Imminent pathology in microvascular decompression for idiopathic trigeminal neuralgia

Objective: to know about the impending pathology in microvascular decompression for idiopathic trigeminal neuralgia

Methodology: this was a prospective observational study conducted in the Department of Neurosurgery, Lady Reading Hospital Peshawar, from 20[th] August 2012 to 25[th] august 2013. The clinical and the operative records of the patients were noted and demographics such as the age, sex, side of the lesion as well as the per-operative impending pathology i.e. compression by an artery, vein or distortion by adhesions or a combination of them compressing upon the trigeminal nerve root was recorded on a predesigned proforma. All patients undergoing surgery for idiopathic trigeminal Neuralgia were included in the study. Patients who had trigeminal neuralgia secondary to a mass lesion were excluded from the study. The data was expressed in percentages and was analyzed through SPSS version 16

Results: total of 55 patients in the study period fulfilled the criteria. There were 28 males and 27 females with a male to female ratio approaching 1:1. The age range was from 28 to 73 years with a mean age of 54.6 years. In 56.4% the pathology was right sided and in 34.5% it was left sided while in 9.1% it was bilateral [operated unilateral at the time]. The impending pathology was compression by an artery in 76.6%, by a vein in 21.6% or purely by adhesions in 1.6% of cases

Conclusion: compression by an artery is the most common pathology en-countered in the microvascular decompression for trigeminal neuralgia

Spectrum of intramedullary spinal cord tumours: case series of 30 patients

Objective: to assess the frequency of intramedullary spinal cord tumours based on clinical and histological features

Materials and methods: this descriptive study was performed at the Department of Neurosurgery Lady Reading Hospital Peshawar, from 20[th] Jan 2003 to 19[th] Jan 2009. Treatment charts of patients with spinal tumours were reviewed and patients operated for spinal tumours were identified. A total of 30 patients out of 480 cases of spinal tumours with different intramedullary spinal tumours were considered in this study. Their frequency, clinical features, and histological reports were analyzed in different aspects

Results: there were total of 30 patients with mean age of 36 years and a wide range beginning as young as 6years. Seventeen patients [56%] were male and 13[43%] were female. Common presenting complaints were loss of sensation in 24 patients [80%], paresis in 20 patients [66%], altered sensation in 12 patients [40%], back pain 11 patients [36%] and sphincteric disturbances 9 patients [30%]. MRI spine was the main diagnostic tool and was done in 30 [100%] cases. Cervical spine was involved in 12 patients [40%], cervicothoracic 6 patients [20%], thoracic 10 patients [32%], conus 2 patients [08%]. Ependymoma was the most common intramedullary spinal cord tumour 20 patients [60%], while 07 [21%] patients had astrocytoma and 03[09%] had haemangioblastoma. We had follow up of 1 year with follow up visit after every 3 months. Superficial wound infection in 2 [6.66%] patients, CSF leak in 3[10%] cases.Worsening of neurodeficit in 3[10%] patients

Conclusion: ependymoma and astrocytoma constituted majority of cases. Intramedullary spinal cord tumours peak during 3[rd] to 4[th] decade of life

Endoscopic third venfri'cufosfomy for obstructive hydrocephalus

To determine the success rate of endoscopic third ventriculostomy [ETV] for treating obstructive hydrocephalus. Cross-sectional observational study. The Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from May 2010 to November 2011. Patients with Obstructive hydrocephalus due to aqueductal stenosis, tectal and non-tectal tumour and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. Patients with congenital hydrocephalus and secondary to meningitis were excluded. Endoscopic third ventriculostomy was performed. Success, complications and mortality was noted. Data was analyzed by descriptive statistics using SPSS software version 17. There were 155 patients including 72 males and 83 females with ratio of 1: 1.33. Success rate was 71%. Indication of surgery was obstructive hydrocephalus due to aqueductal stenosis, posterior fossa tumour, brain stem and CP angle tumour. Complications were seen in 18 patients including mortality in 3 patients. ETV is effective, safe and successful procedure in patients with obstructive hydrocephalus. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients

Level of spinal involvement in patients operated for spinal tuberculosis

To determine the frequency of different levels of spinal involvement in patients operated for spinal tuberculosis. This observational study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from January 2008 to December 2010. In this study medical record of all patients operated for spinal tuberculosis were analyzed. The frequency of different spinal levels involved was determined. Patients were divided into five groups based on the involvement of different vertebral level i.e. cervical, upper dorsal, lower dorsal lumbar and sacral. Data stratified regarding age, sex and locality. Results were analyzed and presented in the form of tables, bar and pie charts by using SPSS software version 11 for analysis. A total of 81 patients with spinal tuberculosis were operated during this period. Their age ranged from 13 to 65 years. Patients presented with male to female ratio of 1.25 to 1. Per-operatively majority of the patients [i.e., 49.38%] had involvement of lower dorsal spine [D7 to D12], while 19.75% had involved cervical vertebrae, 22.22% involved upper dorsal spine that is from D1 to D6 while only 8% had lumbar vertebrae involved. Most of the patients had multilevel involvement, which is 70.37%. This study shows that most of the patients with spinal tuberculosis involve lower dorsal spine while lumbar area in very little and no sacral area involvement. We found that most of the time it was multiple level involvement rather than single vertebrae

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

Histological findings of posterior fossa tumors in children

To find out different histopathological types of posterior fossa tumors in children. This Descriptive study was carried out in Department of Neuro surgery Govt. Lady Reading Hospital Peshawar from June 2003 to May 2008, All patients with posterior fossa tumors under 14 years were included in the study. Patient with brainstem glioma, posterior fossa abscesses and pineal tumors were excluded. A total of 117 patients were included. There were 80 male and 37 female with sex ratio of 2.1:1 with age range from 6 months to 14 years with mean age of 8.9 years and SD + 5.4. Computerized Axial Tomography / Magnetic Resonance Imaging of the brain were done for establishing diagnosis. Different surgical procedures for tumor removal were performed and specimen was sent for histopathological study in all operative cases. Out of 117 patients Medulloblastoma was seen in 38 [32.7%], Ependymoma in 23 [19.65%] Astrocystoma in 25 [21.36%], Hemangioblastoma in 19 [16.23%] Tuberculoma in 4 [3.41%] Meningioma in 2 [1.7%] and dermoid and epidermoid cyst in 3 cases each [2.56%]. Medulloblastoma was seen commonly between 6-10 years in 22 [18.8%] patients. Astrocystoma between 6 -10 years in 12[10.25%] patients. Ependymoma is common below 5 years in 17[14.5%] patients. Hemangioblastoma between 6-10 years in 15 [12.82%] patients, tuberculoma in 3[2.56%] patients in 6 -10 years of age. Medulloblastoma and Pilocytic Astrocystoma and Hemangioblastoma are common tumors between 6-10 years of age and Ependymoma is common below 5 years. Tuberculoma is also tumor mimicking condition occurring in posterior fossa