Pakistan Journal Of Neurological Surgery
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Frequency of External Ventricular Drain Related Infection
Get PDFObjective: To evaluate the frequency of external ventricular drain (EVD) related infections. Material and Methods: This observational study was conducted at the department of Neurosurgery / pathology, Postgraduate medical institute, Lady Reading Hospital Peshawar from July 2014 to December 2014. A total of 18 consecutive patients, who undergone EVD, irrespective of their age and gender were included in the study. Those who had intracranial infection, Cerebrospinal fluid leak (CSF) or revision of EVD (external ventricular drain) were excluded from the study. Results: We had total 18 patients who underwent EVD in the study period. There were 44.4% males and 55.6% females. Their age range was from 1-69 years with the mean age of 40years. Main indication for EVD was intracranial hemorrhage in 55.6% cases. Post EVD infection was observed in 16.6%. Conclusions: We conclude that external ventricular drainage is an effective and quick technique for the management of acutely raised intracranial pressure with dilated ventricular system. The incidence of EVD related infection is significant (16.6%). Early diagnosis is made on the basis of CSF culture, gram staining and routine evaluation for increased white cell count, increased proteins and decrease glucose level. This will help to permit immediate and specific treatment
To Determine Frequency of Cerebrospinal Fluid (CSF) Rhinorrohea after Trans-sphenoidal (TSS) Surgery
Get PDFIntroduction: Trans-sphenoidal approach has been a major technique for surgical treatment of sellar pathology since the 1960s. With the development of technical possibilities and increase in surgeons’ expertise, mortality and morbidity after such interventions have decreased. Postoperative cerebrospinal fluid (CSF) rhinorrhea, however, remains the most serious and life – threatening complication. The purpose of this study was to determine the magnitude of cerebrospinal fluid rhinorrhea after trans-sphenoidal surgery, so that proper protocols could be taken for its prevention and management in order to reduce the morbidity of these patients.
Materials and Methods: A total of 116 patients, 20 to 60 years of age with sellar and supra-sellar tumours of any size were included. Patients with Rathke’s cleft cyst, meningoceles, recurrent pituitary adenomas and h/o previous surgery and radiation were excluded. All the patients had undergone trans-sphenoidal removal of the tumour and were followed after 24 hours, one week and one month post-operatively and noted for presence of any cerebrospinal fluid rhinorrhea.
Results: Mean age was 45.23 ± 8.71 years in our study. Out of the 29 patients, 44.82% were male and 55.72% were females with ratio of almost 1:1. According to type of tumour, 56.90% were sellar and 43.10% were suprasellar. Cerebrospinal fluid (CSF) rhinorrhea was found in 3 (10.34%) patients, whereas there was no Cerebrospinal fluid (CSF) rhinorrhea in 26 (89.65%) patients.
Conclusion: This study concluded that frequency of CSF rhinorrhea after trans-sphenoidal surgery (TSS) is 10.34% in our population.
Abbreviations: CSF: Cerebrospinal Fluid. TSS: Trans-sphenoidal Surger
Clinical Characteristics and Outcome Assessment of Brain Abscess in Children and Adolescents; a 2 Years Neurosurgical Perspective
Get PDFBackground: Brain abscess is a serious infective disorder of the central nervous system with high rates of prolonged morbidity and mortality. Effective neurosurgical management is the key to lower morbidity and death rates due to this disease.Material and Methods: This study was conducted prospectively at the Department of Neurosurgery, Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Presenting clinical features, radiological characteristics and surgical findings were recorded. Emphasis was placed to test the effectiveness of prompt surgery, good antibiotic coverage and the use of drainage tubes in reducing recurrence rates and lowering mor-bidity and mortality. The patients were followed for one month postoperatively and their functional outcome plus radiological resolution recorded.Results: 48 cases were included in the study with 33 (68.8%) males and 15 (31.3%) females and mean age of 9.7 years (SD ± 4.5). Median GCS on presentation was 12 (SD ± 3.1) and mean diameter of the abscess cavity was 4.8 cm (SD ± 1.3). The mean of length of stay was 6.6 days (SD ± 2.7) while median GOS at discharge was found to be 4 (SD ± 1.2). Eighteen of the 48 patients were lost to follow up. Overall mortality was 14.6% (7 patients). There was a significant correlation between admission GCS and GOS at discharge (r = 0.87 and p = < 0.001).Conclusion: The paediatric age group is more susceptible to central nervous system infections and cerebral abscess development. Moreover, the higher prevalence of congenital heart diseases, pulmonary disorders and head trauma leads to higher incidence, prolonged morbidity and increased mortality. Surgical interventions for brain abscess have good outcome. However, early diagnosis is the key to saving lives
Two Years Audit of Parkinsonism Patients at Royal Commission Hospital Yanbu, Kingdom of Saudi Arabia
Get PDFIntroduction: Parkinson`s disease (PD) is the second most common neurodegenerative condition affecting patients. It is broadly classified as `movement disorder’ with a variety of clinical features, including bradykinesia, rigidity and tremor. PD is better defined as multisystem neurodengerative disorder causing a large number of motor and non-motor complications. In this study we described our experience regarding follow up parkinsonism patients.Objectives: To determine clinical outcome in patients of Parkinsonism in our setup.Materials and Methods: This was a retrospective as well as follow up of new patients of Parkinson`s disease in the department of neurology at Royal Commission hospital Yanbu – one of the biggest industrial city of Kingdom of Saudi Arabia. Duration of study was two years; from January 2011 to December 2012. This study included 50 patients with diagnosed case of Parkinsonism and newly diagnosed cases.Results: The age range was 40 – 110 years; there were 4 patients (8%) of age range 40 – 41 years, 2 patients (4%) of age range 46 – 50 years, one patient (2%), 7 patients (14%) of age range 61 – 65 years, 11 patients (22%) of age range 66 – 70 years, 2 patients (4%) of age range 86 – 90 years and one patient (2%) was of 110 years. The last patient mentioned has a daughter who was 80 years of age and was included in the study. Around 45 patients were diagnosed for the first time as case of Parkinsonism and these were started on management / treatment with good clinical improvement.Conclusions: Not all the patients need to commence treatment at time of diagnosis, but drugs should be started when symptoms begin to interfere with daily life. We found that all such patients when prescribed treatments sho-wed excellent improvement in terms of activities of daily life
Brachial Plexus and Peripheral Nerves Injuries Based on Etiology and Site
Get PDFObjective; To determine the brachial plexus and peripheral nerves injuries based on etiology and site.Materials and Methods: This prospective observational study was conducted at neurosurgery department of lady Reading hospital Peshawar from 1st January 2011 to 30th June 2012 with total 1½ year duration. After taking consent from ethical research committee operative records of all those patients were started to document who were admitted in the mentioned duration with brachial plexus and peripheral nerves injuries and documentation was done according to the preformed proforma including age, sex, etiology, type of nerve, site of injury according to operative findings while excluding neuropathies due to compression, metabolic, immunologic causes. Data was analyzed from different angles by SPSS software.Results: Total 36 patients were included in this study in which 28 were males and 8 were females having age distribution of 10 in first 2 decades, 14 in 3rd decade and remaining 12 patients in 4th – 7th decades. Among 36 cases of peripheral nerves injuries 22 were in upper limbs, 12 in lower limbs and right and left side distribution was equal while the most common cause was fire arm injuries followed by injuries due to the sharp objects .Based on location and nerve involvement the ulnar nerve injury at the wrist joint was most common followed by common peroneal nerve injury at popliteal fossa then sciatic nerve at gluteal region.Conclusion: Brachial plexus and peripheral nerves injuries occurs mostly due to FAI and sharp objects. in upper limbs Ulnar nerve at wrist joint while in lower limbs common peroneal nerve at popliteal fossa are most commonly injured
Familial Epilepsy – A Population Based Study in Yanbu Kingdom of Saudi Arabia
Get PDFIntroduction; Epilepsy is a common and important neurological condition. It effects children & adults and occurs in every major population of the world. Epilepsy is heterogeneous condition, manifesting on its own or as complication of other neurological or systemic diseases and its clinical form, severity and outcome vary widely. Treatment has improved considerably in recent years and the choice of the medical therapy has widened greatly. The following study shows high incidence of familial epilepsy in a Yanbu – one of the biggest industrial city of Kingdom of Saudi Arabia. Objectives: To study the incidence of familial epilepsy in patient population of Yanbu, Kingdom of Saudi Arabia. Material and Methods: This is a retrospective study of epilepsy patients, as well as follow up of new patients of epilepsy who presented in the department of neurology at Royal Commission hospital Yanbu Kingdom of Saudi Arabia. Duration of study was two years; from January 2011 to December 2012. This study included 100 patients with diagnosed of epilepsy. Results: The age range was 10-60 years; there were 39 patients (78%) of age range 10 – 20, 30 patients (60%) of age range 21 – 30, 11 patients (22%) of age range 31 – 40, 11 patients (22%) of age range 41 – 50, and 9 pat-ients (18%) of age range 51 – 61. There were both diagnosed cases of epilepsy as well as those who presented for the first time in the neurology department. Conclusions: It was seen during study that 40 patients out of 100 patients had two or more family members having epilepsy. We have not seen such high incidence in any of the studies done in the past. What could be the probable cause of this high incidence, remains to be elucidated, one possible explanation might have been polygenic inheritance amongst such patients
A Study of Various Shunt Related Complications in a Tertiary Care Hospital
Get PDFObjective: The purpose of this study is to evaluate the frequency of various complication in patients with ventri-culoperitoneal shunt (VP shunt) for hydrocephalous in a tertiary care hospital.Material and Methods: This descriptive study on patients for whom Ventriculoperitoneal shunt was done for hydrocephalus was carried out in neurosurgery department, Hayatabad Medical Complex, Peshawar from 1st May 2010 to 30th February 2013. Only patients of hydrocephalous with established complication from both gen-ders without age discrimination were included in the study and patients with complications after revised shunts were excluded as complications rate is different in the two entities and will bias the study results. The patients were seen either in emergency room, ward or neurosurgical OPDs. Routine follow up schedule was examination at discharge, one month and then 6 months post operatively on outpatient bases. History, Clinical examination and full investigations which included FBC,CRP , CSF R/E (if required to rule out infection), X-Ray shunt series and CT scan brain and ultrasound abdomen pelvis were done as required in all patients. The clinical data was put into semi structured Performa and analyzed by SPSS version 10. Frequency and percentage was calculated for categorical variables. Mean ± SD was calculated for age. Results were presented as graphs and tables.Results: The total number of children operated upon was 112 of whom 71 (63.39%) males and 41 (36.61%) females. Forty one patients (36.61%) were less than one year at the time of presentation. Thirty seven (33.03%) patients were in age range of 1 – 10 years, 19 (16.96%) were in 11 – 20, 10 (8.92%) were in 21 – 30 age range, 4 (3.57%) were from 31 – 40 and one patient (0.89%) was in the age range of 41 – 50. Shunt blockage was seen in 54 (48.21%) followed by infection 38 (33.93%). Shunt erosion was seen in 11 (9.82%), extrusion in 5 (4.46%). While 4 patients died in the study period due to shunt related complications.Conclusion: The commonest shunt related complication is shunt blockage followed by shunt infection. Upper end of the shunt is more prone to complications than the lower end .Shunt related complications are serious clinical conditions and may lead to death of the patient
Decompressive Craniotomy Verses Conservative Management in Severe Traumatic Brain Injuries
Get PDFMaterials and Methods: Study design; prospective study, department of neurosurgery SZH, Rahim Yar Khan.
Study Duration: 2 years and 1 month from 1 st June 2011 to 31 July 2013.
Study Subject: 100 patients were divided into two groups i.e. I and II Group. Group I patients were managed conservatively and group II patients were managed surgically. Follow up was done at 3, 6, 9, 12 months after discharge and outcome in terms of improvement in GCS was compared between these two groups.
Results: Improvement in GCS to 11 or above was achieved in 60% patients of group I and in 68% patients of group II who were discharged with GCS 12 or above.
Conclusion: Our study suggests that operative measures for TBI gives better outcome as compared to conservative management.
Abbreviations: GCS = Decompressive craniotomy, duraplasty. ICP = Intracranial hypertension. TBI = Traumatic brain injury. ICU = Intensive Care Unit
Reversible Dementia in victims of Chronic Subdural Hematomas
Get PDFObjective: The objective of this joint study was to offer the prompt surgical treatment to all diagnosed victims of Reversible dementia with chronic subdural hematomas in our population. Evaluation was based upon comparison of their Pre and Postoperative MMS scoring and HDS-R grading.Materials and Methods: This study started in June 2013 and is currently ongoing at the Services Institute of Medical Sciences with its allied Services Hospital, Lahore as a joint venture principally between the departments of Neurosurgery and Neurology. We included 30 cases in this study.Results: Out of 30 cases there were 25 (83.3%) males and 05 (16.66%) females patients. Twenty five out of 30 victims (83.3%) were suffering from dementia pre operatively. Twenty out of these patients (80%) recovered fully and three patients (10%) partially. 02 patients (6.6%) neither improved nor deteriorated. Twenty eight out of 30 victims underwent surgical evacuation by burr holes with closed drainage system under general anesthesia (91.1%) and 2 under went under local anesthesia (6.6%) due to their co-morbid conditions.Complications: There was no noticeable mortality. One patient complained of post operative pyrexia with convulsions (%) and was managed satisfactorily by conservative treatment. Another patient complained of head-ache for 3 days which was also managed conservatively pie diagram – II. There was no intracranial wound infection in our study.Conclusion: It was concluded that there was marked post operative improvement in patient’s memory, behavior and neurological status. This was established by proper recording, documentation and comparison of their pre and post operative MMS scoring and HDS-R grading system. It is recommended that the victims of chronic subdural hematomas should be offered prompt evacuation to improve their neurological status
Recurrence of A.com – ACA Complex Cerebral Aneurysms after Coiling
Get PDFObjective: To assess the recurrence of A.com – ACA complex cerebral aneurysms after coiling.
Materials and Methods: This study was conducted from July 2010 to December 2013 at the department of Neuroradiology, PGMI, Lahore General Hospital, Lahore. A total of 50 patients with cerebral aneurysms at the level of A.com – ACA complex were included in this study of both gender (male and female) and in the age range of 45 – 65 years.
Results: Out of 50 patients, there were 20 (40%) males and 30 (60%) female patients. Their age ranged from 45 – 65 years. The maximum numbers of patients were in their fifth and sixth decade of life. In our study successful coiling was done in all patients with minimal recurrence/recanalization of cerebral aneurysms at A.com – ACA complex.
Conclusion: Coiling is minimally invasive endovascular procedure routinely performed to treat cerebral aneurysms with an aim to highlight the significance of recognizing the large sized aneurysms recurrence / recanalization by regular follow up and early intervention to decrease morbidity and mortality of the patients.
Abbreviations: GDCs = Guglielmi detachable coils. SAH = Subarachnoid hemorrhage