ICP monitors.Results: Out of 30 patients, there were 21 (70%) male patients and 9 (30%) female patients.The male to female ratio was 2.33:1. In 20 (67%) patients the ICP ranged from 25 – 34 mm Hg. There were 10 (33%) patients having ICP of 35 – 50 mm Hg. The mean intracranial pressure was 29.5 ± 6.96. The Glasgow coma scale of our patients was such that there were 2 (6.6%) patients had GCS 5. In GCS 6 there were 20 (66%) patients. There were 3 (10%) patients who had a GCS of 7. In GCS 8 there were 5 (16.6) patients. The ventilation duration was 5 – 15 days. The frequency of hospital stay in our patients 10 – 30 days. There were 2 (7%) patients of Glasgow outcome scale of grade – I. In grade – II, there were 3 (10%) patients, no patient in Glasgow outcome scale grade – III, There were 10 (33%) patients in grade – IV while 15 (50%) patient were in grade – V. In the follow up cases, after 1 month, there were no patient in grade – I. Therewere 3 (10%) patients of GOS grade – II, in grade – III there were 4 (13%) patients, there were 8 (27%) patients grade – IV. 15 (50%) patients patient of grade – V. After 3 month, there was 1 (3%) patient in grade – I. There were 2 (7%) patients of GOS grade – II, in grade – III there were 2 (7%) patients, there were 10 (33%) patients grade – IV. 15 (50%) patients patient of grade – V.Conclusion: It is concluded that ICP monitoring is improving the outcome of traumatic brain injury patients. Most of the patients were in young age. Majority of the patients had a low Glasgow coma scales. In our study most of the patients were male. In this study there is short duration of ventilation in patients and a short hospital stay in patients of TBI in which ICP is monitored and addressed promptly
Mid to Long-term Outcome of Anterior Cervical Discectomy with Fusion
Get PDFBackground: Cervical degenerative conditions such as intervertebral disc prolapse and degenerative cervical spondylosis results in pain and disability, especially in the middle age and elderly. The treatment of choice is surgical decompression once conservative treatment fails. We studied the outcome of anterior cervical decom-pression with instrumented fusion in order to analyse its effectiveness in terms of pain and disability improve-ment. Materials and Methods: This is a retrospective descriptive study. 30 patients were operated during June 2013 and May 2015 (2 years). All patients operated for cervical degenerative conditions were included.Data was collected about neck pain and functional impairment preoperatively using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores. The same scales were used during the follow-period for 6 months. Favourable outcome was defined as 50% reduction in pain and functional improvement to Grade 1 (12 – 15) or normal scores (16 – 17). Results: Mean age was 59.70 years ±8.12SD.Mean preoperative VAS was 6.70 and it was 1.80 ± 0.85 SD at 6 – month follow-up. Mean JOA score was 11.57 preoperatively while at 6-month follow-up, it was 14.97 ± 1.92 SD. There was a significant difference between mean VAS score preoperatively and mean VAS score postoperatively (mean difference; 4.9, 95% CI; 4.48 to 5.32, p < 0.001, t(29): 23.86). Similarly, there was statistically significant difference between mean JOA score preoperatively and mean JOA scores postoperatively (mean difference; -3.4, 95% CI; -3.95 to -2.85, p < 0.001, t(29): -12.61). Conclusion: Anterior cervical decompression with graft placement and instrumented fusion are safe and effective methods for relieving pain as well functional improvement in patients with cervical radiculopathy and myelopathy.Keywords: , , , , surgical outcome
Post Operative Leg Pain Relief after Microdiscectomy through Fenestration in Patients Having Sciatica Due to Lumbar Intervertebral Disc Prolapse
Get PDFObjective: To measure the post operative leg pain relief after Microdiscectomy through fenestration in patients having sciatica due to lumbar intervertebral disc prolapse.Place and Duration of Study: This descriptive case series study was done at Department of Neurosurgery, Nishtar Hospital, Multan from 05-05-2012 to 04-11-2014.Materials and Methods: One hundred patients undergoing Microdiscectomy through fenestration for prolapsed unilateral, single level, lumbar intervertebral disc, meeting inclusion criteria, were selected. Informed consent was taken from the patients. Leg pain was assessed using “visual analogue scale (VAS)” before surgery. Postoperative leg pain was assessed using VAS on 7th postoperative day.Results: Out of total 100 patients 77 (77%) were male and 23 (23%) were female. Mean age was 30.90 ± 7.22 years, the age distribution was from 15 to 45 years. The mean decrease in VAS leg pain score was 4.13 points (from mean pre-operative 7.79 to mean postoperative 3.66 at 7th post-operative day), 97% patients had reported a decrease in VAS score of 2 or greater than 2 points post-operatively. Leg pain relieved in 97 (97%) patients.Conclusion: Good pain relief was observed in our study after Microdiscectomy through fenestration in patients having sciatica. The procedure is safe, effective and reliable in pain management in patients having sciatica due to lumbar intervertebral disc prolapsed
Out Come of Endoscopic Discectomy
Get PDFObjectives: To evaluate the outcome of endoscopic discectomy, in terms of symptomatic recovery in patients with unilateral and monosegmental nerve root compression due to prolapsed, sequestrated or migrated disc in lumbar spine.Study Design: This was a descriptive case series.Setting: Department of Neurosurgery, Lahore General Hospital, Lahore.Materials and Methods: This study included 35 patients with symptomatic lumbar disc herniation. All the patients were treated with endoscopic discectomy. The outcome was determined at 6 months follow up based on McNab’s classification system. Duration of study was 1 year from June 2014 to June 2015.Results: According to McNab’s classification system, 31(88.57%) patients had successful outcome including excellent and good results. Discitis was seen among 3 (8.57%) patients, dural tear in 3(8.57%) patients and recurrence in 1(2.86%) patient.Conclusion: Endoscopic Discectomy is a safe and effective treatment modality for patients with unilateral and monosegmental lumbar disc herniation
A Comparative Study of Operation Theatre Disinfection by Fumigation Using Different Compounds
Get PDFA comparative study of operation theatre disinfection by fumigation using different compounds.Background and Objective: Objective of this study was i) to evaluate the efficacy of formalin and quaternary ammonium compounds (QUAT). ii) To compare the efficacy of both agents/techniques for operation theatre disinfection.Study Design: This was an interventional, Case control study. This study was conducted at Children Hospital & Institute of Child Health Sciences, general operation theatre.Material and Method: A total of 200 samples were collected out of which 80 samples ( plates as well swabs) were collected before and after formalin fumigation and 120 samples prior and after spray fogging using QUAT based compound. The samples were cultured on blood and Mac-Conkey agar. Identification and isolation was performed in microbiology department according to bacteriological standards.Results: During fumigation by formaldehyde 34.3% samples (n = 32) were pre positive while 21.9% samples were post positive on different surfaces. On the other side 47.9% samples (n = 48) were pre positive while only 18.7% samples were post positive on different surfaces. Average bacterial count of air reduced from 744 (21 cfu/m3) to 329 (9 cfu/m3) after formalin vapor and 858 (25 cfu/m3) reduced to 492 (14 cfu/m3) after fogging.Conclusion: This study proves that fogging by less toxic compounds takes less time and has fewer disadvantages if we use automatic equipment having fine particle siz
MRI Guided Stereotactic Biopsies or Aspirations in Deep Seated Brain Lesions: An Experience of 146 Cases at Nishtar Hospital, Multan
Get PDFObjective: To determine frequency of positive biopsies or aspirates and safety in deep seated brain lesion, with use of Magnetic Resonance Imaging compatible stereotactic system.Study Design: Prospective cross sectional.Setting: The study was performed at Neurosurgery Department Nishtar Hospital, Multan.Duration of Study: From 01-07-2008 to 30-06-2012.Material and Methods: A total of 146 patients of age between 12 – 18 years of either sex having deep, intrinsic cystic lesion of the brain less or equal to 4 cm2 in size and excluding the extensively vascular lesion diagnosed on Computed Tomography and Magnetic Resonance Imaging underwent Stereotactic biopsy or aspiration with Mag-netic Resonance Imaging compatible Leksell’s stereotactic system. The tissue specimens were analyzed by stan-dard histopathological methods. The safety was measured in context of absence of complications i.e. hemorrhage, new onset of neurological deficit and fits. Data was analyzed via computer software SPSS 10 version for win-dows.Results: Among 146 patients with deep seated cystic brain lesions were selected for aspiration by using MRI guided stereotactic system. Their age ranged from 12 years to 80 years with Mean = 37.73 ± Standard deviation (SD) = 18.12. Among them 86 (58.9%) were male and 60 (41.1%) female. Biopsies or aspirates were positive in 136 (93.2%) cases while negative in 10 (6.8%) cases.Conclusion: We conclude that MRI assisted stereotactic brain aspiration is safe and effective procedure with a high diagnostic yield at our center
Outcome of Traumatic Posterior Fossa Epidural Hematomas
Get PDFObjective: To present our experience in the management and outcome of posterior fossa epidural hematoma (PFEDH).Materials and Methods: It was a descriptive study, conducted in Head injury unit Hayatabad Medical Complex, Peshawar, from December 2009 to October 2012. All patients having traumatic posterior fossa extradural hematoma confirmed on CT Brain were included in this study. The information regarding patient demographical details, clinical presentation, operative finding and post operative follow-up findings were entered into a semi structure Performa. The data was analyzed by SPSS version 17.Results: Out of 41 patients, there were 32 (75.6%) males and 9 (21.9%) females. The age of patients ranged from 5 to 60 years. In this study the mean age was 20.4 years. Majority of patients 17 (41.4%) were in the age range of 21 – 30 years. Pre-operative GCS score were recorded in which most of the patients 21 (51.2%) were in the GCS score 13 – 15. Clinically 33 patients presented with vomiting, 25 with altered level of consciousness, and 29 with headache. Post-operative GCS score were recorded in which 31(75.6%) patients were in the GCS score 13 – 15, 9 (21.9%) patients were in the GCS score 9 – 12 and 1 (2.43%) patient was in the GCS score 3 – 8. Conclusion: CT scan brain should be immediately done if there is even little doubt of posterior fossa extra-dural haematoma (PFEDH). Posterior fossa creniectomy has got good results. Mortality and morbidity can be decreased in PFEDHs if they are diagnosed earlier and promptly treated
Diathermy Stimulation to Avoid Nerve Injuries during Trans-pedicular Screw Placement in Dorso-lumbar Spine
Get PDFObjective: To demonstrate the utility of diathermy in avoiding nerve injuries due to misplacement of trans-pedicular screws (TPSs) during Dorso-lumbar spinal fusion.Study Design: Retrospective studyPlace and Duration of the Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from Oct. – 2007 to Oct. 2012.Materials and Methods: In this retrospective study, diathermy was used to assess whether a screw deviated from the pedicle by observing synchronous leg movements caused by intermittently touching a diathermy to the pedi-cular instrument. Diathermy was performed in 159 cases in which 561 pedicle screws had been placed.Results: Leg movements were observed in 36 cases and the sensitivity of diathermy was 82.7%, the specificity of 98.6%. No neurological complications associated with the placement of pedicular screws were observed after adding diathermy stimulation to the conventional methods.Conclusion: Diathermy may be helpful to avoid nerve injuries during transpedicular screw placement
Endoscopic Third Ventriculostomy as CSF Diversion in Hydrocephalus with Posterior Fossa Lesions
Get PDFObjective: The purpose of this study is to describe the role of External Third Ventriculotomy (ETV) for treating hydrocephalus before or during removal of posterior fossa tumor.Design: Quasi experimental study.Place and Duration of Study: Neurosurgery department Peoples University of Medical and Health Sciences for women Nawabshah, from 1st January 2009 to 31st December 2010.Material and Methods: Patients were admitted for hydrocephalus with posterior fossa tumors. Endoscopic third ventriculostomy performed and posterior fossa tumors were excised completely or partially. Post operative persistent hydrocephalus was treated with repeat ETV or VP shunt.Results: The study population consisted of 8 patients with male preponderance (6 males 75% and 2 females 25%). Age group included 5 months to 40 years with mean age 20.2 years. 7 patients (87.5%) did not require postoperative shunting.Conclusion: ETV is an alternative and effective method of treating hydrocephalus associated with posterior fossa tumors avoiding external drains or shunts. It decreases the risk of post-resection hydrocephalus