Intracranial tuberculomas: presenting symptoms and outcome with anti tuberculosis drugs treatment

Background: Tuberculosis is still common in developing countries, and sometimes involves central nervous system, proper diagnosis and early treatment effectively reduces the mortality and morbidity associated with this disease

Objective: Observe presenting symptoms and outcome on anti-tuberculosis drug treatment

Material and Methods: This prospective study was conducted in the Department of Neurosurgery in collaboration with Department of Pathology, Ayub Teaching Hospital Abbottabad from March 2010 to December 2016. 22 patients; 8 females and 14 males were studied for their signs and symptoms and outcome after anti-tuberculosis drug treatment

Results: The most common location of tuberculous lesions was supratentorium [81%] particularly in parietal lobe [50%] followed by frontal lobe [22.7%] and occipital lobe [18.2%]. 45% patients had prior history of tuberculosis. Headache was the predominant complaint [72.7%] followed by altered sensorium [31%], seizures [27.3%] and cranial nerve palsies [22.7%]. After 12 months of anti-tuberculosis treatment ATT, about 87% of patients had either resolved or regressed tuberculoma

Conclusion: Brain tuberculomas are benign lesions with" malignant" behavior. Early diagnosis and anti-tuberculosis drug treatment can effectively treat this lesion forever. So in developing countries like Pakistan, when there is cystic, nodular or multiple lesions, there should be suspicion for brain tuberculoma and work up should be done because of very good prognosis associated with anti-tuberculosis drug treatment

Transnasal endoscopic repair if cerebrospinal fluid rhinorrhoea

Background: Cerebrospinal fluid [CSF] leaks can arise as a complication of trauma, hydrocephalus, endoscopic sinus surgery or it may occur spontaneously without any identifiable cause. Surgical repair is recommended in patients who do not respond to the conservative management. In recent years transnasal endoscopic approach has become the preferred method for repairing the CSF leaks and better outcomes have been reported as compared to the intracranial approaches that were previously used. Objective of this study was to analyse the outcome of transnasal endoscopic repairof CSF rhinorrhoea. Methods: This prospective study was conducted in the Department of Neurosurgery, Ayub Medical College, Abbottabad, from March 2007 to March 2010. Twenty-one patients with CSF rhinorrhoea were included in study that were diagnosed on the basis of clinical evaluation, glucose concentration of nasal discharge, computed tomography [CT] and magnetic resonance imaging [MRI]. These patients did not respond to conservative management and were operated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9 months and the outcome was analysed. Results: The patients included in the study ranged in the age group of 12–55 years. Among the patients 13 [57%] were female and 8 [38%] were males. The cause of CSF rhinorrhoea was traumatic in 16 [76.19%], Idiopathic or spontaneous in 4 [19.04%] and 1 [4.7%] case was related to endoscopic surgery for pituitary macroedenoma. In 10 [47.6.8%] patients the site of leak was cribriform plate, 5 [23.8%] had from sphenoid, 4 [19.04%] from frontal sinus and in 2 [9.5%] Ethmoid was affected. Primary surgery was successful in 17 [80.95%] of cases. In 2 [9.5%] cases re-exploration had to be performed. In 1 patient re-exploration had to be done for the third time. Overall success rate was 95%. One patient presented with CSF leak and meningitis 1 month after surgery and unfortunately died. Conclusion: Transnasal endoscopic repair of CSF rhinorrhoea is highly successful, safe and less traumatic. Keywords: Transnasal endoscopic repair, CSF Rhinorrhoea, CSF leak, transnasal endoscopic duroplasty

Types of brain tumors in hazara division and northern areas of Pakistan

Background: Early diagnosis and management of brain tumors is important to reduce morbidity and mortality. The objective of this study was to calculate frequency of different types of brain tumors in patients operated and managed at Ayub Teaching Hospital, Abbottabad

Methods: This study was carried out at Neurosurgical Department of Ayub Teaching hospital, Abbottabad from September 1999 to October 2003. Records of patients who consented for surgery after CT scan evidence of brain tumors, which were proved on biopsy later on, were included in the study. The tissue biopsy was taken by open craniotomy or by computerized stereotactic method. Pattern of different brain tumors was studied during this period

Results: Our study revealed predominantly tumors arising from neuroepithelium [49.2%] while tumors arising from meninges were relatively low [23.3%]. Nerve sheath tumors [4.2%], germ cell tumors, mal-developmental origin [2.5%], blood vessel tumors [5.8%] and miscellaneous tumors [6.6%] were found relatively in a very low frequency

Conclusion: Evaluation of brain tumor frequency will help in future management plan that may be in the form of open craniotomy, stereo tactic radiosurgery, whole brain radiotherapy or gamma knife surgery