Pakistan Journal Of Neurological Surgery
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Minimal Invasive Burr – Hole Management of Traumatic EDH
Get PDFIntroduction: Epidural hematoma (EDH) is a neurosurgical emergency. Delay in urgent treatment may lead to severe morbidity and even mortality. Conventionally, EDH was treated by formal craniotomy. Rarely, minimally invasive burr – hole drainage is employed especially in critically sick patients. We believe every case of pediatric EDH can be successfully drained by minimally invasive burr – hole drainage.Materials and Methods: This study was conducted at the Department of Pediatric Neurosurgery, The Children’s Hospital and the Institute of Child Health Lahore, between 19-01-2014 and 24-03-2016. The medical record of patients with EDH managed by minimally invasive burr – hole technique was reviewed in prospective way for history, clinical examination, investigations, management given, complications, and outcome.Results: There were a total of 50 patients. Thirty four were male and 16 were female patients (M:F 2.1:1). Age was ranged between 45 days and 12 years (6.48yr ± 3.30yr). In 27 patients etiology of EDH was fall from roof and in 5 patients it was fall from bed/sofa, in 3 children fall from lap, in 8 fall from stairs, in 6 children it was road traffic accident, and brick fall over head in 1 child. Preoperative GCS was 3 – 8 in 11 patients, between 9 - 12 in 18, and between 13 – 15 in 21 patents. CT scan/MRI was performed in all patients for diagnosis, as per availability. All patients were operated by minimally invasive burr – hole drainage technique. Postoperatively, 1 patient required re-drainage by the same technique. There was one expiry in our series. All the 49 patients are discharged at GCS 15/15.Conclusion: A survival rate of 98% is evident of safety and effectiveness of minimally invasive burr – hole drainage of EDH in children with added benefits of less operative time, operative morbidity, and hospital stay
Frequency of Cauda Equina Syndrome in Patients with Lumbar Disc Herniation
Get PDFIntroduction: Herniation of the lumbar inter-vertebral disc can cause severe compression of the cauda equina. A precise understanding of this syndrome is important because any delay in diagnosis and treatment may result in poor outcome. Objective: The objective of this study is to determine the frequency of Cauda Equina Syndrome in patients with lumber disc herniation. Materials and Methods: This cross sectional descriptive study was conducted at Department of Neurosurgery, Postgraduate Medical Institute Lady Reading Hospital, Peshawar. A total of 127 patients of cauda equina syndrome were taken through convenience (non-probability) sampling, in a period of six months (from November, 2010 to May 2011). Patients of both genders presented with unilateral or bilateral foot drop, ankle areflexia, saddle anesthesia and urinary incontinence due to lumber disc herniation were included while patients with spinal tumors, lumbar Spinal stenosis and recurrent disc herniation were excluded. The data was analyzed using the statistical program SPSS version 10. Results: Out of 127 patients majority of the patients were male i.e. 65.35% (n = 83) 44.65% were female. Most of the patients were between 31 – 40 years of age followed by 20 – 30 years, 29.92% (n = 38). Frequency of cauda equina syndrome in patients with lumbar disc herniation was found in 11.02% (n = 14). Conclusion: The relationship between Cauda Equina Syndrome was found with lumbar disc herniation and the frequency was found in accordance to other studies. Cauda Equina Syndrome is most common in the patients between 31 – 40 years of age, followed by 20 – 30 years of age. Gender distribution of the patients showed that majority of the patients were male. Frequency of cauda equina syndrome in patients with lumbar disc herniation was 11%
Underlying Causes of Lumbar Disc Disease in Young Adults
Get PDFBackground: Rationale of the study was to gather data about the underlying causes of lumbar disc herniation in young adults as awareness of these etiological factors will help the clinician extract a relevant medical history, perform a directed physical examination, and order appropriate imaging studies. This will aid in initiating early intervention, be it conservative or operative, and achieving a favorable outcome.Purpose: To determine the underlying causes of lumbar disc herniation in young patients.Materials and Methods: This Descriptive Cross – sectional study was conducted at Department of Neuro-surgery, Sandeman Provincial Hospital, Quetta. A total of seventy five (n = 75) adult patients of either gender less than 30 years of age with chronic back pain were included in the study. Underlying causes were ascertained through detailed history and clinical examination. Subsequently, all patients underwent MRI for the detection of the prolapse.Results: 72% (n = 54) of patients were males and 28% (n = 21) were females 81.3% (n = 61) were found to have disc herniation due to mechanical load (trauma, RTA, weight lifting). 16.0% (n = 12) had systemic disease and 2.7% (n = 2) had a positive family history indicating genetic etiology. Out of 61 patients where underlying cause was mechanical load, 21 patients gave history of trauma, 19 had history of RTA. 14 were long distant drivers and 7 had history of heavy weight lifting.Conclusion: In this study, mechanical load (trauma, RTA, long distant drivers and weight lifting) was found to be the major underlying cause of lumbar disc herniation in young adults
Etiology of Brain Abscess in Patients Presenting to Neurosurgery Department of Lady Reading Hospital Peshawar
Get PDFObjective: To determine the etiology of brain abscess in patients presenting to Neurosurgery Department of Lady Reading Hospital, Peshawar.Materials and Methods: This retrospective study was conducted in Neurosurgery Department, Lady Reading Hospital, Peshawar from March 2015 to February 2016. All patients admitted with brain abscess were included in the study while patients with meningitis, encephalitis, subdural empyema, and tuberculoma were excluded. Patient’s age, gender, pre-operative symptoms and etiology of brainabscess were recorded on a designed Proforma from hospital charts.Results: Out of 42 patients, males were 30 (71.42%) while females were 12 (28.58%). They were most common in first three decades, having total number of patients of 35 (83.33%) with the mean age of 30.15 ± 2 SD. The three most common pre-operative symptoms were fever, headache and vomiting. Most common sources of infect-ion were otitis media 20 (47.61%) and congenital heart diseases 7 (16.66%). In 31 (73.80%) patients temporal and parietal lobes were involved.Conclusion: Brain abscess is common in young to middle age population due to unhygienic status of ears with malepredominance. Temporal lobe of the brain is most common site of abscessand majority of the patients present with nausea, vomiting, fever, signs of raised intracranial pressure and meningism
Patterns of Motorbike Accidents Related Head Injuries in Patients Presenting to a Tertiary Care Hospital of Peshawar
Get PDFObjective: To determine the different patterns of motorbike related head injuries in patients presenting to a tertiary care hospital of Peshawar.Materials and Methods: It was a prospective (observational) study, which was conducted at the Neurotrauma ward of Neurosurgery department, Lady Reading Hospital, Peshawar from January 2016 to June 2016. Total number of patients were 246. We included those patients who were having impaired Glasgow Coma Scale (GCS), danger signs and having some abnormal findings on CT brain. We excluded those patients who were having GCS 15/15 and those patients of head injury having associated co-morbid conditions.Results: There were 230 (93.49%) males and 16 (6.5%) females. Age range was 1 to 80 years. Majority of pati-ents were drivers (55.28%). Only 6 (2.43%) drivers used helmet. Ninety patients (36.58%) had an ICU stay of more than one week. Seventy six (30.89%) patients were operated and 170 (69.1%) patients were treated con-servatively. Mortality was 14.63% in our study.Conclusion: Majority were males in our study, most of the patients who sustained head injury in motorbike accidents were drivers. Thirty six percent of the patients needed ICU stay of more than 1 week. Maximum of the patients needed conservative treatment
Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarct
Get PDFObjective: To know outcome of Decompressive hemicraniectomy in patients presented with malignant middle cerebral artery (MCA) infarct.Materials and Methods: This prospective study was conducted in Neurosurgery department of Lady Reading Hospital, from December 2011 toNovember 2014. A total number of 10 patients were included in the study. All patients were admitted in neurosurgery ward through emergency, were subjected to detail history and exami-nation. After preoperative workup patients were operated in emergency. We analyzed gender, age, Glasgow Coma Scale (GCS) on admission, pre-surgical evaluation, clinical status on pre-surgical exam, and Glasgow Outcome Scale (GOS), immediate postoperatively, at 3 months and 6 months after discharge. We assessed out-come by Glasgow outcome score and modified Rankin scale (mRS). Data was analyzed by SPSS version 17.Results: Of the total 10 patients, 8 (80%) were male and 2 (20%) were female. Age ranged from 40 to 75 years (mean 62.7 ± 11.19 years). On admission, the mean GCS was 10 (Ranged from 8 to 12). Time between onset of symptoms and decompressive craniectomy was less than 24 hours in 2 (20%), 24-48 hours in 3 (30%), 48 – 72 hours in 1 (10%) and 72-96 hours in 4 cases (40%). Early surgery (? 48 hours) was carried out in 5 (50%) cases and late surgery (? 48 hours) in other 5 (50%) patients. Length of stay in the hospital was 7 to 16 (mean 11.5) days. Surgery improved significantly the GCS of patients comparing the immediate preoperative scores (6 to 10) and immediate post-operative GCS 5 to 15 (mean 10).Conclusion: Decompressive hemicraniectomy increases the probability of survival without increasing the number of very severely disabled survivors. Still, the decision to perform surgery should be made on an individual basis in every patient
Combined Approach for Excision of Advanced Angiofibroma : A Study of 12 Cases
Get PDFTo determine effectiveness of combined skull base approach for excision of advanced angiofibroma.Materials and Methods: This study was conducted at the Department of Ear, Nose, Throat, Head and Neck Surgery and Neurosurgery, Post Graduate Medical Institute Lady Reading Hospital Peshawar. This was retrospective observational study. The duration of the study was 5 years from Jan., 2003 to Dec., 2008. This study included 12 cases with advanced (stage IIIA and IVB) of Nasopharyngeal angiofibroma. These cases were assessed in terms of detailed history, through examination and radiological investigations to stage according to the Fisch classification. The tumour was completely excised by combined approach of a team of Neurosurgeons and ENT surgeons. No recurrence found in 30 months post-op observation.Results: This study included 12 cases. All were male. Age of the patients was in range of 14 to 19 years with mean of 16.5 years. They belonged to lower and middle class of society. They presented with history of unilateral nasal obstruction (100%) while MRI where needed. The disease was involving nose, nasopharynx, sinuses and had Extracranial and intracranial extension. Nine cases (75%) were in stage IIIB and 3 cases (25%) in stage IVA according Fisch classification. The procedure time was average 7.5 hours and average 700 ml blood was transfused. Platal fistula formed in one case (8.3%) and no recurrence found on 18 months follow up.Conclusion: The cooperation of neurosurgeons and otorhinolaryngological doctors provides a good way to minimize invasiveness in skull base surgery. Sufficient preoperative preparation, well equipped theatre and surgical expertise are necessary for complete resection of benign tumor like angiofibroma
Clinical Presentation and Postoperative Outcome in Patients with Chronic Subdural Hematoma
Get PDFObjective was to study the clinical features of chronic subdural hematoma and Postoperative outcome after one week of surgery in chronic subdural hematoma. It was a descriptive study. It was a hospital based study which was conducted in the department of neurosurgery at PIMS; from 1st July 2002 to 30th June 2003.Thirty patients of chronic subdural hematoma were included in this study. This study was conducted on thirty patients suffering from chronic subdural hematoma. These patients were selected on the basis of history, clinical features and C.T. scan or M.R.I. findings, showing the evidence of chronic subdural hematoma. For data analysis, spss 8 software was used.Results: Thirty patients were studied. Among them, there were twenty four male patients and six female patients. The male to female ratio was 4:1. The age range was 40 to 88 with average of 61 years. Twenty one patients (70%) gave a history of head injury. Nine patients (30%) did not remember any injury to the head. Twenty two patients (73%) had hemipresis. Twenty patients (66%) presented with headache. Seventeen patients (56%) had a history of bed wetting. Fourteen patients (47%) presented with behavioral changes. CT scan of twenty three (76.6%) patients showed unilateral hematoma while the remaining seven (23.3%) showed bilateral chronic subdural hematoma. Twenty eight were operated under general anesthesia while the rest were operated under local anesthesia. On discharge twenty six 86.6% patients showed excellent outcome. Mortality rate was 6.6%.Conclusion: Chronic subdural hematoma is an important reversible cause of disability in the elderly. Most of them present with hemipresis, headache, and urinary incontinence. While some of them present with behavioral changes and memory loss. When patients were followed after one week of surgery it was found that most of them had an excellent outcome. Mortality and morbidity of chronic subdural hematoma has decreased markedly in recent years because of improved diagnostic facilities and prompt surgical intervention
Etiology and Outcome of Non-traumatic Coma
Get PDFAbstract: Non-traumatic coma is a result of heterogeneous group of diseases and is an important cause of morbidity and mortality in children. Local data is scarce on epidemiology. Literature on pediatric non-traumatic coma is rather inconclusive, as there are a few systematic studies, and most of them are retrospective.Objectives: The Purpose of this study was to determine the specific age group, etiology and outcome of non-traumatic coma in children.Materials and Methods: In an observational study over a period of 6 months from 1st July 2010 to 31 December 2010, files of 111 children aged between 1 month – 16 years admitted with non-traumatic coma GCS (Glasgow Coma Scale of < 12/15 with at least 6 hrs. duration) to the emergency section of Pediatrics Department of Jinnah Hospital Lahore were reviewed. Data was collected from the files and entered using SPSS version 16. Chi-square and P value were calculated. Etiology was determined from history, physical examination and relevant investiga-tion. Outcome was grouped as died or discharged (with normal neurological examination with mild to moderate disability or vegetative state / severe neurological disability), left against medical advice or referred.Results: Etiology was infectious in 66 (60%) patients, accidents / intoxication in 13 (11.4%) patients, epilepsy (status epileptics) in 12 (10.8%) patients, encephalopathy in 8 (7%) cases, metabolic (diabetic ketoacidosis, inborn error of metabolism) in 5 (4.50%) patients. Overall mortality was in 29 (26.12%). Mortality was high in infants 53.12% as compared to other age groups.Conclusion: The most common cause of non-traumatic coma in children was Central Nervous System infections. Mortality was high in infants
Surgical Outcome of Anterior Skull Base Approach for Combined ENT and Neurosurgical Lesions
Get PDFObjective: To determine surgical outcome of Anterior Skull Base approach for combined ENT and Neurosurgical Lesions.Material and Methods: This descriptive study was conducted at the departments of ENT, Head, Neck Surgery and Neurosurgery Postgraduate Medical Institute (PGMI) Lady Reading Hospital Peshawar from March 2003 to Feb. 2008, with a total duration of five years. All these patients were admitted in ENT department. These patients were evaluated in terms of detailed history, thorough examination and radiological investigations. Incisional biopsy of the nasal mass was taken in cases where angiofibroma was excluded clinically, and then proper approach for excision of the lesion was planned. A well informed consent was taken from patient explaining the procedure, its risks, benefits and associated complications. The intracranial lesion was completely excised by neurosurgeons with help of microscope while the extracranial portion of the lesion was excised by ENT surgeon. The specimen of the lesions was examined by Histopathologist.Results: This study included 23 patients in the age range of 12 – 51 years, mean age 25 years. Eighteen patients were male and five were female with female to male ratio of 1:3.6. These patients presented mainly with comp-laints of nasal obstruction, epistaxis and headache. CT scans were performed in all 23 cases (100%) while MRI in 5 cases (21.73%). These patients presented with advanced disease on radiological findings and they were treated by combined approach by Neurosurgeons and Otorhinolaryngologists. On histopathology of the specimen angiofibroma was on top. Two patients were subjected to radiotherapy postoperatively. There was no mortality and no recurrence of the disease.Conclusion: The anterior skull base approach has good surgical outcome in terms of complete clearance of the disease and minimum morbidity for combined neurosurgical and ENT lesions irrespective of the nature of the lesion