Pakistan Journal Of Neurological Surgery
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Outcome of Chronic Subdural Hematoma Evacuation in Association with Its Etiology
Get PDFObjective: To evaluate outcomes of the chronic subdural hematoma (cSDH) evacuation in association with its etiology at a tertiary care Hospital.
Materials & Methods: A prospective clinical cohort study was done at the Neurosurgery department of Pakistan Institute of Medical Sciences (PIMS) Islamabad. Diagnosed cases with cSDH, aged more than 18 years, both genders were scheduled for surgical evacuation by standard neurosurgical techniques as per indications, and Hospital protocols were incorporated. Postoperative CT scans of all patients were examined. Patients were followed for a minimum of 3 months post-surgery. Favorable outcomes were categorized as good recovery and moderate disability, while unfavorable outcomes included severe disability, persistent vegetative state, and death.
Results: There were 51 patients with cSDH, with a mean age of 69 years. Males were in majority 74.5% and females were 25.5%. The common causative factor was old age, in 33.3% of cases followed by Trauma 17.6%, old age combined with hypertension (11.8%), hypertension and anticoagulant (7.8%), followed by post-VP shunt (3.9%), and various combinations of old age, trauma, hypertension, anticoagulant use, and alcohol consumption. The good outcome was 92.2% improvement with a moderate disability 3.9%, and 3.9% died. Among patients, those with trauma and hypertension, and hypertension, anticoagulant, and alcohol consumption had worse outcomes, including one death in each group.
Conclusion: Overall, outcomes of chronic subdural hematoma evacuation were observed to be favorable. Only two patients died, both of whom had etiological factors such as trauma and hypertension, or hypertension, anticoagulant use, and alcohol consumption
Bertolotti's Syndrome: Injection Vs. Conservative Management – A Comparative Study
Get PDFObjective: Bertolotti's syndrome, characterized by the presence of lumbosacral transitional vertebrae (LSTV), is a common cause of low back pain. This study compares the effectiveness of injection therapy versus conservative management in relieving pain and reducing recurrence in patients with Bertolotti's syndrome.
Materials and Methods: A retrospective study was conducted at the Department of Neurosurgery, Lady Reading Hospital-MTI, Peshawar from January 2021 to December 2023. Fifty patients diagnosed with Bertolotti's syndrome were divided into two groups: 25 received injection therapy, and 25 underwent conservative management. Data on pain relief, recurrence rates, patient satisfaction, and complications were analyzed. With significance set at p < 0.05, the two groups were compared statistically using chi-square and t-tests.
Results: Injection therapy resulted in significantly greater pain relief (84%) compared to conservative management (60%) (p = 0.03). Regarding recurrence rates, they were lower in the injection group (24%) compared to the conservative group (40%) (p = 0.04). Patient satisfaction was equivocal between the two groups (p = 0.35). The incidence of minor complications was higher with Injection therapy including localized tenderness and temporary nerve irritation.
Conclusion: Injection therapy is better in short-term pain relief and lower recurrence rates in patients having Bertolotti's syndrome. However, long-term outcomes are similar between injection therapy and conservative management approaches
A Study of Brain Metastases and Tuberculomas Examination Using MRS and DWI
Get PDFObjective: The present comparative study evaluates brain tuberculomas and metastasis using a combined analysis of MRS and DWI in the Pakistan context.
Materials & Methods: The present comparative study was conducted at the Department of Neurology, Aziz Fatimah Medical and Dental College Faisalabad, Pakistan. This comparative prospective analysis also included 118 newly diagnosed, untreated individuals who were suspected or confirmed to have nervous system tuberculosis (NST) using sophisticated MRI methods such as DWI and MRS. Linear regression was utilized to compare tuberculomas based on the apparent diffusion coefficient value of high-grade gliomas and metastatic lesions.
Results: Tuberculomas displayed predominantly isointense (61%) and hypointense (58.3%) signals on T1W and T2W images, respectively. Metastases showed a higher occurrence of T2 hyperintensity (61.6%) and T1 hyp0intensity (46.2%). Neurocysticercosis consistently appeared hypointense and hyperintense across all imaging modalities. High-grade gliomas were primarily hypointense on T1W (60%) & hyperintense on T2W (100%) images. Abscesses were uniformly hyperintense on T2W images. Mean ADC values were highest in neurocysticercosis (1.64 × 10?³ mm²/s) and lowest in abscesses (0.396 × 10?³ mm²/s). MRS revealed distinctive metabolite ratios, with high NAA/Cr & NAA/Ch0 in neurocysticercosis and elevated Ch0/Cr in high-grade gliomas.
Conclusion: There is no discernible benefit to using DWI to distinguish tuberculomas from gliomas and metastases. It is possible to distinguish tuberculomas from gliomas and metastases using their distinct metabolite pattern on MRS
Etiological Spectrum of patients with Hypokalemic Paralysis
Get PDFObjective: To determine the etiological spectrum of patients with Hypokalemic paralysis.
Materials & Methods: A descriptive Cross-Sectional study was conducted in the Department of Neurology, Mayo Hospital Lahore. The duration of the study was 12 months. After history and examination, biochemical tests (serum levels of sodium, potassium, magnesium, bicarbonate, chloride, blood pH, urine pH, and urine calcium), along with serum TSH and free T4 levels were measured. Dengue serology was performed for fever-related cases. The following were considered as the outcome variables: thyrotoxic periodic paralysis (TPP), hypokalemic periodic paralysis (HPP), renal tubular acidosis (RTA), dengue fever, Gitelman syndrome, and gastroenteritis.
Results: A total of 125 patients participated in the study. The mean age was 42.62 years. There were 65 males and 60 females. The mean potassium level was 2.61 ± 0.40 mmol/L (range: 2-3.40 mmol/L). Etiological factors included HPP (55.2%), TPP (25.6%), RTA (32.8%), and Gitelman syndrome (24.8%).
Conclusion: Over half of the patients (55.2%) were diagnosed with HPP, with other causes being TPP (25.6%), RTA (32.8%), and Gitelman syndrome (24.8%). It is crucial to quickly identify these conditions in patients with hypokalemic paralysis to improve treatment prognosis
Endoscopic Excision of 3rd Ventricular Colloid Cyst
Get PDFObjective: To evaluate the surgical outcomes of endoscopic resection of colloid cysts, focusing on assessing the extent of resection achieved and determining the rate of complications associated with the procedure.
Materials & Methods: This prospective cohort study was conducted on symptomatic patients who underwent endoscopic removal of colloid cysts Neurosurgery department of Nishtar Medical University, Multan for 2 years. Demographic data, radiological data, clinical data, co-morbidities, length of hospital stay, duration of surgery, and complications that occurred in post-operative time were recorded. Preoperative radiological evaluations through CT scan and MRI were made for the determination of cyst size, location, presence of hydrocephalus, and enhancement.
Results: The mean size of cysts of the patients was 17.54±1.17 mm. The mean operative time and length of stay in the hospital of the patients was 115.26±12.63 minutes and 5.38±1.72 days, respectively. It was seen that content suction was easy in 76.5% of patients and difficult in 23.5% of patients. EVD insertion was observed in 14.7% of patients. According to extent resection, there was complete resection in 73.5% of patients and subtotal resection along with coagulation of residual contents in 26.5% of patients. Wound infection was found in only one patient 2.9% and 2.9% of the patient died.
Conclusion: Endoscopic resection of colloid cysts is an effective and reliable method, achieving complete removal in most cases while carrying a low risk of recurrence and exhibiting low morbidity and mortality rates
Incidental Findings of Dextrocardia in Patient with Cerebellar Arteriovenous
Get PDFCerebral arteriovenous malformations (AVMs) have a congenital origin, and the diagnosis rate during infancy and youth is only 18-20%. The clinical presentation of intracranial haemorrhage is observed in 75-80% of paediatric patients. The introduction of novel agents for endovascular management has led to enhanced surgical outcomes by preoperative AVM embolization. Dextrocardia with situs inversus is also a rare congenital abnormality in children. A significant proportion of individuals diagnosed with dextrocardia remain oblivious to their condition due to the prevalence of asymptomatic cases. We are documenting a case involving a 12-year-old girl who was presented with an altered state of consciousness and vomiting. Her Neuroimaging showed posterior fossa bleed and diagnosed with cerebellar arteriovenous malformation (AVM). Endovascular embolization of AVM was done and an incidental finding of dextrocardia with situs inversus was noted during the procedure. This case report aims to find if there is any association between Brain AVMs and Dextrocardia in the paediatric population.
Keywords: Dextrocardia, Arteriovenous Malformatio
Comprehensive Analysis of Spinal Dysraphism: Early Institutional Experience at Pediatric Neurosurgery of Punjab Institute of Neurosciences
Get PDFObjective: To examine the demographic and clinical characteristics of pediatric patients presenting with spinal dysraphism.
Material and Methods: This retrospective study was conducted at the Department of Pediatric Neurosurgery, Punjab Institute of Neurosciences in Lahore and included data from patients aged <16 years with spinal dysraphism over 7 months from March 2023 to September 2023. Data analysis was performed using SPSS version 27.0.
Results: Among 32 patients, age distribution: <1 year (37.5%, mean age: 5.58±2.31 months), 1-4 years (25%, mean age: 3.25±0.6 years), 5-15 years (37.5%, mean age: 11±2.6 years). Gender: 22 males (68.75%), 10 females (31.25%). The most prevalent clinical presentations were Myelomeningocele (18.75%) and Meningocele (15.63%), both predominantly observed in patients under 1 year of age. Among the cutaneous findings, Fluid sacs (34.38%) and Tuft of Hair (15.63%) were the most common. In terms of other clinical findings, Lower Limb Weakness (50.00%) and Lower Limb Muscle Atrophy (21.88%) had the highest percentages.
Conclusion: The study revealed a diverse age distribution, with Myelomeningocele and Meningocele being common clinical presentations, especially in infants. Some of the physical signs of the condition included a fluid sac. a tuft of hair on the back, and weak and underdeveloped leg muscles
Clinical Outcomes of Full Endoscopic Lumber Spine Surgery in the Management of Recurrent Disc Herniation
Get PDFIntroduction: Full-endoscopic lumbar discectomy (FELD) has been suggested as a potentially advantageous substitute for the surgical therapy of re-herniated lumber discs. This prospective study aimed to determine the clinical outcomes of full endoscopic lumber spine surgery in re-current disc herniation.
Material and Methods: This prospective observational study was conducted over 2 years, from May 2020 to May 2022 with a year follow-up period. The study included patients who presented to the outpatient department with lumbar disc re-herniation that was confirmed to be symptomatic by conducting clinical evaluation, magnetic resonance imaging (MRI), and/or computed tomography (CT) scans. Depending on the location and size of the disc herniation, either an interlaminar or transforaminal route was used during full endoscopic lumbar spine surgery.
Results: 442 lumbar disc surgeries were carried out in total over the 2-year research period. Of these procedures, 87 cases were reherniation surgeries, which made up about 19.6% of all lumbar disc surgeries. The majority of patients (80% in transforaminal and 75% in interlaminar) had incisions less than 8mm in length. Less than 5% of cases in both method groups experienced complications during the procedures, most of which were mild dural tears and bleeding.
Conclusion: This study concluded that recurring lumbar disc herniations can be safely treated with full endoscopic lumber spine surgery with good intra and post-operative outcomes while minimizing further structural damage compared to open interventions
Ultrasound Guided Midline Catheter Insertion and Its Associated Complications in ICU Of Lahore General Hospital
Get PDFObjectives: A midline catheter is a vascular access device that is frequently used among patients requiring long-term medications. Along with its benefits, it holds some complications during insertion and use. So, with this study, we aimed to determine the associated complications during the insertion and use of midline catheters among patients admitted to the ICU of Lahore General Hospital.
Materials & Methods: A cross-sectional study was conducted in the ICU of Lahore General Hospital including 70 patients fulfilling the inclusion criteria and who required a midline catheter for further treatment. We recorded and analyzed the data of those patients, to whom we attempted to insert ultrasound-guided midline catheter. In this study, we observed the success rate of catheter insertion along with associated complications like hematoma, arterial puncture, occlusion of the catheter, dislodgement, edema, and thrombosis.
Results: Mean age of patients was 42.74 ± 10.48 years. The most common diagnosis at the time of catheter insertion was sepsis (52.9%). Median attempts for catheter insertion were 1 with (IQR 1 to 1, minimum 1; maximum 4). The success rate of the ultrasound-guided midline catheter insertion was 95.7%. Occlusion of catheters was frequently observed among 10.4% of patients. The arterial puncture was noted among four patients at the time of insertion. Thrombosis was observed in only one patient.
Conclusion: Ultrasound-guided midline catheter is beneficial and safe for ICU-admitted patients who need long-term treatment and use of Vasopressors
A Study on Ocular Manifestations Seen in Patients with Cerebral Palsy
Get PDFBackground: Cerebral palsy (CP) encompasses various neurological disorders like abnormal brain development or permanent brain damage, impacting muscle tone, and motor function. This study assessed ocular manifestations in patients with CP, including visual acuity, refractive errors, ocular alignment, and anterior and posterior eye segments.
Materials & Methods: This retrospective study was conducted at the Department of Ophthalmology Khyber Teaching Hospital (KTH) from 1st November 2022 to 30th September 2023. Data collected included detailed medical, ocular, and birth histories, age and gender of the patient, type of CP, visual acuity (VA) if possible, type of refractive error, ocular alignment and motility and anterior and posterior segments examination of the eyes. Data analysis was done using SPSS version 23.
Results: The study included 40 patients of which twenty-nine (72.5%) were male. The study found spastic CP to be the most prevalent in 23 (57.5%) patients followed by hypotonic CP 12 (30%) and mixed type 5 (12%). VA was examined in CP patients over 4 years with a mean VA of 0.6 and a range of 0.0 to 0.8 LogMAR. Strabismus was found in 33(82.5%) patients with esotropia being the most common in 21 (52.5%) patients, exotropia in 6 (15.0%) patients, and vertical deviation in 6 (15.0%) patients. Ocular motility defect of abduction deficit was found in 2 (5%) patients. Other findings included ptosis in 1(2.5%), nystagmus in 2(5%).
Conclusion: Most children with cerebral palsy exhibit ocular abnormalities, necessitating regular ophthalmic examinations to prevent life-long visual disabilities/complications and to support their overall development