Objective: Studies have shown that postoperative dexamethasone administration in patients in whom posterior spinal surgical interventions have been carried out reduces the postoperative pain and decreases the analgesia requirement. Our study aimed to find out whether the use of postoperative steroids in patients that had undergone posterior spinal surgical procedures led to an increased incidence of wound infections. Materials and Methods: The medical data of 52 patients in whom posterior spinal surgical interventions had been performed were retrospectively analyzed. The patients were divided into two groups. In the first group, postoperative dexamethasone had been administered after spinal surgery, and in the second group, no postoperative dexamethasone had been given. The two groups were then compared for their association with postoperative surgical site infection. Results: Forty-five patients were included in the group in whom postoperative dexamethasone was given. Six (13.3%) of these patients developed postoperative surgical site infections. None of the seven patients in the second group in whom no postoperative dexamethasone had been administered developed postoperative wound infection. The difference in infection rate between the two groups did not reach statistical significance (p = 0.3). Conclusion: An infection rate of 13.3% in the group of patients in whom postoperative dexamethasone had been administered is considerably high as compared to the 1 – 2% incidence quoted in the literature for simple laminectomy procedures. A prospective study with a larger sample size is needed to accurately define the relationship between postoperative dexamethasone administration and surgical site infection following posterior spinal surgery.
{"title":"Relationship between Postoperative Dexamethasone Following Posterior Spinal Surgery and Surgical Site Infection","authors":"Imran Altaf","doi":"10.36552/pjns.v26i3.779","DOIUrl":"https://doi.org/10.36552/pjns.v26i3.779","url":null,"abstract":"Objective: Studies have shown that postoperative dexamethasone administration in patients in whom posterior spinal surgical interventions have been carried out reduces the postoperative pain and decreases the analgesia requirement. Our study aimed to find out whether the use of postoperative steroids in patients that had undergone posterior spinal surgical procedures led to an increased incidence of wound infections. \u0000Materials and Methods: The medical data of 52 patients in whom posterior spinal surgical interventions had been performed were retrospectively analyzed. The patients were divided into two groups. In the first group, postoperative dexamethasone had been administered after spinal surgery, and in the second group, no postoperative dexamethasone had been given. The two groups were then compared for their association with postoperative surgical site infection. \u0000Results: Forty-five patients were included in the group in whom postoperative dexamethasone was given. Six (13.3%) of these patients developed postoperative surgical site infections. None of the seven patients in the second group in whom no postoperative dexamethasone had been administered developed postoperative wound infection. The difference in infection rate between the two groups did not reach statistical significance (p = 0.3). \u0000Conclusion: An infection rate of 13.3% in the group of patients in whom postoperative dexamethasone had been administered is considerably high as compared to the 1 – 2% incidence quoted in the literature for simple laminectomy procedures. A prospective study with a larger sample size is needed to accurately define the relationship between postoperative dexamethasone administration and surgical site infection following posterior spinal surgery.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89261565","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}
Anas Ahmed, Lal Rehman, Farrukh Javeed, Yousra Hatif, Sehrish Altaf, Sagheer Ahmed
Objective: To assess the post-operative status of Facial Nerve in cerebellopontine angle (CPA) lesion via retro-sigmoid approach and also its complications and outcome. Materials & Methods: This prospective study was conducted at the Department of Neurosurgery, JPMC Karachi from a period of 10-12-2021 to 10-06-2022.The sample size of our study was 37 patients. All the patients were operated for CPA lesions and followed for three months to assess the outcome efficacy. Results: Our study showed that the mean age was 37 years, with a range of 27 to 65 years, in which the males were 18 (48.6%) and the females were 19 (51.4%). Out of 37 patients, 28 (75.7%) were diagnosed with vestibular schwannoma, while 6 (16.2%) were meningiomas, and 3 (8.1%) were epidermoid cysts. Gross total resection was performed in 14 (37.8%) patients, while subtotal resection (STR) in 23 (62.2%). Facial nerve function in terms of House-Brackmann at 3 months was found to be grade I in 26 (70.3%), grade II in 9 (24.3%), grade III in 1 (2.7%), and grade IV in 1 (2.7%). Conclusion: The CPA is a small corridor through which important neurovascular structures pass. Identification of CN VII is important in large CPA tumours to preserve facial motor nerve function. For all kinds of CPA lesions, gross total excision should be the aim of surgery.
{"title":"Post-operative Status of Facial Nerve in Cerebello-Pontine Angle Lesion via Retro-Sigmoid Approach; Complications and Outcome","authors":"Anas Ahmed, Lal Rehman, Farrukh Javeed, Yousra Hatif, Sehrish Altaf, Sagheer Ahmed","doi":"10.36552/pjns.v26i3.785","DOIUrl":"https://doi.org/10.36552/pjns.v26i3.785","url":null,"abstract":" \u0000Objective: To assess the post-operative status of Facial Nerve in cerebellopontine angle (CPA) lesion via retro-sigmoid approach and also its complications and outcome. \u0000Materials & Methods: This prospective study was conducted at the Department of Neurosurgery, JPMC Karachi from a period of 10-12-2021 to 10-06-2022.The sample size of our study was 37 patients. All the patients were operated for CPA lesions and followed for three months to assess the outcome efficacy. \u0000Results: Our study showed that the mean age was 37 years, with a range of 27 to 65 years, in which the males were 18 (48.6%) and the females were 19 (51.4%). Out of 37 patients, 28 (75.7%) were diagnosed with vestibular schwannoma, while 6 (16.2%) were meningiomas, and 3 (8.1%) were epidermoid cysts. Gross total resection was performed in 14 (37.8%) patients, while subtotal resection (STR) in 23 (62.2%). Facial nerve function in terms of House-Brackmann at 3 months was found to be grade I in 26 (70.3%), grade II in 9 (24.3%), grade III in 1 (2.7%), and grade IV in 1 (2.7%). \u0000Conclusion: The CPA is a small corridor through which important neurovascular structures pass. Identification of CN VII is important in large CPA tumours to preserve facial motor nerve function. For all kinds of CPA lesions, gross total excision should be the aim of surgery.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73300477","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}
Hassaan Zahid, Lubna Ijaz, Amna Malik, Laeeq Ur Rehman, Malik M, Nadeem Khan
Objective: To find out the incidence of hydrocephalus after excision and repair in infants presenting with Spina Bifida Aperta. Materials & Methods: This prospective cohort study was conducted at the Pediatric Neurosurgery Department, Children Hospital & The Institute of Child Health, Lahore, Pakistan, from January 2021 to October 2021. A total of 62 infants of both genders presenting with spina bifida Aperta undergoing repair were included. Data of the patients, i.e., name, age, gender, head circumference, location, and width of the defect, accompanying bladder, limb anomalies, radiological, laboratory findings, and diagnosis (meningocele or meningomyelocele) were noted. Patients were followed postoperatively for 1-month, and the incidence of post-surgery hydrocephalus was noted. Results: Out of 62 children, 36 (58.1%) were male and 24 (41.9%) female. The mean age was noted to be 138.82 days. Most children, 36 (58.1%), were found to have meningocele. The most frequent local meningocele/meningomyelocele was noted to be lumbosacral, 22 (35.5%). Post-surgery hydrocephalus was noted among 11 (17.1%) cases. No significant association of gender, age, head circumference, defect size, the maximum dimension, diagnosis (meningocele or meningomyelocele), or location was noted with post-surgery hydrocephalus among study cases (p > 0.05). No mortality was reported. Conclusion: Meningomyelocele and lumbosacral location of the defect were among the prominent factors affecting the incidence of post-surgery hydrocephalus. Keywords: Spina Bifida Aperta, Meningiocele, Myelomeningocele, hydrocephalus, lumbosacral
{"title":"Incidence of Development of Hydrocephalus after Excision and Repair of Spina Bifida Aperta in Infants","authors":"Hassaan Zahid, Lubna Ijaz, Amna Malik, Laeeq Ur Rehman, Malik M, Nadeem Khan","doi":"10.36552/pjns.v26i3.789","DOIUrl":"https://doi.org/10.36552/pjns.v26i3.789","url":null,"abstract":"Objective: To find out the incidence of hydrocephalus after excision and repair in infants presenting with Spina Bifida Aperta. \u0000Materials & Methods: This prospective cohort study was conducted at the Pediatric Neurosurgery Department, Children Hospital & The Institute of Child Health, Lahore, Pakistan, from January 2021 to October 2021. A total of 62 infants of both genders presenting with spina bifida Aperta undergoing repair were included. Data of the patients, i.e., name, age, gender, head circumference, location, and width of the defect, accompanying bladder, limb anomalies, radiological, laboratory findings, and diagnosis (meningocele or meningomyelocele) were noted. Patients were followed postoperatively for 1-month, and the incidence of post-surgery hydrocephalus was noted. \u0000Results: Out of 62 children, 36 (58.1%) were male and 24 (41.9%) female. The mean age was noted to be 138.82 days. Most children, 36 (58.1%), were found to have meningocele. The most frequent local meningocele/meningomyelocele was noted to be lumbosacral, 22 (35.5%). Post-surgery hydrocephalus was noted among 11 (17.1%) cases. No significant association of gender, age, head circumference, defect size, the maximum dimension, diagnosis (meningocele or meningomyelocele), or location was noted with post-surgery hydrocephalus among study cases (p > 0.05). No mortality was reported. \u0000Conclusion: Meningomyelocele and lumbosacral location of the defect were among the prominent factors affecting the incidence of post-surgery hydrocephalus. \u0000Keywords: Spina Bifida Aperta, Meningiocele, Myelomeningocele, hydrocephalus, lumbosacral","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88788671","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}
Objectives: The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures. Materials and Methods: A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level. Results: In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%). Conclusion: Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation. Keywords: Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome.
{"title":"The Radiological Outcome of Thoracolumbar Spine Fracture Fixation in Short Vs Long Segment","authors":"Ehtisham Ahmed khan Afridi, Idrees Ahmed, Sidra Maqbool, Aqsa Shahzadi, Saadia Maqbool","doi":"10.36552/pjns.v26i3.778","DOIUrl":"https://doi.org/10.36552/pjns.v26i3.778","url":null,"abstract":"Objectives: The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures. \u0000Materials and Methods: A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level. \u0000Results: In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%). \u0000Conclusion: Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation. \u0000Keywords: Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82126671","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}
Rana Zubair Mahmood, Faheem Ahmed Usmani, Mukhtiyar Ahmed Lakho, Talha Abbas, M. Yasin Khan, Sarfraz Khan, Touqeer Ahmed
Objectives: The study compared the outcomes of VP shunt at Choudhary’s vs Keen’s point. Material and Methods: A quasi-observational study was conducted on 50 patients who presented to NS-2, PINS, with the complaint of hydrocephalus. The study was conducted for 3 months from 1st November 2021 to 31th Jan 2022. Results: Mean age was 40 years. In 25 (50%) patients, VP shunts were done through Choudhary’s point while in 25 (50%) patients VP shunts were done through Keen’s point. All patients were evaluated on day 3rd POD, 7th POD, 15th POD, and 90th POD. All patients were improved on 3rd POD. On the 7th POD, 15 (30%) patients deteriorated and showed signs of raised ICP. In these patients, the upper end of VP shunts is again revised due to blockage. On 15th POD, the upper end of VP shunts was blocked in 3 (6%) patients and their upper end was revised. On 90th POD, 2 (4%) patients were presented with upper-end blockage, and again shunt revision was done. VP shunts in all these patients were done through keen’s point approach. Blockage of the lower end of VP shunt occurred in 10% of patients in which 8% were operated through Keen’s point approach while resting 2% of patients were operated through Choudhary’s point approach. Conclusion: VP shunts through Choudhary’s point approach yield good results as compared to Keen's point approach. This site is described by professor Muhammad Anwar Choudhary, as more convenient for insertion of VP shunt.
{"title":"Comparison of Surgical Outcomes of ventriculoperitoneal (VP) Shunt at Choudhary’s Point vs. Keen’s Point","authors":"Rana Zubair Mahmood, Faheem Ahmed Usmani, Mukhtiyar Ahmed Lakho, Talha Abbas, M. Yasin Khan, Sarfraz Khan, Touqeer Ahmed","doi":"10.36552/pjns.v26i2.760","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.760","url":null,"abstract":"Objectives: The study compared the outcomes of VP shunt at Choudhary’s vs Keen’s point. \u0000Material and Methods: A quasi-observational study was conducted on 50 patients who presented to NS-2, PINS, with the complaint of hydrocephalus. The study was conducted for 3 months from 1st November 2021 to 31th Jan 2022. \u0000Results: Mean age was 40 years. In 25 (50%) patients, VP shunts were done through Choudhary’s point while in 25 (50%) patients VP shunts were done through Keen’s point. All patients were evaluated on day 3rd POD, 7th POD, 15th POD, and 90th POD. All patients were improved on 3rd POD. On the 7th POD, 15 (30%) patients deteriorated and showed signs of raised ICP. In these patients, the upper end of VP shunts is again revised due to blockage. On 15th POD, the upper end of VP shunts was blocked in 3 (6%) patients and their upper end was revised. On 90th POD, 2 (4%) patients were presented with upper-end blockage, and again shunt revision was done. VP shunts in all these patients were done through keen’s point approach. Blockage of the lower end of VP shunt occurred in 10% of patients in which 8% were operated through Keen’s point approach while resting 2% of patients were operated through Choudhary’s point approach. \u0000Conclusion: VP shunts through Choudhary’s point approach yield good results as compared to Keen's point approach. This site is described by professor Muhammad Anwar Choudhary, as more convenient for insertion of VP shunt.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"2002 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88314836","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}
Usman Ahmad Kamboh, Mehwish Manzoor, Muhammad Ashraf, Nabeel Chaudhary, Mehreen Mehboob, Manzoor Ahmad
The correlation between hydrocephalus and spinal cord tumor was first described by Kyrieleis et. al. 1% concomitant presence was documented by Mirroni et.al. Moreover, the understanding of the pathophysiological association between these two conditions is still lacking. 11 years old girl presented in the outpatient department of Jinnah hospital Lahore with complaints of difficulty in walking for the last 2 years, numbness of right leg for the last one year, and severe bilateral sciatica for 2 months. On further inquiry, she told that she is also suffering from headaches and blurred vision for the last 6 months. Her neuroimaging revealed hydrocephalus and mixed density heterogeneously enhancing intradural lesion at the conus. She underwent ventriculoperitoneal shunting for hydrocephalus and laminoplasty followed by excision of spinal tumor reported being myxopapillary ependymoma grade II. The presence of headache along with signs & symptoms of raised intracranial pressure in these patients warrant cranial imaging. CSF diversion for hydrocephalus and gross total excision of the spinal lesion is the standard acceptable treatment.
{"title":"11 Years Old Female with Synergistic Presentation of Cranial and Spinal Pathologies: Myxopapillary Ependymoma with Hydrocephalus - A Rare Entity","authors":"Usman Ahmad Kamboh, Mehwish Manzoor, Muhammad Ashraf, Nabeel Chaudhary, Mehreen Mehboob, Manzoor Ahmad","doi":"10.36552/pjns.v26i2.697","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.697","url":null,"abstract":"The correlation between hydrocephalus and spinal cord tumor was first described by Kyrieleis et. al. 1% concomitant presence was documented by Mirroni et.al. Moreover, the understanding of the pathophysiological association between these two conditions is still lacking. 11 years old girl presented in the outpatient department of Jinnah hospital Lahore with complaints of difficulty in walking for the last 2 years, numbness of right leg for the last one year, and severe bilateral sciatica for 2 months. On further inquiry, she told that she is also suffering from headaches and blurred vision for the last 6 months. Her neuroimaging revealed hydrocephalus and mixed density heterogeneously enhancing intradural lesion at the conus. She underwent ventriculoperitoneal shunting for hydrocephalus and laminoplasty followed by excision of spinal tumor reported being myxopapillary ependymoma grade II. The presence of headache along with signs & symptoms of raised intracranial pressure in these patients warrant cranial imaging. CSF diversion for hydrocephalus and gross total excision of the spinal lesion is the standard acceptable treatment.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86330642","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}
Usman Ahmed Kamboh, Nabeel Choudhary, Mehwish Manzoor, Asif Raza, Ghulam Naseer-ud-Din, Muhammad Adeel Rauf
Introduction: Traumatic brain injury patients present in the emergency room with a variable conscious status depending upon the severity of the injury. The process of aspiration starts from the scene of trauma as the patients with Traumatic brain injury and chest trauma have higher rates of aspiration pneumonia. Materials and Methods: We conducted a prospective study to assess the impact of bronchoscopy lavage and aggressive chest physiotherapy on the Critical Pulmonary Infection Score of Patients with Severe Traumatic Brain Injury in the Neurocritical Care Unit. Patients with severe traumatic brain injury who met the inclusion criteria were enrolled in the study. Patients of both genders, ages ranging from 05 – 70 years were included in the study. Results: 48 patients who met the inclusion criteria were enrolled in the study. 8 patients expired before 7 days and were excluded from the study. 88% were male and 12 % were females. Out of 40 patients, 30 were ventilated and 10 were managed without ventilation. Brain contusion was the most common CT scan finding. Out of 40 patients, 18 underwent surgical intervention, with decompressive hemicraniectomy being the most commonly performed procedure. Out of 40 patients, 32 patients underwent bronchoscopy. 8 patients out of 32 had more than two sessions of bronchoscopy. Conclusion: As Critical Pulmonary Infection Score is an important indicator for pneumonia in the neurocritical care unit, the importance of standardized chest care with the help of bronchoscopic lavage and chest physiotherapy in keeping the Critical Pulmonary Infection Score on the lower side can prevent patients from developing life-threatening pneumonia.
{"title":"Impact of Bronchoscopic Lavage and Aggressive Chest Physiotherapy on Clinical Pulmonary Infection Score of Patients of Severe Traumatic Brain Injury","authors":"Usman Ahmed Kamboh, Nabeel Choudhary, Mehwish Manzoor, Asif Raza, Ghulam Naseer-ud-Din, Muhammad Adeel Rauf","doi":"10.36552/pjns.v26i2.698","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.698","url":null,"abstract":"Introduction: Traumatic brain injury patients present in the emergency room with a variable conscious status depending upon the severity of the injury. The process of aspiration starts from the scene of trauma as the patients with Traumatic brain injury and chest trauma have higher rates of aspiration pneumonia. \u0000Materials and Methods: We conducted a prospective study to assess the impact of bronchoscopy lavage and aggressive chest physiotherapy on the Critical Pulmonary Infection Score of Patients with Severe Traumatic Brain Injury in the Neurocritical Care Unit. Patients with severe traumatic brain injury who met the inclusion criteria were enrolled in the study. Patients of both genders, ages ranging from 05 – 70 years were included in the study. \u0000Results: 48 patients who met the inclusion criteria were enrolled in the study. 8 patients expired before 7 days and were excluded from the study. 88% were male and 12 % were females. Out of 40 patients, 30 were ventilated and 10 were managed without ventilation. Brain contusion was the most common CT scan finding. Out of 40 patients, 18 underwent surgical intervention, with decompressive hemicraniectomy being the most commonly performed procedure. Out of 40 patients, 32 patients underwent bronchoscopy. 8 patients out of 32 had more than two sessions of bronchoscopy. \u0000Conclusion: As Critical Pulmonary Infection Score is an important indicator for pneumonia in the neurocritical care unit, the importance of standardized chest care with the help of bronchoscopic lavage and chest physiotherapy in keeping the Critical Pulmonary Infection Score on the lower side can prevent patients from developing life-threatening pneumonia.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85862964","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}
Abdul Aziz khan, Junaid Alam, Muhammad Irfan-ud-Din, Nisar Ahmad, Muhammad Idrees, Waseef Ullah
Objective: Pituitary lesions cause morbidity and mortality in all age groups due to their hormonal hypersecretion, its mass effects, and post-surgery complications. The present study determined the frequency of functional and non-functional pituitary adenomas. Materials & Methods: The study included patients (n = 114) presenting with functional and non-functional pituitary adenoma. Pituitary adenomas were diagnosed based on MRI brain with contrast and the size of the tumor was noted a tumor having a size of 10 mm or more was labeled as macro adenoma and a tumor having a size less than 10 mm was labeled as microadenoma. Pituitary adenomas were stratified among age, gender, duration of symptoms, types of adenomas, types of functional adenoma, and type of the tumor on a size basis. Results: Most of the patients had TSH- secreting adenoma (21.9%). 52.6% were found with microadenoma and 47.4% had macro adenoma. Patients with functional adenoma were 30.7% and with non-functional adenoma 32.5% were male while patients with functional adenoma were 26.3% and with non-functional adenoma 10.5%were female (p = 0.018). Patients with functional adenoma (43.9%) and non-functional adenoma (8.8%) were found to have microadenoma, whereas patients with functional adenoma (13.2%) and non-functional adenoma (34.2%) were found to have macroadenoma (p = 0.000). Patients with functional adenoma having a duration of symptoms below 1 year were 11 (9.6%), 1 to 3 years were 25 (21.9%), 17 (14.9%) were 4 to 6 years, and 12 (10.5%) above 6 years duration of symptoms. Conclusion: Patients with pituitary adenomas should be diagnosed early to receive successful therapy.
{"title":"Abdul Aziz Khan","authors":"Abdul Aziz khan, Junaid Alam, Muhammad Irfan-ud-Din, Nisar Ahmad, Muhammad Idrees, Waseef Ullah","doi":"10.36552/pjns.v26i2.699","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.699","url":null,"abstract":"Objective: Pituitary lesions cause morbidity and mortality in all age groups due to their hormonal hypersecretion, its mass effects, and post-surgery complications. The present study determined the frequency of functional and non-functional pituitary adenomas. \u0000Materials & Methods: The study included patients (n = 114) presenting with functional and non-functional pituitary adenoma. Pituitary adenomas were diagnosed based on MRI brain with contrast and the size of the tumor was noted a tumor having a size of 10 mm or more was labeled as macro adenoma and a tumor having a size less than 10 mm was labeled as microadenoma. Pituitary adenomas were stratified among age, gender, duration of symptoms, types of adenomas, types of functional adenoma, and type of the tumor on a size basis. \u0000Results: Most of the patients had TSH- secreting adenoma (21.9%). 52.6% were found with microadenoma and 47.4% had macro adenoma. Patients with functional adenoma were 30.7% and with non-functional adenoma 32.5% were male while patients with functional adenoma were 26.3% and with non-functional adenoma 10.5%were female (p = 0.018). Patients with functional adenoma (43.9%) and non-functional adenoma (8.8%) were found to have microadenoma, whereas patients with functional adenoma (13.2%) and non-functional adenoma (34.2%) were found to have macroadenoma (p = 0.000). Patients with functional adenoma having a duration of symptoms below 1 year were 11 (9.6%), 1 to 3 years were 25 (21.9%), 17 (14.9%) were 4 to 6 years, and 12 (10.5%) above 6 years duration of symptoms. \u0000Conclusion: Patients with pituitary adenomas should be diagnosed early to receive successful therapy.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87179972","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}
Tariq Imran Khokhar, Muhammad Nauman Hasan, Sumira Kiran, Khawar Anwar, Muhammad Aqeel Natt
Objectives: To determine the incidence and outcome of intraventricular tumors treated micro-surgically at the Punjab Institute of Neurosciences, Lahore, Pakistan. Materials and Methods: A retrospective study of a series of 42 patients with the initial diagnosis of intraventricular tumors who underwent microsurgical resection over a period of 04 years. The extent of resection was decided by post-operative imaging (CT Brain), performed on immediate or 1st post-op day, and by MRI on outdoor follow-up after an average of 4 weeks. Post-operative complications and the Glasgow outcome scale were also recorded. Results: The majority of patients presented with nonspecific symptoms. 47.6% patients presented with headache, nausea/vomiting (40.5%), decreased vision (21.4%), fits (19%) and hydrocephalus (9.52%).29patients (72.5%) underwent microsurgical excision through the anterior transcortical approach, followed by 08 (19.05%) via the posterior transcortical approach. GTR was achieved in 33 (78.57%). Based on histopathology reports, 14 (33.3%) were ependymomas, 11(26.2%) meningiomas, 07 (16.67%) sub-ependymomas, 5 (11.9%) central neurocytomas, and 2(4.76%) Choroid Plexus Papilloma. Significant postoperative intraventricular bleed was noted in 04 (9.52%) patients, minor I/V bleed in 06 (14.28%), hydrocephalus in 07 (16.67%), subdural collection in 02 (4.76%), and motor deficit in 03 (7.15%) patients. Based on Glasgow Outcome Scale, 32 (76.2%) had GOS5/5, 7 (16.67%) with GOS 4/5, while 02 patients expired in the postoperative period. Conclusion: Intraventricular tumors require special neurosurgical consideration. Early diagnosis, better preoperative planning, and an adequate microsurgical approach are necessary to achieve maximum safe resection and improvement in patients’ symptoms and overall condition.
{"title":"Incidence and Surgical Outcome of Intraventricular Tumors at a Tertiary Care Hospital in Lahore, Pakistan","authors":"Tariq Imran Khokhar, Muhammad Nauman Hasan, Sumira Kiran, Khawar Anwar, Muhammad Aqeel Natt","doi":"10.36552/pjns.v26i2.700","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.700","url":null,"abstract":"Objectives: To determine the incidence and outcome of intraventricular tumors treated micro-surgically at the Punjab Institute of Neurosciences, Lahore, Pakistan. \u0000Materials and Methods: A retrospective study of a series of 42 patients with the initial diagnosis of intraventricular tumors who underwent microsurgical resection over a period of 04 years. The extent of resection was decided by post-operative imaging (CT Brain), performed on immediate or 1st post-op day, and by MRI on outdoor follow-up after an average of 4 weeks. Post-operative complications and the Glasgow outcome scale were also recorded. \u0000Results: The majority of patients presented with nonspecific symptoms. 47.6% patients presented with headache, nausea/vomiting (40.5%), decreased vision (21.4%), fits (19%) and hydrocephalus (9.52%).29patients (72.5%) underwent microsurgical excision through the anterior transcortical approach, followed by 08 (19.05%) via the posterior transcortical approach. GTR was achieved in 33 (78.57%). Based on histopathology reports, 14 (33.3%) were ependymomas, 11(26.2%) meningiomas, 07 (16.67%) sub-ependymomas, 5 (11.9%) central neurocytomas, and 2(4.76%) Choroid Plexus Papilloma. Significant postoperative intraventricular bleed was noted in 04 (9.52%) patients, minor I/V bleed in 06 (14.28%), hydrocephalus in 07 (16.67%), subdural collection in 02 (4.76%), and motor deficit in 03 (7.15%) patients. Based on Glasgow Outcome Scale, 32 (76.2%) had GOS5/5, 7 (16.67%) with GOS 4/5, while 02 patients expired in the postoperative period. \u0000Conclusion: Intraventricular tumors require special neurosurgical consideration. Early diagnosis, better preoperative planning, and an adequate microsurgical approach are necessary to achieve maximum safe resection and improvement in patients’ symptoms and overall condition.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81494801","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}
Syed Aamir Shah, Fahmida Arab Mallah, Imran Mirbaher, Muzamil Dilbar, Ubaidullah, Muhammad Anees
Objectives: To determine the Consequences and out-turn of ozone with and without the use of peri-ganglionic infiltration of corticosteroids in lumbar spinal generative disc disease. Material and Methods: Comparative study was conducted in the Neurosurgery Department Pakistan Institute Of Medical Sciences Islamabad from December 2014 to November 2020. We included 338 patients with herniated lumbar disc with backache and radiculopathy. Randomly categorized in groups A and B. Group A was given 4 to 6 ml of intradiscal ozone along with 40 to 80 mg of peri-ganglionic methylprednisolone while group B only received 4 – 6 ml of intra-discal ozone. The visual analog scale was used to assess the degree of pain and modified Macnab criteria were used to assess the post-procedural outcome, periodic follow was carried out up to 6 months after the procedure. Results: 169 patients were enrolled in group A with 70 females and 90 males. Group B had a total of 169 patents with 89 females and 80 males. In group A, a single procedure was required in 89 patients, twice in 27, and thrice in 10 patients to completely obliterate pain. While in group B, 71 patients had the single procedure, twice in 92 and thrice in patients. Data were compared by the Chi-square test, which was further confirmed by a significant P-value of 0.061. Conclusion: The combination of percutaneous ozone chemodiscolysis along with the preganglionic injection of steroids as compared to single ozone therapy is the most effective, rapid, and long-lasting method of relieving backache and radiculopathy associated with lumbar disc herniation.
{"title":"Management and Outcome of Ozone Therapy in the Lumbar Spine Disc Disease with and without Use of Corticosteroids","authors":"Syed Aamir Shah, Fahmida Arab Mallah, Imran Mirbaher, Muzamil Dilbar, Ubaidullah, Muhammad Anees","doi":"10.36552/pjns.v26i2.695","DOIUrl":"https://doi.org/10.36552/pjns.v26i2.695","url":null,"abstract":"Objectives: To determine the Consequences and out-turn of ozone with and without the use of peri-ganglionic infiltration of corticosteroids in lumbar spinal generative disc disease. \u0000Material and Methods: Comparative study was conducted in the Neurosurgery Department Pakistan Institute Of Medical Sciences Islamabad from December 2014 to November 2020. We included 338 patients with herniated lumbar disc with backache and radiculopathy. Randomly categorized in groups A and B. Group A was given 4 to 6 ml of intradiscal ozone along with 40 to 80 mg of peri-ganglionic methylprednisolone while group B only received 4 – 6 ml of intra-discal ozone. The visual analog scale was used to assess the degree of pain and modified Macnab criteria were used to assess the post-procedural outcome, periodic follow was carried out up to 6 months after the procedure. \u0000Results: 169 patients were enrolled in group A with 70 females and 90 males. Group B had a total of 169 patents with 89 females and 80 males. In group A, a single procedure was required in 89 patients, twice in 27, and thrice in 10 patients to completely obliterate pain. While in group B, 71 patients had the single procedure, twice in 92 and thrice in patients. Data were compared by the Chi-square test, which was further confirmed by a significant P-value of 0.061. \u0000Conclusion: The combination of percutaneous ozone chemodiscolysis along with the preganglionic injection of steroids as compared to single ozone therapy is the most effective, rapid, and long-lasting method of relieving backache and radiculopathy associated with lumbar disc herniation.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73886656","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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