Pakistan Journal Of Neurological Surgery
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Surgical Outcome of Chronic Subdural Hematoma by Two Burr Hole Technique
Get PDFObjective: To study postoperative outcome of chronic subdural hematoma by two burrhole technique.Study Design: It was a descriptive cross sectional study.Place and Duration of Study: It was a hospital based study which was conducted in the Department of Neuro-surgery HMC, from 10th June 2014 to 10th March, 2015.Materials and Methods: This study was conducted on one hundred and ninety – three (193) patients of chronic subdural hematoma. These patients were selected on the basis of history, clinical features and CT scan brain showing presence of chronic subdural hematoma. For data analysis SPSS version 20 software was used.Results: We studied one hundred and ninety – three (193) patients. Among these patients one hundred and forty– five were male and forty – eight were female with a male to female ratio of 3.1:1. The age range was 20 to 80 years with an average of 65.9 years. One hundred and ten patients (59.0%) gave a history of head injury. Eighty– three (43.0%) patients did not give history of any injury to the head. Twenty-nine patients were operated under local anesthesia while rest of one hundred and sixty – two were operated under general anesthesia. On discharge one hundred and sixty – three (84.5%) patients showed favorable outcome and thirty (15.5%) patients showed unfavorable surgical outcome. Out of them thirteen patients died with a mortality rate of 6.7%.Conclusion: Chronic subdural hematoma is an important reversible cause of mortality and disability specially in elder patients. A favorable surgical outcome was observed when patients of chronic subdural hematoma were operated by two burr hole technique and assessed after three days of surgery. Mortality and morbidity of chronic subdural hematoma has decreased markedly in recent years because of improved diagnostic facilities, early surgical intervention, good and minimal invasive surgical procedures
International Neurosurgical Events
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Assistant Professor, Department of Neurosurgery, King Edward Medical University, Lahore
3rd Joint Scientific Meeting of RSSA & AIRP. Main Conference, 9th, 10th – 11th October 2018 Jeddah
1st EANS Trauma & Critical Care Update Meeting. December 13-14, 2018, Lund, Sweden
Brainstorm on Brainstem. International Conference on Diagnostics and Treatment of Brainstem Lesions.
The 2nd International Patient Experience Summit 2019. Shaping the Future of Health Care “Empathy + Culture”. 4th – 6th February, 2019.
WFNS 2019. September 9 – 12, 2019
LINC International Neurovascular Course. Multimodality Management of Intracranial and Spinal AVMs. University of Thessaly School of Health Sciences, Department of Neurosurgery. March, 29 & 30, 2019
Outcome of Surgically Managed Depress Skull Fracture in a Tertiary Care Hospital
Get PDFObjective: To know about the outcome of depress skull fracture (DSF) in a tertiary care hospital.Material and Methods: This study was conducted at the department of neurosurgery PGMI/LRH from 20th December 2012 to 19th June, 2013. A total of 83 patients operated during this time were reviewed and the data including age, sex, location of fracture, timings of surgery, post operative status of the patient, presence or absence of any neurological deficit as well as post operative complications was enlarged.Results: In this study there were 64 males and 19 females with a male to female ratio of 4: 1. Age range was 1 to 58 years commonest decades were 5 – 10 years 36.10% (group 2) and 10 – 20 (16.9%) and 20 – 30 (15.7%) years (group 3 and 4) comprising respectively. The most common region was the parietal 30 (36.1%) followed by frontal 26 (31.3%). The right side was more affected than the left side (60.2% vs. 39.8%). The time of surgery was mostly in the interval between 9pm to 6am. More than 90% has good outcome with minimal neurologic deficit, while three patients expired who initially had a very low GCS score. One patient has dysphasia post operatively and 2 had weakness of the upper limbs who were operated for the frontoparietal fracture.Conclusion: DSF is a common emergency encountered in a neurosurgical unit and the timely management of these patients is crucial to avoid any complication. If managed timely they have very gratifying results
Spectrum of Surgically Treated Closed Head Injury in Department of Neurosurgery Lady Reading Hospital Peshawar
Get PDFObjective: To know the burden of surgically managed closed head injury in neurosurgery unit Lady Reading hospital Peshawar. Material and Methods: This is descriptive cross sectional study was conducted from December 2012 to may 2013 (6 month) in neurosurgery unit lady reading hospital Peshawar. All cases of TBI including fall, RTA and physical assault requiring surgical intervention were included. Cases of penetrating head injury, bomb blast injuries and compound depressed skull fracture were excluded. Once the target population was identified, further data were collected on a designed proforma from the hospital charts and operative records of the patients. Data was entered into statistical program SPSS 16 software and was expressed in percentages. Data was presented in different charts and tables. Results: A total of about 1087 patients of head injury were admitted through emergency in neurosurgical unit Lady reading hospital Peshawar during 6 month duration, out of which 247 patients were operated for different intracranial injuries. There were 196 males and 51 females with a male to female ratio of 4:1. The age range was from1 to 72 years and the mean age was 29.05 years. Out of the 247 patients about 96 (38.88%) were having extradural hematoma, 80 (32.38%) with depressed skull fracture,38 (15.38%) with chronic subdural hematoma and 33 (13.36%) were having acute subdural hematoma. Conclusion: Almost every fourth case of a closed head injury patients require surgical intervention. Extradural hematoma and Depress Skull Fracture were the common surgical entities. Most of the patients were male and in the age group of 21 – 40 years reflecting that surgical intervention carries significant impact
Effectiveness of Microvascular Decompression for the Treatment of Idiopathic Trigeminal Neuralgia
Get PDFObjective: To review the efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia.Materials and Methods: This descriptive cross sectional study was conducted at Neurosurgery Department of Naseer teaching Hospital, Peshawar from 1st January 2016 to 31st December2017. All patients fulfilling the inclusion criteria undergo micro vascular decompression (MVD). MRI brain was done in all patient to exclude the secondary cause. Patients were examined on 5th post operative day and clinical finding documented. Outcome of surgery is determined by visual analogue scale in which Pain was graded as no pain (0 score), mild (1 – 3), moderate (4 – 7), severe (8 – 10) to see the pain relief.Results: Forty four patients were operated for trigeminal neuralgia (TN). There were 18 (41%) males and 26 (59%) females. Mean age was 33 years. Entry zone of trigeminal nerve was point of conflict in 33 (75%) patients. The mandibular division (V2) was involved in 26 (59%) patients, followed by maxillary division (V3) in 13 (29.54%) patients and ophthalmic division (V1) in 5 (11.36%) cases. At fifth postoperative day, status of pain relief was analyzed amongst 44 patients and it was observed that 37 (84.09%) patients had no pain, 5 (11.36%) had mild pain and 1 (2.27%) had severe pain. Postoperative complications were observed as nausea and vomiting in 15 (34.09%) patients, Diplopia in 6 (13.63%), facial palsy in 6 (13.63%), CSF leak in 5 (11.36%), mild deafness in 5 (11.36%), wound infection in 4 (9.09%) and cerebellar infarction in 3 (6.81%) patients.Conclusion: Microvascular decompression is an effective surgical option for trigeminal neuralgia refractory to medical treatment
Microdiscectomy in Relieving Neurological Symptoms in Patients with Lumbar Disc Herniation
Get PDFIntroduction: Minimally invasive spine surgical approaches such as microdiscectomy have gained attention in recent years due to less tissue damage, speedy and acceptable neurological improvement with less complication.Objective: To assess efficacy of microdiscectomy in improving neurological status in patients with lumbar disc herniation.Material and Methods: A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean ± SD, Median (Range) and Frequency (percentage). Mc Neumer’s chi square test and paired t test were used to see association between pre-operative and post-operative Neurological status (MRC grade, sensory status, SLR) depending on their nature viz: qualitative or quantitative respectively in SPSS version 15 and hence efficacy of microdiscectomy was assessed.Results: Out of 70 patients 74% were male and 26% were females. Mean ± SD of patients was 37.6 ± 13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common characteri-stics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5-S1 level (96%) where Prolapse and extrusion were most common MRI findings. As compared to pre-operative (3.4) muscle power 1st and 42nd day power were respectively 4.0 and 4.7 (p = 0.001). Pre-operatively only 32 (45.7%) had normal sensation which improved to 38 (54.3%) and 51 (72.9%) respectively in 1st and 42nd day of surgery (p = 0.001). Pre-operative mean SLR improved to 98.6 degrees in 1st POD and continued to be the same till 42nd day (p = 0.001). All the MRC findings, sensory status and SLR values in each post-operative days were statistically significant with the baseline by paired t test (p = 0.001).Conclusion: Microdiscectomy is one of the effective procedures which can be adopted for symptomatic unilateral lumber disc herniation with significant improvement in Neurological statuses
Outcome of Partial Application of Non-operative Tools in Management of Severe Traumatic Brain Injury in a Developing Country
Get PDFObjective: To see the outcome of partial application of non-operative tools like endotracheal intubation and early enteral nutrition on mortality in severe traumatic brain injury. Introduction: Severe Traumatic Brain Injury (TBI) is the leading cause of death in children and young adults1. Mainstay in management of severe head injury is based on the concept that little can be done about primary brain injury but a lot can be done to minimize secondary brain injury because its severity and duration influences the outcome. Several non operative tools can prevent this secondary brain injury and can improve outcome but from these tools only some can be applied in developing countries. These are Endotracheal Intubation, Ventilatory Support, Sedation & Paralysis, Analgesia, Normothermia, Normovolemia, Electrolyte Balance, Enteral Nutrition, Head Elevation and Mannitol
Pak. J. of Neurol. Surg. - Vol. 14, No. 1, Jan. – Jun., 2010 -35- ORIGINAL ARTICLE Clinical Features, Etiological Factors, Neurological Imaging and Outcome in Children with Ischemic Stroke
Get PDFObjective was to study etiological factors, clinical features, neuroradiological findings, Outcome in infants and children who present with ischemic stroke.Study design: It was a descriptive study.Setting: It was a hospital based study which was conducted in the Children Hospital, Pakistan Institute of Medical Sciences from 1st August 2002 to 30th December 2003.Method: In this study children were included who presented with weakness, altered sensorium, seizures, or any focal deficit. CT brain was done in all these children. Those having evidence of infarct were studied for clinical features, etiological factors and out come. Those having neurological infection, trauma, brain tumor, and abscess were excluded from the study. For data analysis, SPSS 8 software was used.Results: Total of studied thirty patients were enrolled in the study. Age range was from two month to twelve years. Male to female ratio was 3.3 to 1. Sixteen (53%) were 6-12 years of age while 12 (40%) were 2-5 years age and only 2 (6.6%) were below one year of age. Etiological factors were identified in 12 (40%) of the patients, out of which cardiac pathology was found in most of the patients i.e. is 10 (33.3%).There were 2 (6.6%) patients having deficiency of protein C and S .No predisposing factor was identified in 18 (60%) patients. Clinical presentation was studied and was found 29 (96.6%) patients presented with hemiperesis. Facial weakness was present in 15 (56%) of children. Seizures were present in 16 (53.3%) of patients, while 11 (13%) were uncon-scious. Thirteen (43%) were febrile on presentation. Seven (23%) were having swallowing problem, 4 (13.3%) were having headache and only 3 (10%) got visual problem. Middle cerebral artery infarct was commonest seen in that is 19 (63.3%) cases. Lanticulo striate artery infarct was found in 5 (16.3%). Anterior cerebral artery infarct was 4 (13.3%) and only 2 (6.6%) were having Posterior cerebral artery infarct. Complications were also studied in these patients. Seizures were present in 18 (60%) of patients. Nine (30%) developed mild to severe chest infection, while 10 (33.3%) later on develop urinary tract infection. Weight loss was observed in 11 (36.6%) patients. Outcome was studied with the help of Glasgow coma outcome scale. Ten (33.3%) patients showed good outcome, moderate disability was present in 14 (46.6%) of patients, and severe disability was present in 4 (13.3%) of patients, 2 (6.6%) patients died.Conclusion: It was concluded that ischemic stroke is not rare in Pakistani children. Cardiac disease is the most important and preventable predisposing factor for ischemic stroke. Every effort should be made to diagnose and treat the congenital cardiac disease as early as possible. Middle cerebral artery infarct was the most common infarct. Computed tomography of brain was found to be very useful and sensitive investigation for diagnosis of ischemic infarct. If available neuroimaging studies should be performed in suspected stroke children. Mortality is low while morbidity was quite high among the survivors. Since this was a hospital based study and may not represent general pediatric age group, therefore large scale population based studies should be planned for the future
Frequency of Wound Infection after Single Level Anterior Cervical Discectomy without Bone Grafting
Get PDFObjective: To determine the frequency of wound infection after anterior cervical discectomy without bone graf-ting in patients with single level degenerative cervical disc herniation diagnosed on magnetic resonance imaging.Material and Methods: This observational study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from April 2009 March 2010. Sixty five (65) con-secutive patients who undergone single level anterior cervical discectomy without bone grafting for degenerative cervical disc herniation were included in the study irrespective of their age and gender. The patients were obser-ved for post-operative wound infection including superficial wound infection and discitis recorded.Results: Out of 65 cases, 64.4% were males and 35.4% females. Majority 27.7% cases were in the age range of 41 – 50 years, 24.6% in the age group of 31 – 40 years and 18.5% in the age range of 21 – 30 years. We also had patients in other age groups. Majority of women, 30.8% of the total, were house wives, followed by (27.7%) those having sedentary life style as teachers, students and bankers. Mean duration of the symptoms was 5.53 months and mean duration of hospital stay was 6.95 days. Postoperative superficial wound infection was in 3.1% cases and discitis in 1.5% patients.Conclusions: Age group of 41 – 50 years affected more than other age groups. Cervical disc herniation was common in men. Postoperative superficial wound infection was observed in 3.1% patients and discitis in 1.5% cases. Age group of 41 – 50 years affected more than other age groups. Cervical disc herniation was common in men. Postoperative superficial wound infection was observed in 3.1% patients and discitis in 1.5% cases. From the results of this study it is concluded that Cervical disc herniation is more common in male and the common age group affected is 41 – 50 years. Postoperative superficial wound infection was noted in 3.1% cases and Post-operative discitis was observed in 1.5% cases. Postoperative wound infection was common in males than females and was evident within 6 weeks of surgery
Endoscopic Transsphenoidal Surgery for Acromegaly
Get PDFObjective: The aim of this study was to determine the preoperative predictors of the extent of resection and endocrinological remission following endonasal endoscopic removal of growth hormone (GH) – secreting pituitary adenomas. Trans-sphenoidal surgery is the preferred treatment modality for growth hormone (GH) – secreting pituitary adenomas. In many series, the reported postoperative remission is based mainly on achieve-ment of GH levels less than 2 ng/ml. Strict criteria for insulin – like growth factor I normalization and even lower GH levels (< 1 ng/ml) are now suggested to define cure of acromegaly, but the evidence does not yet support such low GH levels in epidemiological follow-up. We analyzed our postoperative results in a sample of local popu-lation with acromegaly. Methods: Seven patients harboring GH – secreting adenomas (07 macroadenomas) underwent transsphenoidal surgery between 2005 and 2007 in Lahore General Hospital. The patient group included 03 women and 04 men of 23 – 50 years of age. All the patients were operated for the first time. Biochemical remission was defined as a repeated fasting or glucose – suppressed GH level of 2 ng/ml or less, and a normal insulin – like growth factor I level. Results: The majority of acromegalic patients (83%) had macroadenomas > 1 cm in maximum diameter. Gross – total resection was achieved in 05 (71%) of 07 patients. Notably, endoscopic transsphenoidal surgery allowed complete resection of all lesions without cavernous sinus invasion, regardless of the suprasellar extent. Biochemical remission was achieved in 06 (85%) of 07 patients. A postoperative reduction in GH serum levels were associated with a higher rate of biochemical cure (p < 0.05). Significant differences were observed between pre- and postsurgical serum GH levels in male patients with Acromegalic tumors. Although mean serum GH concentrations were discernibly higher in patients as compared to controls (30.2 ± 3.1 vs 0.4 ± 0.1). In all the three premenopausal female patients included in the study, the individual presurgical serum GH levels were greater than those following surgery. The mean value was significantly higher than of the controls (38.9 ± 10.3 vs 0.2 ± 0.6 ng/ml, respectively).These values exceeded the normal serum GH concentrations described for healthy women (7 ng/ml or less). Following surgical removal of the adenoma, serum GH concentrations showed a marked decline of GH levels in all patients. Conclusion: A purely endoscopic endonasal trans-sphenoidal adenoma resection leads to a high rate of gross – total tumor resection and endocrinological remission in acromegalic patients, even those harboring macro-adenomas with wide suprasellar extension. Extended approaches and angled endoscopes are useful tools for increasing the extent of resection.