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OBJECTIVES: To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH). METHODS: The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded. RESULTS: Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant. CONCLUSIONS: Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant.
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BACKGROUND: Triple neural tube defects are rare. To the author's knowledge, there are only four reported cases available in the literature up to date. Controversies exist with regards to the development of neural tube defects. We revisit the multisite closure theory and try to explain the mechanism of neural tube defects in our case. CASE PRESENTATION: We report a case of one-month-old baby boy who presented to us with three distinct neural tube defects. He had occipital and cervical encephaloceles along with thoracolumbar myelomeningocele accompanied by syrinx and mild hydrocephalus. All the three defects were surgically corrected with good neurological outcome. CONCLUSION: In the multisite model of human neural tube closure, there are only two fusion sites and two neuropores unlike in mouse. This can explain the origin of open neural tube defects including anencephaly and myelomeningocele (as in our case) but cannot account for the development of encephalocele, which appears to be a post neurulation defect.
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Encefalocele/cirurgia , Meningomielocele/cirurgia , Defeitos do Tubo Neural/cirurgia , Humanos , Lactente , Masculino , PescoçoRESUMO
BACKGROUND: The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. METHODS: This cross-sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma. RESULTS: A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients. CONCLUSIONS: In depressed skull fractures, there are high chances of associated traumatic dural tears which should be vigilantly managed.
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Lesões Encefálicas Traumáticas/etiologia , Dura-Máter/lesões , Fratura do Crânio com Afundamento/complicações , Adolescente , Adulto , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/cirurgia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Fatores de Risco , Ruptura , Fratura do Crânio com Afundamento/diagnóstico , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Backache is a significant source of disability and suffering in our society. The treatment modalities need continued enhancement in order to achieve the desired goals of lowering morbidity and financial losses while improving the response of the patient. METHODS: This prospective comparative study was conducted at the department of Orthopaedics and Spine Surgery, Khyber Teaching Hospital Peshawar from July 2013 to June 2015. Two interventional groups were designated; Group 1 was comprised of 54 patients who were injected with epidural bupivacaine plus methylprednisolone while Group 2 included 55 patients who were injected with bupivacaine only. Outcome was assessed using the visual analogue scale and Oswestry disability index (ODI). RESULTS: Fifty-five female and 54 male patients with mean age 49.37 years±10.46 SD, Mean symptoms duration was 15.01 months±9.32 SD. Common presenting symptoms were backache (77.1%), lower limbs pain (66.1%), dermatomal paresthesias (54.1%) and neurogenic claudication in 57.8% patients. The mean visual analogue score (VAS) after injection was 3.18±1.29 while mean ODI after injection was 23.615. There was a statistically significant reduction in VAS scores (2-sided p=0.003, OR =4.03, 95% CI: 1.535-10.60) following the injection. CONCLUSIONS: An epidural spinal injection is a viable option for achieving relief of pain & improves functioning in individuals with radicular backache. However, further research is advised in order to clarify the role of ESI for long-term relief.
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Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Glucocorticoides/uso terapêutico , Dor Lombar/tratamento farmacológico , Metilprednisolona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Injeções Epidurais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escala Visual AnalógicaRESUMO
BACKGROUND: The incidence of early post-traumatic seizures after civilian traumatic brain injury ranges 4-25%. The control of early post-traumatic seizure is mandatory because these acute insults may add secondary damage to the already damaged brain with poor outcome. Prophylactic use of anti-epileptic drugs have been found to be have variable efficacy against early post-traumatic seizures. The objective of this study was to compare the efficacy of Phenytion and Levetiracetam in prevention of early post-traumatic seizures in moderate to severe traumatic brain injury. METHODS: This randomized controlled trial was conducted in department of Neurosurgery, Ayub Medical College, Abbottabad from March, 2012 to March 2013. The patients with moderate to severe head injury were randomly allocated in two groups. Patients in group A were given phenytoin and patients in group B were given Levetiracetam. Patients were followed for one week to detect efficacy of drug in terms of early post traumatic seizures. RESULTS: The 154 patients included in the study were equally divided into two groups. Out of 154 patients 115 (74.7%) were male while 29 (25.3%) were females. Age of patients ranges from 7-48 (24.15±9.56) years. Ninety one (59.1%) patients had moderate head injury while 63 (40.9%) patients had severe head injury. Phenytoin was effective in preventing early post traumatic seizures in 73 (94.8%) patients whereas Levetiracetam effectively controlled seizures in 70 (90.95%) cases (p-value of .348). CONCLUSIONS: There is no statistically significant difference in the efficacy of Phenytoin and Levetiracetam in prophylaxis of early posttraumatic seizures in cases of moderate to severe traumatic brain injury.
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Anticonvulsivantes/uso terapêutico , Lesões Encefálicas/complicações , Epilepsia Pós-Traumática/prevenção & controle , Fenitoína/uso terapêutico , Piracetam/análogos & derivados , Adolescente , Adulto , Criança , Feminino , Humanos , Levetiracetam , Masculino , Pessoa de Meia-Idade , Piracetam/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Traumatic fracture of the spine 'is a serious neurosurgical condition that has serious impact on the patient's quality of life. Thoracolumbar junction is the most common site of spinal injuries. The aims of management of thoracolumbar spinal fractures are to restore vertebral column stability, and to obtain spinal canal decompression. This ultimately leads to early mobilization of the patients. This study was conducted to compare preoperative and post-operative vertebral height, kyphotic angle and sagittal index in patients treated with pedicle screws and rods in thoracolumbar spine fractures. METHODS: This cross-sectional study was conducted in the department of Neurosurgery, Hayatabad Medical Complex, Peshawar from 1st. February 2010 to 31st. July 2011. A total 161 patients with unstable thoracolumber spine fracture were included in this study. In these patients fixation was done through transpedicle screws with rods. Anteroposterior and lateral views X-rays of thoracolumbar spine were done pre and post operatively. RESULTS: Out of 161 patients, 109 (67.7%) were males and 52 (32.3%) females. The age of patients ranged from 20 to 70 years (mean 42.2 years) with 71 (44.1%) in the age range of 31-40 years. Preoperative average vertebral height was 9.4194. mm while postoperative average was 19.642 mm. The mean kyphosis was 23.06 degrees preoperatively. Immediately after surgery the average correction of kyphosis was 9.45 degrees. The pre-operative average sagittal index was 19.38 degrees, which was reduced to an average 5.41 degrees post operatively. CONCLUSIONS: Transpedicular fixation for unstable thoraco-lumbar spinal fractures achieves a stable fracture segment with improvement of vertebral height, kyphotic angle and sagittal index. Hence, preventing the secondary spinal deformities.
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Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. METHODS: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. RESULTS: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4%) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2%) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3%) cases, both CSA and AICA in 3 (5.6%) cases, venous compressions in only 1 (1.8%) patient and thick arachnoid adhesions were seen in 10 (18.9%) patients. Postoperatively, 33 (68%) patients were pain free, in 14 (26.45%) patients pain was significantly improved whereas in 3 (5.6%) patients there was mild improvement in symptoms. Three (5.6%) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2%) patients post-operatively, 4 (7.5%) patients developed wound infection and 1 (1.8%) patient developed aseptic meningitis. Three (5.6%) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. CONCLUSION: MVD is a safe and effective surgical option for treating patients with idiopathic TGN with better surgical outcome and fewer complications.
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Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Carpel tunnel syndrome is a common compression neuropathy of the median nerve causing pain, numbness and functional dysfunction of the hand. Among the available treatments, surgical release of the nerve is the most effective and acceptable treatment option. The aim of this study was to see the outcomes of surgical release of carpel tunnel using open technique. METHODS: This descriptive case series was conducted at the Department of neurosurgery, Ayub Teaching Hospital Abbottabad from April 2013 to March 2014. One hundred consecutive patients with carpel tunnel syndrome were included who underwent open carpel tunnel release surgery. They were followed up at 1, 3 and 6 months. Residual pain, numbness and functional improvement of the hand were the main outcome measures. RESULTS: Out of 100 patients, 19 were males. The age ranged from 32 to 50 years with a mean of 39.29±3.99 years. The duration of symptoms was from 5 to 24 months. In the entire series patient functional outcome and satisfaction was 82% at 1 month, 94% at 3 months and 97% at 6 months. 18% patient had residual pain at 1 month post-operative follow-up, 6% at 3 months and 3% at 6 month follow-up. CONCLUSION: Open carpel tunnel release surgery is an effective procedure for compression neuropathy of the median nerve. It should be offered to all patients with moderate to severe pain and functional disability related to carpel tunnel syndrome.
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Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Dor/etiologia , Adulto , Síndrome do Túnel Carpal/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Medição da Dor , Período Pós-Operatório , Fatores de TempoRESUMO
BACKGROUND: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the postoperative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. METHODS: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups.58 Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. RESULTS: In this study mean age of the patients was 32.8 +/- 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. CONCLUSION: The difference in pain after 1 month of the intervention was not statistically significant.
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Síndrome do Túnel Carpal/terapia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/métodos , Adulto , Feminino , Seguimentos , Humanos , Injeções , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Apparently normal looking patients after traumatic brain injury can have serious neurological deterioration, and one of the common causes of such deterioration is extradural haematomas. This study was conducted to determine the frequency of extradural hematoma and common types of trauma leading to it among patients presenting with skull fracture due to head injury. METHODS: This cross-sectional study was conducted in the department of Neurosurgery Ayub Medical College, Abbottabad from June 2011 to June 2012. All patients who were suspected to have Skull fracture on X-ray skull, during the study period, were included in study after informed consent and later on CT-Scan brain was done to see for extradural hematoma. Findings were recorded on a predesigned pro fonna including demographic data, radiological findings and the type of head trauma. RESULTS: Out of 114 patients 85 (74.5%) were males and 29 (225.4%) were females. Age ranged from 2 to 70 years (18.23 +/- 16.5 years). Among these patients the most important cause of head injury was fall from height in 65 (57%), followed by road traffic accidents in 39 (34.2%), and assault in 10 (8.8%) patients. The most common site of fracture was parietal in 49 (43%) of patients, followed by frontal bone in 28 (24.6%) of patients, occipital bone in 24 (21.1%) of patients, and temporal bone in 23 (20.2%) of patients. Frequency of extradural hematoma among linear skull fracture was in 34 (29.8%) patients. Extradural hematoma was most common with parietotemporal linear skull fractures (73.5%). CONCLUSION: Extradural haematoma occurs commonly with linear skull fractures, so patients with linear skull fracture should be properly evaluated with CT brain.
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Lesões Encefálicas/complicações , Hematoma Epidural Craniano/epidemiologia , Fraturas Cranianas/complicações , Adolescente , Adulto , Idoso , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hematoma Epidural Craniano/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Retrospectivos , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Though the classical type of trigeminal neuralgia is the most common type with the neurovascular conflict causing the symptoms, yet quite some patients have the secondary type of trigeminal neuralgia in which space occupying lesions are responsible for the symptoms. This study was conducted to determine the frequency of cerebellopontine angle tumours in patients presenting with complaints of trigeminal neuralgia. METHODS: This case series descriptive study was conducted in the department of Neurosurgery, Ayub Medical College, Abbottabad, from January 2009 to January 2012. It included patients who presented with symptoms of trigeminal neuralgia. Patients were subjected to further radiological investigation like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to look for secondary causes of trigeminal neuralgia. RESULTS: Among the 134 patients with age ranges 13-64 (51?4.3) years of age, 78(58.2%) were females and 56 (41.7%) were males. Frequency of cerebellopontine angle tumours in patients was 14 (10.4%), among them epidermoid was most common lesion being present in 10 (7.4%) of patients and accounted for 75% of Cerebellopontine Angle tumours in these patients. Meningioma and vestibular schwanoma accounted for 2(1.4%) cases each. In secondary trigeminal neuralgia mean age of onset of symptoms was 39.5±5.2 years as compared to classic trigeminal neuralgia which is 53±2.1 years. CONCLUSION: Trigeminal Neuralgia can be a typical symptom in cerebellopontine angle tumours like epidermoid, especially in young patients, so all the patients with trigeminal neuralgia should be investigated for lesion in cerebellopontine region.
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Neoplasias Meníngeas/epidemiologia , Meningioma/epidemiologia , Neuroma Acústico/epidemiologia , Neuralgia do Trigêmeo/etiologia , Adolescente , Adulto , Idade de Início , Feminino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Meningioma/complicações , Meningioma/diagnóstico , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Adulto JovemRESUMO
Background and objectives: Glioblastoma multiforme (GBM) is the most aggressive, malignant, and therapy-resistant tumor of the brain. Blockade therapy targeting the programmed cell death protein 1 (PD-1)/programmed death ligand (PD-L1) axis is currently under investigation for the clinical management of the GBM. This study has quantified the plasma levels of PD-L1 as a biomarker for the clinical management of GBM. Methods: A cohort (n = 128) of Pakistani adult glioblastoma patients together with age- and sex-matched healthy controls was used for quantification of pre-surgery levels of plasma PD-L1. PD-L1 protein and mRNA were measured by PD-L1 platinum enzyme-linked immunosorbent assay and quantitative real-time PCR, respectively. Receiver operating characteristic (ROC) curve analysis was used to compute area under the curve (AUC) for specificity and sensitivity analyses. The Kaplan-Meier survival analysis was employed to compute overall survival. Results: PD-L1 protein and mRNA were significantly higher in GBM compared to the healthy controls (p < 0.0001). Mean PD-L1 concentration for the GBM was found to be 48.98 ± 2.290 pg/ml compared to 27.63 ± 1.281 pg/ml for controls. Gene expression analysis showed statistically significant upregulation (p < 0.0001) of PD-L1 in blood of GBM compared to healthy controls. Plasma PD-L1 showed an AUC of 0.840 (p < 0.0001; 95% CI = 0.7716 to 0.9090) where a cutoff value higher than 46 pg/ml demonstrated 100% specificity and 57.81% sensitivity. Higher pre-surgery levels of PD-L1 were found to be associated with overall poor survival [p < 0.0001; HR (log-rank) = 0.08; 95% CI = 0.04 to 0.15]. Age, gender, and ethnic background were not found to be associated with plasma PD-L1 levels. Conclusion: The study concludes that blood-based measurements of PD-L1 in GBM can be a promising prognostic marker and therapeutic target besides a rapid and relatively non-invasive screening tool for routine clinical management. Future work extending the analysis to larger cohorts through multi-center collaborations involving pre-treatment and post-treatment groups is required to fully explore the usefulness of circulating PD-L1 for effective clinical applications.
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Neoplasias Encefálicas , Glioblastoma , Adulto , Humanos , Glioblastoma/diagnóstico , Glioblastoma/terapia , Glioblastoma/genética , Antígeno B7-H1/metabolismo , Estudos Retrospectivos , Ligantes , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Neoplasias Encefálicas/genética , Biomarcadores Tumorais/metabolismoRESUMO
BACKGROUND: Traumatic Brain Injury (TBI) is the leading cause of death in all age group. The incidence of CSI increases with the severity of TBI so prompt care of cervical spine is necessary in all patients with moderate to severe head injury. The objective of this study was to determine the frequency of cervical injury in patients with moderate to severe head injury and different types of trauma. METHODS: This descriptive cross sectional study was conducted in department of Neurosurgery Ayub Medical College, Abbottabad from October 2011 to October 2012. A total of 369 patients were included in this study by consecutive (non probability) sampling. All patients were subjected to X-rays and CT-Scan of the skull for evaluation of head injury. X-rays and CT scan with MRI of cervical spine were done for evaluation of cervical spinal injury. RESULTS: A total of 369 patients were included in our study, out of which 276 (74.8%) were males and 93 (25.2%) were females. Age of the patients ranged from 3-90) years with mean of 31.93 +/- 21.35. Among these patients most common cause of injury was fall 196 (53.1%), whereas the RTA was 159 (43.1%) and assault was 14 (3.8%). Out of the 369 patients 42 (11.3%) were found to have cervical spinal injuries. CONCLUSION: The frequency of cervical injury associated with moderate to severe head injury remains the same in all over the world with minor difference in percentages; that we have observed in our study. Furthermore, we have observed that cervical injury is directly proportional to the severity of head injury. All the head injured patients should be suspected of having cervical spinal injury unless proved otherwise.
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Vértebras Cervicais/lesões , Traumatismos Craniocerebrais/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologiaRESUMO
BACKGROUND: Cerebrospinal fluid (CSF) leaks can arise as a complication of trauma, hydrocephalus, endoscopic sinus surgery or it may occur spontaneously without any identifiable cause. Surgical repair is recommended in patients who do not respond to the conservative management. In recent years transnasal endoscopic approach has become the preferred method for repairing the CSF leaks and better outcomes have been reported as compared to the intracranial approaches that were previously used. Objective of this study was to analyse the outcome of transnasal endoscopic repair of CSF rhinorrhoea. METHODS: This prospective study was conducted in the Department of Neurosurgery, Ayub Medical College, Abbottabad, from March 2007 to March 2010. Twenty-one patients with CSF rhinorrhoea were included in study that were diagnosed on the basis of clinical evaluation, glucose concentration of nasal discharge, computed tomography (CT) and magnetic resonance imaging (MRI). These patients did not respond to conservative management and were operated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9 months and the outcome was analysed. RESULTS: The patients included in the study ranged in the age group of 12-55 years. Among the patients 13 (57%) were female and 8 (38%) were males. The cause of CSF rhinorrhoea was traumatic in 16 (76.19%), Idiopathic or spontaneous in 4 (19.04%) and 1 (4.7%) case was related to endoscopic surgery for pituitary macroedenoma. In 10 (47.6.8%) patients the site of leak was cribriform plate, 5 (23.8%) had from sphenoid, 4 (19.04%) from frontal sinus and in 2 (9.5%) Ethmoid was affected. Primary surgery was successful in 17 (80.95%) of cases. In 2 (9.5%) cases re-exploration had to be performed. In 1 patient re-exploration had to be done for the third time. Overall success rate was 95%. One patient presented with CSF leak and meningitis 1 month after surgery and unfortunately died. CONCLUSION: Transnasal endoscopic repair of CSF rhinorrhoea is highly successful, safe and less traumatic.
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Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Adolescente , Adulto , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Intramedullary spinal cord tumours (IMSCT) are among the uncommon lesions at spinal cord. They can present with a vast array of symptoms and cause severe neurological deficits. With advent and frequent use of MRI more and more patients with IMSCT are picked up. By using modern microsurgical techniques better surgical outcome is achieved. The Objective was to analyse the surgical outcome of the patients with intramedullary Spinal Tumour operated at Ayub Teaching Hospital (ATH). Abbottabad. METHODS: Eighteen patients with IMSCT who presented at Neurosurgery Unit. ATH. Abbottabad during 2000-2010 were included in this study. Patients were diagnosed on the basis of MRI. They were operated using standard microsurgical techniques. Patients were followed up for a mean duration of 18 months after surgery and their preoperative and postoperative neurological status was analysed. RESULTS: Patients with age group ranging from 15-50 (37.72 +/- 8.94) years with IMSCT were operated. Sixty-one percent of the patients were male and 39% were female. The region most commonly affected was cervical (44%) followed by conus medullaris (33%), cervicothoracic and thoracic each had frequency of 11%. Gross total removal (> 95%) was possible in 72% of cases while in rest of 28% cases resection of 80-95% was possible. Histologically 38.9% of the lesions were ependymomas, 27.8% were astrocytomas and 22.2% were teratomas. Neurofibromas and Primitive Neuroectodermal Tumours (PNET) each accounted for 5.5% of the cases. Overall postoperative neurology improved in 10 (55%) of patients, remained unchanged in 5 (27%) of cases, and deteriorated in 3 (16%) patients. One patient was lost in follow-up. Surgery on tumours in cervical and thoracic region carried a relatively poor outcome as compared to the lesion of conus. There were no deaths due to surgery. CONCLUSION: Surgical removal of IMSCT is beneficial to patients with acceptable surgical risk. Better outcome is expected if the patients with good Frankel grade are diagnosed and operated early the course of disease.
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Neoplasias da Medula Espinal/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Paquistão/epidemiologia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: The Chiari Malformation I (CMI) is a disorder of uncertain origin that has been traditionally defined as downward herniation of the cerebellar tonsils through the foramen magnum. The anomaly is a leading cause of syringomyelia and occurs inassociation with osseus abnormalities at the craniovertebral junction. In contrast to other Chiari malformations, CMI tends to present in the second or third decade of life and is sometimes referred to as the 'adult-type' Chiari malformation. The objective was to document clinical and radiological findings in Arnold Chiari Malformation-I. METHOD: This was a descriptive study carried out in Ayub Teaching Hospital Abbottabad at Neurosurgery Department during July 2008-July 2010. We examined a prospective cohort of 60 symptomatic patients. All patients underwent magnetic resonance imaging of the head and spine. RESULTS: There were 40 female and 20 male patients. The age of onset was 24.9 +/- 15.8 years. Common associated radiological problems included syringomyelia (60%), scoliosis (25%), and basilarinvagination (12%), increased cervical lordosis 5 (8.5%), and Klippel Feil syndrome 2 (3.3%). The most consistent magnetic resonance imaging findings were obliteration of the retrocerebellar cerebrospinal fluid spaces (70% patients), tonsillar herniation of at least 5 mm (100% patients), and varying degrees of post fossa anomalies. Linical manifestations were headaches, pseudotumor-like episodes, a Meniere's disease-like syndrome, lower cranial nerve signs, and spinal cord disturbances in the absence of syringomyelia. CONCLUSION: These data support accumulating evidence that CMI is a disorder of the para-axial mesoderm that is characterised by underdevelopment of the posterior cranial fossa and overcrowding of the normally developed hindbrain. Tonsillar herniation of less than 5 mm does not exclude the diagnosis. Clinical manifestations of CMI seem to be related to cerebrospinal fluid disturbances (which are responsible for headaches, pseudotumor-like episodes, endolymphatic hydrops, syringomyelia, and hydrocephalus) and direct compression of nervous tissue.
Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Radiografia , Adulto JovemRESUMO
AIM: To observe the outcome of burr hole evacuation of extradural hematoma (EDH) in mass head injury. MATERIAL AND METHODS: This study included patients of any age who sustained head injury in the earthquake of October 8, 2005, were diagnosed as EDH on computed tomography (CT) scan and were admitted in the neurosurgery ward over a period of 3 days. All patients were followed by serial CT scans and neurological assessments. RESULTS: A total of 36 patients were included in this study. There were 25 male and 11 female patients and the age range was from 5 years to 50 years. All cases were the victim of the earthquake. All patients underwent surgery for evacuation of EDH through a single burr hole. One patient required craniotomy for EDH due to neurological deterioration on the second postoperative day, and 1 patient died. CONCLUSION: As EDH is potentially fatal lesion, evacuation of EDH through a single burr hole has good outcome with less chances of recurrence and complications in mass head injured patients as seen with earthquakes.
Assuntos
Desastres , Drenagem/métodos , Terremotos , Hematoma Epidural Craniano/cirurgia , Trepanação/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Incidentes com Feridos em Massa , Pessoa de Meia-Idade , PaquistãoRESUMO
BACKGROUND: Deep seated lesions of the brain cannot be approached by conventional neurosurgical approach stereotactic system offers minimally invasive and accurate approach to such lesions. This study was carried out with an objective to determine the safety, efficacy and diagnostic yield of stereotactic biopsies of brain lesions using Brown-Roberts-Wells (BRW) system. METHODS: This study was carried out in patients with intracranial lesions at Ayub teaching hospital Abbottabad from September 1999 to October 2003. Suitable patients with intra cranial lesions underwent computerized stereo tactic biopsy with BRW system. Tissue specimens were analyzed in histopathology department of the Ayub Medical College and results were obtained. Data was analyzed via computer software SPSS 8.0 version for windows. RESULTS: Fifteen patients were selected for stereotactic brain biopsy. Age ranged from 15 years to 54 years. Among them 09 (60%) were male and 06 (40%) were female patients. Out come of the procedure was highly promising in terms of safety and positive diagnostic yield in 14 patients (93.3%), and histopathalogical validity of results (93.3%). Only one patient suffered mild neurological deficit (6.7%), one patient had inconclusive tissue diagnosis and invalid result (6.7%). biopsy proven lesion was astrocytoma in 04 patients (26.7%), anaplastic astrocytoma in 04 (26.7%), gliomatosis in 02 (13.3%), tuberculomas in 03 (20.0%). metastatic adenocarcinomas in 01 (6.7%) and lymphoma in 01(6.7%). CONCLUSIONS: We conclude that computerized stereotactic brain biopsy is safe and effective procedure with a high diagnostic yield at our center.
Assuntos
Neoplasias Encefálicas/patologia , Técnicas Estereotáxicas , Adolescente , Adulto , Anestesia Local , Biópsia , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , PaquistãoRESUMO
BACKGROUND: Early diagnosis and management of brain tumors is important to reduce morbidity and mortality. The objective of this study was to calculate frequency of different types of brain tumors in patients operated and managed at Ayub Teaching Hospital, Abbottabad. METHODS: This study was carried out at Neurosurgical Department of Ayub Teaching hospital, Abbottabad from September 1999 to October 2003. Records of patients who consented for surgery after CT scan evidence of brain tumors, which were proved on biopsy later on, were included in the study. The tissue biopsy was taken by open craniotomy or by computerized stereotactic method. Pattern of different brain tumors was studied during this period. RESULTS: Our study revealed predominantly tumors arising from neuroepithelium (49.2%) while tumors arising from meninges were relatively low (23.3%). Nerve sheath tumors (4.2%), germ cell tumors, mal-developmental origin (2.5%), blood vessel tumors (5.8%) and miscellaneous tumors (6.6%) were found relatively in a very low frequency. CONCLUSION: Evaluation of brain tumor frequency will help in future management plan that may be in the form of open craniotomy, stereo tactic radiosurgery, whole brain radiotherapy or gamma knife surgery.