25 research outputs found
A Rare Presentation of Extradural Ewing Sarcoma in the Lumbar Spine: A Case Report
No full textIntroduction: Ewing sarcoma (ES) is the most prevalent malignant bone tumor in children and adolescents, mainly impacting the axial skeleton and long bones. Extradural manifestations of Ewing sarcoma, particularly in the lumbar spine, are rare and may pose diagnostic challenges. This manuscript describes an unusual case of an epidural lumbar region, Ewing sarcoma, presented with acute neurological symptoms.
Case Presentation: A 14-year-old male patient presented with a history of a fall resulting in paraparesis and urinary incontinence for the last 1 week. MRI revealed an extradural lesion compressing thecal sac at the L4-L5 level. An extradural hematoma or an ependymoma were the initial differentials, and intravenous steroids were commenced, resulting in partial relief of symptoms. Later on, a core needle biopsy and immunohistochemical staining were performed, confirming Ewing sarcoma with positive CD99 and vimentin. Surgical excision of the tumor was performed, achieving clear margins, and there was significant improvement in patient symptoms.
Discussion: Lumbar epidural Ewing sarcoma in the lumbar spine is unusual and can result in acute neurological symptoms, creating a diagnostic dilemma. This case report testifies to the significance of maintaining high suspicion and emergency action for extradural spinal tumors. A complete surgical excision confirmed the diagnosis and improved the patient's neurology.
Conclusion: Recognising a spinal tumor and swift treatment is vital to patient improvement, especially in acute cases. A delay can result in permanent neurological harm to the patient
Clinical Outcome and Complication of Endoscopic Endonasal Transsphenoidal Surgery (ETSS) for Pituitary Adenoma: A Retrospective Study at Prime Teaching Hospital Peshawar
No full textObjectives: The study aimed to ascertain the clinical outcome and complications of endoscopic endonasal transsphenoidal surgery (ETSS) for pituitary adenomas.
Material & Methods: A retrospective study conducted at the Department of Neurosurgery Prime Teaching Hospital Peshawar, Pakistan. Pituitary adenoma was diagnosed in 89 patients on MRI Brain with contrast and post-surgical biopsy. Post-surgical outcomes and complications were documented.
Results: Out of 89 patients, 54% were male, and 46% female patients. The mean age was 42 ± 5 years. Headache was reported in 92% as a most common presentation, followed by decreased visual acuity in 62 %, amenorrhea in 22%, and acromegaly in 29% of patients. Overall, the symptoms related to surgical improvement were observed in 72% of patients. A good surgical outcome was observed in 80% of patients with microadenomas, as compared to the patients with macroadenomas. The most common complication was the transient diabetes insipidus followed by Cerebrospinal fluid (CSF) leak and post-operative hematoma.
Conclusion: Endoscopic endonasal transsphenoidal surgery (ETSS) is a safe, less invasive, cosmetically effective technological advancement for pituitary adenomas
Microsurgical Resection of Intracranial Dermoid and Epidermoid Tumors
No full textObjective: To Ascertain the outcome of microsurgical resection of intracranial dermoid and epidermoid tumors.Materials and Methods: This prospective study was carried out in Neurosurgical Department, Lady Reading Hospital (LRH) Peshawar and followed for 3 years after microsurgical resection. All the patients with suspected intracranial Dermoid and epidermoid tumors (IDETs) on imaging study pre-operatively and later confirmedpostoperatively (after histopathology) were enrolled. Patients having recurrent tumor, opting for nonsurgical management and those deem unfit for surgery were not included in the study.Results: 27 patients were included in the study with 12 (44.4%) males and 15 (56.6%) female. Age of the patients rangefrom 11 to 58 years.Mean age was 38.6 years. Epidermoid tumors were 19 (70.3%) in number and dermoid 8 (29.7%) in number. The most common presentation was increased intracranial pressure (ICP) and cranialnerve deficit. The lesion was located in infratentorial location in 15 (56.6%) patients, 12(44.4%) were supratentorialy located. Gross total removal (GTR) was performed in 21 (77.8%) patients, while in six patients (22.2%) subtotal removal (STR) was attempted. 1 (3.7%) patient died while 2 (7.4%) patients had permanent morbidity post operatively, all other patients (89%) improved. Recurrence occurred in 9.5% of GTR patients while in STR patients, 33.3% patients were noted with increase in residual tumor on neuroimaging.Conclusion: Microsurgical resection with GTR is possible for most IDET and gives good results with minimalcomplications
Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease
No full textObjective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage.
Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22.
Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months.
Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc diseas
Early Outcome of Ventriculoperitoneal (VP) Shunt in Terms of Improvement and Complications
No full textObjective: To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications.
Material and Methods: This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study.
Results: A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year.
Conclusion: VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period.
Keywords: Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC)
Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop
No full textObjective: To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop.
Material and Methods: This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief on a Visual Analogue Scale (VAS) after 1 month and then after 6 months.
Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery, power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ? 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40).
Conclusion: Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits
Resolution of Syringomyelia After Posterior Fossa Decompression with and Without Duraplasty in Chiari Malformation-1
No full textBackground: Chiari malformations (CMs) encompass a range of clinicopathological conditions that exhibit diverse etiology, pathophysiology, and clinical characteristics. This study was done to compare the resolution of syringomyelia after posterior fossa decompression with and without duraplasty in Chiari malformation-1 (CM-1).
Methods: This Quasi-experimental study was conducted at the Department of Neurosurgery, Mardan Medical Complex, Mardan, from January to November 2023. A non-probability, consecutive sampling technique was adopted. Thirty-two children of either gender, aged below 16 years, presenting with CM-1, and planned to undergo either posterior fossa decompression with duraplasty (PFDD) or posterior fossa decompression without duraplasty (PFD) were analyzed. Duration of procedure (minutes) estimated intra-operative blood loss (ml) and post-surgical complications were noted. Outcomes in terms of resolution or improvement in syringomyelia along with syrinx diameter were compared after 6 months. Qualitative variables were compared using chi-square or Fisher's exact test, and quantitative variables were assessed using independent sample t-tests with p<0.05 considered significant.
Results: Out of 32 children analyzed, 18(56.3%) were boys while the mean age was 11.4±4.2 years. There were 18(56.3%) patients who underwent PFDD while the remaining 14(47.7%) had PFD performed. Syringomyelia resolution (88.9% vs. 92.9%, p=0.7024) were relatively similar. Duration of surgery (2.4±0.7 hours vs. 3.6±1.4 hours, p=0.0035) and hospitalization (29.5±8.5 hours vs. 40.5±9.4, p=0.0018) were significantly less among children who underwent PFD when compared to PFDD.
Conclusion: Foramen magnum decompression with and without duraplasty in Chiari malformation-1 showed similar clinical outcomes and both were effective in reducing the syrinx size associated with syringomyelia.
Keywords: Etiology, Foramen Magnum, Hospitalization, Spinal Cord, Syringomyelia
Spectrum of Spinal Dysraphism in Pediatric Patients in a Tertiary Care Hospital
No full textObjectives: To report the spectrum of spinal dysraphism presenting in pediatric patients admitted to the Department of Neurosurgery Lady reading hospital Peshawar.
Material & Methods: A descriptive case series was conducted and total of 89 patients (age between 2 months to 12 years) were included who underwent the surgical treatment. All patients were examined for clinical and radiological diagnosis of spinal dysraphism.
Results: The average age at treatment was 23 ± 39.77 months. The most recurring (52.8%) presenting symptom was the swelling on the back followed by lower limb weakness. Meningocele was reported in 11.2%, myelomeningocele in 47.2%, myelomeningocele & hydrocephalus in 12.4%, tethered cord syndrome in 25.8%, and diastematomyelia 3.4% of patients. Excision combined with the repair was done in 58.4%, release & repair done in 29.2% and endoscopic third ventriculostomy/ventriculoperitoneal shunts with the repair were done in 12.4% patients. Cerebrospinal fluid leak was reported in 3.7%, wound infection in 4.5% and mortality was reported in 3.4% patients.
Conclusion: Overall, a good outcome was reported in the majority of our patients. Surgical procedures like myelomeningocele’s excision & repair, tethered cord’s release & repair, and ETV/VP shunt in patients with hydrocephalus can lead to satisfactory clinical outcomes
Neurological Outcomes and Helmet Use among Motorcyclists Admitted to a Tertiary Neurosurgical Center in Pakistan
No full textObjective: To determine neurological injury patterns, severity, outcomes, and helmet use prevalence among motorcyclists admitted to a tertiary neurosurgical unit.Results: We enrolled 113 patients (mean age 26.9 ± 17.5 years; 85.0% male). Helmet use was 1.8% (n=2). Drivers comprised 62.8% and passengers 37.2%. Predominant diagnoses were traumatic brain injury (26.5%), extradural hematoma (15.9%), brain contusion (15.0%), and subarachnoid hemorrhage (14.2%). On admission, 69.0% had mild, 18.6% moderate, and 12.4% severe head injury. Conservative management was performed in 86.7% (n=98), and 13.3% (n=15) underwent surgery. ICU admission was required for 8.0% (n=9). Median hospital stay was 2 days (IQR 1–2). Overall mortality was 8.0% (n=9), all among non-helmeted riders. The two helmeted patients sustained only mild injuries, required no surgery or ICU care, and were discharged without complications. Conclusion: Helmet use was rare but associated with milder injuries and zero mortality. Strengthened legislation, enforcement, and public education are urgently needed to reduce preventable neurotrauma. Keywords: Helmet use; traumatic brain injury; motorcycle crash; neurosurgical outcomes; Pakistan
Factors Influencing Employees' Intention to Leave Job
No full textThe purpose of this study was to investigate the factors affecting to employees' intention to quit job in private universities in Kabul, Afghanistan. For the purpose of the study, job satisfaction, job stress, person organization fit and organizational commitment were considered as the independent variables while the intention to leave was considered as the dependent variable. The sample was 70 randomly selected employees of private universities in Kabul, Afghanistan. A questionnaire was distributed among them to collect the data. The hypotheses were tested using correlation and regression analysis. The results explained that job satisfaction, person organization fit and organizational commitment of employees at private universities were significantly and negatively correlated with their turnover intention. This study recommended managers to improve job satisfaction, person organization fit and organizational commitment of employees to reduce their turnover intention. On the other hand, job stress in positively correlated with intention to leave job suggesting to reduce job stress in order to reduce employee turnover
