Intracranial cystic meningiomas: A rare type of tumours.

INTRODUCTION: Intracranial cystic meningiomas are rare and preoperative diagnosis is difficult. The present study was performed to assess the clinical and radiological outcome of intracranial cystic meningiomas. METHODS: We performed a retrospective analysis of 13 patients (mean age: 49.9 years) who underwent surgical resection of intracranial cystic meningiomas from January 2006 to February 2014. There were 5 male and 8 female patients. The Glasgow Outcome Scale was used to assess the clinical outcome at 6 months. RESULTS: Headache was the main presenting clinical feature. Most of the tumours were located on the right side. The frontal convexity was the most common site. Gross total resection was performed in 10 patients. The most common histopathological type was meningothelial variety. CONCLUSION: Intracranial cystic meningiomas are usually benign that occur in relatively young patients. Resection of cysts that show contrast enhancement is essential to reduce recurrence.

Infection in compound depressed fracture of the skull.

OBJECTIVE: To find out the association of wound infection with dural tear, free bone fragments and late presentation in patients operated for compound depressed fracture of the skull. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted in the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad from January 2002 to December 2002. SUBJECTS AND METHODS: There were 56 patients with compound depressed fracture of the skull, who were operated in the department. Their clinical, radiological and operative findings were studied. The postoperative condition of the wound was noted. The patients were followed up for six months. All of them were given antibiotics. The mode of trauma, time of arrival and site of fracture were noted. The mean age, male to female ratio and rate of postoperative wound infection were determined. RESULTS: Among the 56 patients operated for compound depressed fracture, there were 30 adults and 26 children. Male to female ratio was 4.6:1. Mean age was 21.7 years. Major mode of trauma in children was fall, while most of the adult patients presented with history of assault and RTA. There were 71.42% fractures in frontal and parietal regions. Three patients (5.35%) got wound infection postoperatively. CONCLUSION: Dural tear, free bone fragments and late presentation (more than 8 hours after trauma) were the important risk factors. Early surgery and proper debridement with antibiotic cover play an important role in reducing the rate of wound infection.

Role of fixateur interne in thoracolumbar junction injuries.

OBJECTIVE: To evaluate the use of fixateur interne in thoracolumbar junction injuries. DESIGN: An interventional descriptive study. PLACE AND DURATION OF STUDY: This study was conducted in the Department of Neurosurgery, PIMS from September 1996 to September 2001. PATIENTS AND METHODS: Seventy-nine patients with posttraumatic instability of lower thoracic or upper lumbar spine were surgically managed. Frankel grading was used to determine the neurological status of the patients. White and Panjabi criteria was used to determine the instability of the spine. All the patients with unstable spine undergoing surgery were included in the study. Open reduction and internal fixation using fixateur interne was done in all the cases. Changes in neurological status and complications were noted postoperatively and on subsequent follow-ups. RESULTS: Most of the patients undergoing surgery were young. The commonest mode of trauma was due to fall in 59 patients. None deteriorated postoperatively. Initially, there were only 19 patients in Frankel E whereas at 1-year follow-up, there were 27 patients in Frankel E. On an average, there was 0.9 Frankel improvement. Average blood loss in an operation was 250 ml, average time for operation was 70 minutes and the average postoperative hospital stay was 7.9 days. There were 02 (2.5%) implant failures and their implants were removed. There were 02 (2.5%) cases of wound infection. The hardware was removed in one patient while in the other, the infection was controlled with antibiotics and wound debridement alone. CONCLUSION: Fixateur interne may be useful choice for achieving reduction and stability in most thoracolumbar injuries for early ambulation and faster recovery.

Role of cerebrospinal fluid diversion in posterior fossa tumor surgery.

OBJECTIVE: 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 METHODS: 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. RESULTS: 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 percent of the patients remained shunt-free. CONCLUSION: Although management of hydrocephalus secondary to posterior fossa tumors is controversial, majority of the patients need temporary cerebrospinal fluid diversion

Road traffic accidents as a major contributor to neurosurgical mortality in adults.

OBJECTIVE: To assess the contribution of Road Traffic Accidents (RTAs) to neurosurgical mortality in adults. DESIGN: It was a descriptive study. PLACE AND DURATION OF STUDY: The study was carried out at Pakistan Institute of Medical Sciences (PIMS), Islamabad. from June, 1998 to June, 2002. PATIENTS AND METHODS The clinical records including radiological records and death certificates were studied. Absolute and relative frequencies of neurosurgical mortality were noted. Mean age and male to female ratio of the patients who died due to RTAs were also determined. RESULTS: There were 315 post-traumatic deaths. RTAs contributed to 281 deaths while head injury was the cause of death in 268 patients. A significant number of patients died below the age of 40 years (63%) and male to female ratio was 6.8:1 secondary to RTAs. CONCLUSION: RTAs are a major contributor to neurosurgical mortality especially in adults. RTAs are one of the preventable causes of neurosurgical deaths.