Pakistan Journal Of Neurological Surgery
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Prognostic Indicators in Patients with Severe Head Injury: A 2 Year Retrospective Experience at Mayo Hospital, Lahore
Get PDFIntroduction: Traumatic brain injury (TBI) is an important public health care problem in the western world and equally being pandemic in the developing world. It is one of the most common causes of death in young adults and it can affect people’s lives enormously. Since many years the prognostic indicators of severe head injury had been field of research. Knowing the factors responsible for poor prognosis and preventing them outcome of severe head injury can be improved.Material and Methods: A retrospective study was conducted analyzing past records of the patients in department of Neurosurgery, Mayo Hospital from Nov 2011 to Nov 2013 with diagnosis of severe head injury (Glasgow Come Scale < 9). All patients except the patients with brain death, associated poly trauma, spinal injuries were excluded from the study. Total sample of 236 either managed conservatively or surgical and observed in Intensive care unit were study population. Prognosis was assessed with Glasgow Outcome Score (GOS) on or before (if patient expired before 30 days) 30 post admission day. Age, GCS, CT findings, Pupils were compared with GOS to find probable predictors of prognosis. GOS of less than 4 was regarded as poor prognosis. Categorical variables like GCS, pupils, CT findings were presented in the form of frequency (percentage) whereas continuous variables like age were presented in the form of mean ± SD and median (range). Association between GOS and probable prognostic indictors was seen by chi square test.Results: Out of 236 patients, 188 were male and 48 were female. Mean ± SD age of patient was 32.8 ± 14.6 years. Age group 15 – 45 years had maximum number of patients. Road traffic accident was major cause of severe head injury and majority had GCS 3 after resuscitation. More than half of the patient had bilaterally reactive pupils, 10% patient had post traumatic fits and half of the patients had features of base of skull fracture. 208 (8%) patient had abnormal CT findings. 30% patient on CT scan had closed cisterns and half of the patients has midline shift of 1.5 – 3 mm. More than 35% cases had surgical lesions over CT scan. Patients with age group < 15 years, GCS < 4, with closed cisterns, with surgical lesions and with midline shift of more than 3 mm had 30 day GOS < 4, which is regarded as poor prognostic marker.Conclusion: Prognosis in patient with severe head injury is determined by age, presenting post resuscitation GCS, mode of injury, CT findings and surgical lesions
Glossopharyngeal Neuralgia and its Surgical Management
Get PDFObjective: The purpose of the study was to evaluate the surgical management of Glossopharyngeal Neuralgia.Materials and Methods: It a retrospective study of seven (7) cases of Glossopharyngeal Neuralgia who were surgically managed at Department of Neurosurgery Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur. It is retrospective study with study period of eight (8) years from January 2003 to December 2010 with follow up period of two years.Results: Four (4) were female and three (3) were male patients. Age range was 40 to 60 years with average age of 45 years. In all the patients except one, IX nerve sectioning alongwith sectioning of upper rootlets of X nerve was performed in the posterior fossa through retrosigmoid approach. In one patient, Microvascular Decom-pression was performed for the pain syndrome. There was recurrence of same pain in that patient after six months of surgery. Second surgery was done in that patient to section the IX nerve only in the posterior fossa. All cases were that of “IDIOPATHIC GLOSSOPHRYNGEAL NEURALGIA”. In all the patients there was satisfactory re-lief of pain after surgery with no significant complications related to the procedure.Conclusion: So the sectioning of The Glossophryngeal Nerve is a useful procedure for the relief of this pain syndrome. Another good alternative is Microvascular Decompression of this nerve at root entry zone in the pos-terior fossa
Comparison of Surgical and Medical Treatment in Patients with Haemorrhagic Stroke
Get PDFOptimal management of spontaneous intracerebral haemorrhage (ICH) remains one of the highly debated areas in the fields of neurosurgery. Earlier studies comparing open surgical intervention with best medical management failed to show a clear benefit. More recent experience minimally invasive techniques have shown greater promise. We present our experience of 46 patients who presented to neurosurgery, neurology, Medical, Surgical and allied specialities at SIMS / Services Hospital Lahore with clinical and CT scan Brain based diagnosis of Haemorrhagic Stroke and comparison as per outcome between Surgical and Medically treated patients. This is an ongoing study.Objective: To compare the outcome results of surgical and medical management of the Haemorrhagic Stroke patients.Study Design: A prospective ongoing study.Place and Duration of Study: SIMS / Services Hospital, Lahore December 2013 until July 2015.Materials and Methods: 46 patients who presented to neurosurgery, neurology, Medical, Surgical and allied specialities at SIMS/ Services Hospital Lahore with clinical and CT scan Brain based diagnosis of Haemorrhagic Stroke.Results: Surgical treatment of patients with haemorrhagic Stroke fulfilling the inclusion criteria carries a little Edge over the patients undergoing medical treatment for the haemorrhagic stroke as per our ongoing study.Conclusion: Treatment of spontaneous haemorrhagic stroke although debateable but still the surgical treatment specially minimal invasive techniques have favourable prognosis
Posterior Fossa Reconstruction for Chiari Malformation Type I: Experience with 17 Cases
Get PDFObjective: To assess the results of posterior fossa reconstruction in patients with Chiari I malformation.Material and Methods: This observational study was conducted at the department of Neurosurgery, medical and teaching institute (MTI), Lady Reading Hospital Peshawar from July 2013 to June 2015. A total of 17 consecutive patients with Chiari I malformation who undergone posterior fossa reconstruction and fulfilled inclusion criteria were included in the study irrespective of their age and gender. The patients were assessed postoperatively for clinical and radiological (syringomyelia) improvement and post operative complications for a period of 6 months.Results: We had total 17 patients who underwent posterior fossa reconstruction for Chiari I malformation. There were 41.2% males and 58.8% females. Age of the patients ranged from 10 – 52 years with the mean age of 31 years. The most common clinical features were headache (64.7%) and sensory impairment (58.8%). We had syringomyelia in 70.1% and scoliosis in 47.1% cases. After surgery headache improved in 81.1% patients, sensations in 70% cases and syringomyelia in 91.1% cases. The overall morbidity in the form of complications was in almost 47% cases. One patient (5.9%) died after surgery.Conclusions: We conclude that posterior fossa reconstruction is a safe and effective procedure for the manage-ment of Chiari I malformation. This results in improvement in patients symptoms with acceptable complications. These complications respond to conservative treatment most of tim
Primary Decompressive Craniectomy – Salvation in Closed TBI
Get PDFObjective: To evaluate the role of early Decompressive Craniectomy in closed traumatic brain injury in relation to functional outcome.Material and Methods: A study was conducted at the Department of Neurosurgery, Northwest General Hospital and Research Centre Peshawar Pakistan. 09 months Data from 22/06/2011 to 21/03/2012 was collected, and all the consecutive cases of closed head injury that required Decompressive Craniectomy (Primary Decompression) based on clinical an radiological findings were included in the study.Results: Out of 23 patients, 13 showed moderate to good recovery making this procedure one of the priority treatment options in closed traumatic brain injury.Conclusion: The promising outcome in our study suggests that an early Decompressive Craniectomy should be considered in severe closed head injury to improve the outcome
Outcome of Titanium Mesh Cage and Dynamic Compression Plate (D.C.P) in Anterior Spinal Fixation in Dorsolumbar Tuberculosis
No full textTuberculosis is endemic in Pakistan and mostly spine is affected in extra-pulmonary cases. Anti TB chemotherapy remains the standard conservative treatment. Surgery is performed in cases with failure of medical therapy, significant spinal deformity and/or compression of neural element. As TB spine mostly affects anterior elements of the spine, debridement and fusion by an anterior approach is the procedure of choice.Material and Methods: We included 60 patients in our study in age range of 15 — 60 years with no sex predilection from September 2012 to October 2014. Debridement of the involved spinal segments and recon-struction of the damaged vertebral bodies by using Titanium mesh cage fixed with D-C Plates and screws was done and outcome assessed at 3 months both neurologically and radio logically.Results: In our study, mean age of the patients was 31.7 years. 63.3% were males and 36.7% were females. Pre-Operatively, most of the patients were in Frankel Grade C (41.7%). At 3 months follow-up, 76.7% of the patients improved neurologically. Radio-logical evidence of fusion was found in 85% of patients.Conclusion: Titanium Mesh Cage filled with bone pieces and fixed by DCP and screws to reconstruct the tuberculous spine via an anterior approach along with ATT leads to the fusion of spine, maintaining height and stability in majority of the cases
Complications in Intracranial Aneurysms without Assisted Technique Coiling
Get PDFObjective: To report an experience of complications occurring during endovascular coiling (without assisted technique) in intracranial aneurysms.Materials and Methods: This study was conducted from January 2010 to December 2013at the department of Neuroradiology, PGMI Lahore General Hospital, Lahore. A total of 300 patients were included in this study of both gender (male and female) and in the age range of 25 – 65 years. In our study all the patients with ruptured and un-ruptured aneurysms had undergone coiling.Results: Out of 300 patients, there were 123 (41%) males and 167 (59%) females’ patients. Their age ranged from 30 – 65 years. In this study the overall mean age is 48.36 years. The maximum numbers of patients were in their fifth and sixth decades of life. Coiling was successfully performed in all patients with very low complication rate (1%).Complications: There were only 3 complication which were recurrence / recondition 1 (0.3%) case detachment of coil 1 (0.3%) case of small rebleed from aneurysm (0.3%) 1 case each.Conclusion: Coiling is a safe and less invasive procedure for bothruptured and un-ruptured intracranial aneurysms with very less complications and low morbidity and mortality rate as compared to other invasive procedures
Frequency of Hydrocephalus in Pediatric Tuberculus Meningitis Patients
Get PDFObjective: Objectivity of study is to determine the frequency of hydrophalus in pediatric tuberculus meningitis patients. Materials and Methods: This prospective observational study was done in pediatrics department Lady Reading Hospital Peshawer from 1st January 2013 to 31st June 2015 with 2½ years duration. All patients of tuberculus meningitis who survived with both gender and age ranging from 1 to 10 years were included. Pediatric patients admitted with other diseases, age greater than 10 years and those who expired due to tuberculus meningitis were excluded. Patient’s demographic features, vaccination status, clinical features of tuberculus meningitis and Frequency of hydrocephalus post meningitis were doccumented according to the proforma. Follow up duration was 6 months, SPSS version 189 used for data analysis, Results represented in the form of tables. Results: 38 patients fulfilled inclusion criteria. Females 22 (57.90%) were common than males 16 (42.10%). Patients age was in the range of 1 to 10 years with the mean age 5 years ± 5 SD. Fever 35 (92.10%), headache 37 (97.36%), vomiting 31 (81.57%) and failure to thrive 32 (84.21%) were dominant in clinical presentation. 29 (76.31%) patients vaccination status was satisfied. 14 (36.84%) patients developed hydrocephalus in 6 months follow-up. Conclusion: Hydrophalus is common in post tuberculus meningitic patients. It mostly affect non vaccinated patients
Increasing the Implication of Endoscopy to a Wide Spectrum of Intraventricular Lesions: A Review of Our Experience
Get PDFIntroduction: Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a case series to share our experience with endoscopic management of intraventricular lesion.Materials and Methods: 17 patients, both male and female, from 5 to 50 years of age were endoscopically operated during 1.5 years. Intraventricular lesions < 4cm, mildly vascular and soft in consistency were included. The average operative time was 90 minutes and the average hospital stay was 4 ± 1.5 days. Follow up was done at 2 weeks, 6weeks and at 6 months.Results: Out of 12 males and 5 females there were 6 colloid cysts, 3 supra sellar arachnoid cysts, 5 intraventri-cular tumors and 3 pineal tumors. Complete resection of lesion was achieved in 4 out of 6 patients with colloid cyst (66.6%). Size of supra sellar arachnoid cyst reduced along with improvement of hydrocephalus in all 3 patients (100%) Positive tumor biopsy was possible in 100% of cases. Adjuvant endoscopic third ventriculostomy was performed in 9 (52.9%). Septostomy was done in 1 (5.9%). Post op Ventriculoperitoneal shunt was required in 4 (23.5%) cases. There was no peri or post operative mortality.Conclusion: With proper patient selection endoscopic surgery can yield results at par with microsurgery with added benefits of minimum patient discomfort, shorter hospital stay and improved cosmetic results
Micro-endoscopic Disectomy: Early Experience and Results
Get PDFObjective: This prospective study was conducted to assess results and experience with microscopic endoscopic disectomy (MED).Study Design: This is a prospective study carried out at PNS Shifa, which is a tertiary care hospital, from July 2011 to June 2012.Methods: Thirty eight patients underwent surgery in which the MED system was used; all procedures were performed under general anesthesia. All patients were followed prospectively. MED system used in this study consisted of tubular retractors and an endoscope with xenon light source and HD image system by Karl Storz co. Germany. Outcomes were measured using Macnab criteria.Results: Thirty eight patients (27 males, 11females) underwent MED for prolapsed lumbar intervertebral disc. Mean operating time was 80 minutes. Follow up ranged from 3 to 12 months with a mean follow up 7.8 months. Thirty two patients had an excellent outcome while three had a good outcome. Three patients had a poor outcome. One patient with a big dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Three complications were noted and were all related to dural tears.Conclusions: Minimally invasive surgery using MED is clinically effective and reliable. Patient satisfaction is high and complications rates are comparable with those associated with traditional microdiscectomy procedures.Abbreviations: MED: Microendoscopic discectomy, HD: High Definition