Pakistan Journal Of Neurological Surgery
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Extensive Surgical Exposures for Enormous Skull Base Meningiomas: A Single Institutional Experience
Get PDFBackground: Huge, sizeable, anterior skull base meningioms are relatively common in tertiary care hospitals. Here, a single institutional experience dealing with such lesions is presented.Material and Methods: A retrospective review of 30 consecutive patients was done, who were treated for a variety of anterior skull base meningioms at Department of Neurosurgery, Lahore General Hospital, Lahore. Management and outcome were noted and analyzed.Results: In this study, thirty skull lesions were identified in 21 female (70%) and 9 male (30%) patients, with a mean age at diagnosis was 39.7 years. These benign lesions commonly presented with headache (n = 19), visual deterioration (n = 9) & seizures (n = 5). Olfactory groove (n = 15) was the most frequent site encountered in this study followed by planum (n = 5), tuberculum sallae (n = 4) and clinoidal area (n = 2). Gross total resection achieved in all patients by fronto-orbital craniotomy (n = 15), while frontal craniotomy alone or with temporal extension performed in other patients (n = 13 + 2). Complications observed more in frontal craniotomy patients, than fronto-orbital craniotomy patients.Conclusions: Majority of the extensive anterior skull meningiomas can be addressed by enormous fronal exposure including supraorbital rim to reduce the intraoperative brain retraction, with wide surgical exposure & great surgical freedom for gross total excision with ease. Recurrence is uncommon after gross total resection
Central Nervous System (CNS) Tumour Registry: A Single Neurosurgical Centre Experience of Four Years
Get PDFObjective: To evaluate the pattern of CNS tumours according to site and age.Study Design: Observational.Duration of Study: 1 Jul 2011 to 30 June 2015.Patients and Methods: This is a retrospective audit of CNS tumour registry carried out at our neurosurgical center over the period of four years. A total of 653 cases with age range of 1-80 years, both gender and histo-pathological proven CNS tumours were included in the study. Data of age, gender, location and histological diagnosis was obtained from the patient’s clinical records and entered in study proforma. Data was analyzed by using SPSS (version-17) with descriptive statistics.Results: Overall the Supra-tentorial tumours were 69.52% with commonest site of Parietal in 24.0% and histology of Glioblastoma Multiforme (GBM) in 37.0%. Infra-tentorial tumours were 16.84% with commonest site of Cerebellar in 53.63% and histology of Primitive Neuroectodermal Tumours (PNET) in 26.36%. Sellar tumours were 6.27% and Spinal tumours 7.35% with commonest being Neurofibroma in 39.58% cases. Metastases in CNS were found in 6.38% cases.Conclusion: This analysis depicts that most of the supratentorial tumours of adult age are neuroepithelial in lobar areas especially of GBM type while in children the more common tumours are infratentorial, in cerebellar area and of PNET origin. The audit will help us to stratify our workload management and formulate tumour pathways
Conservative Management of Extradural Hematoma in Minor Head Injury
Get PDFObjective: To determine the frequency of favourable outcome in conservative management of extradural hematoma in minor head injury.Material and Methods: A total of 100 patients with head injury having extradural hematoma were selected for this study. This study was conducted from 15th August 2009 to 14th February 2010 at Department of Neuro-surgery, Lahore General Hospital Lahore.Results: Patients aged 5 to 60 years of both genders. Extradural hematoma was confirmed on CT scan brain in every minor head injury patient. Patients with extradural hematoma associated with moderate or severe head injury, extradural hematoma of any size with midline shift or effacement of ventricle and extradural hematoma in posterior fossa of any size were excluded from study. Follow up of CT scan was done within 8 hours and then after two weeks. In case of determination of GCS scan brain was done immediately. The mean age of the patients was 21.8 ± 9.7 years. There were 72 (72%) male and 28 (28%) female patients with male to female ratio of 2.6:1. Glasgow Coma Scale (GCS) was 14 in 69 (69%) and 15 in 31 (31% patients. Most of the patients (32%) were suffered in frontal site. The most significant factors associated with unfavourable outcome were younger age. There were (92%) patients had favourable while (8%) were un-favourable and were operated for removal of extradural haematoma. There was no mortality.Conclusion: Small extradural haematoma can be managed conservatively in minor head injury, these cases especially frontal and narrative occipital region. However follow up CT scan brain should be performed in these 48 hours and at 2 weeks or any time when patient determines. If there is deterioration patient should be operated upon. Removal of extradural haematoma there was no mortality
Outcome of Adolescent Bike Riders after Road Crash with and without Safety Measures in a Developing Country
Get PDFBackground: Road traffic crash is of growing public health importance worldwide contributing significantly to the global disease burden. There is paucity of published data on road traffic crashes in our local circumstances. This study was carried out to describe the outcome in patients of traumatic brain injury after road traffic crash in our local setting and provide baseline data for establishment of preventive strategies for the well being of adolescent bike riders.Methods: This was a prospective hospital based study of road traffic crash victims carried out at Department of Neurosurgery, Jinnah hospital Lahore from January 2015 to December 2015. After informed consent from patients or their attendants, all patients were consecutively enrolled into the study. A total of 1490 patients were enrolled in the study who presented in emergency after road crash and only the bike riders were observed for the outcome. Data was collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.Results: A total of 1490 road traffic crash victims were studied. All patients were male. The patients ages ranged from 12 to 57 years with the mean and median of 22.5 and 26 years respectively. The patients were divided into five groups as GROUP-A 10-20yrs age, GROUP -B 21-30yrs, GROUP -C 31-40 yrs, GROUP-D 41-50yrs and GROUP-E 51-60yrs. Regarding the vehicle only bike was included. Number of patients in group A was 340 (22.8%), group B 650 (43.6), group C 80 (5.3), group D 320 (21.4%) and group E 100 (6.7%). Regarding the mechanism 618 (41.4%) patients came after bike skidding, 636 (42.6%) patients came after bike with bike crash and 236 (15.8%) patients came after bike with other vehicle crash. Among total number of patients 216 (14.4%) were those having severe traumatic brain injury (STBI). Mortality rate among STBI was 106 (49.07%). The highest mortality was noticed in group C was 37.7% and in group A(adolescent patients) was 24.5% and this was significant (P < 0.001) whereas regarding the outcome according to Glasgow outcome scale, Grade 5 was observed in 63.6% and Grade 4 & 3 in 13.02% & 14.4% respectively and Grade 2 in 1.7% of the patients. The stratification of patients was also done regarding the severity of injury and their outcome according to GOS. It showed that in group A 22.03% patients with mild TBI had GOS 5 & 6.78% with moderate TBI had GOS 5. Regarding severe TBI of group A 15.38% patients had GOS 2 & 24.53% had GOS 1 which was highest in all groups, same stratification was done for other groups as well which showed that the outcome in group A is devastating and its results are comparable with the elder age groups.Conclusion: Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality especially for youth. Urgent preventive measures in the form of helmet wearing for bike riders and enforcement of traffic rules targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. There should be uniform implementation of traffic rules and regulation of motorcycle industry all over the country
Role of Topical Usage of Vancomycin Powder in Prevention of Wound Infection in Spinal Surgery
Get PDFObjective: To determine the efficacy of topical usage of vancomycin powder at wound site to prevent wound infection in spinal surgery.Material and Methods: A prospective study of 62 patients during a period of 6 months with follow-up of 2 weeks post-operatively was performed at Lahore General Hospital Lahore. Patients were divided into two groups: group A and group B, each containing equal numbers of patients. In group A, only prophylactic intravenous antibiotics were used for 5 days. In group B intravenous antibiotics along with topical Vancomycin powder were used at operative site in spinal surgery.Results: During period of follow-up in 2 weeks post-operatively, incidence of wound infection in group A patients was 6.42% in comparison to Group B patients which was 2.4%. No adverse effects were documented by direct usage of Vancomycin powder at wound site.Conclusion: Topical usage of Vancomycin powder at wound site reduces infection rate significantly in spinal surgery
Analyzing the Rate of Complications after Endoscopic Transsphenoidal Surgery for Removal of Pituitary Adenomas
Get PDFObjective: Analyzing the rate of complications after endoscopic transsphenoidal surgery for removal of pituitary adenomas in neurosurgery department lady reading hospital Peshawar.Materials and Methods: Retrospective study of 58 patients who underwent endoscopic transsphenoidal surgery for pituitary adenomas between July 2013 and June 2016. The Criteria for diagnosis of complications were clinical and radiological.Results: 11 (18.96%) of the 58 patients who underwent endoscopic transsphenoidal surgery developed per-operative or postoperative complications most of which were managed successfully resulting in good outcome.Conclusion: The rate of complications observed in our hospital are comparable to those in the international literature. There is a drop in the rate of complications with increasing experience of the neurosurgeon
The Improvement in Kyphotic Angle after Anterior Decompression and Cage Placement in Tuberculosis of Thoraco-lumbar Spine
Get PDFBackground: Musculoskeletal Tuberculosis is a rare form of TB comprising only 3% of all Tuberculosis patients. The commonest and most dangerous form of Tuberculosis, Spinal Tuberculosis accounts for 50% of all cases of musculoskeletal Tuberculosis. The anterior decompression with cage alone without added instrumentation with bone graft is cost effective as compared to added instrumentation in patients of third world countries.Objective: To determine the improvement in terms of mean change in postoperative kyphotic angle after anterior decompression and cage placement with bone graft in tuberculosis of Thoraco-lumbar spine.Materials and Methods: The Quasi Experimental study was conducted in the Department of Orthopaedics and Spine of Ghurki Trust Teaching Hospital, Lahore from 1st May 2014 to 31st Apr 2016.60 patients who qualify the inclusion criteria were included. All patients underwent anterior decompression and placement of Inter body Titanium Mesh Cage with packed bone graft. Pre, Post-operative and follow-up lateral view x-rays were taken to check and record the post operative change in kyphotic angle as well as loss in follow up. All the patients were followed for at least 1 year. Boston brace was applied for at least 6 months. Data was analyzed using SPSS 17.0Results: There were 38 (63.3%) males and 22 (36.7%) females. The patients aged between 15 – 30 years were 32 (53.3%), those between aged 31 – 45 years were 15 (25%) and between 46 – 60 years there were 13 (21.7%). There were 10 (16.6%) patients with 0 – 10 degree improvement, 36 (60%) patients with 11 – 20 degree improve-ment and 14 (23.4%) patients with 21 – 30 degree improvement. Paired t-test result for change in angle is p = 0.000 which is statistically significant.Conclusion: Anterior decompression with Standalone Titanium mesh cage and bone graft in patients suffering from caries spine showed immediate post operative improvement in kyphotic angle as well as no significant loss in correction in follow-up
Use of Closed Drainage System for a Period Between 3 To 7 Days, Under Antibiotic Cover is Safe in Chronic Subdural Hematoma Treatment
Get PDFChronic subdural hematoma is a common neurosurgical problem in the elderly. There has been interest in the use of closed system drainage after initial irrigation. This may lead to infection. The objective of our study was to assess the risk of infection with the use of drain over a period of 7 days. In 27 patients closed system drainage was used. It was removed whenever drainage became less than 25 ml/24 hours. The upper limit for keeping the drain was 7 days. None of the patients required the drain for more than 7 days. The risk of meningitis was assessed. There was no patient who developed local wound infection or meningitis. Conclusion: It is safe to use closed drainage system for continued drainage of chronic subdural hematoma under antibiotic cover for 7 days
Accessory Limb with Spina Bifida Occulta
Get PDFCongenital accessory limb attached to low back is exceedingly rare anomaly and only few cases have been reported previously (1). The author presents one additional interesting case where spina bifida L4 L5 and S1 was covered by the appendage of accessory limb
Operative Management of Olfactory Groove Meningioma: Five Years’ Experience
No full textObjective: To analyze patients operated for olfactory groove meningioma during five years’ times.Methods: This observational study was conducted in the department of neurosurgery, postgraduate medical institute lady reading hospital Peshawar. The clinical records of the patients were analyzed and data regarding clinical presentation, imaging studies, surgical and histological records, discharge letters and follow-up were noted.Results: A total of 168 patients with meningiomas were operated between January 2007 and December 2011 in the department. There were 24 patients with olfactory groove meningiomas, including 18 women and 6 men with a mean age of 52.6 years (range, 26-75 years). Most patients presented with headache 22 (91.6%) followed by decrease vision in 12 (50%) cases and mental disturbancein 6 (25%) patients. Most of the patients 7 (29.2%) had either large or giant14 (58.3%) meningioma.there were 23 patients operated through the bifrontal and 1 through the frontolateral approach. Total tumor removal (Simpson Grade 1 or 2) was achieved in most cases 21 (87.5%). Perioperative mortality was in one patient and morbidity in 33.3% cases. The overall recurrence rate was 4.2% (1 out of 24) during the study period.Conclusion: Olfactory groove meningiomas were removed mainly through bifrontal approach. Through this approach even large tumors could be removed with low recurrence rate but had high mortality rate. However for some small meningioma frontolateral resection could be achieved which provides quick access to the tumor with less brain exposure with a low morbidity rate and no mortality but had high recurrence