Pakistan Journal Of Neurological Surgery

Day Care Spine Surgery Versus Conventional Spine Surgery: A Comparative Analysis

2024-08-22T14:59:29+00:00

Objective: To evaluate the effectiveness, cost-efficiency, and patient benefits of daycare spine surgery as compared to traditional spine surgery.

Materials & Methods: This study was conducted at the neurosurgery department of Bakhtawar Amin Trust and Teaching Hospital Multan from January 2022 to October 2023. This was a prospective study involving 103 patients diagnosed with cervical PIVD, lumbar PIVD, IDEM, and extradural spinal tumors. Participants were equally split into two groups, one undergoing daycare and another with conventional spine surgery. They were analyzed by Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), Neck Disability Index (ODI), time of operation, duration of hospitalization, cost of surgery, and follow-up duration.

Results: Results showed that daycare spine surgery had significantly less hospital stay duration (p-value
< 0.01), low costs (p-value < 0.01), and low post-operative VAS scores (p-value < 0.05) relative to traditional spine surgery. Additionally, improvements in ODI and NDI scores were more in the daycare group (p-value
< 0.01). The duration of surgery and blood loss was also less than the conventional surgery.

Conclusion: Daycare spine surgery has proved to be a better replacement for conventional surgery, having decreased resource use, enhanced cost-effectiveness, and better patient outcomes.

Comparison of the Efficacy of Oral and Local Steroids in the Management of Carpal Tunnel Syndrome

2024-10-01T11:15:34+00:00

Objective: This research was conducted to compare the efficacy of oral steroids with local steroid injection in the carpal tunnel as regards relieving the symptoms and improvement in neurophysiological parameters.

Materials and Methods: This study was performed at the Neurology Department, Punjab Institute of Neurosciences, Lahore. 72 patients were part of the study and divided into 2 groups; Group A (oral steroids) and B (steroid injection). Patients in Group A received a local injection of 1.5cc Normal Saline and oral prednisolone (20 mg once daily for two weeks, followed by 10 mg once daily for the next two weeks), whereas those in Group B received a local injection of 15 mg triamcinolone and an oral placebo for four weeks. The outcome was assessed using the Global Symptom Score.

Results: The average age of the patients involved in the study was 47 years. There were 33(46%) males and 39(54%) females. The mean Global Symptom Score for group A was 28.9 at baseline (0 week) and 23.5 at 4 weeks. In group B, it was found to be 27.1 at 0 week and 16.05 at 4 weeks. Independent T-test for comparing groups A and B showed a non-significant p-value at 0 week and significant at 4 weeks (p-value of 0.04).

Conclusion: The study concluded that local injection of steroids (triamcinolone) is more efficacious in improving carpal tunnel syndrome symptoms as compared to patients receiving oral steroids.

Long-Term Outcomes of Aneurysm Management in Elderly Patients with Subarachnoid Hemorrhage

2024-10-02T07:05:15+00:00

Objective: To analyze the long-term outcomes of patients with poor-grade aneurysm management of elderly patients with subarachnoid hemorrhage (aSAH).

Materials & Methods: A prospective study was conducted at Shahida Islam Medical College and Hospital, Lodhran, Pakistan from March 2023 to February 2024. The study enrolled patients aged 65-85 years who were admitted to the hospital with a diagnosis of poor-grade aneurysmal subarachnoid hemorrhage. Evaluations involved clinical examinations, imaging studies, and standardized outcome measures such as the modified Rankin Scale (mRS) to assess neurological and functional outcomes.

Results: At the 3-month follow-up, 23.8% of patients had an mRS score of ? 3, while 76.2% had an mRS score of > 3. Among those with an mRS score of ? 3, 44.8% were aged 65-75 years, and 55.2% were aged 76-85 years. Similarly, at the 12-month follow-up, 26.2% of patients had an mRS score of ? 3, and 73.8% had an mRS score of > 3. Among patients with mRS score of ? 3, 37.5% were aged 65-75 years. Among those with an mRS score of > 3, 43.3% were in the 65-75-year age group and 56.7% were in the 76-85-year age group.

Conclusion: Long-term outcomes gradually improved even among elderly patients with severe subarachnoid hemorrhage (SAH) if they were provided with aneurysm repair as surgical management. Patients with older age having SAH should not be ignored for surgical management based on their age.

Clinical Outcomes of Full Endoscopic Lumber Spine Surgery in the Management of Recurrent Disc Herniation

2024-06-05T08:31:46+00:00

Introduction: 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.

Tuberculous Meningitis: A Retrospective Study on Complications and Imaging Findings and Their Outcomes

2024-08-15T17:18:21+00:00

Objective: This study aims to emphasize the need for radiologists to remain vigilant about the common imaging findings and complications of CNS-TB (central nervous system tuberculosis), particularly TBM (tuberculous meningitis), to improve diagnosis and patient management.

Materials and methods: The authors conducted a retrospective analysis of radiological findings from 96 TBM patients at a tertiary care hospital, focusing on the frequency of TBM complications identified through MRI and CT, and their correlation with age, gender, and outcomes.

Results: A total of 96 patients having TBM (median age 21.6 years, range 8 months–70 years) were identified. There were 36 (37.5%) males and 60 (62.5%) females. Complications occurred in a significant portion of the cohort: tuberculoma (n = 55, 57.3%), hydrocephalus (n = 45, 46.9%), infarcts (n = 27, 28.1%), and cerebritis
(n = 4, 4.2%). 11 patients of the study population died. Deaths were primarily related to tuberculomas (45.45%), hydrocephalus (27.27%), and infarcts (45.45%). Adult females showed a higher prevalence of fatal complications, indicating significant gender differences.

Conclusion: In TBM, the most common complications are tuberculomas and hydrocephalus, followed by infarcts and cerebritis. Notably, adult females show a higher prevalence of fatal complications. These results emphasize the need for early detection and targeted management strategies to improve patient outcomes

Neuroscience in Acute Stroke Treatment: Current Strategies and Emerging Therapies in Pakistan

2024-08-22T16:04:37+00:00

Objective: To discuss the current strategies and emerging therapies in treating acute stroke in Pakistan. Explores how personal beliefs influence health behavior and decision-making.

Materials & Methods: The present qualitative study of neuroscience in acute stroke treatment was carried out at the Department of Neurology at Aziz Fatimah Medical and Dental College, Faisalabad. The theoretical concepts of the Health Belief Model (HBM) apply to explore how personal beliefs influence health behavior and decision-making in acute stroke treatment, strategies, and emerging therapies. All acute stroke patients of the Department of Neurology from June 2023 to June 2024 were interviewed for thematic analysis. Interviews were transcribed on MS Word, and then they were coded using software called QDA Miner Lite.

Results: The study found intravenous thrombolysis, mechanical thrombectomy, stroke units, and tele-stroke services, which could gradually be made a part of the healthcare infrastructure. Improvement in stroke management is expected with emerging therapies like neuroprotective agents and stem cell therapy also helpful for acute stroke treatment. The study found major problems in awareness and accessibility of acute stroke treatment, current strategies, and emerging therapies.

Conclusion: The study revealed that stroke care optimization in Pakistan reduces the burden of disabilities and mortality related to stroke. Although most significant urban centers offer advanced care for stroke patients, accessibility to their services is still not present for those residing in remote and rural areas.

Outcome of Spinal Dysraphism Surgery without Electrophysiological Monitoring in a Resource-Constrained Country; 5-Year Experience: A Way Forward for Pediatric Neurosurgery

2024-10-01T13:30:28+00:00

Objective: This study aimed to see the outcome of spinal dysraphism surgery without electrophysiological monitoring.

Materials & Methods: A prospective study was conducted in the department of neurosurgery, Jinnah Hospital Lahore. A total of 125 patients were included in the study. Data was collected on a proforma regarding symptoms, location, variety, surgical technique, and rehabilitation, and analyzed for the outcome.

Results: Out of 125 patients, 30 patients presented with swelling, 65 with cutaneous stigmata and 30 had neurological deficits. The spinal dysraphism was located in the lumbosacral region in the majority (63%) of cases and no patient was found to have it in the cervical region. 76% of patients had static outcomes despite a lack of electrophysiological monitoring, 17% of patients showed improvement in neurological deficits and 7% deteriorated.

Conclusion: The outcome of surgery for spinal dysraphism even without intraoperative electrophysiological monitoring can be satisfactory if done carefully by an expert team.

Pattern of Traumatic Brain Injuries and Their Frequencies in Motorcyclists

2024-08-22T04:57:09+00:00

Objective: To identify different patterns of Traumatic Brain Injury (TBI) and their frequencies among motorcyclists presenting to our Neurotrauma unit.

Material and Methods: This cross-sectional study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. A total of 156 patients were enrolled. An elaborate history was taken from all patients after initial stabilization. Baseline investigations and radiological work-ups, including CT scans of the brain, were performed to identify the pattern of injuries. Patients were followed up until discharge to monitor improvement in TBI.

Results: Out of 156 patients, 90.4% (n=141) were males with an average age of 33.3±9.39 years and 9.6% (n=15) were females with an average age of 34.0±10.4 years. The severity of TBI was categorized as mild in 53.2%, moderate in 32.1%, and severe in 14.7% of cases. The most common patterns of TBI observed were contusions (42.3%), extradural hematomas (23.1%), cranial fractures (10.3%), intracerebral bleeds (7.7%), subdural hematomas (7.1%), traumatic subarachnoid hemorrhages (6.4%), and other TBI patterns (3.2%).

Conclusion: The study concluded that different patterns of TBI exist among motorcyclists. It is recommended that preventative measures such as helmet use be enforced to reduce the occurrence of such injuries

Etiological Spectrum of patients with Hypokalemic Paralysis

2024-07-15T17:32:27+00:00

Objective: 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.

Effectiveness of Endoscopic Third Ventriculostomy Versus Ventriculo-Peritoneal Shunt in Obstructive Hydrocephalus

2024-08-22T15:35:52+00:00

Objective: To analyze the effectiveness of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal (VP) shunt for the surgical management of obstructive hydrocephalus.

Material and Methods: The comparative cross-sectional study was conducted in the Neurosurgery department of Lady Reading Hospital, MTI Peshawar. The duration of the study was 4 years, i.e.; August 2019 to July 2023. All the patients diagnosed as obstructive hydrocephalus because of posterior fossa tumor, aqueductal stenosis, already shunted, and tectal and non-tectal tumors were in the inclusion criteria, while patients with post-infectious hydrocephalus, congenital hydrocephalus including intra-ventricular hemorrhage and with acute hydrocephalus presenting to the emergency department were in the exclusion criteria. Analysis of the data was done by using statistical software SPSS.

Results: There were a total of 302 patients in the study, which were divided into 2 groups; 155 patients had undergone ETY, while 147 patients had VP shunt. Successful results in the case of ETV were 71%, while in VP shunt was 66%. The complication rate was 10.32% in ETV, while 14.96% in the VP shunt group.

Conclusion: ETV is the better substitute for VP shunt as it’s effective, with less complication rate, an economical, safe, and successful procedure in the surgical management of patients suffering from obstructive hydrocephalus.

A Study of Brain Metastases and Tuberculomas Examination Using MRS and DWI

2024-10-01T12:36:53+00:00

Objective: 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.

Comparative Analysis of Percutaneous Full Endoscopic Discectomy and Microdiscectomy in the Management of Lumbar Disc Herniation

2024-06-05T08:45:29+00:00

Objective: Percutaneous Full Endoscopic Discectomy and Microdiscectomy are two of the least invasive surgical procedures used in the management of lumber disc herniation. This study aimed to evaluate the clinical outcomes of percutaneous full endoscopic discectomy and microdiscectomy in the management of lumber disc herniation.

Materials and Methods: This retrospective study spanned two years. Patients with the diagnosis of lumbar disc herniation confirmed by clinical symptoms and imaging studies undergoing PFED or MD were included. The primary outcome measures included pain relief, assessed using the Visual Analog Scale (VAS), and functional improvement, and measured using the Oswestry Disability Index (ODI). Secondary outcome measures included the occurrence of surgical complications and length of hospital stay.

Results: This retrospective analysis included 480 participants in the study, with 247 patients undergoing Percutaneous Full Endoscopic Discectomy (PFED) and 233 patients undergoing Microdiscectomy (MD). In the PFED group, patients experienced an average mean reduction in leg pain score of 6.97 ±1.96 on the Visual Analog Scale (VAS) as compared to microdiscectomy (4.95 ± 2.45).

Conclusion: Our study concluded that both percutaneous full endoscopic discectomy and microdiscectomy are safe and efficient surgical techniques in the management of lumber disc herniation. However, PELD showed several possible benefits, such as quicker recovery and earlier LBP reductions, improvement in bowel and bladder symptoms along earlier return to work.

Quality of Life, Psychological Stress, and Cognitive Decline Post-Ruptured Anterior Communicating Artery Aneurysm Endovascular Treatment

2024-08-22T14:45:38+00:00

Objective: The study assessed depression, quality of life, and cognitive function in patients who underwent coiling for anterior communicating artery aneurysm rupture.

Methods: A retrospective sample of patients with ruptured anterior communicating artery aneurysms treated at our facility were enrolled from the timeframe of August 2018 and October 2021. This research includes 60 individuals who had coil treatment in total. They all finished the QoL and cognitive follow-up surveys. The core aim of the questionnaire was to evaluate each participant's cognitive impairments and depressive symptoms. To determine baseline clinical state, retrospective reviews of patient charts were conducted along with demographics, postoperative course, and specifics of endovascular coiling.

Results: There were 22 females and 38 males. The presentation lasted anything from six months to three years, with most of it taking place in a single year. Of those who experienced post-coiling neurological impairments, 27% had none, and 73% had none. While 38% had no symptoms, 21% had mild depression, 20% had moderate depression, and 21% had severe depression symptoms. 62% of patients experienced depressive symptoms and a decline in cognition following therapy for ruptured ACoA aneurysms.

Conclusion: Following therapy for ruptured AComA aneurysms, 62% of patients experienced cognitive deficits and depressive symptoms. The difficulties specific to aneurysms associated with AComA that result from injury to anterior brain areas such as the striatum, ventromedial prefrontal (orbitofrontal) cortex, or frontal cortex may be the source of these symptoms.

Complications following Pediatric Posterior Fossa Tumors Surgery

2024-08-23T11:04:13+00:00

Objective: The goal of this study was to identify complications postoperatively occurring after posterior fossa tumor surgery in the pediatric population.

Methods: A retrospective review of cases of children under 15 years who underwent surgery for Posterior fossa tumors was conducted. Documented complications arising in the postoperative phase, in-hospital mortality rates, their management, and the patient’s general well-being were tracked till discharge. Complications were categorized based on a contracted version of the original Clavien-Dindo system, a system that was specifically designed for ranking the severity of surgical complications.

Results: 64.5% of males and 35.4% of females have a mean age of 9.22 ± 1.7 years. Between the onset of symptoms and the diagnosis, the average duration of time was 42.3 ± 12.8 days. The number of medulloblastoma cases was 19 and 11 cases each of ependymoma and pilocytic astrocytoma. Overall, the mean duration of stay was 8.1 ± 3.9 days. Hydrocephalous and CSF leaks from incision sites were the most frequent postop compilations, accounting for 58.3% of all the complications. Other complications reported were wound site infections in 12.5% of cases, peri-tumor edema in 16.6%, cerebellar mutism in 10.41%, tumor bed bleeds in 6.2%, and hospital-acquired pneumonia in 5.3% of cases.

Conclusion: The development of hydrocephalus and cerebrospinal fluid leaks were the most frequent complications, followed by peri-tumor edema, tumor bed hematoma, cerebellar mutism, oropharyngeal apraxia, also systemic complications including sepsis, postoperative pneumonia, and meningitis.

Non-Neoplastic Etiologies of Adult-Onset Hydrocephalus

2024-10-01T16:37:32+00:00

Objective: To analyze non-neoplastic causes of adult-onset hydrocephalus and review their associations with clinical parameters.

Materials & Methods: This is a retrospective cross-sectional study conducted at the Department of Neurosurgery of a tertiary care hospital, from 1^st January 2024 to 30^th June 2024. We included 89 adult patients with hydrocephalus of any cause except brain tumors. To diagnose each type of hydrocephalus, we have established primary selection criteria based on patient history and imaging results.

Results: In our analysis, meningitis was the leading cause of hydrocephalus (n=28, 31.46%), followed by subarachnoid hemorrhage (n=23, 25.84%), trauma (n=21, 23.59%), and hydrocephalus with normal pressure (n=17, 19.1%). Among the four mentioned etiologies, meningitis was more common in the fourth and fifth decade of life (12/28 patients, p = 0.166), whereas the rest of the etiologies were more prevalent in the sixth to seventh decade, highlighting a significant correlation between age and these conditions. Additionally, significant p-values also suggested a correlation between gender and etiology in this cohort. However, when comparing genders, trauma was observed more frequently among male patients while subarachnoid hemorrhage and meningitis were noted more often among female patients.

Conclusion: In our study, meningitis was the most common cause of hydrocephalus. A better understanding of non-neoplastic causes and their links to demographics will improve risk assessment and management in patients.

Evaluation of Clinical Teaching Quality in Residency Training in a Tertiary Care Hospital Using EFFECT (Evaluation and Feedback for Effective Clinical Teaching) Survey

2024-05-10T10:14:40+00:00

Objective: To evaluate the quality of clinical teaching in residency training in a tertiary care hospital.

Materials and Methods: The research was conducted in Mardan Medical Complex, Mardan. The study lasted two months, and the participants were enrolled using the simple purposive sampling technique. This prospective cross-sectional study used a validated “EFFECT” questionnaire divided into seven domains containing 58 items. The questionnaire was distributed among the postgraduate trainees of different specialties of the FCPS program, excluding other specialty programs (MS/MD/MCPS), through an online Google form. The data was analyzed using Excel 2022 software.

Results: The number of residents who participated was 89. 71 (80%) were male and 18 (20%) females. The mean age was 29 years. Overall, the residents' perception of their supervisors was good. Few items were scored satisfactory by the residents. The results were also analyzed between four subgroups of the participants: male/female, senior (years 3-5)/junior (years 1-2) residents, medical & allied and surgical & allied residents, and senior (above 50 years age) and junior (below 50 years age) teachers. Significant (P value<0.05) differences were identified among the sub-group responses in different domains.

Conclusion: Overall, the residents' perceptions of their clinical teachers are good. However, there is room for improvement in multiple domains, and some parts of the teaching require special considerations.

Keywords: EFFECT (Evaluation and Feedback for Effective Clinical Teaching), FCPS (Fellow of College of Physicians and Surgeons Pakistan), Clinical Teaching.

Evaluating Mean Platelet Volume as an Independent Risk Factor for Stroke

2024-07-20T05:38:27+00:00

Objective: The study aimed to evaluate the effects of mean platelet volume on stroke.

Materials & Methods: A cross-sectional study was conducted at Muhammad Medical College, Mirpurkhas, Pakistan. The sample size of this study was 200 participants including 50 stroke patients and 150 controls. Participants were aged 40-80 years, with a baseline NIHSS score of ? 5. Blood samples (5 ml) were collected and analyzed for mean platelet volume (MPV). Blood pressure was measured manually.

Results: The results show that individuals with raised MPV have a higher incidence of stroke than individuals with normal MPV. The Chi-Square test revealed a significant association between elevated MPV and stroke incidence (p = 0.0001). The demographic data showed that the stroke group had a higher mean age (59.32±8.14 years) compared to the control group (52.19±12.30 years), with a significant p-value of 0.0002. Systolic and diastolic blood pressures were significantly higher in the stroke group (p < 0.05). MPV was significantly elevated in stroke patients (11.94±0.65 fL) compared to controls (7.90±0.83 fL), with a p-value of 0.0001.

Conclusion: There is a significant relationship between raised MPV in patients with stroke compared to the normal population.

Outcome of Chronic Subdural Hematoma Evacuation in Association with Its Etiology

2024-08-22T15:51:05+00:00

Objective: 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.

Endoscopic Excision of 3rd Ventricular Colloid Cyst

2024-10-01T13:07:36+00:00

Objective: 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.

Frequency and Clinical Presentation of Spina Bifida at Liaquat University Hospital

2024-07-18T09:14:26+00:00

Objective: The study was conducted to observe the clinical presentation and variation of Spina Bifida in the study population.

Materials & Methods: This retrospective study analyzed the prevalence and clinical presentation of Spina Bifida among surgical patients, in which 172 cases admitted via OPD were included. Data collected covered demographics and clinical details, including age, gender, cousin marriage, region, type of Spina Bifida (meningocele or meningomyelocele), hydrocephalus association, and defect width were diagnosed by MRI lumber spine and CT scan brain which was done in all patients.

Results: Over three years, a total of 1,756 elective surgeries were performed, with 172 cases identified as Spina Bifida, representing approximately 9.8% of the total surgeries conducted. Sub-classification of Spina Bifida cases delineated 166 (96%) cases as Spina Aperta and 6 (4%). Predominantly featured myelomeningocele (MMCs), comprising approximately 81% of the aperta cases. Further stratification of MMCs based on size revealed varying proportions, with approximately 64 (37%) less than 3*3cm, 76 (44%) between 3*3cm and 5*5cm, and 32 (19%) exceeding 5*5cm, indicating a spectrum of severity within this subset of cases. Anatomical distribution delineated the majority of Spina Bifida cases (approximately 95.9%) located in the lumbar region, with fewer occurrences observed in the dorsal (2.9%) and cervical (1.2%) regions.

Conclusion: These findings underscore the multifaceted nature of Spina Bifida, encompassing diverse clinical presentations, anatomical variations, and associated anomalies, necessitating a comprehensive and multidisciplinary approach to management tailored to the individualized needs of patients.

The Surgical Outcome of Intramedullary Spinal Cord Tumors

2024-07-10T16:48:34+00:00

Objective: This study focused on assessing the surgical outcome of the intramedullary spinal cord tumor.

Materials & Methods: A prospective study was conducted in the Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi. The clinical records and imaging studies of 42 patients with intramedullary spinal cord tumors who underwent surgery, were analyzed and followed up. The data was collected for tumor location, histology, extent of resection, and pre and postoperative neurological status.

Results: Around 64.3% of patients were predominantly males while 35.7% were females. The mean age was found to be 43.3 years. The highest frequency (52.4%) of tumors was located in the thoracic region. Most patients presented with Frankel’s grade C (52.4%). In 54.8% (n:23) patients, subtotal excision or incomplete excision was done, in 12 patients (28.6%), complete resection was done. In histology, most patients had low-grade Ependymoma (40.5% n:17) and 7 patients (16.7%) had high-grade Ependymoma. Postoperatively, 33.3% (n:14) patients had grade D and were able to walk, followed by 28.6% (n:12) with grade B.

Conclusion: Progression-free survival is increased by adjuvant radiation combined with subtotal resection; complete resection is still the key to improved results. Thoracic-located tumors possess an increased risk of surgical morbidity. The preoperative neurological function is an important predictor of increased functional survival, including histology and the extent of resection. Long-term survival outcomes are achieved with an early and aggressive surgical treatment targeted at total tumor excision.