experience of intracranial meningioma

Meningiomas are benign tumours of brain. Surgical removal including resection of involved bone and dura is curative in 90% of cases. However complete removal may entail unwarranted risk if the tumour involve or is adjacent to venous sinuses or neural structure. Thirty three cases of meningiomas were treated in the Department of Neurosurgery, Bolan Medical College,Quetta from 1992 to 2002. There were 5 perioperative deaths. Nineteen patients underwent complete tumour removal while in 14 patients subtotal or decompressive surgery was performed. Pre and postoperative neurological status of patients was rated accorted to Karnofsky rating scale. Six patients had karnofsky rating scale below 70 preoperatively. The average survival time with good quality of life was 8.5 years. The preoperative clinical condition, size of tumor, age and location and postoperative complications affected the overall outcome and quality of life. Four patients develop recurrence of tumor

Brachial plexus trauma: management by inter costal nerve transfer of the musculocutaneous nerve

Brachial plexus injuries are common in patients with road traffic accidents and missile injuries. Management is difficult and differs according to the level of the lesion. Intercostal nerve transfer is a well-established and effective technique for irreparable brachial plexus injuries. Thirteen cases of brachial plexus injuries were treated in the Department of Neuro Surgery, Bolan Medical College Quetta by intercostal to musculocutaneous nerve transfer, without nerve graft to obtain elbow flexion; between 1994 and 1998. The results were evaluated clinically using scale developed by Wright and used by Daniels, William and Worthingham. The overall success rate with motor functions of grade 4 or more was obtained in 65 percent of the patients. Factors contributing towards good results were early operation [less than 5 months after trauma], use of 3 intercostal nerves, mixed nerve to mixed nerve anastomosis, nerve repair without graft or tension and shoulder stability

Acute extradural hematoma analysis-factors influencing the outcome of patients undergoinm surgery in coma

Mortality due to extradural hematoma is virtually restricted to patients who undergo surgery while in coma. We have analysed the factors influencing the outcome of 24 patients who underwent evacuation of extradural clot when brought in comatose state. The study was conducted at Sandeman Provincial Hospital, Quetta from December 1994 to October 1996. The study was conducted randomly. Out of 24 patients, 10 patients [42 percent] made a good functional recovery, 7 patients [29 percent] died while 7 were moderately/severely disabled [29 percent]. The factors which affected the overall results were mechanism of trauma, age of patient, interval between trauma and surgery, Glasgow coma score at operation, associated intracranial lesions and hematoma volume etc. The duration of postoperative coma also affected the final outcome. The mortality rate was significantly higher in patients who were operated later than 12 hours [43 percent] than in patients operated on within 6 hours of injury [10 percent]. This study attempts to indentify factors responsible for higher mortality and morbidity in patients with extradural hematoma

Hypoglossal-facial nerve anastomosis in management of facial nerve injuries

Eleven cases of permanently injured facial nerve were admitted in our department during a period of two years from January 1996 to 1998. There were nine males and two female patients. The age ranged between 22-62 years. Hypoglossal-facial anastomosis has been the procedure of choice in the repair of permanently injured facial nerve in cases such as fracture of petrous bone, after mastoidectomy and CP angle tumours. Though the series is small, but the failures are few and complications rare. Most results are good to excellent