CLINICAL FEATURES AND OUTCOME ANALYSIS OF INTRACRANIAL HYDATID CYSTS.

BACKGROUND: Hydatid cyst of the brain is serious zoonotic parasitic infections which have profound health consequences if left untreated. The surgical excisions of the cysts are rewarding for both the patient the neurosurgeon. METHODS: The study was conducted prospectively at Department of Neurosurgery Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Patients with a diagnosis of intracranial hydatid cysts were included, clinical and radiological features recorded, intervention and postoperative outcome were analysed. RESULTS: Eleven patients with a male to female ratio of 1.7:1. Mean age was 12.4 (SD ± 6.5) years with median GCS on arrival of 10 (SD ± 2.5). Clinical features were headache (81.8%), vomiting (90.9%), seizures (36.4%), focal deficits (54.5%) and papilloedema (72.7%). The median GCS on discharge was 13 (SD ± 1.1) while GOS at 1 month follow up was 4 (SD ± 0.7). The bivariate analysis showed inverse correlation (R² = -0.68; p = 0.02) between duration of symptoms and outcome while GCS on admission was positively correlated (r(s) = 0.75; p = 0.007) with the outcome. There was no mortality. CONCLUSION: Despite its rarity the clinical features are non-specific while radiological features help in establishing diagnosis. Earlier diagnosis and prompt intervention is the key to favourable outcome.

Treatment of traumatic unstable thoracolumbar junction fractures with transpedicular screw fixation.

OBJECTIVE: To assess the effectiveness of transpedicular screw fixation in neurological recovery and pain control in thoracolumbar junction injuries. METHOD: This audit was carried out in the Neurosurgery Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from November 2008 to April 2010. Written informed consent was taken from all patients. Detail history, clinical examination, x-ray dorsolumbar spine (or CT scan dorsolumbar spine) and MRI dorsolumbar spine were done in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Post traumatic unstable thoracolumbar junction fractures were included in this study. Open fractures, fractures with significant kyphotic deformity, fractures with anterior retropulsed fragments, multiple level fractures requiring long segment fixation, pedicles fractures and pathological fractures were excluded from study. The short-segment transpedicular fixation was performed in all patients. Effect of transpedicular screw fixation on pain relief was measured by improvement in Dennis pain scale. History of pain relief and neurological assessments of patients were done on each follow up visit. The data was analyzed in SPSS 16.0. RESULTS: Transpedicular screw fixation was performed in 80 patients including 55 males and 25 females. Mean age was 35 +/- 6.75 years (range 15-61 years). The level of injuries were D11 = 6 (7%) cases, D12 = 13 (16%) cases, L1 = 40 (50%) cases, L2 = 15 (19%) cases, D12 & L1 = 6 (8%) cases. There were 43 (54%) Wedge fractures, 9 (11%) fracture subluxations, burst fracture in 14 (17%), translational injuries in 8 (10%) while distraction injuries in 6 (8%) cases. Pre operative neurological status according to Frankel grading was: grade A, 48 (60%) cases, grade B 12 (15%) cases, grade C 6 (7%) cases, grade D 4 (5%) cases and grade E 10 (13%) cases. Six months post operatively, there were 16 (20%) cases in grade A, grade B 34 (42.5%) cases, grade C 16 (20%) cases, grade D 4 (5%) cases and grade E 10 (12.5%) cases. Pain control was assessed by improvement in Dennis pain scale. Pre operatively there was no patient in P1, 4 (5%) patients in P2, 16 (20%) in P3, 24 (30%) in P4 and 36 (45%) in P5. Six months later there were 56 (70%) patients in P1,16 (20%) in P2, 4 (5%) in P3 and 4 (5%) patients in P4.There was no patient in P5. CONCLUSION: Thoracolumbar junction injuries are common in young male patients. Transpedicular screw fixation is useful choice for achieving better neurological recovery and good pain control in traumatic thoracolumbar fractures.