Neurological improvement after cervical traction in patients with cervical spine injury

To estimate frequency of neurological improvement after cervical traction in patients with cervical spine injury. This observational study was conducted at Department of Neurosurgery, Lady Reading Hospital, Peshawar - Pakistan from December 2010 to November 2011. The medical record of all cases, in which cervical traction was applied for cervical spine injury, was checked from record room. Documentation was done according to proforma designed, indicating age, sex, neurological status before and after cervical traction and investigations with findings on X-rays, CT and MRI. The data was analyzed from different angles in SPSS software. A total of 30 patients were included in this study. There were 20 males and 10 females. The age of the patients ranged from 13 to 80 years [mean= 31.07 +/- 15.45]. Majority of the patients [83.3%] were young, in the age range of 13- 40 years. Neurological improvement was noted in 14 [46.7%] patients. It was more in age group of 13-20 years [66.7%] and in those who presented with weakness of Frankle grade "B" and "C" [66.7% each]. The improvement was more in patients in whom anatomical alignment of spine was achieved. Skeletal cervical traction is safe and effective means of early decompression of spinal cord with neurological improvement. It is more effective in young individuals and those presenting with Frankle grade B and C weakness

Experience with endoscopic third ventriculostomy in the management of hydrocephalus secondary to posterior fossa tumor

To analyze the outcome of endoscopic 3[rd] ventriculotomy in the management of hydrocephalussecondary to posterior fossa tumor. Sixty five cases of hydrocephalus secondary to posterior fossa tumor underwent endoscopic3[rd] ventriculostomy in the Department of Neurosurgery, Lady Reading Hospital, Peshawar Pakistan from January, 2011 to June, 2012 [18 months]. This was an observational study and the sampling was by simple random method. The study included 65 patients, 37 males, 28 females; M/F ratio, 1.32; with the age range 1-45 years. Fifty one percent [33 cases] of posterior fossa tumors occurred in children less than five years, 23% [15cases] in the 6-10 year age group, 16% [11 cases] occurred in 11-14 years and 10% [06 cases] in age group >14 yrs. Endoscopic third ventriculostomy was performed in 54 [83.07%] patients with successful outcome. Ventriculoperitoneal shunt was required in 5 [7.69%] patients for the suspicion of inadequate ventriculostomy. Ventricular drainage device [EVD] was inserted in 2 [3.07%] cases for hemorrhagic CSF. In 4 [6.15%] patients no drainage procedure was done [4th ventricle floor not involved / Aqueduct opening visible]. Preoperative endoscopic third ventriculostomy [ETV] control the intracranial pressure [ICP], avoid the necessity of an emergency procedure, allow appropriate scheduling of the operation for tumor removal, and eliminate the risks related to the presence of an external drainage. The most common age group involved was under 5 years. The success rate of ETV was 83% and Medulloblastoma was the most common Histopathological findings

Unilateral approach for bilateral decompression of lumbar spinal stenosis: a minimal invasive surgery

To assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression. Cross-sectional observational study. Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from January to December 2010. A total of 60 patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy [30 patients, Group A], or a unilateral approach [30 patients, Group B]. Clinical outcomes was measured using the scale of Finneson and Cooper. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months. Data was analyzed by descriptive statistics using SPSS software version 17. Adequate decompression was achieved in all patients. Compared with patients in the conventional laminectomy group, patients who received the novel procedure [unilateral approach] had a reduced mean duration of hospital stay, a faster recovery rate and majority of the patients [88.33%] had an excellent to fair operative result according to the Finneson and Cooper scale. Five major complications occurred in all patient groups, 2 patients had unintended dural rent and 2 wound dehiscence each and fifth patient had worsening of symptoms. There was no mortality in the series. The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements. An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability, as it requires only minimal muscle trauma, preservation of supraspinous/intraspinous ligament complex and spinous process, therefore, allows early mobilization. This also shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory outcome.

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

Role of anterior decompression with internal fixation in dorsal spine tuberculosis

To assess efficacy of anterior decompression and internal fixation using mesh cage and rod with screws in patients with dorsal spine tuberculosis This observational study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from July 2010 to June 2012 [2 years]. There were 38 patients with dorsal spine tuberculosis who underwent anterior decompression and fusion using anterior spinal instrumentation and allograft replacement. We included those patients in our study, who undergone anterior decompression with internal fixation for dorsal spine tuberculosis, of both genders irrespective of their age. We excluded those patients who were unfit for surgery, treated conservatively, involved spine other than dorsal spine or undergone procedure other than anterior approach for Carrie's spine. Clinical outcome of the patients was assessed using the frankle grade. The patients were observed for post-operative complications, neurological improvement and bony fusion. We had total of 38 patients who undergone the procedure in whom23 [60.5%] were males and 15 [39.5%] females with male / female ratio of 1.5: 1. Their age ranged from 4-70 years [mean 37years]. The most common level involved were between D5-D12 for which thoracotomy was needed. Preoperative neurodeficit was observed in 76.3% patients of whom 89.7% showed improvement after surgery. Our patients had 7.9% complications after surgery. We had wound infection in 5.3% and dyspnea in 2.6% cases. There were no graft related complications and bony fusion was observed in all the patients. It is concluded from our study that anterior decompression with internal fixation using cage and rod with screws is an effective procedure in dorsal spine tuberculosis. It has few complications and yields good results

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

Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group

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

Per-operative findings of blocked ventriculoperitoneal shunt: a study of 72 cases

Most patients with hydrocephalus are treated with ventriculo-peritoneal [VP] shunt placement; however, malfunction is common and is usually caused by mechanical failure. The aim of this study was to evaluate the per-operative findings accompanying presumed VP shunt malfunction. This is a descriptive study of 72 patients operated for shunt malfunction in the Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January to December 2008. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. Common presenting features were vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upper end block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2 patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shunt revision was performed in most of cases [80.6%]. The importance of clinical features cannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexus is common operative finding

Carotid body tumor: MRI appearance

A 52-year-old male presented with a painless swelling of the right side of the neck of four months duration. The clinical examination was unremarkable except for the swelling. On deep palpation pulsations were felt. Patient was referred to radiology department for ultrasonography neck on grey scale imaging there was an echogenic mass at the level of carotid bifurcation on Doppler study there was blood flow within the mass associated with displacement of the internal carotid artery due to pressure effect. Carotid body tumor was suspected and patient underwent for CT and MRI for confirmation

Neck swelling in children: an unusual presentation

Neck swelling in the children's has always been a diagnostic challenge for radiologists. A 3 year boy presented in the surgical outdoor with a painless lateral neck mass and was referred to our department for USG neck. On USG ectopic thymus was suspected. MRI was advised to confirm the ultrasound finding .MRI confirmed our ultrasound diagnosis by typical appearance of thymic tissue using different sequences. Information about this anatomic variant and of its variable clinical presentation is essential and it should be included in the differential diagnosis of neck masses, especially in children

Surgical outcome of transpedicular fixation in thoracolumber fractures

Development of transpedicular screw fixation techniques and instrumentation systems has brought short-segment instrumentation [fixation of one normal vertebra above and below an injured segment] into general clinical practice. The purpose of this study is to report the surgical outcome of thoracolumber fractures treated with short-segment pedicle instrumentation. A retrospective review of all surgically managed thoracolumbar fractures during two years was performed. The 84 surgically managed patients were instrumented by the short-segment technique. Patients charts, operation notes, preoperative and postoperative radiographs, computed tomographic scans, magnetic resonance imaging [MRI] was done. Neurological findings [Frankel functional classification], and follow-up records up to 6 months were reviewed. Transpedicular fixation was performed in 84 cases including 52 male and 32 female with male to female ratio 1.6:1. Mean +/- SD of age was 40 +/- 13.75 years [range15-60]. The level of injuries was different in different age groups. Outcome was assessed on Frankle grading. No patient showed an increase in neurological deficit. Most of the patients showed improvement to the next grade. Screw breakage occurred in 8 cases, bed sores in 16 cases and deep vein thrombosis in 3 cases. Misplaced screw in 5 cases. Eight cases got wound infection. Although long term follow-up evaluation needs to verified, the short term follow-up results suggest a favourable outcome for short-segment instrumentation

Management of chronic subdural haematoma

The objective of this study was to assess the management strategy of chronic subdural haematoma and to find out the best treatment option. The study was conducted in the Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar. Duration of study was 6 months from 1st July, to 31st December, 2004. All the cases were included. It was a prospective observational study. No patient was excluded from this study. Both the sexes and all ages were included. After relevant investigation all patients were operated by performing single/double Burr hole or craniotomy. Out come of patients was recorded. The age range of our patients was from 1 year to 90 years. There were 13 males and 4 females and ratio was 4:1. Ten [58.8%] patients had features of raised intracranial pressure in the form of headache and vomiting and nine [52.9%] patients had come with focal neurological deficit. The GCS of patients was from 13 to 15 in fifteen [29.4%] patients, from 8 to 12 in ten [58.8%] patients, and two [11.8%] patients had GCS below 8. Head injury was the cause in thirteen [76.5%] patients. Brain atrophy was seen in two [11.8%] cases and one patient [5.9%] had bleeding disorder. Subdural haematoma was unilateral in fifteen [88.2%] patients and bilateral in two [12%]. All the patients were operated upon and two burr holes were performed in the majority [59%]. Single burr hole was the other method done in five [29.4%] patients and craniotomy was done in two cases [11.8%], as the second line treatment. Respiration was done in three [17.6%] cases. Post-operative complications were recollection [17.6%], seizures [35%] and two [11.8%] had post-operative wound infection, fifteen [88.23%] patients improved after treatment and two [12%] remained static. None of them deteriorated and the mortality was nil. Burr hole aspiration can be reasonably used as a first line of treatment for chronic subdural haematoma