Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
To Determine Outcome of Lumboperitoneal Shunt in Patients of Normal Pressure Hydrocephalus
Get PDFThe patient presenting with gait disturbance, cognitive decline, or urinary incontinence represents a common cli-nical dilemma for the practicing neurologist and neurosurgeon. Although these symptoms are suggestive of normal pressure hydrocephalus (NPH), they are not specific to the diagnosis and commonly occur in neuro-degenerative conditions or nonspecifically in advanced age. A lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension and normal pressure hydrocephalus.Objective: The objective of the study is to determine outcome of lumboperitoneal shunt in patients of normal pressure hydrocephalus.Study Design: Case series study.Place and Duration of Study: This study was conducted from December 19, 2012 to June 18, 2013 in the department of neurosurgery, Bahawal Victoria Hospital Bahawalpur.Subject and Methods: 96 patients of normal pressure hydrocephalus, admitted in neurosurgery ward BVH Bahawalpur were included in the study. LP shunt procedure was done under general anesthesia. 3 weeks after operation complete clinical examination, urodynamic study and CT scan brain was done to see outcome of LP shunt.Results: Total 96 patients were included in our study. The mean age of patients was 67.43 years with standard deviation of 5.395 years. Out of 96 patients, 47 (48.96%) were female and 49 (51.04%) patients were male. Out of 96 patients, 81 (84.38%) patients showed improved gait and 15 (15.62%) patients showed no improvement. Out of 96 patients, 49 patients showed improvement in incontinence while 47 patients showed no improvement. Out of 96 patients, 53 patients showed improvement in memory while 43 patients showed no improvement in memory.Conclusion: Lumboperitoneal shunt placement is a safe and effective shunting for normal pressure hydro-cephalus, resulting in significant symptomatic improvement with a low risk of over-drainage
Neurological Outcome of Carpal Tunnel Decompression in Carpal Tunnel Syndrome
Get PDFObjective: To evaluate the outcome of carpal tunnel decompression in Carpal tunnel syndrome. Study Design: Prospective and retrospective observational study. Materials and Methods: This study was conducted at the Department of Neurosurgery, PGMI / AMC / Lahore General Hospital, Lahore, during the period of 4 years from Jan. 2009 to Jan. 2013. All patients with symptoms and signs of carpal tunnel syndrome and with positive nerve conduction study were included in our study. Exclusion criteria was those unfit for surgery such as patients on warfarin and patient with mild symptoms treated with wrist splint and oral analgesic, diabetic, hypothyroid patient, patients in which nerve conduction study points to radiculopathy and patients with history of trauma with carpal bone fracture were excluded from study. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated. Baseline and one – year follow-up data were analysed for 57 patients (62 hands). Results: A total of 57 patients (62 hands) treated with surgery between Jan 2009 and Jan 2013 agreed to participate in the study. Complete data at baseline and 1 year were available for 57 patients (62 hands). There was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. Eight patients (14%) requested advice on scar management or had queries regarding the duration of post-operative recovery of sensation and function. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Patient satisfaction as judged using a Picker questionnaire was very high. Conclusions: A highly efficient clinical service involving both diagnostics and treatment can be delivered through minimum hospital visit and day care surgery while maintaining optimal outcomes and high patient satisfaction
The Role of Decompressive Craniectomy in Traumatic Cerebral Contusions; A Prospective Observational Study
Get PDFBackground: To investigate the role of decompressive craniectomy in traumatic cerebral contusions in terms of factors affecting outcome and the various surgical strategies which can be taken into consideration for contusion resection and cerebral decompression.Material and Methods: The study was conducted from July 2013 to June 2014 at Department of Neurological Surgery Hayatabad Medical Complex Peshawar. A total of 35 patients were enrolled. The criteria included patients with traumatic cerebral contusion(s) who were eligible to undergo surgical decompression. The surgical procedures for intervention were classified according to the individual patient needs. Demographic data, inclu-sion parameters, surgical procedures, post-operative outcome and complications were recorded and analysed.Results: Thirty five patients were included with a mean age of 37.8 ± 13.8 years, 23 (65.7%) males and 12 (34.3%) females. The median Glasgow coma score at arrival was 8 ± 2.4, median Glasgow comma score at discharge was 9 ± 5. The median Glasgow outcome score at 3 months was 4 ± 1.6 and a mean total hospital stay of 10.9 ± 8.1 days.Conclusion: Cerebral contusions comprise one of the most serious kind of traumatic brain insult with long term physical, mental and economic sequelae while imparting a heavy load of hospital inpatient mortality and mor-bidity
Normal Pressure Hydrocephalus: Selection of Patients for Shunt Placement
Get PDFObjective: To determine the criteria in our setup, for patients with normal pressure hydrocephalus (NPH), based on clinical and radiological findings.Material and Methods: This is multiple center study, including departments of Neurosurgery at LGH, Lahore / KEMU, Lahore. Over 25 years, 240 patients were included purely on clinical criteria of poor memory, sphincter loss, gait apraxia and Evan’s ratio ? 0.30 on CT or MRI. All patients had shunting procedures.Results: Hundred and ninety patients were improved and all of them had significant reduction in Evan’s ratio i.e. ? 0.06. Only 10 patients had infection out of whom 8 lost to follow up while 2 had shunt revision.Conclusion: Shunting procedures especially VP shunt shows good results if selection is stringent and no co-morbidity is associated
Management of Pediatric Brain Abscess: Experience with 21 Cases
Get PDFObjective: To evaluate clinical presentation, diagnosis and treatment of brain abscess in pediatric age group.Material and Methods: This observational study was conducted at the department of Neurosurgery / pathology, Post-graduate medical institute, Lady Reading Hospital Peshawar from Jan 2011 to December 2013. A total of 21 consecutive patients who undergone surgery (aspiration / excision) for brain abscess with age less than 14 years were included in the study irrespective of their gender. Those treated conservatively or age more than 14 years were excluded from the study.Results: We had total 21 children who underwent surgery for brain abscess in the study period. There were 62% males and 38% females. Most of the patients presented with fever (66.7%) and headache / vomiting (61.9%). Otitis media (33.3%) and cyanotic heart disease (23.8%) were the common predisposing factors. CT brain with contrast was done in all the patients with brain abscess. Most of the children (52.4%) with brain abscess were offered bur-hole aspiration. In 57.1% patients the culture report was positive. The commonly identified orga-nisms were streptococci in 41.7 % cases and staphalococci in 25%.Conclusions: We concluded from this study that otitis media and cyanotic heart disease were the common pre-disposing factors for pediatric brain abscess. The common presenting features were fever followed by headache / vomiting. CT brain with contrast is the investigation of choice to diagnose brain abscess. Most of the children with brain abscess needs aspiration. Culture was positive in most but not all the cases
Surgical Outcome of Spontaneous Intracebellar Haemorrhage
Get PDFIntroduction: The management of spontaneous intracerebellar hemorrhage has always been a challenge for neurosurgeons and neurophysicians. So far, neither medical nor surgical intervention has been shown consis-tently to improve the outcome. In this study, we described our experience of surgery for the treatment of sponta-neous cerebellar haemorrhage.Objective: To determine the frequency of good outcome of surgical evacuation of intracerebellar hematoma.Materials and Methods: This was a descriptive prospective study conducted at the department of Neurosurgery PGMI / Lahore General Hospital Lahore. Duration of study was 1 year from 6th August 2010 to 6th August 2011. This study included 75 patients with spontaneous intracerebellar haemorrhage that underwent surgical treatment. Patients were followed for 30 days to see the frequency of good outcome.Results: The mean age of the patients was 60.60, SD 9.43 years (range 43 – 77). There were 15 (20%) patients of age range of 40 – 50 years, 19 (25.3%) patients of age range of 51 – 60 years, 33 (44%) patients of age range of 61 – 70 years, and 08 (10.7%) patients in the age range of 71 – 80 years). There were 51 (68%) male patients and 24 (32 %) female patient in the study. There were 33 (44%) patients who showed good outcome after surgical treatment of spontaneous intracerebellar haemorrhage.Conclusions: Surgery for spontaneous intracerebellar hemorrhage holds good outcome and should be conside-red for intracerebellar hemorrhage
Occipital Encephalocele and Review of Literature
Get PDFEncephalocele is a rare congenital malformation of the central nervous system. It is defined as a congenital herniation of the intracranial compartments through a long defect and contains various rudimentary cerebral tissue components or sometimes only cerebrospinal fluid. They are located at midline of parietal or occipital region when the defect is small. Usually only the meninges herniate and the anomaly is cranial Meningocele or cranium bifidum with Meningocele. We present 47 cases of encephalocele, mostly occipital encephalocele, operated during last 5 years in our hospital at the department of Neurosurgery SZH, RYK. This is a retrospective study.Material and Methods: Between January 2008 and December 2013. Forty seven cases of encephalocele have been treated at our department. They were diagnosed on the basis of clinical findings and CT scan was done in all patients. All patients were operated and diagnosis was confirmed at peroperatively. Demographic, clinical, radiological and operative data were reviewed from hospital charts.Results: The total number of patients was 47, out of which 23 were male and 24 were female. Neurosurgical data of patients with encephalocele over the five years and three months from January 2008 to April 2014 were retrospectively studied. The average age of the patients at the time presentation was 10 months and seven days.Conclusion: Encephalocele is a relatively uncommon neurosurgical entity largely seen in the pediatric population. Treatment of this condition can be rewarding if properly managed early. Occipital, parietal, frontal, and frontonasal types may be approached without opening the cranium, while sincipital and basal encephalocele usually require craniotomy. In this series we present our experience in the operative management of encepha-locele with good outcome and also share our recommendation in technical consideration for surgical approaches
Incidental Durotomy in Lumbar Microdiskectomy; Incidence, Management and Early Sequelae
Get PDFObjective: To know about the incidence, management and early sequelae of incidental durotomy during lumbar microdiskectomy.Materials and Methods: This was a retrospective study. The duration of the study was six months from January 24th to 20th July 2013. The charts and records of the patient from the operation notes were reviewed and the parameters like the age, sex, side and location of the disc, mean hospital stay and any documented leak or neural deficit were recorded on a designed proforma. All patients undergoing lumbar microdiskectomy for the first time were included in the study and the patients having a repeated surgery as well as other indications (stenosis, tumor, trauma) excluded from the study.Results: A total of 147 patients were included in the study including 87 males and 60 females with a male to female ratio of 1.5 to 1. The age range was 18 – 63 years with a mean age of 34 ± 6 years. The most common level was L4 – L5. Right side was more common than the left side and the four patients (2.7%) had an incidental durotomy which was repaired intra-operatively. The patient with an incidental have any focal deficit apart from the prolongation of the hospital stay.Conclusion: Incidental durotomy is an infrequent complication of lumbar microdiskectomy and there is little early clinical sequelae apart from prolongation of hospital stay
Frequency of Hydrocephalus in Patients Presenting with Spinal Dysraphism
Get PDFObjective: The objective of this study is to determine the frequency of hydrocephalus in patients presenting with spinal dysraphism.Material and Methods: This cross sectional descriptive study was conducted at Department of Neurosurgery, Postgraduate Medical Institute Lady Reading Hospital, Peshawar, Pakistan. A total of 119 patients of spinal dysraphism were included through convenience (non-probability) sampling, in a period of six months (from June, 2011 to December 2011). All patients with spinal dysraphism with either sex and age less than 2 years included, while patients with post spinal dysraphism surgery who developed hydrocephalus, posterior fossa lesion causing obstructive hydrocephalus and Patients with post tuberculous meningitis with hydrocephalus were excluded. Hydrocephalus was observed in these patients. The data was analyzed using the statistical program SPSS version 17.Results: Out of total number of 119 patients, majority was males with 66 in number (55.5%), while female were 53 (44.5%). The age of patients ranged from 10 days to 23 months with overall mean age 5.47 + 5.439 months. Majority of patients, 82 (68.9%), were in the age range of 01-06 months. Most of the patients, i.e., 56 (47.1%) were harboring spinal dysraphism at lumbar region. Hydrocephalus was found in quite large number of cases, 79 cases (66.4%), in patients of spinal dysraphism.Conclusion: Spinal dysraphism is slightly more common in males with frequency of 55.5%. Majority of the patients of spinal dysraphism (68.9%) were presented in the age range of 1 – 6 months. Spinal dysraphism is more common (47.1%) at lumbar region. Hydrocephalus was found in 79 cases (66.4%) of spinal dysraphism
Metastatic Posterior Fossa SOL Secondary to Carcinoma Breast
Get PDFAim: To describe our experience with Metastatic Carcinoma (CA) breast in posterior fossa.Materials and Methods: All patients who had history of Carcinoma (CA) breast and had posterior fossa space occupying lesion (SOL) were included in this study. Detailed history, examination and baseline investigations were done and patients were operated on list and are on regular follow up. The duration of study was 2 months and is an ongoing project.Results: Three patients were included in this study. All had previous history of mastectomy for Carcinoma (CA) breast. One had invasive ductal carcinoma, other had ductal carcinoma. Third one didn’t have her previous records with her. All patients presented with SOL in posterior fossa. 1st and 2nd patient had undifferentiated carcinoma and 3rd patient had metastatic differentiated carcinoma on biopsy of SOL brain. It is interesting to note that 1st and 2nd patients completed their chemotherapy and radio therapy while the 3rd patient didn’t consulted her surgeon after mastectomy for further treatment.Conclusion: A multidisciplinary approach is recommended for the long term management of patients with Carcinoma (CA) breast and they should be kept on regular follow-up for the rest of their lives