Spinal Cord Stimulation in The Treatment of Phantom Limb Pain: A Case Report and Review of Literature.

Phantom limb pain is a form of chronic neuropathic pain by which 50-80% of the amputees feel the pain that is not adequately controlled by analgesics. When pain management through pharmacological treatment alone is unsuccessful, surgical treatment options are proven to be effective. We report a case of 61-year-old man who sought consultation with phantom limb pain after his motor vehicular accident and below elbow amputation three years before the consultation. His pain was not relieved by analgesics alone and opted for spinal cord stimulation. Chronic Dual Channel dorsal column stimulation was done using Medtronic Prime Advance SCS System. He was in good pain relief and his VAS decreased from (8/10) to (2/10) but since the last six months follow-up he is complaining of pain again (4/10) for which he is taking analgesics too.

Chondroma of Cerebral Falx: A Rare Intracranial Diagnosis.

Chondromas are benign tumors which mostly occur in extremities but also sometimes in the cranium. Intracerebral chondroma is rare condition. Most intracranial chondromas arise from skull base, but chondroma of falx origin is a rare entity and mostly occurs in relation with syndromic disorders such as Mafucci's syndrome or Ollier's syndrome. Here, we report a rare case of falcine intracranial chondroma in a young man who presented with headaches and weakness of lower extremities and no signs of any syndromic disorder. The purpose of this case report was to raise awareness about intracranial chondromas. Chondroma should be considered in the differential diagnosis of calcified masses arising from the falx.

Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome.

OBJECTIVE: To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome. STUDY DESIGN: Longitudinal analytical study. PLACE AND DURATION OF STUDY: Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010. METHODOLOGY: Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score ² 2) and unfavourable (mRS score > 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia. RESULTS: The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%). CONCLUSION: In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome.