Pakistan Journal Of Neurological Surgery
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Frequency of Extra-dural Hematoma in Patients with Head Injury
Get PDFObjectives: To determine the frequency of extra-dural hematoma in patients with head injury.Patients and Methods: This cross sectional descriptive study was done in neurosurgery department of Hayat-abad Medical Complex, Peshawar, from 2nd February 2012 to 1st September 2012. All patients of head injury, from all ages and both genders were included. Patients in whom EDH caused by bleeding disorders or vascular malformations of the dura mater and post surgical EDHs were excluded from the study. CT scan brain was done for all patients to confirm their diagnosis. The information regarding patient demographical details, clinical presentation and site and size of hematoma was documented in patient’s Performa. The data was analyzed by SPSS version 17.Results: A total of 281 patients with head injuries were included in the study. Out of 281 patients, there were 191 (67.9%) males and 90 (32.02%) females. The mean age was 27 years. Majority of patients 81 (28.8%) were in the age range of 21 – 30 years. EDH was found in 31 (11.03%) patients. Eleven patients (3.91%) had their hemato-mas in temporal region. Temporo-parietal region was involved in 9 (3.2%) patients. Frontal and parietal region was affected in 5 patients (1.78%) each. One patient had extra-dural hematoma in posterior cranial fossa.Conclusion: Extra-dural haematoma is fond in 11% of head injury cases. It is more contain in males as com-pared to females. It is most common in 20 – 40 years of age, temporal and parallel cases are most frequently in-volved regions. The mortality in head injury patients can be reduced if extra-dural hematoma diagnosis and operation done early
Pallidotomy: Effective and Safe in Relieving Parkinson’s Disease Rigidity
Get PDFIntroduction: Parkinson's Disease (PD) is a progressive neurological disorder caused by a loss of pigmented dopaminergic neurons of the substantia nigra pars compacta. The major manifestations of the disease consist of resting tremor, rigidity, bradykinesia and gait disturbances. Before the advent of Levodopa surgery was main stay of treatment of PD. Medical therapy is still the mainstay of treatment for Parkinson's diseasebut its prolonged use results in side effects like drug induced dyskinesia. In 1952 Dr. Lars Leksell introduced Pallidotomy that was successful in relieving many Parkinsonian symptoms in patients. Later on thalamotomy became widely accepted, replacing pallidotomy as the surgical treatment of choice for Parkinson's Disease. Thalamotomy had an excellent effect on the tremor, was not quite as effective at reducing rigidity rather bradykinesia was often aggravated by the procedure.Objective: Effectiveness of Pallidotomy in rigidity in medically refractory Parkinson’s disease and its complications.Study Design: Descriptive prospective case series.Setting of study: Department of Neurosurgery, Lahore General Hospital, Lahore.Duration: June 2013 to April 2016.Materials and Methods: Patients of Parkinson’s disease with predominant component of muscular rigidity despite maximum medical therapy admitted through outdoor department. Detailed history and physical exami-nation was done. Grading of muscular rigidity was done by applying UPDRS score Rigidity part 22. Secondary Parkinsonism was ruled out with the help of CT scan and MRI brain. Surgery was performed after informed consent.Results: Twenty patients were included in the study with no lost to follow up. There were 14 (70%) male and 6 (30%) female patients. Mean age of the patients was 47.58 ± 8.69 years. There were 11 (55%) left sided procedures and 9 (45%) right sided Pallidotomy procedures performed. Mean pre-operative rigidity using UPRDS was 24.9 ± 1.47, while post-operative score was 11.87 ± 1.53. Pallidotomy procedure in our study had no mortality but 4 (20%) patients suffered from procedure related complications one patient (5%) had transient hemiparesis, 1 (5%) suffered from wound infection, 1 (5%) having dysarthria and 1 (5%) transient diplopia.Conclusion: Pallidotomy is effective as well as safe surgical treatment option in reducing rigidity for medically refractory Parkinsonism’s Disease
Comparison Study of Cost Effectiveness, Complications Hospital Stay in Conventional Versus Micro-Discectomy
Get PDFObjective: To study of cost effectiveness, complications and hospital stay in conventional V/S micro-Discectomy.Study Design: Experimental randomized controlled trail.Placed and Duration of Study: My study held in Neurosurgical department of Lahore General Hospital Lahore , duration of study was six months and follow-up was of 06 months after discharge from ward.Sample Size: Forty patients for herniated lumber Disc diagnosed on MRI were divided into two groups of 20 each.Results: Mean age of patients range from 15 to 75 years in group A (open Discectomy) out of 20 patients. 14 patients (70%) stayed < 5 days and 6 patients (30%). stay in hospital > 5 days. In group B 20 patients (100%). Hospital stay < 5 days. C.S.F leak in group A (5%). In group B No. CSF leak recorded in group A. 04 patients (25%) wound infection in Group B, 01 patient (5%) wound infection. Group A patient got prolong hospital stay, on average < 5 days due to extensive dissection and more chance of complication, in comparison Group B patient has less hospital stay, average > 3 days and they are cost effective due to less use of medicines and less chance of complication.Conclusion: Both surgical technical are equally good and effective regarding pain relief but in term of hospital stay and post-operative wound infection microdiscectomy show superior results than conventional Discectomy
Silk ligation and Excision of Giant MC Aaneurysm as Alternative Method of Treatment
Get PDFJean-Louis Petit, in 1760 observed in one of his Patient an aneurysm which got cured spontaneously. Autopsy of the patient after 7 years of diagnosis revealed complete occlusion of carotid artery.1 This suggested carotid ligation as one of the treatment of cerebral aneurysms. James Hunter2 popularized this method in 1800. In 1933, Norman Dott introduced ligation of the neck of an aneurysm with surgical sutures.2 This approach was practiced by Campbell and Burklund in 1953 and Drake and Amacher in 1969.3 They attempted to combine the suture ligation with excision of aneurysms; however, this method failed to gain widespread popularity and was abandoned for surgical clip placement
Controversies in Traumatic Brain Injury: Neurotrauma Experience in Bandung Indonesia
Get PDFObjective: Despite progress in the management TBI, several controversies and questions such as the best use of technological advances and the data obtained from multimodality monitoring, the use of mannitol and hypertonic saline, decompressive craniectomy and barbiturate coma, therapeutic hypothermia, anemia and the role of blood transfusion, and venous thromboembolism prophylaxis in TBI. Our Hospital implementing the multimodal treat- ment for TBI patients.Materials and Methods: This is a multicenter study, conducted at Spine Research Working Group, Division of Neurospine, Pain and Peripheral Nerve Department of Neurosurgery, Faculty of Medicine Universitas Pad- jadjaran – Dr. Hasan Sadikin Hospital, Bandung, Division of Neurotrauma, Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia. The duration of study 1 year from Jan. 2011 to Dec. 2012.Results: In our hospital, within 1 year, the total number of cases of TBI were 2069, or 173 cases / month. The caused of TBI is dominated by traffic accident 1498 (73%) from total cases. Male were more dominant 1537 (74%) compare to female 532 (26%). There were 1488 (72%) cases of mild head injury, 401 (19%) of moderate head injury and 180 (9%) cases of severe head injury. Among the traffic accidents motorbike accidents were predominant, 1132 (55%) cases, followed by pedestrian 322 (16%) cases, falling down 293 (14%) cases, cars 44 (0.2%) cases, crimes 27 (0.1%) cases and others like house family abuse and so on, in 251 (14.7%) cases respec- tively. Time interval from the occurrence site to the hospital was < 4 hours 1008 cases and the rest are > 4 hours. Clinically, we found 1953 (94%) with pupil equal. The mortality rate caused by Traumatic Brain Injury (TBI) in Indonesia on 2011 is 6.2 – 11.2% which is two times compare to the international literature (3 – 8%). Most of them are young adult. However there are still controversies in term of management of TBI.Conclusion: There have been many controversies in the management of TBI. It is depend on the resource and experience of the trauma centre itself. Nevertheless it has to be focus on patient priority and outcomes
Impact of Time Taken on the Surgical Outcome of Epidural Hematoma in Patients with Road Traffic Accidents
Get PDFIntroduction: Traumatic epidural hematoma is a neurosurgical emergency and timely surgical intervention is the standard treatment. The rationale of this study is to highlight the importance of time of surgery on the surgical outcome of epidural hematoma particularly in patients with history of road traffic accidents.Objectives: To determine the impact of time taken on the surgical outcome of epidural hematoma in patients with road traffic accidents.Study Design: Descriptive Case Series.Place and Duration of Study: Bolan Medical Complex Hospital and Sandeman Provincial Hospital, Quetta. From April 2010 to July 2011.Patients and Methods: Sixty adult patients of either gender with H/O road traffic accident with epidural hematoma on axial images of CT scan brain were included. All patients were allocated into three groups with 20 patients in each group. Patients in group I were those in whom time from the occurrence of trauma to the surgical evacuation of hematoma was < 1 hour, 1 to 6 hours in group II and > 6 hours in group III.Results: In group I, 18 (90%) showed favorable and 2 (10%) showed unfavorable outcome. In group II, 14 (70%) showed favorable and 06 (30%) showed unfavorable outcome. In group III, 10 (50%) showed favorable and 10 (50%) showed unfavorable outcome. Significant association was found between outcome and time of surgery (P < 0.05).Conclusions: Frequency of favorable outcome after surgical evacuation was significantly higher in patients in whom surgery was performed within one hour after the trauma
Frequency of Elevated Mean Platelet Volume in Patients with Different Severities of Acute Ischemic Stroke
Get PDFObjective: Determine the frequency of elevated mean platelet volume in patients with different severities of acute ischemic stroke who presented in Lahore general hospital Lahore.Study Design: Cross sectional survey.Duration: Study duration was 1year.Sample Size: 130 patients of acute ischemic stroke.Sample Technique: Non-probability purposive sampling.Methodology: Consecutive 130 patients of acute ischemic stroke presented to emergency department or admitted through OPD within 24 hours of onset of symptoms and fulfilling the inclusion criteria were selected. Patients were divided in two groups based on mRS scoring. MPV was measured by automated hematology analyser Sysmex KX-21. The severity of stroke was assessed by Modified Rankin Score (mRS) between 24 to 72 hours of onset of symptoms.Patients with acute ischemic stroke proved by CT brain presenting within 24 hours of symptom onset and Age 40 and above and both genders were include. Patients with hematological malignancies were excluded from study.Data Collection: 130 patients admitted patients (through emergency and outdoor), Lahore General Hospital, Lahore fulfilling the inclusion criteria were selected for study.The severity of stroke was assessed by modified Rankin Scoring (mRS). The patients were divided in to two groups based on mRS scoring. Mean platelet volume and mRS score were recorded. Major risk factors like hypertension, diabetes mellitus, smoking history and hypercholesterolemia if present were also recorded. The demographic information of these cases like name, age, sex and address recorded. The collected information was entered into SPSS version 11.0. Quantitative variables like age, mean platelet volume were analyzed as mean and standard deviation. Frequencies of elevated MPV in both groups were described. Gender and severity of stroke (mild, moderate to severe) were analysed as frequency and percentage. Elevated MPV was also analysed as frequency and percentage in both groupsResults: Among the enrolled 130 patients 80 (61.5%) were males and 50 (38.5%) were females (Table 1, Graph 1) with age ranging from 41 – 74 years with a mean age of 56.85 ± 10.15 years. 45 (35%) patients had modified Rankin scale (mRS) between 0 to 2 while 85 (65%) patients had mRS between 3 to 6. Overall mean platelet volume was found to be elevated in 85 patients. Among them 62 (73%) patients had mRS of 3 – 6 (group 2) while 23 patients had mRS of 0 – 2 (group 1). Among the 45 (23%) patients who had normal mean platelet volume, 22 belonged to group 1 (mRS 0 – 2) while 23 were in group 2 (mRS 3 – 6).Conclusion: MPV, with an easy way of measurement, may be anearly and important predictor for the prognosis of ischemic stroke
Use of Large Fascia Lata Graft as Dural Substitute in Neurosurgical Procedures at Neurosurgery Department Teaching Hospital D G Khan
Get PDFIntroduction: Allogeneic grafts and other synthetic materials are being successfully used in dural grafting procedures. However, autologous resources including temporoparietal fascia, pericranium, peritoneum, and fascia lata provide an alternate substitute.' The use of fascia lata is the source of choice especially when large tissue is needed.Materials and Methods: We present 21 cases 24 (75%) male, 7 (25%) female patients (age between 10 to 60 years) in which fascia lata was used for dural substitute when there was inadequate regional tissue, such as pericranium or temporalis fascia to repair the dural defect from May 2014 to April 2015, were analyzed retrospectively. Operative indications included in gunshot wound &head trauma 14 patients (50%), tumor in eight (28.5%), cerebrospinal fluid fistula in four (14.5%), infection in two (7.0%). This was a retrospective study and ethical approval was obtained from institutional ethical board. Department of Neurosurgery treated twenty eight patients in which fascia lata was used for dural substitute when there was inadequate regional tissue, such as pericranium or temporalis fascia to repair the dural defect from May 2014 to April 2016.Results: The grafts' dimensions were from 4 × 8 cm to 8 × 18 cm. Clinical and radiologic follow-up was perfor-med up to year after surgery. There were very limited significant complications related to the fascia lata grafting (in terms of cerebrospinal fluid leakage, meningitis, and wound infection. Two patients presented post-operative CSF leakage and were treated by percutaneous lumbar drainage. All patients improved completely, requiring no additional treatment. In few cases infection was either systemic or local, but required long-term and broad-spectrum antibiotic regimen.Conclusion: Fascia lata is relatively simple and effective dural substitute for larger defects without any significant complications in our patients
Roles of Sociodemographic Characteristics in Determining Neurological Outcomes in Patients with Lumbar Disc Herniation after Microdiscectomy
Get PDFIntroduction: Socio-demographic characteristics like age, gender, occupation has important role in causation of lumbar disc herniation which may even affect their recovery after the surgery. We want to explore the difference in improvement in Neurological status in terms of difference in socio-demographic characteristics of patients.Objective: To find variation in improvement in Neurological status in post microdiscectomy lumbar disc herniation patient stratified in terms of socio-demographic characteristics.Material and Methods: A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean ± SD, Median (Range) and Frequency (percentage). Comparisons between categorical and continuous variables were done with the help of t test and one way ANOVA and comparison between both categorical variables was done with the help of chi square test in SPSS version 15.Results: Out of 70 patients 74% were male and 26% were females. Mean ± SD of patients was 37.6 ± 13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common charac-teristics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5-S1 level (96%) where Prolapse and extrusion were most common MRI findings. Improvement in motor power, sensory status was not dependent on any of socio-demographic characteristics. Improvement on SLR was associated with male genders on 1st (p = 0.03) as well as 7th, 21st and 42nd PODs (p = 0.001).Conclusion: Except gender in SLR value improvement, no other socio-demographic characteristics alter the improvement status in LDH patient after microdiscectomy
Spontaneous CSF Rhinorrhoea An Experience at King Khalid University Hospital Riyadh
Get PDFObjective: Spontaneous CSF rhinorrhoea is relatively uncommonly diagnosed entity. The objective of this study was to find out the common features in the study group and try to establish the cause of rhinorrhoea in these patients.Materials and Methods: In this retrospective study, files of all the patients who underwent surgery from January 1996 to December 2007 for spontaneous CSF rhinorrhoea were reviewed. Patients who had history of head trauma or cranial surgery were excluded from the study. All the patients had CT scan brain with CT cisterno-graphy whereas only three patients had MRI brain as well. All the patients had transcranial repair of CSF fistula. Patients were followed for 5 – 12 months with average follow up of 8 months.Results: A total of 7 patients were operated for spontaneous CSF rhinorrhoea between Jan 1996-Dec 07. Four (57%) were females and three (43%) were males. Age range was 6 years to 47 years with mean age of 35.8 years. Duration of fistula ranged from 3 months to 216 months .Two patients had one episode of meningitis. All the patients had CT scan brain with CT cisternography whereas additional MRI was done in 3 patients. Thin cuts coronal CT with CT cisternography picked the lesions in all the patients. All the patients had congenital dehiscence of cribriform plate. All the patients had transcranial repair of CSF fistula. No patient had post-operative CSF leak.Conclusion: All patients in this study group had congenital dehiscence of cribriform plate. CT cisternography with thin cut coronal CT is good diagnostic tool in CSF rhinorrhoea. Early diagnosis and management is mandatory to avoid meningiti