Pakistan Journal Of Neurological Surgery
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Out Come of Surgical Management of Tethered Cord Syndrome
Get PDFObjective: To determine neurological outcome after surgical management of tethered cord syndrome.
Material and Methods: This descriptive study was conducted in the department of Neurosurgery, Lahore General Hospital Lahore. Over a period of Three Years From 2012 to 2014. Study Comprised of Fifty Patients after fulfilling the inclusion and exclusion criteria.
Results: The mean age of the patients was 36 ± 10 Years There were 30 (60.0%) male and 20 (40.0%) female patients. There was improvement in neurological status. The distribution of improvement in neurological status, revealed 35 (70.0%) patients had improvement in back pain, 18 (36.0%) improved motor function and 17 (34.0%) improved urinary incontinence.
Conclusion: It is concluded from this study that back pain, motor function and urinary incontinence improve postoperatively in the majority of patients. The rate of symptomatic improvement was greatest for back pain, followed by motor, and then urinary improvement.
Abbreviations: TCS: Tethered Cord Syndrome. ATCS: Adult Tethered Cord Syndrome
Normal Pressure Hydrocephalus; Outcome after Ventriculoperitoneal Shunt
Get PDFBackground: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. Hakim and Adams des-cribed for the first time the symptoms and signs of NPH which include ataxia, progressive memory loss and uri-nary incontinence. In properly diagnosed cases, ventriculoperitoneal (VP) shunt leads to good outcome.Material and Methods: This study comprised of 40 patients with NPH. The duration of study was 5 years from January 2009 to December 2013. The duration of illness before presentation ranged from one year to 6 years. The patients were diagnosed clinically and CT scan brain was done in all patients (MRI in some patients). All patients underwent Folstein Mini-Mental State Examination. In cases of possible NPH, drainage lumbar puncture (LP) was done and their response was noted. In 35 patients whose families gave consent for surgery, VP shunt was done while families of 5 patients refused surgery. The patients who underwent VP shunt were followed up, which ranged from one to 5 years.Results: The age of the patients was between 52 and 70 years. The majority of patients (25) were between 61-70 years. Out of the 35 patients, 26 (75%) were male while 9 (25%) were female. The initial symptom in all these patients was gait ataxia and the duration of illness ranged from one year to 6 years.Conclusion: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. In properly diagnosed pat-ients, ventriculoperitoneal shunt gives good results
Efficacy of Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus
Get PDFObjective: To assess efficacy of Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus.
Study Design: Cross – sectional observational study.
Materials and Methods: This study was conducted from July 2012 to June 2014 at the department of Neurosurgery, PGMI, Lahore General Hospital, Lahore. Patients with obstructive hydrocephalus due to aqueductal stenosis, tectal and non-tectal tumor and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. The exclusion criteria consisted of patient’s age < 6 months, previous history of ETV, recurrent tumor, patients with congenital hydrocephalus and secondary to meningitis or intra ventricular hemorrhage. Endoscopic third Ventriculostomy was performed in all patients. Success, complications and mortality was noted. Data was analyzed by descriptive statistics using SPSS software version 17.
Results: Out of 60 patients, 34 (56.6%) were males and 26 (43.4%) were females, ranging in age from 1 – 45 years. The maximum numbers of patients were in their two decade of life. ETV had successful outcome in 46 (76.7%) patients. Complications were observed in 14 (23.3%) cases including inadequate Ventriculostomy (8.33%), CSF leak (1.7%), ventricular bleed (1.7%), meningitis (1.7%) and seizures (6.67%). Two patients (3.33%) died in our study on follow up
Conclusion: Endoscopic Third Ventriculostomy is a very effective procedure for the treatment of obstructive hydrocephalus.
Abbreviations: ETV: Endoscopic Third Ventriculostomy. CSF: Cerebrospinal Fluid. OHC: Obstructive Hydrocephalus
Clinical Presentations of Multiple Sclerosis at Royal Commission Hospital Yanbu Kingdom of Saudi Arabia
Get PDFIntroduction: Multiple sclerosis (MS) is an important cause of long standing disability especially in adult females. The incidence is more in Europe. In Europe specially in USA and UK the prevalence is about 120/ 100,000. The annual incidence is around 7 per 100,000, while the life time risk of developing MS is about 1in 400. The incidence of MS is higher in northern Europeans, and the disease is about twice as common in females. Objectives: To study various ways the patients of multiple sclerosis presented in the department of neurology atObjectives: To study various ways the patients of multiple sclerosis presented in the department of neurology at Royal commission hospital Yanbu, Kingdom of Saudi Arabia.Materials and Methods: This is new as well newly diagnosed patients who presented in the emergency as well as outpatient department of neurology at Royal Commission hospital Yanbu, Kingdom of Saudi Arabia. Yanbu is one of the biggest industrial city of Saudi Arabia. Duration of study was two years; from January 2011 to December 2012. The study included 50 patients. We diagnosed 45 patients ourselves and 5 patients were following in the neurology OPD.Results: The age range was 17 – 58; 38 patients were females and 2 were males. Most of the affected patients were in the age range of 17 – 36. Mean duration of illness was from 1 – 9 years. In most of the patients, the initial presentation was weakness and visual loss. Most of the patients were started on interferons and they has very good outcome.Conclusions: Multiple sclerosis involves both brain and spinal cord. Early diagnosis and treatment promises good outcome and rehabilitation. The new treatment modalities have played revolutionary role in modulating the disease.
Abbreviations: MS = Multiple sclerosis
Surgical Repair of the Nerve Injuries in Lower Limb
Get PDFObjectives: Objectives to assess the outcome of surgical repair of the nerve injuries in lower limb.
Material and Methods: This prospective study conduct in the Department of Neurosurgery, Bolan Medical Complex Hospital and Akram Hospital Quetta, From April 2003 to August 2007.
Results: There were 8 sciatic nerve injuries at different level only 4 cases (26%) showing significant outcome. In 3 cases (75%) of common peroneal nerve injury only one (20%) showing significant improvement. While in four cases of deep peroneal nerve only one shown good outcome
Effect of Blood Pressure Lowering Therapy in Stroke Patients
Get PDFObjective: The objective of the study is to assess the effect of blood pressure lowering with Candesartan in patients with stroke and elevated blood pressure admitted in this hospital.Study Design: Prospective descriptive observational study.Setting: Neurosurgery, Medical Emergency / OPD, Lady Reading Hospital, Peshawar.Materials and Methods: This descriptive study was done at the Department of Medicine and Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2013 to May 2014 (for One year and 5 months period) in a total of 357 patients. In this descriptive study, patients presenting to Emergency department or OPD with stroke and elevated blood pressure, presenting within 30 hours of symptom onset and with SBP ? 140 mmHg, diastolic > 90 mmHg, were eligible for inclusion. Exclusion criteria were contraindicat-ions to or ongoing treatment with an angiotensin receptor blocker, markedly reduced consciousness, patients with chronic heart failure and intolerance to ACE inhibitors, patient unavailability for follow-up and pregnancy or breast – feeding. The acute phase treatment was a fixed dose of 4 mg on day 1, 8 mg on day 2 and 16 mg on days 3 to 7. Blood pressure was measured daily with the patient in the supine position using a blood pressure monitor. All patients were follow-up on day 7 and at 1 and 6 months after discharged from hospital.Results: Among 357 cases, 68.06% were males and 31.93% females. Majority (37.25%) belongs to age group of 61 – 70 years. Out of these, 66.10% patients were found to have ischemic and 33.89% patients had hemorrhagic stroke. Highest (40.05%) patients belonged to severe hypertensive group i.e. ? 180/110 mmHg. Target was achieved in 75.91% patients.Conclusions: Our data suggests that lowering BP in acute ICH is probably safe; however, it remains to be seen if this decreases hematoma expansion or improves outcome
Frequency of External Ventricular Drain Related Infection
No full textThe management of brain tumors of the pediatric brain tumors may involve surgical option like craniotomy. This procedure can lead to the complications like cerebrospinal fluid (CSF) leakage which is difficult to manage. This study was an audit of craniotomy among pediatric brain tumor patients.
Objective: To determine the frequency of CSF leak after craniotomy for paediatric brain tumor. Study Design: Descriptive case series.
Setting: Department of Neurosurgery, Nishtar Hospital, Multan.
Duration: 03 year 01/06/2010 to 30/06/2013.
Methods: This study included 208 patients with pediatric brain tumors. All the patients had craniotomy done through supratentorial or infratentorial approach. The patients were followed up for occurrence of CSF leakage upto two weeks. Data was collected in a specially designed performa.
Results: The mean age of the patients was 10.36 ± 4.97 years (range 6 months – 18 years). There were 44 (21.2%) female and 164 (79.8%) patients were male. Craniotomies through supratentorial and infratentorial approach were done in 176 (84.6%) and 32 (15.4%) patients, respectively. CSF leakage was observed among 28 (13.5%) patient.
Conclusions: The CSF leakage rates after craniotomy in pediatric population having brain tumors are high. However, this rate is high among patients who undergo through infratentorial techniques as compared to supratentorial technique.
Abbreviations: CSF = Cerebrospinal fluid. CNS = Central nervous system
Outcome of Anterior Fixation in Lower Cervical Spine Injuries
Get PDFIntroduction: The fractures of cervical spine are divided into upper cervical spine (C1 – C2) and lower cervical spine (C3 – C7) fractures, also called sub-axial cervical spine. Sub-axial cervical injuries rangesfrom minor ligamentous strain or spinous process fracture to complete fracture dislocation with bone and ligament disruption, resulting in severe spinal cord injury.
Objectives: The objective of this study was to determine the efficacy of anterior cervical spine fixation as regards the effective stabilization, immobilization and solid bony fusion in lower cervical spine injuries by the use of cervical spine locking plate (CSLP) attached with cancellous screws.
Study Design: Descriptive case series study.
Materials and Methods: This study was conducted from March 2013 to March 2014 in the department of Neurosurgery unit II, Lahore General Hospital Lahore. A total of 30 patients were included in this study of both gender and in the age range of 16 – 60 years.
Results: In our study, there were 23 (76.7%) male patients and 7 (23.3%) female patients. The majority of the patients 25 (83.3%) were in the age range of 21 – 50 years with mean age was 38.2 ± 11.7 years. On one month follow up, the mean Frankel grade was 3.5 ± 1.6, 3.53 ± 1.6 on 3 months follow up and 3.6 ± 1.8 on 6 months follow-up. Similarly, 12 (40%) patients remained catheterized, 16 (53.3%) patients had normal control and 2 (6.7%) patients had partial recovery in 1 month time. After 3 months, 4 (13.3%) patients remained catheterized, 20 (66.7%) patients had normal control and 6 (20%) patients had partial recovery. After 6 months 3 (10%) patients remained catheterized, 25 (83.3%) patients had normal control and 2 (6.7%) had partial recovery. On follow up of one, three and six months, x-ray finding showed in 9 (30%) patients of good condition and 21 (70%) patients of satisfactory condition. Conclusion: The use of anterior approach in treatment of the injured lower spine is safe and effective.
Abbreviations: CSLP = cervical spine locking plate
Fothergill Disease Wincing Facial Pain or Toothache: Incidence of Tooth extraction in Fothergill Disease
Get PDFBackground: Fothergill Disease commonly cause pain in jaws. Here, incidence of unnecessary tooth extraction and simple dental treatment was noted while managing this disease, is presented.Methods: A prospective review of 30 consecutive patients was done, who were treated for Fothergill disease at Department of Neurosurgery, PGMI / Lahore General Hospital Lahore from 2012 to 2013. The clinical presentation, dental surgeon evaluation, simple dental procedures and tooth extractions, were noted and analyzed.Results: In this study, thirty Fothergill disease patients were identified in 18 females (60%) and 12 males (40%) patients, with a mean age at diagnosis of 56.0 years. Right facial pain was relatively more common in 17 (56.66%) patients. Lower jaw was involved more alone in (n = 6) with upper jaw in (n = 12). Despite the typical nature of facial pain a large no of patients (n = 12) 40%, visited dental surgeons. Simple dental procedures in the form of local injections or root canal was done in (n = 5), while tooth extracted in (n = 7)Conclusions: All peridental area pain are not due to dental disease, Exact diagnosis and treatment of jaw pain is mandatory to avoid unnecessary dental treatment
Surgical Management and Outcome of Lumbosacral Disc Herniation (Study of 100 Cases)
Get PDFObjective: To discuss the surgical management and outcome of lumbosacral disc herniation.
Material and Method: The study was conducted in BMCH and Akram Hospital Quetta from April 2005 to November 2006, 100 patients of both gender included in study. Age range was 30-25 yrs. MRI lumbosacral spine done in all cases.
Results: Excellent result was observed in 80% of patients while fair result in 12% and results were same in 6% of patients. Poor result in 2%