Pakistan Journal Of Neurological Surgery
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Cerebral Arteriovenous Malformations: Outcome after Microsurgery
Get PDFObjectives: To find out the results of microsurgical excision of cerebral Arteriovenous Malformations.Materials and Methods: This study was conducted from January 2005 to December 2007 at the department of Neurosurgery, PGMI Lady Reading Hospital Peshawar. A total of 12 patients of cerebral AVMs were included in this study. All the patients, who undergone surgery for cerebral AVMs, irrespective of their age and gender, were included in the study. Their clinical features, radiological reports, peroperative findings and surgical outcome were analyzed in different aspects.Results: Of the total 12 patients, there were 8 males and 4 female patients. Their age ranged from 14 years to 36 years with the mean age of 23.4 years. Six patients presented with primary intracerebral hemorrhage, five cases with seizures and one patient was diagnosed incidentally after a minor head trauma. There were four patients with AVMs on left parietal region, one at right occipital, two at left occipital, two at frontal, one at right parieto occipital, one at left fronto parietal and one at right parietal region of the brain. In our study the out come of excision of AVMs at the eloquent areas of the brain was good in young patients as compared to the old patients. There was single mortality in our study.Conclusion: Microsurgical techniques and appropriate radiological investigation is the basis for good surgical outcome
Out Come of Mini Open Carpal Tunnel Release (OCTR) in Patients with Carpal Tunnel Syndrome
Get PDFBackground: Among peripheral neuropathies the incidence of carpal tunnel syndrome (CTS) ranks higher. At present surgery is considered as gold standard technique among the various available treatment options. Mini OCTR is the minimally invasive technique with better efficacy and less morbidity.Materials and Methods: Thus is prospective nonrandomized clinical study in which mini open carpel tunnel release (OCTR) under local anesthesia with a 2-year follow-up.45 patients diagnosed with carpal tunnel syndrome, some patients have bilateral disease so total number of cases 55.Results: Instant response was noted in 78.2% cases in regard to pain and numbness. At final follow up 95% reported improvement and 5.5%% reported persistence of symptoms, with no functional deficit.Conclusion: Under local anesthesia, the mini OCTR technique is a treatment of choice in reducing the morbidity and cost.Abbreviations: OCTR: Open Carpal Tunnel Release. CTS: Carpal Tunnel Syndrome
Outcome of Myelomeningocele Repair and Early Post-operative Complications
Get PDFIntroduction: Neural tube defects are one of the most common congenital birth defects resulting in a significant number of physical, mental and social disabilities in the earlier years of life. Amongst the central nervous system anomalies which are reported in 31% of newborns with anomalies, myelomeningocele (MMC) is the most common of the central nervous system defects with upto 71% occurrence.Objective: To determine frequency of post-operative complications in the repair of myelomeningocele.Material and Method: This study was a Descriptive case series conducted at Pakistan Institute of Medical sciences (PIMS) Islamabad from March to September 2016. Consecutive (non-probability) sampling technique was used.Total of 156 patients were included in the study who presented in neurosurgical department of PIMS, Islamabad suffering from meningomyelocele. Mean Age of presentation of patients was 58.58 days ± 26.01 Std. deviation. 88 patients (56.4%) were males and 68 (43.6%) were females. 79 patients had size of defect < 5 cm, 68 patients had size of defect ranging from 5-10 cm and 9 patients had defect size > 10 cm in size. 21 patients (13.5%) wound showed signs of surgical site infection while 135 patients (86.5%) wounds healed satisfactorily. 37 patients (23.7%) had CSF leakage while 119 patients (76.3%) recovered completely. Post-operative pyrexia was noted in 141 patients (90.4%) while 15 patients (9.6%) remained afebrile. Post-operative Hydrocephalus was seen in 35 patients (22.4%) as compared to 121 patients (77.6%) with no hydrocephalus post operatively.Conclusion: The study concluded that early diagnosis and prompt management is key to recovery of child. Early operation without subsequent complications is the backbone of treatment
Management and Outcome of Chronic Subdural Hematoma: A Prospective Study of Shaikh Zayed Hospital, Lahore
Get PDFBackground/Objective: Chronic subdural hematoma (CSH) is a type of intracranial hemorrhage is commonly seen in old age. It has a poor prognosis when misdiagnosed or a delayed treatment can lead to significant morbidity. We evaluated the effectiveness of available surgical treatments for the management and outcome of CSH.Method: The prospective cases (n = 48) of CSH were included from Department of Neurosurgery, Sheikh Zayed Hospital, Lahore during January 2014- December 2017. Detailed history of patients was taken along with comprehensive examinations with CT scans and MRIs. The CSH patients were treated surgically either with burr-hole evacuation (unilateral/bilateral) with irrigation or burr-hole drainage with drain 48 to 72 hours.Results: The mean age of male patients was 68 years and 56 years in female patients. Most of our patients recovered (81.25%; GOS 5) uneventfully. Patients were mostly treated with burr-hole evacuation with irrigation. The 15% patients had required ICU management with GOS 2-3. Older (> 65 years) male patients were at higher risk of CSH. Trauma was not the only major cause of the CSH as history of trauma was not present in the majority (< 25%) of the patients. We found following significant risk factors, i.e., hypertension (73%), DM (62.5%) and ischemic heart disease (60%) and intake of anticoagulant/antiplatelet drugs (60%). A 4% recurrence was reported in our CSH patients. Stroke as a postoperative complication was reported in two patients (4%) and only one patient (2%) died of aspiration pneumonia.Conclusion: Chronic subdural hematoma can be effectively treated by simple surgical intervention if diagnosed early and mortality can be reduced. We found burr-hole evacuation (unilateral/bilateral) with irrigation an effective treatment against CSH, as most of our patients (> 80%) were recovered with it. The trauma was not the only cause of CSH as history of trauma was not present in the majority of the patients, therefore, some other factors are also involved in the CSH formation in old age
Outcome of Surgical and Radiotherapy Treatment of Medullobalstoma, (Our Experience in 15 Cases)
Get PDFObjective: To assess the efficacy of surgery and radiotherapy for the medulloblastoma.Material and Methods: It is a study of fifteen (15) cases of Medulloblastoma operated at The Department of Neurosurgery Quaid-e-Azam Medical College / B.V. Hospital Bahawalpur. Study span is three years from January 2004 to December 2006 with follow up period of 5 years.Results: Age range was 2 – 12 years with average age of 7 years. Eight (8) patients were male and seven (7) were female. In all patients surgery was performed. Radiotherapy (Craniospinal Axis) was given to all but two patients who expired before the initiation of radiotherapy, one patient died, two week after surgery and second patient, one month after surgery. Out of Thirteen (13) patients who were treated by surgery and radiotherapy, 4 died before 5 year of age (between 3 and5 year of age) and 9 patients were alive at 5 year follow up. So, our 3 year survival rate was 86.66% and 5 year survival rate was 60 %.Chemotherapy was not given to any patient. Mortality after surgery was 13.33%.Conclusion: It is concluded that mainstay of treatment for medulloblastoma is surgery followed by radiotherapy to the whole craniospinal axis
Effectiveness of Open Surgery for Supratentorial Gliomas in Terms of Improvement in Karnofsky Performance Score
Get PDFIntroduction: Glioma is a primary brain tumor derived from neuralgia cells like astrocytes, oligodendrocytes and ependymal cells. It is a non curable malignant tumor. Therefore, the objective of the treatment is mainly to improve quality of life.Objective: To determine the effectiveness of open surgery for supra-tentorial glioma in terms of improvement in Karnofsky performance score.Materials and Method: This Descriptive case series study was conducted at Neurosurgery Department PGMI / LRH Peshawar from January 2012 to December 2012 (1 year). Total 144 consecutive patients with supra-tentorial glioma of more than 18 years of age who underwent open surgery (craniotomy with tumor resection) were included. Pre and postoperative Karnofsky performance score was recorded.Results: Total of 144 patients were included in the study, of which 101 were males and 43 females. Age ranged from 19 years to 65 years with 36.8% of the patients in the 3rd decade of life. Majority of the patients had supra-tentorial glioma in the frontal lobe making 38.9% of the whole. In 63.9% of the patients, the procedure was effective. It was more effective in young individuals as compared to patients of middle and old age. Furthermore, the success rate was more in patients with frontal lobe tumor followed by those with parietal glioma.Conclusion: Open surgery with total or partial resection of tumor is an effective procedure for the treatment of supra-tentorial glioma. Its effectiveness is influenced by the age of patient, location of the tumor and preoperative Karnofsky performance score
Degree of Agreement between Perfusion CT and Delayed CT in Early Detection of Cerebral Ischemia in Patients with Clinical Signs of Stroke
Get PDFStroke is the third most common cause of death and the first leading cause of disability in developed and developing countries.1 A comprehensive evaluation of stroke may be performed with a combination of Computed Tomography (CT) or Magnetic Resonance (MR) Imaging techniques. Unenhanced CT (NECT) can be performed quickly, can help identify early signs of stroke and can rule out hemorrhage. CT angiography and CT perfusion imaging, respectively, can depict intravascular thrombi and salvageable tissue indicated by a penumbra. The present study highlights the importance of utilization of CT perfusion imaging technique in the detection of stroke at a time when plain CT is less likely to be helpful and urgent medical treatment can significantly alter the course of this catastrophic event.Objectives: The aim of this study was to determine the degree of agreement between perfusion CT and delayed CT in early detection of cerebral ischemia in patients with clinical signs of stroke having negative early NECT scan.Results: This study was conducted on 150 patients with clinical suspicion of stroke but having no or early signs of infarction on NECT scan during a period of six months from August 2013 to February 2014. The age of patients ranged from 29 to 90 years with mean age 63.80 ± 13.62 years with maximum number of patients aged between 71 – 80 years i.e. 61 (40.7%) and Minimum number of patients aged between 20 – 30 years i.e. 4 (2.7%). 74 patients (49.3%) out of total number of patients included in the study had signs of infarct on NECT while 76 patients (50.7%) had no signs of infarct on NE CT. 138 patients (92.0%) showed signs of infarct on perfusion CT while 12 patients (8.0%) had no signs of infarct on perfusion CT. Out of the 138 patients positive on perfusion CT, 131 proved to be positive on follow up CT and were thus true positive while 7 patients were false positive. Cohen ? coefficients were calculated to determine the agreement between NECT and perfusion CT. A value of .607 was derived for ? with standard error of ± .113 which shows substantial agreement between perfusion CT and delayed CT.Conclusion: Because CT is still the primary imaging modality in patients with acute stroke, perfusion CT evaluation improves the rate of detection of infarction in comparison with NECT alone. The use of multi-detector row CT demonstrated improved detection rate of perfusion deficit, particularly in patients with minor neurologic symptoms. We believe multimodal CT evaluation can aid decision making for treatment of patients suspected of having a stroke
Outcome of Surgical Management of Chronic Subdural Hematoma
Get PDFObjective: To determine outcome of surgical management of Chronic Subdural Hematoma.Study Design: Descriptive Study.Materials and Methods: Patients with Chronic Subdural Hematoma diagnosed on CT scan brain admitted to the Neurosurgery Department, Bolan Medical College/Hospital, Quetta Pakistan from January 2008 to December 2017. Patients included in the study were those who presented with CSDH only and all those patients were excluded who had undergone surgery previously elsewhere. At the time of admission the neurological status was classified according to a Grading Scheme which was proposed by Markwalder et al. Radiological evaluation was done by CT Scan before surgery and routine CT Scan of each patient was done one day after surgical inter-vention, one week after and anytime if required. Outcome was determined by GCS and GOS. Good Recovery and Moderate Disability were considered as favorable outcome while Severe Disability, Persistent Vegetative State and Death as unfavourable outcome.Data Analysis: SPSS software was used for data analysis.Results: A total of 145 patients were treated with surgical evacuation of CSDH. 121 (83%) patients were men while 24 (17%) were women with Male to Female ratio of 5:1.10 (7%) patients had Markwalders Grade 1, 57 (39%) had Markwalders Grade 2 while 46 (32%) patients had Grade 3 and 32 (22%) had Grade 4. Recurrence occurred in 20 (14%) patients. 129 (89%) patients had favourable outcome while 16 (11%) had unfavourable outcome.Conclusion: The favourable outcome of surgical evacuation of Chronic Subdural Hematoma is quite high if operated early. Moreover, the course and outcome is affected by several factors particularly the initial neurological status at the time of diagnosis
Surgical Management of Tuberous Sclerosis
Get PDFTuberous sclerosis is a genetic disorder with incidence of 1 into 6000 birth. It is a multi-systemic disorder. Seizures associated with tuberous sclerosis (TS) can be difficult to control with medical therapy.Objective: To determine the role of surgery for the management of seizures and other symptoms in Tuberous Sclerosis.Material and Method: Four patients with TSC who underwent surgery were admitted in the Department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan and Department of Neurosurgery, PGMI / Lahore General Hospital, Lahore.Results: We admitted 5 cases, 3 males and 2 females. All presenters with seizers other presenting feature were headache and vomiting in all 5 cases, vomiting in 5 cases. All cases were operated were craniotomy and removal of tumour. Surgery were V.P. Shunt was performed in 3 cases. All 5 cases revealed excellent outcome and seizures well controlled with anticonvulsant postoperatively which were poorly controlled preoperatively. All 5 cases were discharged in satisfactory condition within 2 – 3 weeks. Histopathology the histopathology of all 5 cases were subependymal giant cell astrocytoma (SEGA).Outcome: All 5 cases revealed excellent outcome and the seizures were well controlled post-operatively with anticonvulsants. While pre-operative fits, were poorly controlled. All 5 cases were discharged in satisfactory condition with 2 – 3 weeks.Conclusion: The surgery had excellent outcome for tuberous sclerosis provided timely decision is taken to treat the tumor and associated hydrocephalus. Most of these patients will lead ventriculoperitoneal shunt or EVD as an emergency step to save the life
Six months Analysis of Posterior Fossa Surgery in Neurosurgery Unit-I, Punjab Institute of Neurosciences (PINS)
Get PDFObjective: This is a prospective study. Posterior fossa tumors are a common entity presented in our tertiary care neurosurgical setup. Although the treatment of posterior fossa tumor has underwent a lot of changes over the period of last two decades but unfortunately in the developing countries the Neurosurgical facilities are still not up to the mark.Materials and Methods: We analyzed the posterior fossa surgery done for the last six months (Feb. 2017 – Aug. 2017) in Neurosurgery Unit I of Punjab Institute of Neurosciences.Results: A total of 15 cases were operated from Feb 2017 to Aug 2017. Immediate outcome was seen at the time of discharge. Nine out of 15 patients were female (60.00%), 6 patients were male (40%). Maximum 6 cases (40.00%) were seen in 3rd decade of life. Main presenting complain was headache 3 cases (20.00%) followed by vomiting 7 cases (46.66%), vertigo in 5 cases (33.33%), hearing and visual loss in 4 cases (26.66%) and balance disturbance was observed in 3 cases (20.00%). Regarding location 6 cases (40.00%) were tumor midline posterior fossa SOL, 5 cases (33.3%) were CP angle lesions, 3 cases (20.00%) were in cerebellar hemisphere and 1 case (06.60%) was noted in the 4th ventricle. Nine of procedure (60.00%) remained continued for 4 – 8 hours and remaining 6 took up to 4 hours (40.00%). Gross total excision was achieved in 5 cases (33.33%), Maximum debulking (more than 80 percent tumour removal) was achieved in 10 cases (66.66%). Associated procedure V-P Shunt was done in 8 cases (53.33%) and EVD in 4 cases (26.6%).Complications: CSF leakage and re-exploration for dural repair was needed in 1 case (06.60%).Outcome: Ten patients were discharged on different status (66.66%) while mortality was noted in 5 cases (33.33%)