Transcallosal, transforaminal approach for excision of colloid cysts of third ventricle

Objective: To study the efficacy of transcallosal, transforaminal approach in excision of colloid cysts of third ventricle in terms of complete excision and post-operative complications. Study Design: Prospective observational study. Place and Duration of Study: Study was carried out in neurosurgery department of CMH Rawalpindi, from July 2009 to Jun 2014

Material and Methods: All suspected cases were subjected to CT scan and MRI of brain for diagnosis and size and site of colloid cyst. All patients having colloid cyst of anterior third ventricle irrespective of age, sex and size of the cyst were included in the study. Patients with recurrence or previous surgery were excluded from the study. Patients with psychiatric illness and abnormalities of memory were also excluded. A uniform approach in terms of position of patients, craniotomy site and flap elevation was adopted for all patients. Post operatively the complications were recorded at 2nd day and 6th week. Derangement of short and long term memory, beads stringing and touch localization were recorded on a specific proforma

Results: A total of 19 patients with colloid cyst of 3[rd] ventricle were included, thirteen were male and 6 were female patients. The most common presentation was headache and vomiting. Most frequent cyst size was 1-2 cm and was present in 57.9%, while 4 patients presented with a large cystic swelling measuring 2-3 cm. A preoperative shunt had to be inserted in two cases due to sudden deterioration of the neurological status. Most of the cases [68.4%] presented with hydrocephalus, and it was absent only in 6 cases. Complete excision was obtained in 17 cases while in 2 cases the cyst could not be removed completely. Most frequent complication on 2[nd] postoperative day was the impaired short term memory which was present in 13 patients. Beads stringing was impaired in 9 patients on 2[nd] post-operative day. On sixth post-operative week, only 2 cases had short term memory loss as improvement occurred in all complications

Conclusion: Transcallosal, transforaminal approach is an effective and safe approach for the excision of colloid cysts of anterior third ventricle. Very few complications of less severity and temporary nature are associated withthis approach

Outcome of decompressive craniectomy [DC] for severe traumatic brain injury [STBI] in adults

To evaluate the outcomes of decompressive craniectomy [DC] in adults with severe traumatic brain injury [STBI]. Observational cross-sectional. Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 [32.03 +/- 8.01] years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid [CSF] leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Favourable neurological outcome was seen in 21 patients [53.85%] where as 6 patients [15.38%] had moderate to severe disability and 3 patients [7.69%] were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale [GCS] range 6-8 had better outcome. . Overall 9 patients [23.08%] did not survive the injury and procedure. As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome

Head trauma due to earthquake October 2005 - experience of 300 cases at the combined military hospital Rawalpindi

To assess the spectrum and management of he ad injuries among earthquake victims. Case series. The study was conducted at Surgical Ward II, Combined Military Hospital, Rawalpindi, from October 2005 to December 2006. Three hundred consecutive cases of head injury, secondary to earthquake were included in the study. Plain X-rays of skulls were undertaken in clinically stable patients with head injuries. Cases with altered level of consciousness and compound depressed fractures were advised CT scan of head. Pus swabs were taken from open wounds. Proformas were maintained for every patient. Head injury was classified as mild, moderate and severe, and each patient was treated accordingly. One hundred and twenty three [41%] patients were children under 10 years of age. Adults below 55 years were 69 [23%] and above 55 years were 108 [36%]. Mean age was 32.2 years [SD + 6.7]. Female to male ratio was 1.1:1. One hundred and sixty five [55%] cases were of mild head injury, 103 [34.3%] patients had moderate head injury and 32 [10.7%] patients had severe head injury. Majority [48.7%] of patients was managed conservatively. Minor surgeries were done in 17% of patients and major surgeries were done in 34.3% of patients. Glasgow Outcome Scale assessment was made at the end of 6 months and 1 year. Mortality increased from 3.3% to 7% in one year time. Patients at the extremes of age are more vulnerable to trauma and should be given timely attention in disaster management plans. General and trauma surgeons should be well-versed with the techniques and indications of burr hole evacuation of life threatening intracranial haematomas in situations, where early evacuation is unattainable

Vascular access for haemodialysis

The aim of this study was to report our results of vascular access surgery and the factors affecting the outcome. Descriptive study with prospective data. This study was carried out at the Combined Military Hospital Rawalpindi, the Military Hospital Rawalpindi and the Armed Forces Institute of Urology form January 1997 to July 2000. Patients with end stage renal disease needing chronic haemodialysis were included in the study. The operative technique used was relatively standard. The fistula initially sited was distal in the arm for as long as possible and in an easily accessible position. Patients who received renal transplant, discontinued dialysis with a functioning shunt and patients who died were excluded form the study. The primary cumulative at one year patency Cimino AV fistula, elbow AV fistula and graft AV fistula is 66%, 70% and 37% respectively. Diabetic patients had much lower patency than non- diabetics. A distal autogenous radio-cephalic fistula should be the first choice in patients requiring chronic haemodialysis. The elbow arterio-venous fistula should he the second choice before planning a prosthetic graft

Non dysraphic intramedullary spinal cord lipoma

True intramedullary spinal cord lipomas are extremely rare. Two cases of intramedullary spinal cord lipoma are presented. The patients did not exhibit any form of spinal dysraphism. The patients presented with gait difficulty, upper limb weakness, sphincter disturbance, dysesthesias and neck pain. The tumors were removed sub-totally and the neurological grade improved postoperatively in one of the patients