Spinal arteriovenous malformations: surgical outcome

Spinal arteriovenous malformations are relatively rare, being one tenth as common as cerebral AVMs and one tenth as common as primary spinal neoplasms. The aim of this retrospective study was to see distribution of this disease in spinal cord and analyse outcome of surgical treatment in our set-up. 5 patients with neurologic deficit due to spinal AVMs were operated upon from March 2000 to Feb 2005. Age ranged from 25-45 years with mean of 35 years. There were 2 females and 3 males with sex ratio of 1:1.5 respectively. Spinal AVMs were categorized as one of 4 types based on pattern of arterial and venous supply. We found that 60% [3 cases] in our series were intradural AVMs while 40% [2 cases] were dural type. We conclude that glomus variety of intradural AVMs was the commonest. The commonest presentation was acute spinal dysfunction and paraparesis. Selective spinal angiography can be negative in spinal AVMs, [20%] in our series, in which CT angiography provided clue to the feeding vessels

Outcome of patients of subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm after surgical clipping

This prospective study was done to determine the outcome of subarachnoid haemorrhage [SAH] due to ruptured anterior communicating artery [a Corn] aneurysm in 8 consecutive patients after craniotomy and clipping of the aneurysm. The study was conducted at Mayo Hospital, Lahore from September 1999 to January 2002. All patients presented with history and examination suggestive of SAH had CT scan brain as first radiological investigation. Patients of SAH were graded clinically according to Hung and Hess scale. After confirmation of diagnosis of SAH, four vessels cerebral angiography was done to localize site of aneurysm in patiens of Hunt and Hess grade I, II and III or after they improved to at least grade III. Craniotomy and clipping of aneursm was done only in patients with Hunt and Hess grade I, II and III. Maximum patients presented during 6th decade i.e., 38%. Male to female ratio was 6:2. Hunt and Hess grade I, II and III was observed in 5,2 and 1 patients respectively. Outcome was assessed according to G lasgow Outcome Scale [GOS]. Good outcome was present in 75% patients and moderate disability in 25%

Surgical outcome of multiple intracranial aneurysms

Multiple intracranial aneurysms are relatively uncommon among patients of intracranial aneurysms. The aim of management has traditionally been the same i.e. clipping of all the aneurysms to eliminate the risk of rebleed. This study was conducted to determine the outcome of patients of multiple intracranial aneurysms at Mayo Hospital Lahore, Pakistan. The study period was from September 1999 to January 2002. Four patients were diagnosed having multiple intracranial aneurysms. Age range was 40 to 65 years and 2 [50%] patients were female. Patients were assessed according to Hunt and Hess grade. Clinical presentation was favoring the site of ruptured aneurysm in one patient and CT brain was suggestive of site in two patients. All patients had 2 aneurysms. In three [75%] cases, aneurysm were unilateral and in one [25%] case, bilateral. Half [50%] patients had clipping of aneurysms through single craniotomy and half [50%] had bilateral craniotomies. Outcome was graded according to Glasgow Outcome Scale. Three [7 5%] patients had good outcome and one [25%] patient died after clipping of aneurysms due to vasospasm, infarction and metabolic disturbance

Brain death

Diagnosis of brain death has always been a difficult decision. Various countries have different diagnostic protocols and legislative requisites. With escalation in incidence of head injuries in recent decades, there will be more and more patients, on ventilatory support, with no real chance of ever regaining consciousness. Clinicians will be required to make these decisions more frequently. Probably the criteria will always be different in countries all over the world. In Pakistan we need to develop a protocol and have it cleared through the legislative process. A "Fatwa" is also needed from the Ulema in Pakistan as is also being practiced in Egypt and Saudi Arabia

Trigeminal neuralgia - microvascular decompression: a study of 25 cases

Twenty five patients with Trigeminal Neuralgia underwent Microvascular Decompression [MVD] of Trigeminal Nerve. This non destructive procedure was effective in over 80% of patients. This is not a terribly difficult procedure but it requires sufficient microsurgical skills to avoid serious complications and to have good results. Ideally all patients should have MRI with high resolution to detect lesions at the root entry zone to avoid negative explorations

Intracranial fungal granuloma: clinical presentation and management

Nine patients with Intracranial Fungal Granulomas are presented in this paper. All patients underwent surgery; six died post-operatively. We are unable to explain the high mortality. This may be due to their compromised immune status of which we could find no evidence except in one

traumatic spinal cord compression delay in the management

Spinal Cord Compression is a common neurosurgical emergency. There should not be any delays in the management of such patients. Patients suffer considerable neurological deterioration with minimal delays in the management of spinal cord compression. A review of 57 patients, suffering from spinal cord compression due to different pathological lesions is presented in this paper

Medulloblastoma clinical presentation and management

Medulloblastoma are midline tumours of childhood which constitute 15-20% of all brain tumours. They metastasize through the CSF pathways to the extracranial sites. In a study male patients did better than female patients. Results are better in patients above six years of age with smaller tumor size. Radical excision and neuraxis radiation play the main role in long survival of patients

Contributions of Abul-Qasim Zahrawi to modern neurosurgery

Abu Al-Qasim Khalaf Ibn Abbas Az-Zahrawi was pioneer and predecessor in the field of neurosurgery. He wrote a book "Kitab al-Tasrif Li-man Ajaza An-al Talif" consisting of 30 volumes. The 30th Volume includes chapters on general surgery, orthopaedic surgery and neurological surgery. He was Islam's greatest medieval surgeon, whose comprehensive medical test, combining Eastern and classical teachings shaped European surgical procedures until the renaissance. The work of Abul Qasim and the surgical teachings practiced and advocated by him do not differ a great deal from the techniques practiced in some areas of the modern day Neurosurgery. The ideas put forth by him expanded the frontiers of medicine and were Instrumental in its advancement. Thus Abul Qasim was a great Muslim surgeon and one of the forefathers and predecessor of modern day Neurosurgery