Pakistan Journal Of Neurological Surgery
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Role of Surgery in the Management of Carrie’s Spine
Get PDFObjective: To assess the efficacy of surgical management of carrie’s spine along with anti-tuberculous medication.Material and Methods: It is a study of 15 cases of carrie’s spien which were treated surgically at the Depart-ment of Neurosurgery Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur. Study span was two years from January 2007 to December 2008. Age range was 20 to 40 years with average age of 25 years. All were young patients belonging to poor socio-economic class. It was a prospective study.Results: Fifteen patients were enrolled in this study. All were young patients belonging to poor socio-economic class. Different regions of the spine involved were; 2 cervical, 6 thoracic, 3 thoracolumbar region. Most of the patients were having history of illness at least for the last three to six months with the complaints of spinal pain, evening fever, loss of weight etc. In all the patients, some kind of surgical treatment like. Costo-transversectomy, corpectomy, removal of dead bone, pus and granulation tissues etc along with some sort of stabilization proce-dure was performed. Patients were able to be mobilized early after surgical procedure and ATT plus other sup-portive treatment was continued for one year along with regular monitoring.Outcome: The result were satisfactory as was desired because aim of surgical management was early mobili-zation of the patients to speed up the recovery. Almost all the patients improved to different extends regarding their neurological status.Conclusion: Surgical management along with medical treatment is indicated in carrie’s spine when the disease is not responding satisfactorily to the chemotherapy alone, when the neurological deficit is appearing or increas-ing. It is necessary to stabilize the spine in all these cases to halt the damage and enhance the recovery
Road Traffic Accident – A Preventable Cause of Head Injury: Experience in Lady Reading Hospital, Peshawar
Get PDFObjective: To study the different causes and aspects of head injury in patients of road traffic accidents.Material and Methods: This observational study was conducted in Neurosurgery Department of PGMI, Lady Reading Hospital Peshawar from January 2010 to June 2010. Patients of all ages with either sex were included in this study, while those patients of head injury having associated thoracic, abdominal or pelvic injuries were excluded. All the data was collected by using a Performa. Data was analyzed by descriptive statistics using SPSS software version 17.Results: Out of total 1344 trauma patients, 638 sustained head injury due to Road traffic accident (RTA). Male were 67.24% (429 patients) and female were 32.75% (209 patients). Most of the patients (66.45%) were up to 30 years of age, i.e., less than 10 years were 23.98% and 42.47% were of the age range of 11-30 years. Majority of the patients (87.93%) were treated conservatively, while 77 patients (12.06%) required surgical intervention and were treated accordingly. Major radiological findings were extradural hematoma and brain edema, 15.98% each, brain contusions 12.69%, skull bone linear fracture, linear fracture with pneumocephalus and subgaleal hema-toma 9.56% each. Out of total 137 patients of severe head injury (GCS = 3 – 8) only 28 expired. Most of the patients (67.86%) had satisfactory condition at discharge.Conclusion: Although majority of the patients of road traffic accident did not require any neurosurgical intervention, most of them remained admitted for quite a long period of time, due only to a cause which could have easily be avoided
Endocrine Accompaniments in Acromegaly Patients Before and After Surgery
Get PDFBackground and Aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH – secreting adenomas. The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal.Methods: The present study is based on 07 patients (04 males and 3 females), 30-50 year of age, diagnosed for Functional Pituitary Adenomas (FPAs) on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls. Follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), growth hormone (GH) and prolactin (PRL) were determined in serum before and following trans-sphenoidal adenomectomy. The GH, FSH, TSH and PRL content of the excised adenoma tissue was also measured in male patients. All hormone determinations were carried out using commercially available immuno-assay kits (ELISA and IRMA) in duplicate.Results: The results demonstrate that the mean serum GH levels in the 04 male and 03 female patients with FPAs were found to be significantly higher before surgical removal as compared to those obtained following surgery. Significant differences were observed between pre- and postsurgical serum GH levels in male and female patients with FPA. GH content was also determined in the male adenoma tissue. Following removal of the adenoma in these 4 male and 03 female patients, peripheral serum GH levels fell within the normal range. The adenoma tissue GH content in patients with initial higher serum GH levels was also significantly greater than that of the other patients. The mean serum PRL concentration in male patients before removal of the adenoma and values obtained after surgical removal of the adenoma and those of control subjects were not significantly different. The mean PRL concentration of the adenoma tissue in all the male patients was not significantly different from the control pituitary tissue. However, the presurgical mean serum PRL concentration were significantly higher in 2 of the 3 female patients included in this study as compared to the control values. Following removal of adenoma, normal serum levels were attained in those patients. In the remaining one female patient serum PRL concentra-tion was within the normal range before and following surgical removal of the adenoma. The mean serum FSH levels in the 04 male patients with FPAs were not significantly different before and after surgical removal of ade-noma tissue. However, an examination of individual values reveals higher FSH levels in 02 of the male patients and in 01 of the three premenopausal female patients. Following surgical removal of the adenoma, serum FSH concentrations showed a marked decline of FSH levels in those patients. However, the remaining two females showed normal FSH levels before and after surgery. The adenoma FSH content of these patients was not signifi-cantly higher than those of the control pituitary tissue. No significant differences were observed between pre and post-surgical serum TSH levels. The TSH content of adenoma tissue was either non-detectable or in the low range as compared to the TSH content determined in control pooled pituitary tissue.Conclusion: Transsphenoidal surgery is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinusEndocrine Accompaniments in Acromegaly Patients Before and After Surgery invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly
Post Traumatic Hydrocephalus: A Review of 68 Cases
Get PDFObjective: To evaluate different factors affecting post traumatic hydrocephalus.Material and Methods: This retrospective study was conducted in the department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from July 2009 to June 2011. Record of all head injury patients was reviewed. Out of 5438 admitted patients with head injury, those who developed post traumatic hydrocephalus were included in the study.Results: A total of 68 patients with post traumatic hydrocephalus were diagnosed over the last two years. Out of these 47 (69%) were male and 21 (31%) female. Mostly they were of young age group between 08 years to 41 years. Mean age of presentation being 20 years. A large group 56 (82%) out of 68 patients were in state of moderate to severe head injury, diagnosed within matter of hours or days, as acute post traumatic hydrocephalus. Those who developed after two weeks, fall in group chronic post traumatic hydrocephalus. Out of these, 55 (81%) patients underwent some sort of CSF diversion procedure like external ventricular drain (EVD) or Ventriculo Peritoneal (VP) Shunt. Subarachnoid hemorrhage, intraventricular hemorrhage, intracranial hematoma, posterior fossa bleed, meningitis and craniotomy were recognized associative factors for development of PTH. There was improvement in about 59% after surgery. And the long term prognosis, expressed in GOS, was good in 44% of the cases.Conclusion: Post traumatic hydrocephalus is a dangerous complication and needs critical consideration and early diagnosis in severe head injury cases
Secondary Brain Injury in Early and Late Tracheostomy in Severe Head Injury Patients
Get PDFObjective: To determine the risk of secondary brain injury during tracheostomy in severe head injury patients.Material and Methods: The study was carried on 180 patients of severe head injury admitted to Neuro ICU in Lady Reading hospital, Peshawar from March 2015 to March 2017. Early tracheostomy was performed in 95 and late tracheostomy in 85 patients. Patients on ventilator with spontaneous breathing and vitally stable were included and those with no spontaneous breathing, vitally unstable or had already tracheostomy been excluded.Results: From a total of 180 patients, 95 (53%) and 85(47%) patients went under early and late tracheostomy group respectively. In the early group, 35 (37%) patients dropped GCS and 60 (63%) were static or improved. Further, patients who dropped GCS in early group, 32(91%) died while 3 (9%) improved or static. Even patients who improved in early group, 10 (17%) died while 50 (83%) improved or static. While in the late group, 9 (11%) dropped GCS more than 2 points and 76 (89%) were static or improved. Further, patients who dropped GCS in late group, 7 (78%) died while 2 (22%) improved or static. Even patients who improved in late group, 6(8%) died while 70 (92%) improved or static. Overall results of the study show that morbidity and mortality is high among early tracheostomy group than late group.Conclusion: It is concluded that there is risk of secondary brain injury during tracheostomy
Von Hippel – Lindau Disease, Involvement of Multiple Members of the Same Families
Get PDFVon Hippel – Lindau disease is a heritable multisystem cancer syndrome that is associated with a germline mutation of the VHL tumour suppressor gene on the short arm of chromosome 3. This disorder is not rare (about one in 36 000 live births) and is inherited as a highly penetrant autosomal dominant trait (i.e. with a high individual risk of disease). Affected individuals are at risk of developing various benign and malignant tumours of the central nervous system, kidneys, adrenal glands, pancreas, and reproductive adnexal organs. Because of the complexities associated with management of the various types of tumours in this disease, treatment is multi-disciplinary.Objectives: We present an overview of the clinical aspects, management, and treatment options for von Hippel-Lindau disease in three families, a total number of 7 patients.Study Design: It was a descriptive observational study.Material and Methods: In this study we included 7 patients belonging to 3 families. In the first family there was a father and a son, both of them had Von Hippel-Lindau disease. In the second family two sisters and one brother was involved, while in the third family one brother and one sister had this disease. This study was conducted in the Department of Neurosurgery, Lahore General Hospital, Lahore.Results: In this study we observed that 1 out of 7 patients died, 1 is bed ridden with paraparesis. The rest 5 patients are passing their normal routine life. We observed that in all of our patients (100%) there was CNS involvement, the recurrence in our series is quite high. (70%), 3 of our patients required permanent V.P. Shunt while 1 patient required per operative EVD. In 2 of our patients eye surgery was required. 1 of our patient underwent the Gama Knife (Radio surgery)
Source of Bleeding in Acute Extra-dural Hematoma
Get PDFObjective: To know about the source of bleeding in acute extra-dural hematoma (EDH) in patients suffering head injury operated in a tertiary care hospital.Materials and Methods: This study was carried out in the Department of Neurosurgery; Govt. Lady Reading Hospital, Peshawar. We retrospectively analyzed the record of patients operated between the December 2012 and June 2013 (six months). Data was entered from the operation notes including the admission number, age, sex, location of the hematoma and presence or absence of fracture, source of bleeding. Data was analyzed using SPSS version 16.Results: A total of 93 patients were operated and three had re-exploration at our department during the six month period and of these 83 were males and 10 were females(male to female ratio; 10:1), fracture was present in 70 (75.3%) patients and the sole cause of bleeding was in patients 49 (52.7%), middle meningeal artery (MMA) was the cause of bleed in 21 (22.6%), both fracture and MMA was the Source of bleed in 14 (15.1%), generalized ooze in 5 (5.4%) and sinus bleed was encountered in 3 (3.2%) while in one patient the source was unidentified (1.1%).Conclusion: The fracture has been associated with the EDH in almost 75% of cases and has been the sole cause of bleed in more than half cases and along with MMA in every fifth case of EDH
Traumatic Subdural Empyema – A Rare Neurosurgical Emergency: Case Report and Review of Literature
Get PDFSubdural empyema is a neurosurgical emergency with potentially overwhelming complications. The prognosis is harmfully affected when early diagnosis is not made. Recent advancement in the imaging techniques, especially contrast enhanced CT Scans and MRI Scans, have improved the precision of radiological diagnosis of this condition, along with reduction in the mortality rate. Regardless of this, there may still be an impediment in diag-nosis, partly due to the subtleness of early radiological signs, especially on non-contrast CT Scan. We present a case report which illustrates some of the radiological manifestations, complications, potential pitfalls in diagnosis and treatment of traumatic subdural empyema.Conclusion: Patient of severe head injury not improving with pharmacotherapy should get a repeat C.T Scan vault to look for delayed hematomas or empyema. Urgent diagnosis and prompt evacuation along with proper anti-biotic therapy can improve the survival of patient having traumatic subdural empyema
Relation of Lipid Profile with Ischemic Stroke
Get PDFObjective: To evaluate correlation of blood total cholesterol (TC), high-density lipoprotein (HDL), triglycerides, and the TC:HDL ratio as risk factors for ischemic stroke.Materials and Methods: After ethical approval from hospital ethical board this case control study was conducted in the department of neurosurgery and neurology Lahore General Hospital Lahore/Punjab Institute of Neurosciences/ Postgraduate Medical Institute/Ameerudin Medical College Lahore. Duration of study was two years from October 2015 to October 2017. A total of 600 patients were included in the study after obtaining written consent from patients. After completion of data collection, data was entered in computer software SPSS version 23 and analyzed for continuous and categorical variables. Continuous/numerical variables were presented as mean and SD and categorical variables were presented in form of numbers and percentages. Independent t-test and chi-square test were applied to see significance of data. P value less than or equal to 0.05 was considered as significant.Results: Overall, 100% (n = 600) patients were included in this study. The study comprised of two equal groups, 50% (n = 300) in each, i.e. cases and controls. The controls had mean total cholesterol (TC), High-density lipoprotein (HDL) and triglycerides 220.76 ± 4.29 mg/dL, 54.02 ± 4.45 mg/dL and 153.99 ± 2.68 mg/dL res-pectively. The TC: HDL ratio was 5.48 ± 1.41 and 4.09 ± 1.22 for cases and controls respectively. The mean differences between total cholesterol (TC), High-density lipoprotein HDL, triglycerides and total cholesterol (TC): HCL ratios were statistically significant among both groups.Conclusion: Results of our study revealed that significant difference was observed between cases and controls regarding the levels of Total cholesterol, HDL, triglycerides and TC:HDL ratio. Cases of ischemic stroke were found with high levels of TC, Tridlycerides, And TC:HDL ratio and low HDL , this difference was found statistically significant with P value 0.001. So it was concluded that hyperlipidemia has significant relation with ischemic stroke
The Clinical Presentation and Management of Brain Abscess
Get PDFIntroduction: It has been reported to account for 1 – 2% and up to 8% of all intracranial space-occupying lesions in patients in developed and developing countries respectively. Bacteria can invade the brain by direct spread or through hematogenous seedling. Delayed surgical drainage has high morbidity and mortality. The diagnosis of a brain abscess is made with clinical features and investigations.Objective: To determine the frequency of clinical presentations, causative pathogens and their antibiotic sensitivity in patients with brain abscess. Results: The mean SD for age was 22.90 ± 14.0 years, the age range from 3 – 45 years. Male to female ratio was 3:1. The most common signs and symptoms of brain abscess were headache 32 (80%). The common predisposing factor for the formation of brain abscess was ear discharge which is 8 (20%) patients. Conclusion: It is concluded that the awareness of predisposing factors, early recognition of clinical features and understanding of the prevalent microbial profile is imperative for better management of children and adults with brain abscess