Pakistan Journal Of Neurological Surgery

Clinical Outcomes of Transforaminal Injection in the Management of Lumber Radiculopathy

Muhammad Farooq, Naeem ul Haq, Tabrez Wali Shah, Mumtaz Ali, Ali Shah Jehan — Sat, 01 Mar 2025 00:00:00 +0000

Objective: The objective of this study was to evaluate the clinical outcomes of transforaminal dexamethasone injection in patients with lumber radiculopathy.

Material and Methods: This one-year cross-sectional study was carried out at Afridi Medical Complex from February 2022 to January 2023. The included patients of lumber radiculopathy underwent a single dose of transforaminal dexamethasone injection under the guidance of a fluoroscope. The outcome measures including pain, disability, and mobility were assessed through VAS, RMDQ, and FTFD before, one month, and two months post-intervention.

Results: The study included 487 patients undergoing the intervention, the mean age of participants was 52.3. Following the injection, the mean leg pain score improved from a baseline of 8.2 ± 1.1 to 3.0 ± 0.8 (p < 0.001). One-month post-injection, it further decreased to 2.5 ± 0.7 (p < 0.001) and at two months to 2.0 ± 0.6
(p < 0.001). When measured at baseline the mobility score of FTFD was 18.6 ± 4.5 cm which then improved to 11.2 ± 3.7 cm after one month and then to a further 7.8 ± 2.9 cm at two months (p < 0.001).

Conclusion: For those patients unresponsive to conservative treatment options including medication and physical therapy, transforaminal dexamethasone injection is a safe and effective intervention in terms of improvement in different outcome measures including pain, disability, mobility, and return to work.

Micro-bleedings of Cerebrum and Leukoaraiosis: Magnetic Resonance Imaging-Based Correlation Analysis by Micro-Bleed Anatomical Rating and Fazekas

Sat, 01 Mar 2025 00:00:00 +0000

Objectives: Using Fazekas and Micro-bleed Anatomical Rating Scales (MARS) to assess the inter-relationship of MB(C) and leukoaraiosis based on magnetic resonance imaging (MRI).

Materials and Methods: Cross-sectional observational research was carried out at the radiology department of RYK Hospital Rahim Yar Khan, Pakistan. The study involved 70 participants who had MRI brain scans and were discovered to have micro-bleeds. The Micro-bleed Anatomical Rating scale (MARS) was used to grade micro-bleeds and Fazeka’s scale was implied for grading leukoaraiosis. The relationship between MARS and Fazeka’s scale was ascertained by Spearman's correlation.

Results: The patient's mean age was 65 years and 2 months, with male to female gender ratio of 1.8:1. A significant correlation (p<0.001) was observed between micro-bleeds grading of MARS and Fazekas grades, with a significant correlation coefficient of 1. Cerebral micro-bleeds also correlated with coexisting diseases, notably hypertension (84.28%), diabetes (60.00%), and smoking (55.71%). MRI analysis showed micro-bleeds were most frequently in variable locations (44.6%), followed by lobar regions (27.7%), deeper areas (18.5%), and basal nuclei (9.2%).

Conclusion: Leukoaraiosis (LA) and MB(C) have a strong correlation that suggests micro-blood vessel ischemia and hemorrhage as ultimate outcomes.

Surgical Outcomes of Lumbar Spine Procedures; A Prospective Cohort Study in A Tertiary Care Hospital

Sat, 01 Mar 2025 00:00:00 +0000

Objective: To know about the surgical results of lumbar spine procedures performed at MTI Hayatabad Medical Complex and Naseer Teaching Hospital Peshawar.

Material and Methods: This prospective cohort study was carried out in the Neurosurgery department at Nasser Teaching Hospital and MTI Hayatabad Medical Complex, from 1^st January 2020 to 25^th January 2024. We included 267 patients, consisting of both genders, that is, male and female, with the ages ranging from 17 years to 72 years. The Lumbar spine procedures included in our study were; Laminectomy, Partial laminectomy, Discectomy, Right and Left Fenestration, all the rest of the lumbar spine procedures were excluded. The surgical outcome was assessed using a VAS score for grading pain before the procedure and 6 months after the procedure.

Results: The study revealed that the average age of the patients was 41.87 years, with a standard deviation of 12.827 years. The youngest patient was 17 years old, and the oldest was 72 years. In terms of gender distribution, males accounted for 46.1% (123 out of 267), while females made up 53.9% (144 out of 267). The most commonly affected site was the L4-L5 level, observed in 133 patients (49.8%), followed by the L5-S1 level, which affected 105 patients (39.3%).

Conclusion: The results indicate that such surgeries can significantly improve patient outcomes in terms of pain relief.

Determining the Occurrence, Predictors and Contributing Factors of Ischemic Versus Hemorrhagic Stroke Among Patients with Post Stroke Epilepsy; A Comparative Study

Aneeqa Saad, Sohaib Hassan, Fatima Nazir Siddiqui, Ashraf Mahmood — Sat, 01 Mar 2025 00:00:00 +0000

Objective: To assess the occurrence, and contributing factors of post-stroke epilepsy in stroke patients and to compare the frequency of ischemic versus hemorrhagic stroke in patients presenting at Nishtar Hospital, Multan.

Materials & Methods: The patients with stroke, fulfilling inclusion criteria admitted to the neurology department of Nishtar Hospital, Multan were recruited in the study. A detailed history of the current illness as well as a history especially related to seizures was questioned. CT scan brain of all the patients was done and type of type i.e., ischemic or hemorrhagic was determined. Patients were followed for 3-month intervals for the occurrence of epilepsy.

Results: out of a total of 136 patients with stroke, ischemic stroke was found in 107 (78.7%) patients and hemorrhagic stroke in 29 (21.3%). Most patients were males 80 (58.8%) while 56 (41.2%) were females. The mean age of the patients was 55.55±10.17 years and the mean BMI was 25.26±5.54 kg/m2. The frequency of obesity, hypertension, diabetes, and smoking was 21.3%, 48.5%, 44.9%, and 44.1% respectively. Seizure was observed in 35(25.7%) patients with stroke, commonly in hemorrhagic stroke (12/17, 70.58%).

Conclusion: Old age, hypertension, and smoking significantly increase stroke risk. Epilepsy can complicate stroke with a higher incidence of hemorrhagic stroke.

Frequency of Functional Outcome Among Patients with Spinal Tumor Visiting Tertiary Care Hospital

Abdul Rauf Memon, Aurangzeb Kalhoro — Sat, 01 Mar 2025 00:00:00 +0000

Objective: To determine the frequency of functional outcomes among patients with spinal tumors.

Materials and Methods: This study was conducted at the neurological surgery department, Liaquat University of Medical and Health Sciences, Jamshoro and it was a descriptive study. A total of 145 patients presenting with spinal cord tumors were admitted through the outpatient department (OPD) and subsequently underwent surgical procedures. The diagnosis was primarily based on MRI findings, and the Frankel scale was used to assess neurological progress.

Results: The current study included 145 patients in total, with 65.5% of them being male. The majority (75.2%) were older than 60, whereas the mean age was 65.65±6.43 years. In contrast to the 15.9% of tumors in the cervical spine, 73.8% in the thoracic spine, and 10.3% in the lumbar spine, there were 13.8% intramedullary and 86.2% extramedullary tumors. Eight percent of patients required dorsal stabilization, 9.7% had surgical issues, 11.7% had medical difficulties, 66.2% required perioperative corticosteroid administration, and 11% required neuromonitoring. Upon admission, 11.7% had radiating pain, 34.5% had back discomfort, 82.1% had sensory deficiency, and 71% had bowel/bladder dysfunction. The mean McCormick score was 3.17±0.67 and 2.56±0.92 on admission and discharge, respectively whereas the mean KPS was 49.42±11.78 and 49.42±11.78 receptively. There were 40% of patients with unfavorable and 60% with favorable outcomes.

Conclusion: Early diagnosis with minimal symptoms leads to better outcomes, whereas delayed presentation and significant neurological deficits are associated with poorer prognosis.

Clinical Determinants and Neurological Manifestation Among Adult Patients with Vitamin B Deficiency

Sat, 01 Mar 2025 00:00:00 +0000

Objective: To assess the factors and neurological manifestations in adult patients with vitamin B12 deficiency.

Materials & Methods: A cross-sectional study was carried out at the Department of Neurology, Liaquat University of Medical and Health Sciences (LUMHS) for the period of Six months after the approval of the study from March 7, 2023, to September 6, 2023. The sample size was calculated using the WHO sample calculator, a total of 253 patients were enrolled. The data was obtained from patients fulfilling the inclusion criteria, and complete history and investigations were done on all the included patients.

Results: The study included 253 patients with a mean age of 46.9±11.5 years, of which 68% were male and 32% were female. Various neurological manifestations were observed among patients with vitamin B12 deficiency. The most common symptom was nerve numbness, affecting 65.2% of patients, followed by motor weakness in 24.1%. Non-traumatic compressive myopathy was found in 20.5% of patients. Other symptoms included ataxia (18.2%), impaired position sensation (14.2%), impaired vibration sensation (11.1%), and optic atrophy (3.9%). Signs of dementia were noted in 4.7% of cases. These findings highlight the diverse range of neurological symptoms linked to vitamin B12 deficiency and their varying prevalence.

Conclusion: It is to be concluded that a wide spectrum of neurological symptoms is associated with vitamin B12 deficiency, highlighting its potential impact on neurological health. Nerve numbness stands out as the most prevalent symptom, affecting a significant majority of patients, followed by motor weakness and non-traumatic compressive myelopathy.

Clinical Management and Outcomes of Traumatic Brain Injury: A Comparative Study of High-Resource and Low-Resource Hospital Settings.”

Saba Zaidi, Attiya Sabeen Rahman, Almas Zafar, Haneea Yasir, Saad Akhter — Sat, 01 Mar 2025 00:00:00 +0000

To compare management strategies and outcomes of TBI in high-resource versus low-resource hospital settings.

Methodology:

This multicenter, prospective observational study included all patients with traumatic brain injury. Data was collected using a standardized questionnaire that included demographics, medical history, injury details, GCS scores and GOSE outcomes. A brain CT scan was performed within 24 hours of injury, and follow-up assessments were conducted at two weeks. Statistical analysis was performed using SPSS version 27, with chi-square test and logistic regression used to assess associations between variables and hospitals.

Results:

Among 124 traumatic brain injury patients, 74% were males with mean age of 41.63 +/- 15.39; and 40.3% aged between 31–50 years, equally distributed between low- and high-resource hospitals. Road traffic accidents caused 75% of injuries, with 39.5% classified as severe TBI. Surgical interventions were performed more frequently in high-resource settings (22.6% vs. 4.8%). Majority of low-resource patients (82.3%) had hospital stays ?3 days compared to 48.4% in high-resource hospitals. At two weeks, unfavorable outcomes (GOSE) were more common in low-resource hospitals (41.9% vs. 33.9%). Co-morbidities increased the likelihood of unfavorable outcomes (OR = 10.868, p = 0.066), as did peripheral injuries (OR = 1.332, p = 0.708). Mild (OR = 0.002, p < 0.001) and moderate (OR = 0.024, p < 0.001) TBI significantly reduced the risk of unfavorable outcomes compared to severe TBI.

Conclusion:

In high-resource settings, a larger proportion of patients experienced severe traumatic brain injuries, underwent surgical interventions, had longer hospital stays and showed relatively better recovery outcomes.

Functional Outcome of Chronic Subdural Hemorrhage on Glasgow Comatose Outcome Scale Extended

Sat, 01 Mar 2025 00:00:00 +0000

Objectives: Chronic Subdural hemorrhage is one of the most common neurosurgical disorders, mainly affecting the older population. The main objective is to assess the functional outcome of patients with Chronic Subdural hematoma on GCOSE.

Materials and Methods: This is a prospective cross-sectional study conducted at Liaquat University Hospital Hyderabad with a duration of January to December 2023. Patients presented with CSDH and different management was performed at the time of discharge or death GCOSE scale was recorded on a predesigned questionnaire.

Results: A total of 63 patients were included in the study, the mean age was 58.26, of which 69.8% were males, the most common presentation was One-sided weakness 58.9%, followed by the altered level of consciousness 57.3%. The mean pre and postoperative GCS was 10.98 and 11.87 respectively. Most of the patients had unilateral collection 89% with a few having bilateral CSDH 11%. The outcome GCOSE was such that 50% of the patients were found in grade VIII i.e. upper good recovery, all the patients that underwent through and through drainage had the best outcome with a p-value of 0.001, however, 22% of the patients were found in grade I (dead).

Conclusion: The functional outcome of Chronic subdural hematoma is best delineated with GCOSE as compared to the modified ranking scale and GOS.

Keywords: CSDH, functional outcome, GCS, GCOSE, head trauma, Glasgow outcome scale, Glasgow outcome scale extended, modified ranking scale.

One-Year Shunt-Free Survival after Secondary Endoscopic Third Ventriculostomy (ETV) for Shunt Malfunction: Insights from a Tertiary Care Center in a Resource-Constrained Setting

Sat, 01 Mar 2025 00:00:00 +0000

Objectives: To assess the one-year shunt-free survival rate in patients undergoing secondary ETV for shunt failure.

Materials & Methods: This retrospective study is done to evaluate the one-year shunt-free outcomes of secondary endoscopic third ventriculostomy (ETV) in 32 patients who presented with ventriculoperitoneal (VP) shunt malfunction due to obstructive hydrocephalus in a tertiary care hospital. Post-operative clinical features of raised intracranial pressure and shunt malfunctions were assessed for one year. MRI or CT scan and a history of shunt revision/insertion during the follow-up period were also noted.

Results: We had 32 patients in our study 17 males (53.1%) and 15 females (46.9%) with shunt malfunction treated by secondary ETV. The mean age at the time of ETV was 12 years with standard deviations ranging from 0.7 to 15 years. The one-year shunt revision-free survival rate was 68.8%. No major complications occurred in patients after the endoscopic procedures.

Conclusion: Results show a significant success rate in achieving shunt-free outcomes, especially in younger patients, favoring, secondary ETV as a viable option as compared to shunt revision.

Keywords: Endoscopy, Hydrocephalus, Ventriculoperitoneal Shunt, shunt failure, Ventriculostomy

Surgical Outcomes of Endoscopic Transsphenoidal Pituitary Surgery

Sat, 01 Mar 2025 00:00:00 +0000

Introduction: Pituitary adenoma are common benign tumors of the brain and causes significant symptoms due to hormonal imbalances (mostly functional pituitary adenoma) and their mass effect on surrounding structures (majority of nonfunctional pituitary adenoma). The aim of this study was to find out the surgical outcomes of endoscopic trans-sphenoidal approach in terms of safety, effectiveness, per-op and post-op complications and relieve of symptoms.

Methodology: This study was conducted at Ali Institute of Neurosciences and Irfan General Hospital, Peshawar, from April 2019 to April 2021. Patients diagnosed with pituitary adenomas (confirmed by MRI) and treated with the endoscopic trans-sphenoidal approach were included. Demographic data was collected, and outcomes were assessed post-surgery and at 6-month follow-up. Data were analyzed using SPSS version-26.

Results: The majority of participants were male (65%) with a mean age of 31 years (range 22-28). Most patients presented with headaches (76%) and visual disturbances (60%), while 53% had hormonal imbalances. Post-surgery 100% reported headache relief 87% showed visual improvements measured by Humphrey perimeter and visual acuity tests, and 97% had favorable endocrinological outcomes based on hormonal profile assessments.

Conclusion: When treating pituitary adenoma, the endoscopic trans-sphenoidal approach is a safe and successful surgical technique that is linked to better patient results and satisfaction. Complications from the operation include intercavernous sinus hemorrhage, diabetes insipidus, hypopituitarism and CSF leakage.

Keywords: Adenoma, Endoscopic trans-sphenoidal, Microscopic trans-sphenoidal, Pituitary adenoma

Exploring the Patterns of Childhood Disability in a Tertiary Care Hospital – A Demographic Analysis

Danish Ali Mir, Tawab, Farooq, Asma, Imran, Ammar — Sat, 01 Mar 2025 00:00:00 +0000

Objectives: To identify childhood disability patterns and associated demographic characteristics presenting to a tertiary care center of excellence.

Materials and Methods: This prospective observational cross-sectional study was conducted at the Department of Rehabilitation, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, from Dec 22 to Nov 23. We included 160 patients in our study. Demographic variables studied were age, weight, physical characteristics, reason for referral and primary diagnoses, family and birth history, access and barriers to rehabilitation services, and overall satisfaction with services provided using a 7-point Likert scale.

Results: Among 160 patients, cerebral palsy was the most common diagnosis (30%), followed by myopathies (18.8%), autism spectrum disorders (13.1%), and musculoskeletal disorders (10%). Other conditions included neurodegenerative diseases (6.9%), intellectual disabilities (6.3%), Down syndrome (4.4%), and spinal dysraphism (3.1%). Comorbidities were common, with 30% of patients showing additional health concerns such as respiratory issues, seizure disorders, and gastrointestinal problems, which further complicate their care and management. Lower-income households showed higher disability rates and early diagnosis was more common for autism and cerebral palsy.

Conclusion: Neurological disorders like cerebral palsy, autism spectrum disorders, and musculoskeletal conditions were the most common childhood disability presentations

Institutional Experience of Microsurgical Clipping for Anterior Circulation Aneurysms with Mini Pterional Craniotomy: A Cosmetic and Pivotal Innovation

Sat, 01 Mar 2025 00:00:00 +0000

Objective: To examine the functional outcome, complications, and aesthetic results with the mini pterional craniotomy for microsurgical clipping for anterior circulation aneurysms.

Material & Methods: This study was conducted at Neurosurgery Unit II of Punjab Institute of Neurosciences Lahore by a single neurosurgical team with 10 years of experience in vascular neurosurgery. A total of 107 patients who fulfilled the inclusion criteria were included in the study. Mini pterional craniotomy was performed in all the selected patients. Data was analyzed for age, gender, location of the aneurysm, and Modified World Federation of Neurological Surgery grade (WFNS) (pre-op, post-op at 3 months). Data was also analyzed for post-op complications along with a subjective assessment of wound scars by patients according to a modified cosmesis scale.

Results: Out of the total 107 patients, 64 (59.8%) were female while 43 (40.2%) were male. Aneurysm was located at the anterior communicating artery in 58 (54.2%) patients and at MCA in 39 (36.4%). The pre-op WFNS grade was 1 in 52 (48.5%) patients and grade 2 in 25 (23.3%) patients. The WFNS grade recorded at 3-month post-op follow-up was grade 1 in 66 (61.6%) patients and grade 2 in 11 (10.2%) patients. Seven (6.5%) patients developed hydrocephalus, 5 (4.6%) got meningitis and 4 (3.7%) developed neurological deficits.

Conclusion: Mini pterional craniotomy has proven itself as a safe and effective surgical procedure. It can be applied to a variety of aneurysmal locations and has a low rate of complications and good outcomes

Frequency of CSF Rhinorrhea in Patients with Skull Base Fractures

Kamran Ullah, Muhammad Irfan Javed — Sat, 01 Mar 2025 00:00:00 +0000

Background: To determine the frequency of CSF rhinorrhea in patients presenting with skull base fractures.

Material and Methods: This was a descriptive cross-sectional study at the Department of Neurosurgery, PGMI/Hayatabad Medical Complex Peshawar for six months in which patients were included through nonprobability convenience sampling. Included were patients who had radiologically confirmed skull base fractures at presentation. The data on clinical presentations, demographics, and the existence of CSF rhinorrhoea was collected and analyzed through SPSS.

Results: A total of 87 patients were included in the study. The mean age was 41.56±1.35 years. The majority of the patients were males 50(57.5%) as compared to females 37(42.5%). Grade of Head Injury determined showed that patients in the mild category were 30(34.5%), moderate was 39(44.8%) while those in the severe category were 18(20.7%) Prevalence of CSF Rhinorrhea among patients was 56(64.4%).

Conclusion: The results of our study concluded that CSF rhinorrhoea is a prevalent consequence of skull base fractures. Meningitis and other potentially fatal consequences can be avoided with early detection and prompt treatment. Those persisting for more than seven to ten days have a high risk of developing meningitis and are more likely to need surgical intervention.