Pakistan Journal Of Neurological Surgery
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Long-Term Outcomes of Aneurysm Management in Elderly Patients with Subarachnoid Hemorrhage
Get PDFObjective: To analyze the long-term outcomes of patients with poor-grade aneurysm management of elderly patients with subarachnoid hemorrhage (aSAH).
Materials & Methods: A prospective study was conducted at Shahida Islam Medical College and Hospital, Lodhran, Pakistan from March 2023 to February 2024. The study enrolled patients aged 65-85 years who were admitted to the hospital with a diagnosis of poor-grade aneurysmal subarachnoid hemorrhage. Evaluations involved clinical examinations, imaging studies, and standardized outcome measures such as the modified Rankin Scale (mRS) to assess neurological and functional outcomes.
Results: At the 3-month follow-up, 23.8% of patients had an mRS score of ? 3, while 76.2% had an mRS score of > 3. Among those with an mRS score of ? 3, 44.8% were aged 65-75 years, and 55.2% were aged 76-85 years. Similarly, at the 12-month follow-up, 26.2% of patients had an mRS score of ? 3, and 73.8% had an mRS score of > 3. Among patients with mRS score of ? 3, 37.5% were aged 65-75 years. Among those with an mRS score of > 3, 43.3% were in the 65-75-year age group and 56.7% were in the 76-85-year age group.
Conclusion: Long-term outcomes gradually improved even among elderly patients with severe subarachnoid hemorrhage (SAH) if they were provided with aneurysm repair as surgical management. Patients with older age having SAH should not be ignored for surgical management based on their age
Efficacy Of Short-Segment Transpedicular Fixation for Thoracolumbar Fractures in Terms of Improvement in Neurological Status
Get PDFObjective: To determine the efficacy of short-segment transpedicular fixation for thoracolumbar fractures in terms of improvement in neurological status.
Materials and Methods: A prospective observational research was conducted at Bacha Khan Medical Complex, Swabi, Section of Neurosurgery. Patients having traumatic thoracolumbar fractures with neurological deficits were subjected to short-segment transpedicular fixation and evaluated for post-operative improvement in neurological status at a 6-month follow-up.
Results: 48 patients participated in the study. Mean age was 35.69±8.22 years and 60.4% were males. History of falls was the most common mechanism responsible for spinal injury i.e. 56.3%. D12 vertebra was fractured in 43.8% of patients. The leading type of fracture was, AO type B in 37.5% of patients. 23 (47.9%) of the patients showed one or more grade improvements in their neurological status on the ASIA scale at 6-month follow-up. Surgical site infection was the common postoperative complication (8.3%).
Conclusion: Short-segment transpedicular fixation is an effective procedure for traumatic thoracolumbar fractures in terms of improvement in neurological status
Navigating Peril: Unraveling the Consequences of violation of Lane by bike riders on Traumatic Brain Injury Outcomes in a Developing Country's Neurosurgical department
Get PDFObjective:
To infer the impact of violation of lane by the bike riders on the severity of injury and clinical outcome.
Materials & Methods:
prospective observational study conducted from 1st January 2023 to 30th June 2023.50 patients who met inclusion criteria were studied for impact of violation of lane on the severity of injury and clinical outcome. Data was analyzed for gender distribution, valid driving license, helmet wearing, trauma scene violation of lane, duration of stay in ward, severity of injury, mode of injury and outcome was assessed by Glasgow outcome scale extended after 1 month.
Results:
In our study 49(98%) patients were male and 1(2%) female. 37 (74%) patients had documented evidence by 1122 regarding lane violation group while 13(26%) patients of lane non violation group. 14(28%) patients had STBI, and 18(36%) patients were categorized in moderate and mild traumatic brain injury each. Neuro monitoring was done in 14(28%) patients. Operative intervention was done in 31(62%) patients and 9(64%) patients were those who had STBI.11(78%) out of 14 patients with severe injury were from lane violation group. Patients of lane violation group were having higher disability i.e. 12 (32.4%).
Conclusion:
Violation of lane is an aberrant driving behavior. It has emerged as a common cause of bike related road traffic accidents leading to mortality. A prevailing disregard for traffic norms adds fuel to this perilous fire, paving the way for grave outcome.
Key words: Severe Traumatic brain injury (STBI), Road traffic accident (RTA), Violation of lane, Bike rider, Intracranial pressure (ICP), Glasgow outcome scale extended.
 
Outcome of Dual Stability and Decompression through Single Posterior Approach in Tuberculosis of Dorsolumbar Spine
Get PDFObjective: To evaluate the outcome of dual stability and decompression through a single posterior approach in patients with tuberculosis of the dorsolumbar spine in terms of Oswestry Disability Index and Frankel Neurological Grading.
Material and Methods: It was a prospective cohort study involving 34 patients with tuberculosis of the dorsolumbar spine who underwent dual stability and decompression through a single posterior approach. Follow-ups were done at 2nd, 6th, 12th and 16th weeks. The outcome was assessed using the Oswestry Disability Index and Frankel Neurological Grading.
Results: In 34 patients, the mean age was 36.59±13.51 years. There were 20 (58.8%) males and 14 (41.2%) females. There were 9 (26.5%) patients who had dorsal spine tuberculosis, while lumbar spine TB and dorso-lumbar spine TB were diagnosed in 13 (38.2%) and 12 (35.3%) patients respectively. The mean surgery time was 4.20±0.66 hours. According to the Oswestry Disability Index, before surgery, 2 (5.9%) patients had minimal disability while after 16 weeks of follow-ups, these numbers increased to 23 (67.7%) showing statistically significant improvements. According to Frankel Neurological Grading, before surgery, 3 (8.8%) patients had normal function while after 20 weeks of follow-up following surgery, 20 (58.9%) had normal functions.
Conclusion: Dual stability and decompression through a single posterior approach were found to have good functional and fusion outcomes according to the Oswestry Disability Index and Frankel Neurological grading
Azathioprine vs. Methotrexate Effectiveness in the Treatment of Generalized Myasthenia Gravis (MG)
Get PDFObjective: The current study investigated the effectiveness of Azathioprine versus Methotrexate in the treatment of generalized MG.
Methodology: An observational, open-label retrospective study was conducted in the Department of Neurology, Mayo Hospital, Lahore, Pakistan. All generalized MG patients with positive acetylcholine receptor antibodies (MGFA class II, III, or IV) aged >16 years, were included. Group 1 (n=31) was taking the combination of oral Prednisolone and Azathioprine (AZA) and group 2 (n=31) was taking the combination of Prednisolone and Methotrexate (MTX). The clinical response was assessed by Myasthenia gravis activities of daily living (MG-ADL) score at the 3rd, 6th, 9th, 12th, & 18th months.
Results: At 3rd month follow-up, the mean MG-ADL score was 2.97 (AZA) vs. 3.39 (MTX), after the 6th month, the score was 0.48(AZA) vs. 1.13 (MTX) (p-value=0.009), after the 9th month: the score was 0.26 (AZA), vs. 0.97(MTX) (p-value=0.002), after the 12th month, the score was 0.29 (AZA) vs. 0.74 (MTX) (p-value=0.079), after 15th month, the score was 0.16(AZA) vs. 0.65(MTX) (p-value=0.009) and after 18th month, the score was 0.42(AZA) vs. 0.52(MTX) (p-value=0.703).
Conclusion: Azathioprine is significantly more efficacious from the 6th, 9th, 12th and after the 15th-month follow-up as compared to Methotrexate in the treatment of MG; however, on the 18th-month follow-up, both steroid-sparing drugs were equally effective. There appears to be no difference in the effectiveness of Azathioprine versus Methotrexate in the treatment of generalized MG
Complications of Post-Traumatic Spinal Surgery
Get PDFObjective: The study aimed to evaluate the frequency and complications of post-traumatic spinal surgeries.
Materials and Methods: A prospective observational study was conducted at JPMC for six months and included 55 patients presenting with post-traumatic spinal injuries who were operated on. Information on the patient’s demographics, clinical findings, radiological findings, type of surgical procedure, and postoperative complications were recorded. A chi-square test was employed to compare difficulties with demographic characteristics.
Results: Our study comprised of patients with an age of 39.55+/-6.19 years; of them, 72.7 percent were males, and overall complications occurred in 30.9 percent of patients, which included wound infection (10.9%), CSF fistula (3.6%), wound dehiscence (1.8%), pneumonia (3.6%), heart arrhythmia (1.8%), lung congestion (1.8%), instrumental loosening (1.8%), postoperative visual loss (1.8%), and diathermy burns (3.6%).
Conclusion: 30.9 percent of patients operated for spinal traumatic injuries developed complications. A few of these complications are dreaded and need to be communicated to patients/attendants and necessary steps should be taken to prevent them
Epilepsy Surgery Outcomes in Patients with Drug-Resistant Forms with Low-Grade Tumors
Get PDFObjective: To evaluate the efficacy of neurosurgical treatment of patients with drug-resistant structural epilepsy caused by low-grade brain tumors.
Materials and Methods: 30 patients with drug-resistant structural epilepsy caused by low-grade tumors. Preoperative evaluation and surgical treatment were performed from 01.01.2016 to 31.12.2023. As a preoperative evaluation, all patients underwent neurological and neuropsychological examination, the semiology of seizures was assessed, and neuroimaging and neurophysiological studies were performed. A histological examination of resected brain areas was performed. Surgical outcome assessed by J. Engel Surgical Treatment Outcome Scale (1993) at 12, 24 months.
Results: 30 patients were treated surgically, 10 (33%) were men and 20 (67%) – women. The mean age of the patients was 29.76 years. Focal motor and non-motor seizures were noted in 12 (40%) patients. 18 (60%) patients had bilateral tonic-clonic seizures with focal onset. All 30 patients underwent resection surgery: 10 patients (33%) underwent anterior mesial temporal lobectomy (AMTLE) , 17 patients (57%) – lesionectomy, 2 – AMTLE plus lesionectomy, and one – lesionectomy plus selective amygdalohippocampectomy (SAH). The results of surgical treatment 12 months after surgery were evaluated in 25 patients. Engel I outcomes after 12 months were in 18 patients (72%), at 24 months in - 73%.
Conclusion: The results of our study demonstrate the efficacy of surgical treatment in patients with drug-resistant structural epilepsy caused by low-grade brain tumors. Significant improvement in seizure control was seen in the Engel I results at 12 and 24 months after surgery (72% and 73%, respectivel
Tuberculous Meningitis: A Retrospective Study on Complications and Imaging Findings and Their Outcomes
Get PDFObjective: This study aims to emphasize the need for radiologists to remain vigilant about the common imaging findings and complications of CNS-TB (central nervous system tuberculosis), particularly TBM (tuberculous meningitis), to improve diagnosis and patient management.
Materials and methods: The authors conducted a retrospective analysis of radiological findings from 96 TBM patients at a tertiary care hospital, focusing on the frequency of TBM complications identified through MRI and CT, and their correlation with age, gender, and outcomes.
Results: A total of 96 patients having TBM (median age 21.6 years, range 8 months–70 years) were identified. There were 36 (37.5%) males and 60 (62.5%) females. Complications occurred in a significant portion of the cohort: tuberculoma (n = 55, 57.3%), hydrocephalus (n = 45, 46.9%), infarcts (n = 27, 28.1%), and cerebritis(n = 4, 4.2%). 11 patients of the study population died. Deaths were primarily related to tuberculomas (45.45%), hydrocephalus (27.27%), and infarcts (45.45%). Adult females showed a higher prevalence of fatal complications, indicating significant gender differences.
Conclusion: In TBM, the most common complications are tuberculomas and hydrocephalus, followed by infarcts and cerebritis. Notably, adult females show a higher prevalence of fatal complications. These results emphasize the need for early detection and targeted management strategies to improve patient outcome
Anterior Lateral Approach for Anterior Decompression, Corpectomy, and Fixation with Webb Morley Procedure for Dorsolumbar Spinal Fracture
Get PDFObjective: Efficacy of anterolateral approach Webb Morley procedure in a low-income country.
Materials & Methods: A descriptive study was conducted at the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro. Patients of any gender presented to us with dorsal or lumber injury, plus a presentation on X-ray / MRI as spinal fractures having bone fragments pressing the cord, especially from the anterior side were included in the study. The assessed tool was based on clinical findings of Frankel's grading.
Results: We had 64 patients, who had dorsal and lumber fractures and went through the procedure of Webb Morley 43 were male and 31 were female patients The male-to-female ratio was 2:1 and the mean age was 39±3 yrs. with a median age was 42.5yrs. Fall (n = 34, 53.12%) was the common cause, road traffic accidents were (n = 16, 25%), fall of heavy objects (n = 11, 17.18%), and assault (n = 03, 4.68%).
Conclusion: Based on the current study of our Centre the anterior lateral approach for lower dorsal and upper lumber level with decompression and fixation with Webb-Morley procedure is a safe and effective method