Endoscopic third ventriculostomy [ETV]; outcome

To know the surgical outcome of endoscopic third ventriculostomy [ETV] in non communicating hydrocephalous. This study was conducted in Abaseen Hospital, Peshawar, from 13th December 2010 to 12th October 2011. Patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients with communicated hydrocephalous, patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous was diagnosed on CT scan brain. The procedure was done under general anesthesia. Clinical Outcome of ETV was evaluated by the time of discharge and on subsequent follow up visits i.e. monthly for the first three months and then at six months. Any patient who subsequently needed VP shunting after the ETV procedure was described as having treatment failure. We operated 27 patients during our study period. Age ranged from 2 years to 57 years with mean age 20.8 years. There were 16[59.26%] males and 11[40.74%] females. Etiologically, 4th ventricular tumors was present in 9 patients [33.33%], tuberculous meningitis in 8[29.62%], aquiductal stenosis in 7[25.92%], brain stem glioma in 1[3.70%]. cerebellar haemengioblastoma in 1[3.70%] and pineal tumor [3.70%] with infra tentorial extension in 1 [3.70%] patient. The procedure was successful in 24[88.89%] patients and converted to ventriculoperitoneal shunts in 3[11.11%] cases. Post operatively CSF leakage was present in 2 [7.40%] patients, transient memory loss in 1[3.70%], pneumocephalus in 1[3.70%] and pseudomeningocele in 1[3.70%] patients. Endoscopic third ventriculostomy is a good alternative to the VP shunt in cases of non-communicating hydrocephalous. Although ETV does have some complications but these are transient and can be minimized with proper patient selection and meticulous surgical technique

Clinical manifestation of cervical neurofibroma type 1 in patients of a tertiary care hospital

To determine the clinical presentation of cervical neurofibroma type 1 [NF 1] tertiary care hospital. This descriptive study was conducted at Neurosurgery department, Lady Reading Hospital Peshawar from February 2001 to July 2011. A total 31 patients with symptomatic cervical spineneurofibromas who underwent surgical decompression and tumor resection were included in this study. Both gender [male and female] and patients in the age range of 20-70 years were included in this study. The patients' demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11. Out of 31 patients, there were 17 [54.8%] males and 14 [45.2%] females. The age of patients ranged from 20 to 70 years. In this study the overall mean age was 32.38 years. Majority of patients fifteen [48.38%] were in the age range of 31-40 years. Most common clinical presentation of patient was quadrapresis in seventeen [54.8%] patients. Cervical neurofibroma type 1 commonly occurred in the third decade of life. Quadriparesis was the common clinical presentation of cervical cord neurofibroma type 1

Management of brain abscesses

To find the etiology and outcome of treatment of brain abscesses. Descriptive case series. Department of Neurosurgery, Hayatabad Medical complex Peshawar, from October 2008 to January 2010. This study was carried out on patients of brain abscesses of all ages and both genders. Patients having fungal brain abscess, amoebic brain abscess and tuberculous brain abscess were excluded. Brain abscess was diagnosed on contrast CT scan. Cases of early cerebritis were treated using parenteral antibiotics for six to eight weeks. Surgical treatment consisted of either burr hole aspiration with the help of brain cannula, re-aspiration or craniotomy and excision of abscess capsule. Therapeutic outcome was assessed with CT scan on follow up. Procedure related complications and mortality were also recorded. A total of 73 patients were managed. The commonest age group was from 11-20 year. The mean age was 26.36 +/- 14.1 year [range - 0.16 - 67 year]. There were 46 [63.01%] male and 27 [36.99%] female patients. The majority of brain abscesses were supratentorial [n=65 - 89.04%]. In 8 [11.96%] cases abscess was in infratentorial region. Contiguous focus of infection was responsible for brain abscess in 29 [39.72%] patients, Majority of patients presented with headache [n=30 - 41.09%] and vomiting [n=25 - 34.24%]. Surgical drainage was performed in 70 [95.89%] patients where as 3 [4.11%] patients were treated conservatively. Initially only burr hole aspiration was done in all surgically treated patients. In 60 [85.71%] patients there was complete resolution. Craniotomy was done in 4 [5.71%] cases. There was no mortality in this study. Sixty one [87.14%] patients recovered without complications. Majority of the cases needed surgical intervention. Burr hole aspiration was effective initial surgical treatment. Cases of early cerebritis successfully managed with broad spectrum antibiotics