Correlation between clinical features and magnetic resonance imaging findings in patients with lumbar disc herniation

To find out the correlation of clinical features and magnetic resonance imaging [MRI] findings in determining the level of lumbar disc herniation. It was an analytic study, which was conducted in the department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, from 1st May 2002 to 1st March 2003. The total number of patients with prolapsed intervertebral disc, selected for this study was fifty. The clinical level of disc herniation was determined and was correlated with MRI findings. For data analysis, SPSS 10 soft ware was used. In 29 [58%] patients there was right sciatica, while eighteen [36%] had bilateral sciatica. Straight leg raising test was positive in 47 [94%] patients. On MRI, 48 [96%] cases had prolapsed intervertebral discs [PIVD] at L4-L5 and L5-S1 levels and 2 [4%] patients had L3-4 disc herniation. Thirty-eight patients had posterolateral disc herniation and 12 patients had central disc herniation. At L4-L5 level, the sensitivity, specificity, positive predictive value and negative predictive value of all clinical features was 92%, 96%, 95.85 and 88.46% respectively. The chi square value for L4-L5 and L5-S1 was 38.78 [P=0.000] and 22.12 [P=0.000] respectively, while for multiple level disc herniation, it was 3.42 [P=0.064]. Majority of PIVD lie in lower lumbar region. There is excellent correlation between the clinical features and MRI findings in the diagnosis of single level disc herniation but no correlation occurs in case of multiple level disc herniations

Role of cerebrospinal fluid diversion in posterior fossa tumor surgery

To assess the role of cerebrospinal fluid diversion in posterior fossa tumor surgery. Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from February 2000 to July 2002 over a period of two and-a-half years. Subjects and Clinical, radiological and operative records of the patients who were operated for posterior fossa tumors were studied. Absolute and relative frequencies of the patients who were managed with external ventricular drainage [EVD] or ventriculoperitoneal shunt [VPS] were determined. Mean age and male to female ratio were also noted. There were 48 patients who were operated for posterior fossa tumors. Mean age was 23 years. Male to female ratio was 1.2:1. VPS was done in 14 patients [29%] pre-operatively, in one patient [2%] per-operatively and in 2 patients [4%] postoperatively. EVD was done in 33 patients out of whom 2 patients were shunted post-operatively. Sixty-five% of the patients remained shunt-free. Although management of hydrocephalus secondary to posterior fossa tumors is controversial, majority of the patients need temporary cerebrospinal fluid diversion