Epidemiology of spinal injuries

One year study was conducted at Lahore General Hospital. A total of 173 patients were admitted. Eighty eight [51%] were from small towns and villages and eighty five [48.9%] were from major cities. Majority of patients [41%h] were between 21 to 40 years of age more men [69.7%] were admitted with spinal injuries than women [30.2%] most of them [39.5%] were from area between 11 to 40 miles around the Lahore General hospital Lahore. Commonest level of injury was cervical region [58.9%] maximum number of injuries [45.7%] were due to road traffic accident. Causative agent in twenty two [12.5%] patients was the firearm injuries. Agriculture related accidents were responsible in their three [19%] patients. Among all the 173 patients electric shock was responsible in four [2.3%] cases. Associated injuries were present in nineteen [10.4%] patients. Twenty one [12.5%] patients died during their stay in hospital. Spinal injury is one of the grave neurosurgical emergencies. It is because it involves young men who are usually the sole bread earners of their families. It has a poor prognosis and its incidence can be reduced by raising safety standards at work places and roads

Spinal tuberculosis easy to diagnose; difficult to manage

The author reviewed 60 cases of spinal tuberculosis treated from Jan 1993 to Jan 1995 at Lahore General Hospital, Clinical findings included back pain in 47[79%] paraparesis in 40[66%] and Kyphosis in 31[52%] patients, less common features included fever, sensory disturbance and sphincter dysfunctions. Predominant vertebral body involvement was present in 26 [43%] and marked bone collapse in 11 [18%] patients. Intraspinal granulomatous tissue causing neurological dysfunction in the absence of bone destruction was seen in 33[55%] cases. All 60 patients received antituberculous medications. Laminectomy and debridement of extra granulomatous tissue or abscess drainage was done in 43 [71%] patients, laminectomy and bracing in 8.3%, biopsy followed by bracing in 11.6% and bracing only in 3.3%. We didn't perform internal stabilization in any of our patients. An average follow-up time of 6 months course of antituberculous therapy [ATT] shorter than six months were invariably associated with disease recurrence. It is suggested that any young female from poor social background with backache and positive family history of tuberculosis should be examined and investigated fully for tuberculous spine and managed with appropriately selected treatment modality and compliance of the patient. Satisfactory outcome can be obtained in majority of patients

Stereotactic management of colloid cysts of 3rd ventricle

Stereotactic aspiration is a valuable surgical alternative for colloid cysts. From Oct 1994 to Oct 1995, 5 patients had computerized tomography-guided Stereotactic removal of colloid, cysts. Leksell CT compatible stereotactic frame was used with complete removal in 2 and partial removal in 3 cases. Volume of colloid material removed ranged from 3-6 ml. Average time spent in hospital was 7 days. No mortality and minimal morbidity was seen. There is no evidence of recurrence in average follow up of 8 months. Stereotactic removal of colloid cysts is safe and provides a new option for management of colloid cysts

Sterotactic biopsy of brain tumours

Computerized tomography assisted Stereotactic biopsy technique using Leksell stereotactic frame was performed on 27 patients with small, multiple and deep seated brain tumours. There were 19 men and 8 women with an age range from 17 to 65 years. Histological diagnosis of 18 glial tumours, 9 non-glial tumours [5 colloid cysts, 4 metastatic lesions] was obtained. There was no mortality and minimal morbidity of 3.7%, histological diagnosis provided the information regarding differentiation from infectious and vascular lesions and grading of malignancy leading to logical guidance for therapeutic management of each lesion, confirming the value of stereotactic biopsy in brain tumours

Acoustic neurinoma surgery; can facial nerve be saved?

In a prospective study at Lahore general and Nishter hospital Multan thirty five cases of acoustic neurinoma were treated over 5 years. Duration of symptoms was between 3 months to 2 years. At presentation 20 patients had involvement of facial nerve. This involvement was of lower motor neurone type. Radiological investigations performed were CT scan in 29 cases and MR in 6 cases. Twenty five patients had Tumour bigger than 5 cm. There was no patient with tumour smaller than 3 cm. The cases were operated upon in parkbench position. Retrosigmoid subocciptal craniectomy was done and tumour was dissected under magnification by operative microscope. Preoperatively it was not possible to identify the nerve in 20 and it was anatomically preserved but deformed [flattened and very flimsy] in 14 patients and normal looking facial nerve was seen in 1 patient only. Postoperatively there was complete nerve deficit which did not improve after 4 years of follow-up

Epidemiology of paediatric head injury

Objective of the study was to identify the magnitude of the problem to find out the factors leading to and to formulate recommendations which can help to reduce the incidence of head injuries. Prospective study at Lahore general hospital was conducted from January to December 1995. There were 1769 paediatric patients admitted during one year. Among these 1120 [63.3%] were boys and 549 [36.7%] girls. Maximum patients [1044 or 59%] were between 6 to 10 years of age. Fall from height was the commonest [1238 or 70%] cause, followed by road traffic accident in 531[30%] and firearm injury in 11 [0.62%] patients. There were 350 [19.8%] patients with severe, 531 [30%] with moderate and 888 [50.2%] with mild head injury. Eight hundred and eighty four [50%] patients did not receive any prehospital treatment, 531 [30%] were seen by general practitioners. 177 [10%] were initially treated at district level hospital and 177 [10%] cases were received from teaching hospitals. We conclude that most of the head injuries are minor and occur due to fall from height. Children are more prone to injuries between 6 to 10 years of age. Most of the head injuries in children do not need operative managements. Families with better social class bring their children with minor head injuries to the hospital. Public education for child supervision and parenthood training can help to reduce the incidence of paediatric head injury