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1.
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2015; 25 (6): 431-433
in English | IMEMR | ID: emr-165644

ABSTRACT

To determine the clinical presentations, complications and mortality in patients with Dandy-Walker Malformation [DWM] after surgery i.e., shunt with y-connector. Case series. Neurosurgery Ward, JPMC, Karachi, from January 2009 to December 2013. Cases of DWM, with associated hydrocephalus, further confirmed on CT scan of brain, were admitted through OPD. Those who were previously operated, those with other associated co-morbid or anomalies were excluded from this study. Combined drainage of the ventricular system and posterior fossa cyst, via dual shunt i.e. cystoperitoneal and ventriculoperitoneal shunt with y-connector was performed in all patients. Complications and mortality after surgical intervention in these patients were noted upto one month after surgery. The data analysis for descriptive statistics was done on SPSS version 20. In this study of 70 patients, majority of the patients were female aged between 1 - 2 years. Hydrocephalus was the predominant symptom as being present in all patients, followed by cerebellar signs in 60 [86%], and other in 5 [7.14%] patients. Complications of surgery were infection and shunt fracture dislocation in 7 [10%] each, malpositioning and shunt blockage in 6 [8.5%] each within one month of surgery, intracranial haemorrhage in 5 [7.14%] patients. Only one patient [1.42%] expired after surgical intervention. In DWM, the commonest presentation is that of hydrocephalus. Shunt malfunction and infection are the commonest complication after shunting. Dual shunt with y-connector has the lowest mortality when compared with other methods for treatment of shunt with y-connector

2.
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2015; 25 (4): 254-258
in English | IMEMR | ID: emr-191593

ABSTRACT

Objective: To evaluate the symptomatic outcome after PFD [Posterior Fossa Decompression] with duraplasty in Chiari-1 malformations. Study Design: Case series. Place and Duration of Study: Department of Neurosurgery, JPMC, Karachi, from July 2008 to September 2012. Methodology: This included 21 patients of Chiari 1 malformations admitted in department through OPD with clinical features of headache, neck pain, numbness, neurological deficit, and syringomyelia. Diagnosis was confirmed by MRI. PFD followed by C1 laminectomy with duraplasty was done in all cases and symptomatic outcome was assessed in follow-up clinic. Results: Among 21 patients, 13 were females and 8 were males. Age ranged from 18 to 40 years. All the patients had neck pain and numbness in h and s. Only 3 patients had weakness of all four limbs and 12 with weakness of h and s. Symptoms evolved over a mean of 12 months. Syringomyelia was present in all cases. All patients underwent posterior fossa decompression with duraplasty with an additional C1 laminectomy and in 2 cases C2 laminectomy was done. Syringo-subarachnoid shunt was placed in one patient and ventriculo-peritoneal shunt was placed in 2 patients. Pain was relieved in all cases. Weakness was improved in all cases and numbness was improved in 19 cases. Syringomyelia was improved in all cases. Postoperative complications included CSF leak in 2 patients and wound infection in one patient. However, there was no mortality. Conclusion: Posterior fossa decompression with duraplasty is the best treatment option for Chiari-1 malformations because of symptomatic improvement and less chances of complications. Key Words: Chiari-1 malformation. Posterior fossa decompression. Duraplasty.

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