Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Surgical Outcomes of Endoscopic Transsphenoidal Pituitary Surgery
Full text linkIntroduction: Pituitary adenoma are common benign tumors of the brain and causes significant symptoms due to hormonal imbalances (mostly functional pituitary adenoma) and their mass effect on surrounding structures (majority of nonfunctional pituitary adenoma). The aim of this study was to find out the surgical outcomes of endoscopic trans-sphenoidal approach in terms of safety, effectiveness, per-op and post-op complications and relieve of symptoms.
Methodology: This study was conducted at Ali Institute of Neurosciences and Irfan General Hospital, Peshawar, from April 2019 to April 2021. Patients diagnosed with pituitary adenomas (confirmed by MRI) and treated with the endoscopic trans-sphenoidal approach were included. Demographic data was collected, and outcomes were assessed post-surgery and at 6-month follow-up. Data were analyzed using SPSS version-26.
Results: The majority of participants were male (65%) with a mean age of 31 years (range 22-28). Most patients presented with headaches (76%) and visual disturbances (60%), while 53% had hormonal imbalances. Post-surgery 100% reported headache relief 87% showed visual improvements measured by Humphrey perimeter and visual acuity tests, and 97% had favorable endocrinological outcomes based on hormonal profile assessments.
Conclusion: When treating pituitary adenoma, the endoscopic trans-sphenoidal approach is a safe and successful surgical technique that is linked to better patient results and satisfaction. Complications from the operation include intercavernous sinus hemorrhage, diabetes insipidus, hypopituitarism and CSF leakage.
Keywords: Adenoma, Endoscopic trans-sphenoidal, Microscopic trans-sphenoidal, Pituitary adenom
A Month in Cross Section: A Case Series of Eleven Sphenoid Wing Meningioma’s: A Single Center Experience
Full text linkIntroduction: Sphenoid wing meningiomas represent 20% of supratentorial meningiomas. The tumor usually involves the visual pathway, the anterior vasculature, and cavernous sinus invasion. A higher morbidity, mortality, and recurrence are documented in comparison to meningiomas in other locations.
Materials & Methods: 11 cases of joint global sphenoid wing meningiomas were operated in September 2022. Patient demographic, clinical, radiology, and per-operative salient features were noted. Post-operative clinical outcomes included improvement in visual acuity, neural deficit, and headache. The extent of resection on radiology plus survival was noted as an outcome measure.
Results: Patients aged 28 to 65 years, with 9 females and 2 males had giant sphenoid wing meningioma. Complete medial sphenoid wing involvement along with neurovascular structures, post-operatively they had visual deterioration, hence, the extent of resection was limited to prevent greater post-operative morbidity. 3/7 undergoing GTR had complete carotid artery encasement, in which full thickness MCA infarct was noted in 6 hours’ post-operative scan, they were later converted to a full 16 cm decompressive craniotomy. One survived with hemiparesis and aphasia while two died – a male (49y) and, a female (65), both left craniectomies. STR was done in four patients, with cavernous sinus invasion and internal carotid encasement.
Conclusion: Giant sphenoid meningioma involving the medial sphenoid wing and associated neurovascular structures is surgically challenging and must be treated with STR. If GTR is to be attempted, early CT Brain postoperatively to prevent mortality
Comparison of Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization Combined and Alone in Peadiatric Hydrocephalus – A Randomized Control Trial
No full textObjective: To evaluate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) improves treatment outcomes in pediatric hydrocephalus compared to ETV alone.
Materials and Methods: This prospective cohort study was conducted at the Department of Neurosurgery, DHQ Hospital, Rawalpindi, Pakistan, over 6 months. Pediatric patients diagnosed with hydrocephalus and meeting inclusion criteria were enrolled and assigned to two cohorts based on the procedure performed: Cohort A (ETV alone, n=35) and Cohort B (ETV + CPC, n=35). Patients were followed for three months postoperatively to assess treatment success, need for reoperation, and mortality. Relative risks (RR) with 95% confidence intervals (CI) were calculated to compare outcomes between cohorts.
Results: The success rate was significantly higher in the ETV + CPC cohort (85.7%) compared to the ETV-alone cohort (45.7%) (RR = 1.87, 95% CI: 1.31–2.66, p<0.001).** The reoperation rate was lower in the ETV + CPC group (8.6% vs. 34.3%, p=0.009), as was mortality (2.9% vs. 20.0%, p=0.024).
Conclusion: The addition of CPC to ETV is associated with significantly improved outcomes in pediatric hydrocephalus, reducing failure rates, need for reoperation, and mortality. These findings support CPC as an effective adjunct to ETV. Further long-term studies are warranted to confirm these benefits
Risk Factors for Postoperative Spinal Infections Following Instrumented Spine Surgery: A Case-Control Study of 500 Cases
Full text linkObjective: Postoperative spinal infections are a significant complication of instrumented spine surgery, contributing to increased morbidity and healthcare costs. This case-control study aimed to identify the risk factors associated with postoperative infections in patients undergoing instrumented spine surgery.
Materials and Methods: We carried out a retrospective case-control study involving 500 patients who underwent instrumented spine surgery at Lady Reading Hospital, Peshawar, between January 2019 and December 2023. Among them, 50 patients (10%) developed postoperative infections and were categorized as the case group, while the remaining 450 patients without infections formed the control group. Data were collected on sociodemographic characteristics, comorbidities, surgical factors, and postoperative care. To identify independent predictors of disease, we applied multivariate logistic regression analysis. A p-value of less than 0.05 was considered statistically significant.
Results: Diabetes mellitus (OR 3.5, p = 0.01), prolonged surgical time (>3 hours) (OR 3.1, p = 0.02), obesity (OR 2.9, p = 0.03), and insufficient antibiotic prophylaxis (OR 2.6, p = 0.04) were significantly associated with postoperative infections. Extended hospital stay was recorded in patients having post-operative infection or multiple readmissions, and reoperation was high.
Conclusion: Factors like diabetes mellitus, extended duration of surgery, obesity, and Failure to appropriately use prophylactic antibiotics may contribute to an elevated risk of infections following surgery. Recognizing these risk factors early and modifying them can reduce the burden of postoperative infection
Correlation Between Neuro-Ortho Clinical Findings and Radiological Patterns in Cervical Spine Trauma
Full text linkObjective: To evaluate the correlation between neuro-orthopedic clinical findings and radiological imaging patterns in patients presenting with cervical spine trauma at a tertiary care hospital.
Materials and Methods: A prospective observational study was conducted at the Department of Radiology and Orthopedics, Lady Reading Hospital, Peshawar. A total of 354 patients aged 14 years and above with suspected or confirmed cervical spine trauma were enrolled. Detailed clinical neuro-orthopedic examinations were performed using the American Spinal Injury Association (ASIA) scale. All patients underwent CT and MRI cervical spine imaging. Clinical findings were correlated with radiological injury patterns.
Results: The mean age of patients was 37.2 ± 10.8 years, with a male predominance (65.5%). Road traffic accidents were the leading cause of injury (59.3%). The most frequent radiological findings were compression fractures (39.5%) and spinal cord signal changes (14.7%). ASIA grades C and D were most common. A statistically significant moderate positive correlation was observed between spinal cord signal changes on MRI and severity of neurological deficit (r = 0.61, p < 0.001).
Conclusion: There is a strong association between clinical neurological impairment and radiological abnormalities in cervical spine trauma. Incorporating MRI with clinical evaluation improves diagnostic accuracy and assists in prognostication. Multidisciplinary neuro-ortho-radiological assessment is crucial for optimal management of cervical spine injuries
Clinical Management and Outcomes of Traumatic Brain Injury: A Comparative Study of High-Resource and Low-Resource Hospital Settings.”
Full text linkTo compare management strategies and outcomes of TBI in high-resource versus low-resource hospital settings.
Methodology:
This multicenter, prospective observational study included all patients with traumatic brain injury. Data was collected using a standardized questionnaire that included demographics, medical history, injury details, GCS scores and GOSE outcomes. A brain CT scan was performed within 24 hours of injury, and follow-up assessments were conducted at two weeks. Statistical analysis was performed using SPSS version 27, with chi-square test and logistic regression used to assess associations between variables and hospitals.
Results:
Among 124 traumatic brain injury patients, 74% were males with mean age of 41.63 +/- 15.39; and 40.3% aged between 31–50 years, equally distributed between low- and high-resource hospitals. Road traffic accidents caused 75% of injuries, with 39.5% classified as severe TBI. Surgical interventions were performed more frequently in high-resource settings (22.6% vs. 4.8%). Majority of low-resource patients (82.3%) had hospital stays ?3 days compared to 48.4% in high-resource hospitals. At two weeks, unfavorable outcomes (GOSE) were more common in low-resource hospitals (41.9% vs. 33.9%). Co-morbidities increased the likelihood of unfavorable outcomes (OR = 10.868, p = 0.066), as did peripheral injuries (OR = 1.332, p = 0.708). Mild (OR = 0.002, p < 0.001) and moderate (OR = 0.024, p < 0.001) TBI significantly reduced the risk of unfavorable outcomes compared to severe TBI.
Conclusion:
In high-resource settings, a larger proportion of patients experienced severe traumatic brain injuries, underwent surgical interventions, had longer hospital stays and showed relatively better recovery outcomes
Caudal Appendage in Neonate: Case Report and Literature Review
Full text linkThe caudal appendage, also called a human tail, is a congenital anomaly located in the lumbosacral region, characterized as a prominent lesion. It is one of the lesions considered a marker of spinal dysraphism and may be classified into 2 groups: “pseudo-tail” and “true tail”. The authors report a case of a newborn baby girl admitted with the complaint of having a 4 cm long tail that had been present since birth. She was referred to us on the eighth day. The clinical examination found a soft, elongated, skin-covered, and non-fluctuating appendage in the lumbosacral region. She had no neurological impairment. A computed tomography scan showed a lumbar appendage associated with a spina bifida. The tail was surgically removed, and both the surgery and postoperative period were uneventful. Histopathological examination of the tail revealed a benign lesion with mature adipose tissue covered by skin. The caudal appendage is a benign congenital anomaly that may be associated with other spinal cord anomalies. Therefore, neurological examination as well as radiological evaluation is recommended to highlight the underlying anomalies
Traumatic Craniocerebral Injury from Axe Strikes: Presentation, Prognosis, and Complications – A Tertiary Care Hospital Study
Full text linkObjective: To evaluate the effects of a brain injury caused by an axe strike, including its presentation, prognosis, and potential complications.
Material and Method: The study was a descriptive, analysis conducted at the Liaquat University of Medical and Health Sciences in Jamshoro, Sindh, Neurosurgery Department. It spanned a three-year from January 2019 to August 2022. Patients were based on consecutive sampling sizes. CT scan brain was done and the brain trauma was categorized. Follow-up was done at 6 months.
Results: A total of 61 cases of Axe injury (hatchet injury) were managed surgically. The female-to-male ratio was 2.8:1. The Average time of surgery was 150±30 mins, wound size due to axe injury was measured it was about 3.5±2.2 cm. The cerebrospinal fluid leak was in 32, and meningitis in 16 patients after repair of neurological deficit. Patients were managed in a high-dependency unit with intravenous antibiotics, anticonvulsants, and mannitol. The Glasgow Coma Scale (GCS) scores of patients on arrival were compared with their scores at discharge.
Conclusion: This study adds a critical view into the presentation, management, and outcomes of patients who suffered brain injuries caused by axe strikes. The severity of injuries varied, with complications such as post-surgical infections, cerebrospinal fluid leaks, and meningitis being common. 
Evaluation of Clinical Teaching Quality in Residency Training in a Tertiary Care Hospital Using EFFECT (Evaluation and Feedback for Effective Clinical Teaching) Survey
Full text linkObjective: To evaluate the quality of clinical teaching in residency training in a tertiary care hospital.
Materials and Methods: The research was conducted in Mardan Medical Complex, Mardan. The study lasted two months, and the participants were enrolled using the simple purposive sampling technique. This prospective cross-sectional study used a validated “EFFECT” questionnaire divided into seven domains containing 58 items. The questionnaire was distributed among the postgraduate trainees of different specialties of the FCPS program, excluding other specialty programs (MS/MD/MCPS), through an online Google form. The data was analyzed using Excel 2022 software.
Results: The number of residents who participated was 89. 71 (80%) were male and 18 (20%) females. The mean age was 29 years. Overall, the residents' perception of their supervisors was good. Few items were scored satisfactory by the residents. The results were also analyzed between four subgroups of the participants: male/female, senior (years 3-5)/junior (years 1-2) residents, medical & allied and surgical & allied residents, and senior (above 50 years age) and junior (below 50 years age) teachers. Significant (P value<0.05) differences were identified among the sub-group responses in different domains.
Conclusion: Overall, the residents' perceptions of their clinical teachers are good. However, there is room for improvement in multiple domains, and some parts of the teaching require special considerations.
Keywords: EFFECT (Evaluation and Feedback for Effective Clinical Teaching), FCPS (Fellow of College of Physicians and Surgeons Pakistan), Clinical Teaching
Outcome of Spinal Dysraphism Surgery without Electrophysiological Monitoring in a Resource-Constrained Country; 5-Year Experience: A Way Forward for Pediatric Neurosurgery
Full text linkObjective: This study aimed to see the outcome of spinal dysraphism surgery without electrophysiological monitoring.
Materials & Methods: A prospective study was conducted in the department of neurosurgery, Jinnah Hospital Lahore. A total of 125 patients were included in the study. Data was collected on a proforma regarding symptoms, location, variety, surgical technique, and rehabilitation, and analyzed for the outcome.
Results: Out of 125 patients, 30 patients presented with swelling, 65 with cutaneous stigmata and 30 had neurological deficits. The spinal dysraphism was located in the lumbosacral region in the majority (63%) of cases and no patient was found to have it in the cervical region. 76% of patients had static outcomes despite a lack of electrophysiological monitoring, 17% of patients showed improvement in neurological deficits and 7% deteriorated.
Conclusion: The outcome of surgery for spinal dysraphism even without intraoperative electrophysiological monitoring can be satisfactory if done carefully by an expert team