Pakistan Journal Of Neurological Surgery

Head Injury Due to Fall from Heights in Pediatric Population of a Middle Resource Country

Fri, 01 Dec 2023 00:00:00 +0000

Objective: One of the serious concerns for public health is unintentional injuries. Falls rank as the second most common cause of unintentional injury deaths globally, after injuries sustained in transportation accidents. The study's goals were to check the mechanisms and severity of the head injury from falls among children.

Materials and Methods: A non-randomized retrospective study was conducted and children aged 0 – 12 years (n = 228) undergoing cranial CT guidance for head injury were enrolled. All patients were treated under the supervision of the neurosurgery department. Detailed radiological evaluation was done and recorded on specialized proforma.

Results: Among the enrolled patients, mild head injury was noted in 49.1% of children while moderate head injury was noted among 40.4% of children. A total of 72 (31.6%) patients had skull fractures, of which 12 (5.3%) had a thin underlying subdural hemorrhage. Four cases of extradural hemorrhage complicated a skull fracture, and eight cases of isolated Subdural hemorrhage (SDH) were observed without a skull fracture. Of those 48 (21%), radiologically evident diffuse axonal injuries were present, and each of them included high-force injury mechanisms.

Conclusion: When children sustain minor trauma, skull fractures, and focal SDH are rather common, although most of the time there are no long-term neurological effects. On the other hand, patients with an equally severe cause of injury were the only ones who experienced diffuse brain injury with significant neurological disability that followed.

The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Fri, 01 Dec 2023 00:00:00 +0000

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction.

Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25.

Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%).

Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.

Evaluation of the Outcome of Transpedicular Fixation for Thoracic and Lumbar Tuberculous Spine Disease

Saad Sultan, Ibrahim, Amer Zaman, Junaid Alam, Fizza Gul — Fri, 01 Dec 2023 00:00:00 +0000

Objective: Pakistan stands sixth in countries, contributing 60% of new TB cases worldwide. TB can involve a wide variety of organs including the spine which at times need neurosurgical intervention. This study aims to determine the overall clinical and radiological outcomes in patients with dorsolumbar spine TB managed by posterior transpedicular screw fixation. The study focused to evaluate the outcome of transpedicular screws fixation for the thoracic and lumbar tuberculous spine.

Materials and Methods: The study included a total of 60 patients were observed. A complete history and systemic physical examination was done. Pre-operative anteroposterior and lateral view radiographs were taken to measure the height of the vertebral body, kyphotic angulation, and sagittal plane index. Short-segment transpedicular fixation was done under general anesthesia by consultant neurosurgeons. All patients were asked for follow-up after one month. Post-operative anteroposterior plus lateral view radiographs were done to measure the height of the vertebral body, kyphotic angulation, and sagittal index.

Results: In our study mean age was 47 years. 58%patients were males and 42% of patients were female. The mean postoperative vertebral height was 18.93 mm ± 1.17 and the mean postoperative Kyphotic angle was 9.68 degree ± 4.03º. The mean postoperative Sagittal index was 5.83 ± 4.55.

Conclusion: The outcome of transpedicular fixation of vertebral height was 18.93 mm ± 1.17, Kyphotic angle was 9.68 degree ± 4.03º) and Sagittal index was (5.83 ± 4.55) for thoracic & lumbar tuberculous spine.

The Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)

Sahibzada Haseeb Ahmed, Nawaz Khattak, Muhammad Kashif Jamal — Fri, 01 Dec 2023 00:00:00 +0000

Objective: Motor neuron disease (MND) can occur in patients with cervical spondylotic myelopathy. The purpose of this study was to determine the prevalence of motor neuron disease in individuals suffering from cervical spondylotic myelopathy (CSM).

Materials & Methods: A prospective study was conducted at the Lady Reading Hospital. The patients
(n = 70) included were between ages 55 to 75 with established clinical and radiological diagnoses of CSM. Motor neuron disease was diagnosed clinically by Awaji criteria. The patients were evaluated with NCS/EMG (Nerve Conduction Studies/Electromyography) and followed for 6 months. The motor neuron disease was confirmed by modified El Escorial criteria.

Results: 40 patients had bilateral upper limb weakness (57%), however, the rest of the 30 patients had unilateral upper extremity weakness (42.8%). Hoffman’s sign was positive in 60% of patients. Lhermitte's sign was also positive in 31% of patients. The majority of patients (55.7%) were found with grade 4 for deltoid followed by 51.4% patients for biceps brachii. MRI showed anterior cord compression at the level of C5 and C6 in 27.14% of patients and C6 C7 in 32.8% of patients. 15.7% of patients were suspected of having both CSM and MND.

Conclusion: CSM and MND can occur in the same patients. The incidence of MND is 5.7% in patients with cervical spondylotic myelopathy, hence in CSM patients, workup must be done for MND as it affects the outcome of surgery in these patients.

Assessment of Neuropsychological Impairment among Individuals with a History of Head Trauma – A Case-Control Analysis

Fri, 01 Dec 2023 00:00:00 +0000

Objective: To determine the frequency of different neuropsychological impairments in traumatic head injury survivors compared to those without a history of head trauma.

Materials and Methods: A case-control study was done in Karachi, Pakistan, during February 2023 and March 2023, with participants aged 18 and above, of both genders, with or without a history of head trauma forming the case and control groups, respectively. Individuals with a history of head trauma or congenital neurological impairment were not included. Screening tools included the ESS, UNS, GAD-7 scale, and PHQ-9.

Results: A total of 303 participants were enrolled, out of these 128 (42.2%) were in the case group and 175 (57.8%) were in the control group. The most common source of head injury was Road Traffic Accidents (53.9%, n = 69). 143 (63.8%) out of 224 males had a positive history of head trauma in their lifetime, making the male gender more susceptible. The majority who had a history of head trauma lie in the age group < 21 years (52.6%, n = 110). No significant association was found between the interpretations of screening scales and history of head trauma.

Conclusion: Traumatic head injuries and their long-term consequences can predispose a person to experience any cognitive impairment in their life. However, in this study, we could not find significant neuropsychiatric deficits in patients with a history of head trauma. Therefore, it is crucial to conduct further large-scale, multi-center, and controlled studies to explore the cognitive and psychological impairment associated with head trauma.

Association of Hydrocephalus in Children with an Encephalocele

Fri, 01 Dec 2023 00:00:00 +0000

Objectives: To describe the association between the occipital encephaloceles with hydrocephalus and how to improve the outcome of patient.

Methodology: Our Prospective study collected records of fifty patients diagnosed with posterior encephaloceles. Data were collected on the gender, location of the encephalocele, presence of neural tissue , dandy walker, microcephaly and hydrocephalus.

Results: Twenty-nine females and twenty-one males were present. Over half of the lesions were supratorcular, while the remaining eight (16%) were torcular and the remaining seventeen (34%) were infratorcular. Primary encephalocele repair were done at an average of 9 days (range 2.5–120 days). In twenty-five of the instances, a diagnosis of hydrocephalus was made. Twenty-four patients had a ventriculo-peritoneal shunt implanted. The average age of implantation of VP shunt was only 1.2 months (range 0.3–9 months). One patient underwent an endoscopic third ventriculostomy with good results. Hydrocephalus was related with Dandy-Walker and ventriculomegaly before encephalocele surgery was performed (p values 0.01 and 0.05, respectively). For hydrocephalus therapy,

Conclusions: Patients born with encephaloceles frequently suffer from hydrocephalus (50%). This is especially true in cases where the patient also has Dandy-Walker syndrome, CMIII malformation, or pre-existing ventriculomegaly. The severity of large encephaloceles is a limiting factor for the development of hydrocephalus when connected with torcular types and microcephaly.

incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital

sahibzada haseeb ahmed, abbas khan — Fri, 01 Dec 2023 00:00:00 +0000

Objective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment.

Materials & Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &dislocations), ligamentous injuries & SCIWORA. The primary outcome was the functional status at 6 months following treatment.

Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery.

Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.