Outcome of open transcortical approach in the management of intraventricular lesions

To evaluate the outcome of management of intraventricular lesions operated by an open transcortical [nonendoscopic] approach. Case series. Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2009 to December 2011, with six months follow-up. All cases with lesions in the lateral ventricle and anterior third ventricle operated by open transcortical approach, were included after informed consent. Total excision of the lesion was attempted in all cases. Patients were analyzed for outcome in terms of establishment of diagnosis, completeness of resection, morbidity and mortality. A total of 33 patients were operated. Twenty three were males and 10 were females. Colloid cyst was diagnosed in 14 patients [42%], giant cell astrocytoma and choroid plexus papilloma in 4 cases each and subependymoma and central neurocytoma in 2 cases each, epidermoid, choroid plexus carcinoma, oligodendroglioma, metastasis, meningioma, ependymoma and cavernous hemangioma in one patient each. The overall outcome could be labeled as good in 24 out of 33 cases [73%] and in 8 cases [24%] it was fair. One patient died due to ventriculitis and was categorized as poor outcome [3%]. Postoperative complications included meningitis, seizures, intraventicular haemorrhage, subdural collection and transient hemiparesis. Nine patients had persistent hydrocephalus requiring ventriculoperitoneal shunt. Conventional open transcortical approach is still effective in getting conclusive biopsy or near total excision of the lesion with minimum morbidity.

Contusion index: its importance in management of traumatic brain contusions

To describe the changes of Glasgow Outcome Scale [GOS] and Glasgow Coma Scale [GCS] after surgical and / or conservative management of patients with contusions based on Contusion Index [C. I.]. Descriptive Study. Department of Neurosurgery, Dow University of Health Sciences/ Civil Hospital, Karachi. Two years and five months between August 2006 and January 2009. 50 patients of ages between 6 to 75 years, including both sexes were evaluated on the basis of contusion index as determined by computerized tomographic scan [C.T. Scan] findings and their Glasgow outcome scores were established. Patients with contusion index 0-3 should be conservatively managed. Patients with contusion index 6 should be given the benefit of some sort of surgical procedure first, which showed best results with surgical management and poor results with conservative management. Patients with contusion index 9, no matter what, always show a poor outcome. We recommend that a future study should be done to arrive at a decision regarding conservative versus surgical management of patients with cerebral contusions based on Contusion Index which will help us avoid unnecessary surgeries and vice versa

Isolated non-compaction of left ventricular myocardium

Isolated non-compaction of the left ventricle is a distinct form of cardiomyopathy. It may be idiopathic or secondary to an identifiable disease. The condition usually presents with symptoms of cardiac failure. The present report is of a child with this disease who was diagnosed at birth and was relatively stable at 5 years of age