Muhammad Ayaz, Hajra Sarwar, Adnan Yaqoob, Mumtaz Ali Khan
Objectives: A Quasi-Experimental study was conducted to determine the impact of Attend-trial-based interventions on the knowledge of the caregivers and the quality of life of Ischemic stroke survivors. Material and Methods: The study was conducted in the acute care hospital located in the rural area, Khyber Pukhtoonkha. A sample of 115 patients and informal caregivers participated in a multifaceted intervention including educational sessions, training and demonstration, and post-training discussion via WhatsApp. A pre-post evaluation of the quality of life, stroke knowledge, functioning, and activities of daily living was completed using validated tools. All information was collected using predesign pro forma and questionnaire. Results: The interventions significantly improved all four outcomes in caregivers and patients. The mean score for the WHOQOL-BREF pre-intervention was 2.91 ± 1.10 which was increased to 4.18 ± 0.86. The pre-knowledge scores were 34.00 which increased to 39.95. There was a statistically significant change between pre and post knowledge scores [t (114) = -3.394, p = 0.001]. Conclusion: The study contributed towards the usefulness of multifaceted education intervention to enhance the rehabilitation efforts of patients and their caregivers in community settings.
目的:进行一项准实验研究，以确定基于出席试验的干预措施对缺血性脑卒中幸存者护理人员知识和生活质量的影响。材料和方法:本研究在位于开伯尔普赫图恩卡农村地区的急症护理医院进行。115名患者和非正式护理人员参与了多方面的干预，包括教育课程、培训和示范，以及通过WhatsApp进行的培训后讨论。使用经过验证的工具完成对生活质量、卒中知识、功能和日常生活活动的前后评估。所有资料均采用预设计形式和问卷调查法收集。结果:干预措施显著改善了护理人员和患者的所有四项结果。干预前WHOQOL-BREF评分平均为2.91±1.10分，高于干预前的4.18±0.86分。前知识得分从34.00分上升到39.95分。前后知识得分差异有统计学意义[t (114) = -3.394, p = 0.001]。结论:本研究有助于在社区环境中实施多方面的教育干预，以提高患者及其照顾者的康复努力。
{"title":"Enhancing Knowledge of Family Caregivers and Quality of Life of Patients with Ischemic Stroke","authors":"Muhammad Ayaz, Hajra Sarwar, Adnan Yaqoob, Mumtaz Ali Khan","doi":"10.36552/pjns.v25i4.625","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.625","url":null,"abstract":"Objectives: A Quasi-Experimental study was conducted to determine the impact of Attend-trial-based interventions on the knowledge of the caregivers and the quality of life of Ischemic stroke survivors. \u0000Material and Methods: The study was conducted in the acute care hospital located in the rural area, Khyber Pukhtoonkha. A sample of 115 patients and informal caregivers participated in a multifaceted intervention including educational sessions, training and demonstration, and post-training discussion via WhatsApp. A pre-post evaluation of the quality of life, stroke knowledge, functioning, and activities of daily living was completed using validated tools. All information was collected using predesign pro forma and questionnaire. \u0000Results: The interventions significantly improved all four outcomes in caregivers and patients. The mean score for the WHOQOL-BREF pre-intervention was 2.91 ± 1.10 which was increased to 4.18 ± 0.86. The pre-knowledge scores were 34.00 which increased to 39.95. There was a statistically significant change between pre and post knowledge scores [t (114) = -3.394, p = 0.001]. \u0000Conclusion: The study contributed towards the usefulness of multifaceted education intervention to enhance the rehabilitation efforts of patients and their caregivers in community settings.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87121565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Butt, Syed Ali Zunair, Aman-ur-Rehman, Alia Latif, Nasir Raza Awan, Khawar Anwar, M. Chaudary
It is relatively common to occur in a Tertiary Care Neurosurgical setup to get a case of Syringomyelia proximal or distal to a space-occupying lesion (SOL) or site of spinal cord compression. In this case series, we are presenting two cases in which syringomyelia developed after traumatic spinal cord injury. On initial radiological investigations, the first case presented as an old D12 fracture with Post-traumatic syrinx formation but on complete workup for the extent of the syrinx, another lesion was found incidentally in the form of an intradural extramedullary SOL at the level of cervicomedullary junction. The SOL turned out histologically as WHO Grade I Meningioma. The second case presented as syrinx formation after gunshot (fire-arm) penetrating spinal cord injury to the D11-12 vertebrae. Treatment plans of both these patients are presented here in detail along with the literature review.
{"title":"Post-Traumatic Syringomyelia: A Case Series","authors":"B. Butt, Syed Ali Zunair, Aman-ur-Rehman, Alia Latif, Nasir Raza Awan, Khawar Anwar, M. Chaudary","doi":"10.36552/pjns.v25i4.626","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.626","url":null,"abstract":"It is relatively common to occur in a Tertiary Care Neurosurgical setup to get a case of Syringomyelia proximal or distal to a space-occupying lesion (SOL) or site of spinal cord compression. In this case series, we are presenting two cases in which syringomyelia developed after traumatic spinal cord injury. On initial radiological investigations, the first case presented as an old D12 fracture with Post-traumatic syrinx formation but on complete workup for the extent of the syrinx, another lesion was found incidentally in the form of an intradural extramedullary SOL at the level of cervicomedullary junction. The SOL turned out histologically as WHO Grade I Meningioma. The second case presented as syrinx formation after gunshot (fire-arm) penetrating spinal cord injury to the D11-12 vertebrae. Treatment plans of both these patients are presented here in detail along with the literature review.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75531480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Khokhar, A. Ali, Ahmad Faizan Bukhari, Muhammad Naveed Majeed, H. Abdul Majid, A. Bashir
Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes. Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically. Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery. Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.
{"title":"Our Experience of Posterior Fossa Tumors Surgeries","authors":"T. Khokhar, A. Ali, Ahmad Faizan Bukhari, Muhammad Naveed Majeed, H. Abdul Majid, A. Bashir","doi":"10.36552/pjns.v25i4.619","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.619","url":null,"abstract":"Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes. \u0000Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically. \u0000Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery. \u0000Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"3 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83403287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Khokhar, Anam Fatima, S. Kiran, Muhammad Naveed Majeed, H. Abdul Majid, A. Bashir
Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy. Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.
{"title":"Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan","authors":"T. Khokhar, Anam Fatima, S. Kiran, Muhammad Naveed Majeed, H. Abdul Majid, A. Bashir","doi":"10.36552/pjns.v25i4.620","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.620","url":null,"abstract":"Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). \u0000Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. \u0000Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy. \u0000Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75150087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To compare the outcome of the TAO vs. no TAO during aneurysm surgery in terms of clinically significant postoperative ischemic changes due to vasospasm. Material and Methods: A quasi-experimental study was conducted at Lahore General Hospital wherein 82 patients were enrolled. This study was conducted when the first author was working as PGR at LGH Lahore during 2015 to 2017. Patients were followed from admission to three-month post-op. During the follow-up, patients with clinical substantial post-op ischemic changes were calculated on CT Angiography for the presence of vasospasm. Results: Mean age of the patients was 45.23 years. Proximal TAO was done in 30% (n=25) patients. Clinically significant post-op ischemic changes were seen in 29.3% (n = 24) patients. Of the patients who underwent proximal TAO, longer occlusion time (> 10 mins) was significantly associated with ischemic changes (p-value 0.015). Age > 50 years also showed a statistically significant association with clinical vasospasm (p-value < 0.001). Conclusion: Temporary proximal artery clipping when employed within a limited duration appears to be safe and has no significant impact on clinical vasospasm. Since vasospasm is multifactorial, avoiding a longer duration of proximal TAO in patients with advancing age could decrease the frequency of post-operative ischemic changes due to vasospasm in such patients.
{"title":"Comparison of Surgical Outcome of Anterior Circulation Aneurysms With and Without Proximal Temporary Artery Occlusion","authors":"S. Aryal, H. Sultan, Muhammad Anwar Chaudary","doi":"10.36552/pjns.v25i4.615","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.615","url":null,"abstract":"Objective: To compare the outcome of the TAO vs. no TAO during aneurysm surgery in terms of clinically significant postoperative ischemic changes due to vasospasm. \u0000Material and Methods: A quasi-experimental study was conducted at Lahore General Hospital wherein 82 patients were enrolled. This study was conducted when the first author was working as PGR at LGH Lahore during 2015 to 2017. Patients were followed from admission to three-month post-op. During the follow-up, patients with clinical substantial post-op ischemic changes were calculated on CT Angiography for the presence of vasospasm. \u0000Results: Mean age of the patients was 45.23 years. Proximal TAO was done in 30% (n=25) patients. Clinically significant post-op ischemic changes were seen in 29.3% (n = 24) patients. Of the patients who underwent proximal TAO, longer occlusion time (> 10 mins) was significantly associated with ischemic changes (p-value 0.015). Age > 50 years also showed a statistically significant association with clinical vasospasm (p-value < 0.001). \u0000Conclusion: Temporary proximal artery clipping when employed within a limited duration appears to be safe and has no significant impact on clinical vasospasm. Since vasospasm is multifactorial, avoiding a longer duration of proximal TAO in patients with advancing age could decrease the frequency of post-operative ischemic changes due to vasospasm in such patients.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89688559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naseeruddin Ghulam, K. Sultan, Mohammad Ashraf, N. Choudhary, U. Kamboh, Nazir Ahmad, M. Raza, Waqa Latif, Syed Shahzad Hussain, Naveed Ashraf
Objective: To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC). Materials and Methods: A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes. Results: 85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates. Conclusion: Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously.
{"title":"Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country","authors":"Naseeruddin Ghulam, K. Sultan, Mohammad Ashraf, N. Choudhary, U. Kamboh, Nazir Ahmad, M. Raza, Waqa Latif, Syed Shahzad Hussain, Naveed Ashraf","doi":"10.36552/pjns.v25i4.606","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.606","url":null,"abstract":"Objective: To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC). \u0000Materials and Methods: A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes. \u0000Results: 85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates. \u0000Conclusion: Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously. ","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77018542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khalid Mahmood, Zafdam Shabbir, M. Ishfaq, M. Irfan
Background/Objectives: Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant mortality and morbidity. 90% of post-traumatic rhinorrheas stop conservatively, 10% of post-traumatic, spontaneous, and post-operative rhinorrhea need surgical repair. Fluorescein is helpful in the detection of CSF rhinorrhea peroperatively. Material and Methods: A descriptive case series was conducted at the Department of Neurosurgery, PINS Lahore in a single unit by a single surgical team. 62 patients were enrolled who met the inclusion and exclusion criteria. The lumbar drain was passed at L4 – L5 level and 0.1 ml of 25% sodium Fluorescein was diluted in 10 ml of CSF. The endoscope passed through the nostril and the leakage point was detected by yellowish-green fluid coming out of the rent under endoscope. After surgery, the patients were followed up after two weeks to observe the efficacy. Post-stratification was done through a chi-square test. Results: The mean age of the patients was 42.85 years. The most common leakage was found from cribriform plate followed by lateral lamella & sphenoid sinus. Gender difference, leakage site, and age of the patients did not have significant effects on the results of using fluorescein dye for detecting the rent. The benefit of using the dye was 79%. Conclusion: This study indicated that intrathecal fluorescein is a highly effective and beneficial approach for pinpoint localization of CSF defect, particularly very minute defects, and plays an important role in the successful treatment of CSF rhinorrhea.
背景/目的:脑脊液鼻漏是一种罕见但具有潜在破坏性的疾病，可导致严重的死亡率和发病率。90%的创伤后鼻漏保守停止，10%的创伤后、自发性和术后鼻漏需要手术修复。荧光素有助于术中脑脊液鼻漏的检测。材料和方法:在拉合尔PINS神经外科由单个外科团队在单个单元进行描述性病例系列研究。符合纳入和排除标准的62例患者入组。在L4 - L5水平通过腰椎引流管，在10ml脑脊液中稀释0.1 ml 25%荧光素钠。内窥镜通过鼻孔，在内窥镜下由鼻孔流出的黄绿色液体检测渗漏点。术后2周随访观察疗效。分层后通过卡方检验进行。结果:患者平均年龄42.85岁。最常见的渗漏是筛状板，其次是外侧板和蝶窦。性别差异、渗漏部位、患者年龄对荧光素染色检测租金的结果无显著影响。使用该染料的效益为79%。结论:本研究提示鞘内荧光素对脑脊液缺损特别是极微小缺损的精确定位是一种非常有效和有益的方法，对脑脊液鼻漏的成功治疗起着重要作用。
{"title":"Efficacy and Role of Intrathecal Fluorescein for Detection of Defect Site for Treatment of Cerebrospinal Fluid Rhinorrhea","authors":"Khalid Mahmood, Zafdam Shabbir, M. Ishfaq, M. Irfan","doi":"10.36552/pjns.v25i4.618","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.618","url":null,"abstract":"Background/Objectives: Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant mortality and morbidity. 90% of post-traumatic rhinorrheas stop conservatively, 10% of post-traumatic, spontaneous, and post-operative rhinorrhea need surgical repair. Fluorescein is helpful in the detection of CSF rhinorrhea peroperatively. \u0000Material and Methods: A descriptive case series was conducted at the Department of Neurosurgery, PINS Lahore in a single unit by a single surgical team. 62 patients were enrolled who met the inclusion and exclusion criteria. The lumbar drain was passed at L4 – L5 level and 0.1 ml of 25% sodium Fluorescein was diluted in 10 ml of CSF. The endoscope passed through the nostril and the leakage point was detected by yellowish-green fluid coming out of the rent under endoscope. After surgery, the patients were followed up after two weeks to observe the efficacy. Post-stratification was done through a chi-square test. \u0000Results: The mean age of the patients was 42.85 years. The most common leakage was found from cribriform plate followed by lateral lamella & sphenoid sinus. Gender difference, leakage site, and age of the patients did not have significant effects on the results of using fluorescein dye for detecting the rent. The benefit of using the dye was 79%. \u0000Conclusion: This study indicated that intrathecal fluorescein is a highly effective and beneficial approach for pinpoint localization of CSF defect, particularly very minute defects, and plays an important role in the successful treatment of CSF rhinorrhea.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82225515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The study was conducted to evaluate the technique and results of the endoscopic supraorbital eyebrow craniotomy for resection of extra-axial skull base lesions. Material and Methods: A case study of 70 patients who underwent the endoscopic supraorbital eyebrow approach was conducted. The patients' lesion location, the extent of excision, hospital stay, complications, and cosmetic results were all examined. A 48-hour postoperative CT scan was conducted, followed by a 6-week MRI to check for residuals. Total resection (complete), near-total resection (>90 percent), and subtotal resection (< 90 percent) were the three types of resection rates. At the follow-up appointment, the wound was evaluated for aesthetic reasons as well as any neurological impairment. Results: There were 39% male patients and 61.4% female patients. The mean age of the patients was 37 years. Craniopharyngioma (88.57%) was reported in most of the patients. In the majority (93%) of the cases, total resection was performed. No complication was observed in 70% of the patients. 14% of patients reported Diabetes insipidus. No intraoperative complications like bleeding or tissue injury were observed. 88.57% of patients were satisfied with the surgical management. Conclusion: With outstanding aesthetic outcomes, the endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive Keyhole method to remove extra-axial anterior skull base and sellar, suprasellar, and parasellar lesions.
{"title":"The outcome of Endoscopic Supraorbital Eyebrow Approach: A Case Series Reported from PINS, Pakistan","authors":"Khalid Mahmood, M. Ishfaq, M. Akmal, M. Irfan","doi":"10.36552/pjns.v25i4.616","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.616","url":null,"abstract":"Objective: The study was conducted to evaluate the technique and results of the endoscopic supraorbital eyebrow craniotomy for resection of extra-axial skull base lesions. \u0000Material and Methods: A case study of 70 patients who underwent the endoscopic supraorbital eyebrow approach was conducted. The patients' lesion location, the extent of excision, hospital stay, complications, and cosmetic results were all examined. A 48-hour postoperative CT scan was conducted, followed by a 6-week MRI to check for residuals. Total resection (complete), near-total resection (>90 percent), and subtotal resection (< 90 percent) were the three types of resection rates. At the follow-up appointment, the wound was evaluated for aesthetic reasons as well as any neurological impairment. \u0000Results: There were 39% male patients and 61.4% female patients. The mean age of the patients was 37 years. Craniopharyngioma (88.57%) was reported in most of the patients. In the majority (93%) of the cases, total resection was performed. No complication was observed in 70% of the patients. 14% of patients reported Diabetes insipidus. No intraoperative complications like bleeding or tissue injury were observed. 88.57% of patients were satisfied with the surgical management. \u0000Conclusion: With outstanding aesthetic outcomes, the endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive Keyhole method to remove extra-axial anterior skull base and sellar, suprasellar, and parasellar lesions.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"8 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75793444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mukhtar, Ijaz Hussain Wadd, Arsalan Haider, M. Zaheer, Rashida Imran
Objective: To assess olfactory dysfunction in Parkinson's disease (PD) patients in Pakistan utilizing an autochthonous smell test. Setting: Tertiary care center, single-center study. Materials and Methods: Eighty-seven non-demented patients with PD, who fulfilled Queen Square Brain Bank Criteria were enrolled at the Movement Disorder Clinic, Lahore General Hospital (LGH), Lahore. Fifty-eight controls matched by gender, age, and place of residence were enrolled among patients and visitors attending other hospital clinics. Both groups underwent olfactory testing using the Pakistani Smell Identification test (PKSIT). The participants were required to identify the smell from a set of choices and were scored out of 10. Results: Among patients in the study group, the mean duration of disease was 4.7 years (range 6 months to 19 years). The PD onset mean age was 52.15 ± 13.02 years among patients. The mean number of smell test items accurately recognized by the PD patients was 4.55 ± 2.4. A multiple linear regression demonstrated that age (P < 0.05) but not disease duration (P = 0.899) was a significant determinant of the smell test result in PD and control groups. The mean number of smell test items appropriately recognized by the controls was 7.33 ± 1.69. Logistic regression showed that the PKSIT had 73.2% sensitivity and 84.3% specificity to distinguish PD from control. Conclusion: PKSIT being easily available, cheap, and more convenient to use in the Pakistani population, can be used in the evaluation of olfactory dysfunction in PD subjects.
{"title":"Anosmia in Parkinson’s Disease in Pakistan: A Matched Case – Control Study","authors":"S. Mukhtar, Ijaz Hussain Wadd, Arsalan Haider, M. Zaheer, Rashida Imran","doi":"10.36552/pjns.v25i4.617","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.617","url":null,"abstract":"Objective: To assess olfactory dysfunction in Parkinson's disease (PD) patients in Pakistan utilizing an autochthonous smell test. \u0000Setting: Tertiary care center, single-center study. \u0000Materials and Methods: Eighty-seven non-demented patients with PD, who fulfilled Queen Square Brain Bank Criteria were enrolled at the Movement Disorder Clinic, Lahore General Hospital (LGH), Lahore. Fifty-eight controls matched by gender, age, and place of residence were enrolled among patients and visitors attending other hospital clinics. Both groups underwent olfactory testing using the Pakistani Smell Identification test (PKSIT). The participants were required to identify the smell from a set of choices and were scored out of 10. \u0000Results: Among patients in the study group, the mean duration of disease was 4.7 years (range 6 months to 19 years). The PD onset mean age was 52.15 ± 13.02 years among patients. The mean number of smell test items accurately recognized by the PD patients was 4.55 ± 2.4. A multiple linear regression demonstrated that age (P < 0.05) but not disease duration (P = 0.899) was a significant determinant of the smell test result in PD and control groups. The mean number of smell test items appropriately recognized by the controls was 7.33 ± 1.69. Logistic regression showed that the PKSIT had 73.2% sensitivity and 84.3% specificity to distinguish PD from control. \u0000Conclusion: PKSIT being easily available, cheap, and more convenient to use in the Pakistani population, can be used in the evaluation of olfactory dysfunction in PD subjects.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"286 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75118646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamayun Tahir, Zulfiqar Ali Shah, Naseer Hassan, M. Ayaz, Mumtaz Ali, F. Azam, Samina Feroz
Objective: In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach Material and Methods: This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus. Results: CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications. Conclusion: Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications.
{"title":"Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach","authors":"Hamayun Tahir, Zulfiqar Ali Shah, Naseer Hassan, M. Ayaz, Mumtaz Ali, F. Azam, Samina Feroz","doi":"10.36552/pjns.v25i4.514","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.514","url":null,"abstract":"Objective: In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach \u0000Material and Methods: This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus. \u0000Results: CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications. \u0000Conclusion: Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"24 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76930005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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