Pakistan Journal Of Neurological Surgery
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Recurrence of Benign Astrocytoma in a Benign form 20 Years after Surgery and Radiotherapy Treatment
Get PDFA 43 years old male primary school teacher presented with the chief complaints of headache for 20 days, double vision for 20 days, unsteady gate and 04 episodes of vomiting in last 20 days before presentation. He had presented 20 years back with the same complaints and on workup he was found to have posterior fossa tumor with resultant hydrocephalus. He had undergone ventriculoperitoneal shunting followed by posterior fossa crani-ectomy with tumor excision followed by radiotherapy. Histopathology examination of his biopsy done at that time was showing grade ?? Astrocytoma
Short Term Complications of Myelomeningocele Repair. An Experience in Neurosurgery Department Lady Reading Hospital Peshawar
Get PDFObjective: To determine the short term complications of Myelomeningocele repair.Material and Methods: This cross sectional study was conducted at Neurosurgery Department, PGMI Lady Reading Hospital, Peshawar from January 2014 to June 2014 with total 6 months duration. All patients having age from 1 to 6 months with either gender who were operated for myelomeningocele were included and those patients having MMC with a prior VP shunt, moribund patients who do not survive for 30 days were excluded from the study. Patients age, gender and short term complications of surgery were documented on pre designed proforma. Minimum one month follow up was done. Data was analyzed by SPSS version 17 and expressed in the form of tables and charts.Results: In this study 58% children were in age range 1 – 2 months and 42% children were in age range 3 – 6 months. Mean age was 2 months with SD ± 1.26. Fifty five percent children were male and 45% children were female. VP Shunt was put in 12% children, CSF Leak was found in 15% and infection was found in 23% of cases.Conclusion: Wound site infection and CSF leak are the most common short term complications of myelo-meningocele repair
Management of Intracranial Aneurysms and Subarachnoid Haemorrhage: Literature Review and Guidelines
Get PDFINTRODUCTION
Egas Moniz discovered an aneurysm by cerebral Angi-ography in 1933.1Cushing introduced first aneurysmmal clip in 1911, Mayfield modified the existing spring clip with cross leg (Schwartz) by making it a smaller, tweezer – like applicator.2An intracranial vascular procedure was first repo-rted with aid of operating microscope which introdu-ced simultaneously magnification and illumination.3Dott in 1933 performed 1st planned intracranial surgery for a saccular aneurysm.4Dandy in 1937 clipped the neck of aneurysm with a metallic clip.5Yasirgill of Zurich and Drake of London Ontario, published a lot on aneurysms of anterior and posterior circulation.6,7An elaborated study of natural history of aneurysm was published by the Pakarinen in 1967.
Lower Backache after Pelvic Surgeries can be an Indicator of Tuberculosis of Lumbar Spine
Get PDFObjective: To find out that lower backache after pelvic surgeries can be an indicator of tuberculosis of lumbar spine.
Materials and Methods: It was retrospective study performed in Lady Reading Hospital Peshawar at Neurosurgical Department from Jan. 2012 to Dec. 2015 of 4 years duration. Patients who presented with backache after pelvic surgeries and diagnosed as tuberculosis lumbar spine were included in this study and other cases of tuberculosis lumbar spine without pelvic surgeries were excluded from this study.
Results: There were 11 patients, 4 (36.3%) were female and 7 (63.7%) were male. Mean age was 58 years and age range was from 35 to 73 years. Three patients (27.3%) had gone through haemorrhoidectomy, 2 (18%) had done TURP (Transurethral prostatectomy), 2 (18.1%) had done transvaginal hysterectomy and other 2 (18.1%) had gone uterine dilatation curettage (D&C). Only 1 (9.1%) patient had done manipulation for lower backache elsewhere.
Conclusion: Lower backache after pelvic surgeries is an alarming sign for tuberculosis lumbar spine and patients should be evaluated by hematological and radiological images like, CT and MRI of lumbosacral spine
Knowledge Regarding Common Risk Factors of Oral Cancer at Liaquat University Hospital Hyderabad
Get PDFBackground: Oral cancer is one of the most life-threatening condition in world early diagnosis of oral cancer can increase the chances of survival rates. The present study was carried out to see the knowledge of common risk factor of oral cancer among adult patients visiting Liaquat university hospital Hyderabad.Objective: The aim of this study was to assess knowledge and awareness of common risk factors of oral cancer among population of Hyderabad City.Material and Methods: Self administered proforma containing 10 questions were distributed into 150 patients age group 18 to 25 years to obtain the information. The question included the information about patient’s age, gender, habits and risk factor of oral cancer.Result: A total 150 patients participated in this study out of which male were 110 and female were 40. This study showed adult populations of Hyderabad have good knowledge regarding risk factor of oral cancer.Conclusion: Despite of having good knowledge regarding risk factors of oral cancer, a big amount of adult population is used to it. Government should take steps in order to ban these harmful products in the region where they are extensively used
Multi-disciplinary Approach: A Modality of Choice in the Management of Osteolytic Skull Lesions
Get PDFIntroduction: Multi-disciplinary approach towards the management of osteolytic skull lesions has evolved as the standard modality of treatment in recent years. Multiple disciplines including Neurosurgery, Anaesthesia,Neuro-Radiology, Plastic Surgery and Neuro-Oncology being working in co-ordination have improved outcome in such cases.Objective: To discuss multi-disciplinary approach as a standard treatment modality of choice.Study Design: Prospective descriptive study.Material and Methods: Patients admitted and operated at the Department of Neurosurgery of PGMI/Lahore General Hospita from July 2015 to July 2016. A total of 20 (n = 20) were study subjects.Results: Among 25 patients that were operated for an osteolytic skull lesion 12 were male and 13 female patients with age ranging from 10 to 60 years. Major complaints swelling (painfull/painless, n = 20), headache (n = 18), vomiting (n = 20), fits (n = 15) and bleeding ulcer (n = 2). On the basis of clinical and MRI diagnosis and biopsy majority had ewing sarcoma (n=10), 5 had meningioma, 1 had chondrosarcoma and 4 had metastatic skull lesion. All of them (n = 20) underwent surgery related to their clinical and MRI findings which included biopsy, excision of lesion, cranioplasty and flap rotation. Complications included infection in 2 patients, which was treated with antibiotics and mortality in 1 case.Outcome: Neurologic status and outcomes were compared with preoperative findings at 1st and 2nd post-operative weeks. Headache, fits, vomiting significantly improved in all patients.Follow-up: All patients had a follow up at 1 and 3 months post-operative.Conclusions: A multi-disciplinary approach is the modality of choice in managing an osteolytic skull lesions.By involving different specialities in a team effort to manage an osteolytic skull lesion can greatly improve the outcome in such cases
Comparative Study on the Out Come of Burrhole Craniostomy for Chronic Subdural Haematoma with or Without Drainage Tube
Get PDFObject: To determine the role of drainage after burr hole craniostomy on the outcome of chronic subdural hematoma in terms of brain damage, infection, hospital stay and recurrence rate. Study Design: Quasi experimental. Place and Duration of Study: Neurosurgery department Bahawal Victoria Hospital Bahawalpur from Jan 2009 to Dec 2009. Methods: Forty patients were divided in two equal groups. In group A drain was placed and in group B patients were managed only with burrhole. Results: The study group was composed of 30 male and 10 female patients (mean age, 58.63 years, age ranges 40-70 years). In 35 patients there was a history of trauma prior to the onset of major neurological symptoms. In group A patients drain was placed. Drainage tube damaged the brain in 2 patients, Infection in 4 patients and seizure in 3 patients. In group B infection in 2 patients, seizure in one patient. Recurrence of CSDH in 2 patients in group A and 4 patients in group B. Conclusion: Chronic subdural hematoma is a discrete clinical entity. Trauma appears to be the primary causative factor that resulted in chronic subdural hematoma Bur hole drainage under local anesthesia forms the basis of treatment. Drainage tube after evacuation of hematoma should be avoided because it can damage the brain parenchyma and prevalence to infection with drain
Early Versus Late Tracheotomy in Patients with Severe Head Injury
Get PDFObjective: A majority of patients with severe head injury whether treated conservatively or being operated, need ventilatory support and require endotracheal intubation. There has been a great discussion regarding the timing of tracheostomy. In this study we observed our admitted patients with severe head injury and noted the role of early tracheostomy in the outcome of these patients.Material and Method: This study included 50 cases of severe head injury presenting in the emergency department of Neurosurgery, Lahore General Hospital, Lahore.Study Duration: The study duration was two years from October 2010 to October 2012.Study Design: Prospective and analytic study.Results: A total of 50 patients with no sex predilection, ages ranging from 10 years to 60 years were included in this study. The patients were divided into 2 groups. Group A, having 25 patients who underwent tracheostomy earlier and Group B, having 25 patients in whom tracheostomy was done late. According to the timing of tracheostomy, patients were classified as early group A (? 7 days; N = 25) or late group B (> 7 days; N = 25). The average time of the tracheostomy procedure was 5.5 ± 1.8 (SD) days in the early group and 11.0 ± 4.3 days in the late group. There were no significant differences between the groups in terms of age, proportion of female sex, GCS, Injury Severity Score, or need for blood transfusion. However, patients in the early group had a significantly shorter stay in the ICU than patients in the late group (19.76 ± 4.4 vs. 28.9 ± 5.6 days; P = 0.0000001). There was no difference between the groups in ventilator days (15.7 ± 6.0 vs. 20.0 ± 16.0 days; p = 0.57) data not shown. There were significant differences between the groups regarding overall mortality 4% vs. 24%; p = 0.041332. Similarly, significant recovery (p = 0.04) was observed in early tracheostomy patients when compared with group B. Conclusion: Early tracheostomy was beneficial, resulting in a shorter ICU stay and decreasing the overall mortality
Surgical Outcome of Cerebellopontine Angle Tumours by Retrosigmoid Approach
Get PDFObjective: To determine the microsurgical outcome of cerebellopontine angle tumours by the retrosigmoid approach. Study Design: Quasi experimental study. Place and Duration of Study: Departments of Neurosurgery Lahore General Hospital and mayo hospital, Lahore from January 1998 to June 2015. Materials and Methods: Four hundred and fifty six patients of cerebellopontine angle tumours of various histologies were operated at the Departments of Neurosurgery, Lahore General Hospital and mayo hospital, Lahore, from Jan 1998 to June 2015. All patients with unilateral or bilateral lesions from 15 to 65 yrs of age and with all different pathologies in cerebellopontine angle were included in the study. Complete blood count, X-Ray Chest and MRI Brain plain and with I.V contrast were done. Patients with pre-operative radiosurgery, multiple surgeries and those unfit for surgery were excluded from the study. All patients were operated under general anaesthesia by retrosigmoid approach in park bench position. Preservation of the facial nerve was attempted in all cases. Post op facial nerve status was compared with pre-op grade by House – Brackman grading. Post op development of hydrocephalus and other cranial nerve complications were also noted and overall morbidity and mortality was studied.Results: Four hundred and fifty six patients, 274 men (60.1%) and 182 women (39.9%), underwent micro-surgical excision of cerebellopontine angle tumours. 410 (89.9%) patients were vestibular schwannomas,22 (4.8%) were meningioma, 9 (1.9%) were epidermoid and 13 (2.8%) were all other pathologies in cerebello-pontine angle tumours. Patient ages ranged from 15 to 65 years (mean 44.11±8.41 years). All patients were operated by the Retrosigmoid approach. Complete resection was achieved in 237 patients (51.9%), subtotal resection (STR) in 209 patients (45.8%), and near-total resection (NTR) in 10 patients (2.1%). Good facial nerve outcomes (House-Brackmann [HB] Grades I-III) were achieved in 82% of the patients who had undergone either NTR or STR, as compared with 73% of patients who had undergone gross-total resection (GTR). Complications included wound infection (2 patients), delayed CSF leakage 10 (2.1% of patients), hydrocephalus requiring VP shunt in 15 (3.2%), basal cranial nerve palsy in 45 patients (9.8%) and mortality in 10 (2.1%). Conclusion: Retrosigmoid approach is relatively easy and safe approach for cerebellopontine angle tumour. Tumours of all sizes can be operated completely and facial nerve can be identified and saved with this approach with less operative time and less chances of CSF leak
Rare Case of Cervical Hygroma Mimicking as Cervical Meningocele
Get PDFCystic hygroma is usually a benign lymphatic malformation that appears mostly before two years of age. It is frequently encountered in head and neck region but it can be present at any site in the body. In neck cystic hygroma is usually present in the posterior triangle of neck. We report a case of 6-months old boy who presented with cystic hygroma in the midline neck posteriorly. Patient was referred to our neurosurgery department with an expected diagnosis of cervical meningocele as site of swelling is common for the cervical meningocele. Clinical examination and radiology made the diagnosis of hygroma. Patient was treated with complete surgical resection satisfactorily. Histopathology confirmed the diagnosis of hygroma