Outcome of burr-hole craniostomy for chronic subdural hematoma

OBJECTIVE: Objective of this study is to determine the outcome of Burr-hole craniostomy for chronic subdural hematoma [CSDH]

STUDY DESIGN: A descriptive study

SETTING: Department of Neurosurgery, Liaquat University Hospital, Jamshoro study period 15th September 2010 to 16th March 2012

METHODS: All patients of either gender presented with clinical and radiological evidence of CSDH and undergoing burr-hole craniostomy. The outcome evaluated by postoperative improvement of patients using Glasgow Coma Scale and Markwalder scale

RESULTS: Among 33 subjects, the mean age of the patients was 65.94 years with age ranges between 30 - 88 years with majority males [63.6%]. 57.6% had history of trauma and 66.7% presented with complain of headache. A significant improvement in the Post-Operative Markwalder grade and Glasgow coma scale [p<0.01] noticed as compare to pre-operative Markwalder grade and Glasgow coma scale

CONCLUSION: Burr hole Craniostomy with closed drainage system under local anesthesia is a good choice of treatment. In CSDH, Burr hole Craniostomy is safe and results are comparable to those of the major series of the literature as the surgical procedure is standardized

Discectomy in single level lumbar disc disease

There is a controversy regarding the treatment of lumbar disc herniation. Most of patients with lumbar disc herniation and radiculopathy improve with rest and medicine. Lumbar disc surgery gives rapid relief to the patients with severe root pain in legs. This study was conducted to see the risks and benefits of surgery in single level symptomatic lumbar disc disease. This prospective study was conducted in Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro during 2007-2009. Patients with severe leg pain, positive straight leg raising, and confirmed disc extrusion on imaging were included and conventional open discectomy was performed. Patients were followed up for one year after the surgery. Forty-five patients were operated for lumbar root pain due to a single disc. Most common disc involved was L4-5 and discectomy was performed. Recurrence of disc occurred in 4 patients. Proper selection of patients is necessary for excellent postoperative results in back surgery. Failed back surgery continues to rise with high rate of lumbar spine surgery as many patients are selected inappropriately.

Surgical outcomes of lumber discectomy in patients with and without degenerative spinal lesions

Objective: To compare the outcomes of conventional open lumbar discectomy on lumbar prolapsed intervertebral disc in relation to the presence or absence of degenerative spinal lesions

Study Design: Observational descriptive study

Patients and Methods: A total of 60 patients were included in the study having prolapsed intervertebral disc, divided into two groups. In group A, 30 patients having simple prolapsed intervertebral disc with radiculopathy with or without neurological deficit, while in group B 30 patients having prolapsed intervertebral disc and degenerative spinal lesion diagnosed on radiographs. MRI was main tool of investigation/ diagnosis in both groups. Surgical procedure hemilaminectomy and discectomy was done at the involved interspace on the appropriate side

Results: In group A, 19 patients were male and 11 patients were female while in group B, 22 patients were male and 8 patients were female. Twenty-seven patients [90%] in group A show good to excellent relief i.e. they are either completely pain free [23 patients] or had residual minor pain [4 patients], while 10% of patients shows little or no improvement. In group B, 76.6% of patients shows good to excellent improvement i.e. they are either completely pain free [19 patients] or had residual minor pain [4 patients], while only 7 patients remained either same or shows little improvement [p=0.29]

Frequency and pattern of cervical spine injuries at Liaquat university hospital Jamshoro- a retrospective study of three years

Objective: To find out the frequency and patterns of cervical spine injuries at Liaquat University Hospital Jamshoro and to compare it with other studies

Study Design: Retrospective descriptive study

Place and Duration of study: Department of Neurosurgery, Liaquat University Jamshoro, from September 2005 to August 2008

Patients and Methods: The records of 46 patients between 13-70 years age presenting with cervical spine injuries were included. After resuscitation all the patients underwent thorough neurological examination. Cervical spine X-Rays and MRI advised. The retrieved data was collected on proforma. Frequencies and percentages were calculated for categorical data, whereas mean and SD were calculated for numerical data

Results: out of 46 patients 39 were males, 7 patients were females. Mean age was 33 years [range 13-70 years]. Majority [43.37%] of patients sustained injuries due to fall from height. Six [13.64%] patients sustained C1-C2 injuries, while rest of patients had lower cervical injury between C3-T1. Radiological Studies showed vertebral body fracture with subluxation in 21 [45.6%] patients whereas only subluxation without fracture was observed in 10 [21.73%] patients. About 12 [26.08%] patients developed vertebral body fracture after injury, while 3[6.51%] patients had only neurological cord injury without any bony or ligamentous injury. About 31 [67.39%] patients sustained incomplete cord injury while 15 [32.60%] patients had complete cord injury

Conclusion: Majority of patients sustained cervical spine injuries after fall. Cervical spine injuries are common in young adult males. Subluxation associated with vertebral body fractures is the most common injury pattern

Pattern of encephaloceles: a case series

Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele [occipital, Scincipital, parietal] admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 [76%] were male and 6 [24%] female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 [80%]. All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it