Search

We seek to compare pain sensation after surgical and conservative treatment in patients having sciatica with lumbar disc herniation in a routine clinical setting. Objectives: To compare the outcome of early surgical intervention versus prolonged conservative treatment in patients with sciatica due to herniated lumbar intervertebral discs. Study Design: Randomized Control Trial. Setting: Department of Neurosurgery, Dow University of Health Sciences, Civil Hospital Karachi. Period: Aug 1, 2017 till May 31, 2018. Material & Methods: Data was prospectively collected from patients after taking a consent. A total of 70 patients, with 35 patients in each Group A (early surgical intervention) and Group B (prolonged conservative treatment) were included. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. P-value of ≤ 0.05 was taken significant. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification independent t-test was applied taking p-value of ≤0.05 as significant. Results: Mean age in group A and B was 45.18±7.64 and 42.78±5.87 years respectively. 30 (85.7%) were male and 05 (14.3%) were female in group A. 28 (80%) were male and 07 (20%) were female in group B. Mean pre and post VAS score in group A was (7.18±0.71 and 2.18±0.55) and group B was (7.78±0.34 and 3.26±0.21). Mean pre and post SF36 BP score in group A was (24.18±3.81 and 65.54±6.14) and group B was (34.29±4.91 and 68.21±5.87). Conclusion: Many patients continue to refer conservative treatment of sciatica, despite of pain but given the results of this study, early surgical intervention appears to be superior to medical management for the treatment of Sciatica with respect to patient outcome. [ABSTRACT FROM AUTHOR]

Background and Objectives: To analyze the functional outcome of open door laminoplasty (ODL) for the treatment of Cervical Ossified Posterior Longitudinal Ligament (OPLL). Study Design: Case series study. Setting: Civil Hospital Karachi. Period: 05 years, 2013 to 2017. Material & Methods: 18 patients (15 Male, 3 Female) underwent ODL for cervical OPLL, over a period of 5 years. Pre-operative & post-operative degree of myelopathy was assessed using Nurick grading score. Patients with Nurick grade > 2 were included in study. MRI compatible titanium micro plates & screws were used. Instability was assessed by X-ray Cervical Spine obtained 6 weeks post-operatively. Results: Mean age of presentation was 52 years. 2 to 3 levels were involved in most cases. Mean operative time was 2 hours 30 minutes. Following Nurick grading 94.4% (n=17) improved by grade 1 or more, while in only 5.6% (n=1) it remained same. No instability or kyphotic deformity was seen on follow up X-rays. Conclusion: ODL is a safe & effective procedure for the treatment of multiple level OPLL. It can avoid complications related to the anterior approach (like unintentional durotomy & spinal cord injury) and diminished the possibility of instability & kyphotic deformity associated with laminectomy alone. [ABSTRACT FROM AUTHOR]

Context: Colloid cyst is a rare tumour of the brain that has a good outcome upon surgical removal. Aims: We present the outcome of surgical management of colloid cyst at our setup based on the experience of last ten years. Study Design, Setting and Period: The type of study is a retrospective review of cases of third ventricular colloid cyst operated at the Department of Neurosurgery, Civil Hospital Karachi, Pakistan, from January 2005 to December 2015. Methods and Material: The patient's data including the clinical records, radiographic data, operative and follow up notes were studied. The patient population was divided into groups based upon the size of the cyst. The surgical approaches utilized were the transfrontal transventricular and transcallosal approach. All the patients also underwent a series of tests to determine the function of the somatosensory, motor and memory functions both pre and post operatively and upon follow up. Statistical analysis used: Data was analyzed using SPSS version 23. Mean and standard deviation was used for continuous variables, while frequency and percentage was used for categorical variables. Results: The study population n= 60 patient, n= 36 males and n= 24 females. The size distribution of the cyst was, n= 4 (6.66%) were less than 1.5cm, n=47 (78.33%) were 1.5-3cm and n=9 (15%) were >3cm. Headache was the most common presenting complaint. Papilledema was observed in 71.66% of the patients, while memory changes were observed in 8.33% of the patients. The surgical excision of the cyst was performed in n= 52, patients while ventriculoperitoneal shunt was performed in n= 8 patients. Conclusions: According to the results of our study the transcallosal approach, is a safe technique, in which the neurological damage is limited due to minimal callosotomy and manoeuvring of the fornix. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study is to determine the prevalence of post operative intracranial infection rate, at Civil Hospital Karachi, Pakistan. Study Design: Retrospective analysis of cases of craniotomy, studying the files of patients who had the procedure done. Setting: Neurosurgical Department at Civil Hospital Karachi Pakistan. Period: Ten years period (2005 to 2015). Method: To determine the incidence and factors associated with infection a sub group analysis was done in all those patients in whom the intracranial infection was caused by a cranial surgery. Patients who were administered antibiotics for the treatment of infection were not included also those who were treated for wound infection without intracranial involvement. Data was analyzed using SPSS version 20. Results: A total of 5800 cranial surgical procedures were performed by a team of 30 neurosurgeons and residents. And a total n= 116 (2%) procedures were done due to post operative infection on a total of n= 70 patients. N= 37 patients were male and n= 33 patients were female, the median age of patients was 50 years and the age range was from 2 to 75 years. The procedures were performed as elective procedures in n= 56 (80%) patients and as an emergency case in n= 14 (20%) patients. The most common organism was methicillin sensitive staphylococcus aureus, and the most surgeries who were found to have a high incidence of post operative infection for craniotomies done for removal of a tumor. Conclusion: The postoperative infection is one of the most important complications of cranial surgical procedures and required immediate attention and treatment, even after taking all the precautionary measures to ensure sterility a small number of patients still develop severe infection needing reoperation for removal of debris and pus. [ABSTRACT FROM AUTHOR]

Introduction: Dandy-Walker Malformation is an inborn condition that includes the triumvirate of cystic enlargement of the fourth ventricle, posterior fossa distension with rise of the tentorium and agenesis of cerebellar vermis. The purpose of this study is to determine the Clinical presentation and associated complications, mortality and morbidity of patient undergoing placement of shunt with Y-connector in Dandy Walker Malformation. Study Design: Case Series comprised of 85 cases. Setting: Neurosurgery Ward of Tertiary Care Hospital in Karachi. Period: February 2011 to December 2015. Methodology: All patients who were presented in OPD with complaints reminiscent of DWM with accompanied Hydrocephalus and then underwent CT scan Brain without contrast to confirm the diagnosis were admitted. The patients who have previous history of operation and other co-morbid anomalies were omitted. These patients undergo drainage of Ventricular system and Posterior Fossa cyst was done mutually via Dual Shunt including Ventricular-peritoneal and Cysto-peritoneal shunt with Y connector. There were few complications and mortality after this surgical intervention which was noted for a month. All records were recorded and evaluated by SPSS v.20. Result: A vast majority of patients included were Female. The average age of patients was 2.5 years +/- 1 Standard Deviation. The chief complaint was Hydrocephalus, existing in all patients, after that cerebellar signs in 55 (64.7%) and other signs in 10 (11.8%) patients. Others signs includes; milestones were delayed, atypical gait and few patients were suffered from psychiatric problems. Complications which were observed were shunt; Fracture/Dislocation in 10 (11.8%), shunt blockage in 8 (9.4%), malpositioning is also 8 (9.4%), Intracranial Hemorrhage in 7 (8.24%) patients and Infection in 10 (11.8%). These complications were observed within a month of surgery. Unfortunately, two (2.35%) patient were also expired after surgical approach. Conclusion: It is concluded that Dandy Walker Malformation is categorized by a triumvirate. Hydrocephalus is a most common symptom and principal cause of referral to hospitals. The commonest difficulty acknowledged after shunting is Malfunction and shunt infections. The lowest mortality is related to Dual Shunt with Y connector when compared to other approaches for management of shunt with Y-connector. Thus, it is found to be a worthy decision in given DWM patients. [ABSTRACT FROM AUTHOR]

Background: Pituitary gland that resides in the sellaturcica is a 60 milligram midline structure. The normal function includes secretion of certain hormones that directly or indirectly regulate the activity of other organs. Some major functions are being controlled by these hormones in the body. Postoperative hypopituitarism and hormonal recovery are well-known consequences of transsphenoidal pituitary adenoma removal. The purpose of the study is to assess the post-surgical changes in the levels of pituitary hormones and to determine the outcome of pituitary adenoma resection in patients with mild hyperprolactinemia Methods: A total of 39 pituitary tumor patients diagnosed on MRI were included in this study during the period of 24 months from Jan 2013 to December, 2014. Pre and post-operative prolactin levels were recorded on a pre designed questionnaire. Patients who have undergone surgery were kept under observation during the period of stay and were observed in follow-up until the third month after discharge. Results: Out of 39 patients, 17(43.58%) were males and 22(56.4%) were females. Satisfactory outcome of pituitary adenoma resection in patients with mild hyperprolactinemia was observed in 82.94%. Conclusion: It has been demonstrated that in expert surgical hands, normal anterior pituitary function is usually maintained and often improved following surgery of non-functioning pituitary adenomas. These results strengthen the indication for surgery in patients with hypopituitarism. However, care should be taken as these results are less likely to be reproduced by surgeons with limited experience in pituitary surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of infection in protocol-based and random ventriculo-peritoneal shunt placement in patients with hydrocephalus., Methods: The prospective, observational study was conducted at Civil Hospital, Karachi, from October 2014 to March 2015, and comprised patients having ventriculo-peritoneal shunt placement who were randomly categorised into Group A that had protocol-based procedure and Group B that had random shunt placement. All patients were followed up for six months to record final outcomes after surgery. A pre-tested questionnaire was used to document findings. SPSS 16 was used for data analysis., Results: Of the 210 patients, there were 105(50%) each in the two groups, overall having 117(55.7%) boys and 93(44.3%) girls. The frequency of infection was 8(7.6%) in Group A and 19(18.1%) in Group B (p<0.05)., Conclusions: With a meticulous surgical technique and modifications to the pre-, intra-, and postoperative care, it is possible to significantly reduce the incidence of shunt infection.