Pakistan Journal Of Neurological Surgery
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Transventricular Endosopic Removal of Third Ventricular Hyperdense Cystic Craniopharyngioma
Get PDFIntraventricular craniopharyngioma, a rare form which is usually a squamous papillary type and CT scan picture shows hypodense lesion. We are reporting an intraventricular hyperdense cystic craniopharngioma in a 6 year old girl which was removed by intraventricular endoscopy. Hyperdense lesions in the ventricle may be due to craniopharyngioma due to their high protein content. These lesions can be better removed with neuroendoscope
Clinicoradiological Features and Early Postoperative Outcome of Depressed Skull Fractures
Get PDFIntroduction: Skull fractures are frequently associated with head injury, especially in younger children and young adults. Upto 12% of head injury cases are associated with depressed fracture with a variety of clinical and radiological features. Clinical and radiological features of intracranial injuries are the chief determinants of postoperative functional outcome.Objectives: We aimed to study the diverse nature of clinical and radiological features and to determine their impact on the postoperative outcome in patients of depressed skull fractures.Materials and Methods: This is a prospectively conducted case series of a descriptive nature, conducted at the department of Neurosurgery, Hayatabad Medical Complex Peshawar between January 2015 and December 2015. All patients between age 15 years and 65 years, from both genders with the diagnosis of depressed skull fractures due to closed head injury were included. Patients with penetrating nature of trauma such as gunshot wounds or stab wounds were excluded.Results: 65 patients with 46 (70.9%) males and 19 (29.2%) females in a ratio of 2.42:1. The most common cause of injury was road traffic accident with a mean age of 25.14 years ± 6.23 SD. Compound fractures were present in 56.9% while the rest were simple. Mean arrival GCS was 11.0 ± 2.29 SD. Mean GCS at discharge was 12.8 ± 3.28 SD and mean GOS was 4.05 ± 1.13 SD. Favourable outcome was recorded in 75.4% of patients while the rest were in unfavourable group. Most common complications were septic which occurred in a total of 15.4% patients and was followed in frequency by CSF leaks postoperatively. There was no mortality.Conclusions: The clinical features such as arrival GCS, pupillary abnormalities, focal deficits and radiological features such as the presence of intracranial and parenchymal lesions predict the outcome in terms of Glasgow outcome score. Most commonly septic complications and CSF leaks occur as complications after surgery
Surgical Outcome of Anterior Circulation Cerebral Aneurysm Surgery, A Review of 52 Cases
Get PDFObjective: To assess the variables contributing to surgical outcome after anterior circulation cerebral aneurysm clipping.Design: Descriptive study.Place and duration of study: Combined Military Hospital Rawalpindi from Jan 2006 to Dec 2010.Material and Methods: A total of 52 cases were included in the study who underwent surgical clipping of anterior circulation cerebral aneurysm at neurosurgical centre CMH Rawalpindi from Jan 2006 to Dec 2010. Data collection was done using non-probability convenient sampling. Both male and female were included in the study. Patients with multiple, unruptured and those of posterior circulation aneurysms were excluded from the study. Patients were divided in two groups. The first group was operated in less than three weeks time after subarachnoid haemorrhage while the second group was operated after three weeks. CT angiography was used for the diagnosis of aneurysms. Postoperatively obliteration of the aneurysms was confirmed radiologically three weeks after the procedure. Postoperative results were compared for each group.Results: Between Jan 2006 and Dec 2010, 52 patients harbouring anterior circulation cerebral aneurysms were selected for the study. Mean age was 48.35 years. 72% were males while 28% females. Overall the patients operated in first group had a combined morbidity of 7% while second group patients had a combined morbidity of 3.6%. Patients less than 50 years of age with aneurysm size of less than 10 mm and Hunt and Hess grade of 1 and 2 had a morbidity of 2.4%. Patients more than 50 years of age with aneurysm size of more than 10 mm and Hunt and Hess grade of 3 had a morbidity of 8%. Only one patient in second group died in the postoperative period due to hypostatic pneumonia.Conclusion: Age of the patient, size of the aneurysm, Hunt and Hess grade and the timing of surgery are independent predictors of surgical outcome in anterior circulation cerebral aneurysm surgery
Out Come of Microvascular Decompression (MVD) for Hemifacial Spasm
Get PDFObjective: To assess the efficacy of MVD for hemifacial spasm.Material and Method: This study included (10) Ten case s of hemifacial spasm treated at the Department of Neurosurgery Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur during a period of (3) three year from January 2007 To December 2009, with follow up period of one year. Micrvascular Decompression (MVD) for 7th nerve was performed in all the cases.Results: Eight (8) were female and (2) two were male patients with age range from 30 – 50 years. Duration of symptoms in all the patients were more than two years and all have used medical treatment already prior to surgery. All the patients were found to be cured from their illness during post-operative follow up period for one years. There were fewer complications those were treated satisfactorily.Conclusion: Micro-Vascular Decompression (MVD) for Hemifacial spasm is an excellent procedure with about more than 90% cure rate, as mentioned in the international literature and was found in our series of cases as well
Surgical Complications Following Removal of Cerebello-Pontine Angle (CP) Lesions
Get PDFObjective: To know about the complications requiring surgical intervention, following removal of cerebellopontine angle lesions.Materials and Methods: We retrospectively reviewed the series of patients who underwent CP angle tumor surgery at our department between January 2010 to May 2014. The patient age and sex along with the chief complaints as well as prior surgery in the form of ventriculoperitoneal shunt or endoscopic third ventriculostomy (ETV) were recorded on a designed proforma. The derived based immediate surgical complications considered were; Cerebrospinal fluid (CSF) leak, post operative Hydrocephalus (HCP) needing a Ventriculperitoneal (VP) shunt, post operative hematoma needing re-exploration and death.Results: A total of fifty six (n= 56) patients were included in this study, with 24 males and 32 females. Age ranged from 3 years to 65 years with a mean age of 41 years, duration of symptoms was from 8 days to 12 years. The means hospital stay was from 8 to 33 days. Prior surgery was performed in 12 patients (21.3%) with 7 patients having a VP shunt and 5 patients having an Endoscopic third ventriculostomy (ETV). CSF leak was encounterdin (7.6%) a deterioration in facial nerve function in 3 (5.4%) patients requiring lateral torsoraphy. Five patients needed immediate re-do surgery with 3 (5.4%) having a VP shunt and 2 (3.6%) patients requiring a re-exploration for post-op hematoma.Conclusions: The immediate surgical complications of the CP angle surgery are the formation of hematoma, development of hydrocephalus while early complications requiring surgery are CSF Leak and facial nerve palsy. Almost all of them require far or less a surgical intervention for management
Spectrum of Skull Lesions in Pediatric Population: A Single Institutional Experience
Get PDFBackground: Pediatric skull lesions are rare. Here, a single institutional experience dealing with such lesions is presented.Methods: A retrospective review of 18 consecutive pediatric patients was done, who were treated for a variety of skull lesions at Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh from 2010 to 2015. The clinical and pathological features, diagnosis, management and outcome were noted and analyzed.Results: In this study, eighteen skull lesions were identified in 10 male (55%) and 8 female (44%) patients, with a mean age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 11). Fronto-orbital (n = 6) was the most frequent site encountered in this study followed by temporo-parietal (n = 3) and parieto-occipital area (n = 2). Gross total resection achieved in 15 patients (83.3%) and reconstruction of skull defect was possible in 11 (61.1%) of them. Excluding the malignant lesions, no recurrence was found in this study cohort for a mean follow up time of 2.8 years.Conclusions: Majority of the skull lesions in children are benign. Pre-operative angiography and embolization is helpful to reduce the intraoperative blood loss. Gross total resection with reconstruction is the treatment of choice. Recurrence is uncommon after gross total resection
To Study the Factors of Favorable Clinical Outcome of Traumatic Brain Injury Due to Firearm
Get PDFAim: The aim of this study is to evaluate factors affecting favorable outcome of traumatic brain injuries caused by bullets and bomb blast wounds.Material and Methods: This was a descriptive study conducted in the department of neurosurgery Hayatabad Medical Complex Peshawar from January 2011 to January 2012. There were 104 patients of bomb blast and bullet injuries to the head were admitted in emergency department of Hayatabad Medical Complex after initial resuscitation shifted to Head Injury Unit. Their neurological, radiological and operative findings were studied for favorable clinical outcome. Neurological assessment was done with Glasgow coma score, X-Ray skull and CT brain was done in all the patient. Emergency surgery was done for all the patients. All patients were fallowed for a period of two month. Brain injuries due to other causes were excluded from the study.Results: Almost all patients (80%) were male, and the mean patient age was 22.3 years. Wounds caused by shrapnel in 70 percent of patients. The Glasgow Coma Score (GCS) score at admission was below 8 in 26 pati-ents (25%) and above 8 in 78patients (75%). In total, 14 patients (13.4%) died despite surgical management.Conclusion: Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prog-nosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates
Recurrence of A. Com – ACA Complex Cerebral Aneurysms after Coiling
Get PDFObjective: To assess the recurrence of A.com-ACA complex cerebral aneurysms after coiling.Materials and Methods: This study was conducted from July 2010 to December 2013 at the department of Neuroradiology, PGMI, Lahore General Hospital, Lahore. A total of 50 patients with cerebral aneurysms at the level of A. Com – ACA complex were included in this study of both gender (male and female) and in the age range of 45 – 65 years.Results: Out of 50 patients, there were 20(40%) males and 30 (60%) female patients. Their age ranged from 45 - 65 years. The maximum numbers of patients were in their fifth and sixth decade of life. In our study successful coiling was done in all patients with minimal recurrence/recanalization of cerebral aneurysms at A.com-ACA complex.Conclusion: Coiling is minimally invasive endovascular procedure routinely performed to treat cerebral aneurysms with an aim to highlight the significance of recognizing the large sized aneurysms recurrence / recanalization by regular follow up and early intervention to decrease morbidity and mortality of the patients
Primary Titanium Mesh Cranioplasty in Open Depressed Skull Fractures
No full textObjectives: Primary reconstruction of open fracture with titanium mesh should be attempted as and when possible because it is feasible, safe, and cosmetically preferable than the conventional staged approach. The aim of the study was to analyze, the benefits of Primary reconstruction of open fracture with titanium mesh than the conventional staged approach.Materials and Methods: We used a primary single – stage reconstruction for patients presenting with open depressed skull fractures. All patients received antibiotic prophylaxis. The patients underwent elevation of the compound fracture and craniotomy if necessary. Debridement was performed, followed by skull reconstruction using a 0.6-mm titanium mesh.Results: We present 14 consecutive 10 (71%) male, 4 (29%) female patients (age b/w 11 to 45 years) who underwent primary reconstruction of open depressed skull fractures from May 2014 to September 2015, were analyzed retrospectively. Clinical and radiologic follow-up was performed one and half year after surgery. The duration of the surgery was 2 to 3 hours. No evidence of adverse healing, wound infection, or implant exposure or extrusion in any of the patients reviewed in our series. Cosmetic deformity correction to excellent level was achi-eved in better way as compared to contra lateral site.Conclusions: Primary reconstruction of open fracture with titanium mesh should be attempted as and when possible because it is feasible, safe, and cosmetically preferable than the conventional staged approach. Further technological advance and larger studies are required to investigate the usefulness of titanium mesh devices in neurosurgery and to obtain long-term good results
Association of Extradural Hematoma with Linear Skull Fracture: a Clinical Study of 79 Cases in a Teaching Institute
Get PDFObjectives: To determine the frequency of extra dural hematoma in patients with linear skull fracture due to head injury.Material and Methods: This cross-sectional study was conducted in the Department of Neurosurgery, Mardan Medical Complex, Mardan from June 2016 to May 2017. Patients of either gender with linear skull fracture and above 2 years of age were included in the study, while patients with bleeding disorder or on anti-coagulants and those presenting 72 hours after injury were excluded from the study. Patient’s demographic profile, type of injury, location of injury and CT findings were recorded and documented on pre designed proforma. Data was analyzed using SPSS version 20.0Results: Out of 79 patients, 55 (70%) were male and 24 (30.3%) were female. Age ranged from 2 years to 60 years (mean 33 years ± 2.54 years). Among these patients the most common cause of head injury was road traffic accident in 44 (55%), followed by fall from height in 20 (25.3%) and assault in 10 (12.6%) of patients. The most commonly fractures skull bone was parietal in 38 (48%) of patients, followed by temporal bone in 21 (26.5%), frontal in 12 (15.1%), and occipital in 8 (10%) of patients. The frequency of extradural hematoma in linear skull fracture was 21 (26.5%).Conclusion: There is strong association of extradrual hematoma with linear skull fracture, therefore a fully conscious person having head injury with skull fracture should be highly suspected for intracranial hematoma