Efficacy of endoscopic third ventriculostomy in non-communicating hydrocephalus.

BACKGROUND: Hydrocephalus is common problem requiring either extra-cranial (shunts) or intracranial (ventriculostomy) diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of non-communicating hydrocephalus. METHODS: This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2nd February 2011 to 1st march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. RESULTS: A total of 171 patients with non-communicating hydrocephalous were included in the study. Out of 171 patients, there were 104 (60.8%) males and 67 (39.2%) females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 (78.4%) patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. CONCLUSION: Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Ventriculoperitoneal shunt blockage.

BACKGROUND: Hydrocephalus is the abnormal accumulation of cerebrospinal fluid within the ventricles and subarachnoid spaces, resulting in increased intracranial pressure. The treatment of choice is placement of ventriculoperitoneal shunt. Ventriculoperitoneal shunt blockage is not an uncommon complication. Objective of the study was to find out the frequency, causes and site of ventriculoperitoneal blockage and to compare it with other studies. METHODS: This case series study was conducted at Department of Neurosurgery Liaquat University Hospital, Jamshoro, from April 2008 to March 2012. The records of 53 patients between 40 days to 45 years age presenting with blocked ventriculoperitoneal shunt were included. All the patients underwent thorough clinical examination and radiological investigations, and shunt revision done. The retrieved data was collected on proforma. Frequencies and percentages were calculated for categorical data. RESULTS: Out of 53 patients 28 were males, 25 patients were females. Age of patients ranged from 40 days to 45 years. Time interval between the ventriculo-peritoneal shunt placement and blockage of shunt ranged from 2 weeks to 9 years. Out of 53 patients, 32 (69.37%) patients had obstruction at distal catheter, whereas 21 (39.62%) patients had ventricular catheter blockage. CONCLUSION: Ventriculo-peritoneal shunt blockage is one of the most common complications of shunt placement procedure. In this study most of the patients (69.37%) had distal catheter obstruction. Majority (35.84%) of the patients presented with shunt obstruction within one year of shunt placement. Shunt obstruction is common in children less than 3 years age.

Cervical spinal injuries in moderate to severe head injuries.

BACKGROUND: Traumatic Brain Injury (TBI) is the leading cause of death in all age group. The incidence of CSI increases with the severity of TBI so prompt care of cervical spine is necessary in all patients with moderate to severe head injury. The objective of this study was to determine the frequency of cervical injury in patients with moderate to severe head injury and different types of trauma. METHODS: This descriptive cross sectional study was conducted in department of Neurosurgery Ayub Medical College, Abbottabad from October 2011 to October 2012. A total of 369 patients were included in this study by consecutive (non probability) sampling. All patients were subjected to X-rays and CT-Scan of the skull for evaluation of head injury. X-rays and CT scan with MRI of cervical spine were done for evaluation of cervical spinal injury. RESULTS: A total of 369 patients were included in our study, out of which 276 (74.8%) were males and 93 (25.2%) were females. Age of the patients ranged from 3-90) years with mean of 31.93 +/- 21.35. Among these patients most common cause of injury was fall 196 (53.1%), whereas the RTA was 159 (43.1%) and assault was 14 (3.8%). Out of the 369 patients 42 (11.3%) were found to have cervical spinal injuries. CONCLUSION: The frequency of cervical injury associated with moderate to severe head injury remains the same in all over the world with minor difference in percentages; that we have observed in our study. Furthermore, we have observed that cervical injury is directly proportional to the severity of head injury. All the head injured patients should be suspected of having cervical spinal injury unless proved otherwise.

Management of thoracolumbar spine injuries at a tertiary care hospital.

BACKGROUND: The purpose of descriptive case series study was to see the conservative and surgical outcome in respect of neurological improvement, sphincter functions and early ambulation in cases of traumatic thoracolumbar injuries in a tertiary care hospital. METHODS: This was a hospital based prospective study comprised of 50 thoracolumbar injury cases registered during the period of 1 year from September 2005 to September 2006. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using Frankle grades. Operative and postoperative record with x-rays and MRI were maintained. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. RESULTS: A total of 50 cases were registered, 43 (86%) were males and 7 (14%) were females. Fall was the most common cause of injury (92%). The most common level involved was L1 (46%). The 2nd common site of injury was T12 (12%). The treatment given was conservative in 42.55%, and surgery was performed on 57.44%. Three (6.38%) patients were left against medical advice. CONCLUSION: Thoracolumbar injuries occur in young population and creates socio-economic burden to the society. Patients with partial neurological deficit benefit from surgery.

Outcome of intramedullary spinal cord tumours: experience with 18 patients operated at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Intramedullary spinal cord tumours (IMSCT) are among the uncommon lesions at spinal cord. They can present with a vast array of symptoms and cause severe neurological deficits. With advent and frequent use of MRI more and more patients with IMSCT are picked up. By using modern microsurgical techniques better surgical outcome is achieved. The Objective was to analyse the surgical outcome of the patients with intramedullary Spinal Tumour operated at Ayub Teaching Hospital (ATH). Abbottabad. METHODS: Eighteen patients with IMSCT who presented at Neurosurgery Unit. ATH. Abbottabad during 2000-2010 were included in this study. Patients were diagnosed on the basis of MRI. They were operated using standard microsurgical techniques. Patients were followed up for a mean duration of 18 months after surgery and their preoperative and postoperative neurological status was analysed. RESULTS: Patients with age group ranging from 15-50 (37.72 +/- 8.94) years with IMSCT were operated. Sixty-one percent of the patients were male and 39% were female. The region most commonly affected was cervical (44%) followed by conus medullaris (33%), cervicothoracic and thoracic each had frequency of 11%. Gross total removal (> 95%) was possible in 72% of cases while in rest of 28% cases resection of 80-95% was possible. Histologically 38.9% of the lesions were ependymomas, 27.8% were astrocytomas and 22.2% were teratomas. Neurofibromas and Primitive Neuroectodermal Tumours (PNET) each accounted for 5.5% of the cases. Overall postoperative neurology improved in 10 (55%) of patients, remained unchanged in 5 (27%) of cases, and deteriorated in 3 (16%) patients. One patient was lost in follow-up. Surgery on tumours in cervical and thoracic region carried a relatively poor outcome as compared to the lesion of conus. There were no deaths due to surgery. CONCLUSION: Surgical removal of IMSCT is beneficial to patients with acceptable surgical risk. Better outcome is expected if the patients with good Frankel grade are diagnosed and operated early the course of disease.

Outcome of cervical disectomy and fusion with stabilization in single level cervical disc.

BACKGROUND: Cervical radiculopathy is a common and distressing problem. Only those patients who failed conservative treatment should undergo surgery. The anterior cervical disectomy is the procedure which offers maximal exposure of the disc space. It easily removes the portion of disc which compresses the nerve root. Possibility of developing late kyphosis from disc space collapse supported the fusion procedure after single level disectomy. The goal of instrumentation is to provide immediate stability, increase fusion rate, prevent graft failure, improve rehabilitation process and possibly no need for external orthosis. Objective of study was To see the results and complications of cervical disectomy thru anterior approach and fusion and stabilisation with titanium made plate. METHODS: This was a prospective study, comprised of 32 patients admitted during period from 2005-2008. Patients presented with radiculopathy or radiculo-myelopathy were evaluated. MRI was carried out in all the cases. Each patient was carefully evaluated to confirm clinico-radiological correlation and patients with significant disc and failure of conservative treatment were included in the study. RESULTS: Males were 28 (87.5%) and female were 4 (12.5%). Twenty patients (62.5%) were in fourth decade. C5-6 was involved in 18 (56.25%) patients. No significant postoperative complications noted. Persistent neck and back pain noted in patients in disectomy group without plating. CONCLUSION: Anterior cervical disectomy, fusion and stabilisation with plating is a safe and easy procedure in single level cervical disc disease without significant complications.

Pattern of encephaloceles: a case series.

UNLABELLED: Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. METHODS: The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele (occipital, Scincipital, parietal) admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. RESULTS: 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 (76%) were male and 6 (24%) female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 (80%). All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. CONCLUSION: Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it.

Anterior decompression, fusion and plating in cervical spine injury: our early experience.

OBJECTIVE: To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. The Descriptive case series study was conducted at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh Pakistan during year 2005 to 2007. METHODS: Patients with cervical spine injuries were admitted during study period were included in this study. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using ASIA impairment scale. Cervical traction was applied to all patients. Operative and post operative record with x-rays and MRI were maintained. Patients with Injury to C3-6 underwent decompression, fusion and local titanium plate implant fixation by anterior approach. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. RESULTS: 37 cases of sub axial cervical spine injuries included in this study during year 2005 to 2007. Out of these, 28 (75.67%) were males and 9 (24.32%) females. Age range was 8-60 years mean (32-40%). Common mode of injury was fall. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. No immediate complication found except temporary dysphagia. CONCLUSION: Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological and radiological outcome.