Spinal Tumours: - Experience at Mayo Hospital

Objective: Spinal tumours are mostly benign, having devastating effects on patients in terms of patient’s dis-ability, morbidity and mortality. Depending upon their site, size and growth potential, they have different clinical effects on the patients. We are presenting a case series of 138 patients managed in neurosurgery department Mayo hospital from Nov 2011 to Sept 2014.metastatic bony spinal lesions were not included in this study . The objectives of my study are to determine: Types of spinal tumours treated in this setting. Common and differenti-ating clinical features among subjects, different locations of the same types and the role of microsurgery. Materials and Methods: It is a retrospective study. 55 Schawanomas, 34 Menengiomas, 15 Ependimomas, 06 Dermoids, 17 Astrocytomas, 07 Plasmacytomas, 02 Aneurysm bone cyst and 02 Teratomas were managed surgi-cally. Schwanoma and meningioma’s prevalence was more in cervical and dorsal areas. plasmacytomas mainly affected dorsal spine, astrocytomas and ependymomas hade different locations. Teratomas occupied conus medu-llaris. Multiple laminectomies and laminotomies were performed according to situation. Radical resections for intradural extramedullary and gross total debulking for intramedullary lesions, under high resolution Microscope was done. Post operative improvements and complications were noted. Results: A radical resection of these tumors results in a good long-term outcome, since the majority is histolo-gically benign. For intradural intramedullary tumours gross total debulking is more appropriate. Adjuvant radi-ation therapy should only be administered for the high grade or malignant tumor. Malignant tumors have a dismal outcome and surgery in these patients should be a conservative debulking. Open door laminotomies are preferable in intradural extramedulary lesions and does not cause post op spinal deformity. Conclusion: Radical surgery for spinal tumors with laminotomies gives good results in terms of patient’s func-tionality and spinal stability

Effectiveness of Endoscopic Third Ventriculostomy in the Treatment of Obstructive Hydrocephalus

Introduction: Hydrocephalus is an abnormal accumulation of cerebrospinal fluid in the ventricles of the brain that is or has been under high pressure. It results in raised intracranial pressure and compressive effects of vital brain structures that can be lethal if not treated in time. Various treatment options had been tried over the years but ventriculoperitoneal shunt has been the most common treatment option. As ventriculoperitoneal shunt is associated with obstruction, infection and over drainage, endoscopic third ventriculostomy has been used to avoid these complications.Objective: To determine the effectiveness of endoscopic third ventriculostomy in the treatment of obstructive hydrocepalus.Material and Methods: This is a descriptive study that was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from October 2010 to October 2011. In this study all patients who underwent endo-scopic third ventriculostomy of more than six months were included. Total of 94 patients were included in the study. Effectiveness of the procedure was measured in terms of improvement in clinical condition i.e. GCS, head-ache, vomiting.Results: Total of 94 patients were included of which 58 were male and 36 were female. Age ranged from one to 70 years, with 50% of the patients were below 10 years of age. Majority of the patients had hydrocephalus due to space occupying lesion making 71.9% of the whole. In 75.5% of the patients the procedure was effective. Effecti-veness had no statistically significant difference in different age groups, however procedure is more effective in hydrocephalus due to space occupying lesion.Conclusion: Endoscopic third ventriculostomy is a very effective procedure for the treatment of obstructive hydrocephalus. It is effective irrespective of the age of the patient and cause of obstruction

Timing of Surgery as a Predictor of Outcome in Traumatic Acute Subdural Hematoma

Objectives: To determine if reducing the time from trauma to surgery is associated with decreased mortality in patients with traumatic acute subdural hematomas. Background: It remains controversial whether decreasing the time from trauma to surgical intervention is associated with increased survival in patients with traumatic acute subdural hematomas. Materials and Methods: This is a prospective study of 8 months from August 2013 to April 2014 conducted at the Department of Neurosurgery, PGMI / Lahore General Hospital, Lahore. Adult patients in whom surgical evacuation of acute subdural hematoma was carried out were included in the study. Age / Sex, presenting Glasgow Coma Scale (GCS) and the time passed from trauma to the start of the surgery was noted. The outcome of the patients was categorized according to the Glasgow Outcome Scale.Results: Forty eight adult patients meeting the inclusion criteria were included in the study. There were 36 males and 12 females. The mortality for patients operated within four hours was 83.3% compared to 75% for patients operated within four to ten hours, and 73.1% for patients operated after ten hours. Two patients (12.5%) in the four to ten hour group, and five patients (19.2%) in the group of patients operated after ten hours had a favourable outcome. Surprisingly, this showed a trend that increased time from trauma to surgery led to a better outcome. However, patients operated early also had more severe neurological injury.Conclusion: A shorter time from injury to surgical evacuation does not decrease mortality in traumatic acute subdural hematoma

Efficacy of Conservative Management with Anti Tuberculosis Treatment in Patients with Spinal Tuberculosis

Introduction: Spinal TB is a result of haematogenous dissemination from primary focus in lungs or lymph nodes. Most of the under developed and developing world is endemic with TB as these populations are poorly nourished, overcrowded and live in sub standard social conditions and TB being an infectious disease spreads and sustains well in these overcrowded settings. Spinal TB is a common pathology in developing countries like Pakistan. We present a cohort study on findings of conservative treatment in patients suffering from spinal TB.Objective: To determine the efficacy of conservative treatment (ATT) in TB spine.Material and Methods: A cohort study was conducted in Bolan Medical Complex, Quetta in a period of 4 years from 2009 to 2013. A total of 135 cases of spinal tuberculosis were selected. Patients with cervical and cranio-cervical, and sacral TB were excluded from the study and also patients with any malignancy and other associated chronic joint conditions related to back were not selected. Patients were confirmed as a case of spinal TB using standard laboratory and radiology diagnostics. The patients were treated with ATT and followed up for 9 months until the completion of therapy.Results: The average age of patients was 48.8 years. Both male (50.4%) and female (49.6%) were equal in proportion in this study. Lumbar region was more affected (71.1%) with TB spine. Almost all study patients (99.3%) were cured with ATT whereas 1 (0.7%) patient was managed surgically.Conclusion: ATT is effective in the treatment of spinal tuberculosis provided timely diagnosis and initiation of therapy

To Determine the Frequency of Brain Abscess and its Common Bacteria in Patients Presenting with Highly Suspected Clinical Features

Objective: To determine the frequency of brain abscess and its common bacteria in patients presenting with highly suspected clinical features.Material and Methods: It was a Descriptive (cross sectional) Study conducted in the Department of Neur-osurgery Lady Reading Hospital Peshawar. Duration of study was 1 year, from Jan 2011 to Jan 2012. Total number of patients with highly suspected clinical features were 134. CT brain and MRI brain was done for these patients. SPSS version 17 was used for data analysis.Results: Among 134 cases, 93 (63%) were male and 41 (3.60%) were female. Majority 49% (n = 66) were between 21 – 30 years of age. Frequency of brain abscess was revealed in 12.69% (n = 17), common bacteria was Streptococcus Viridians having 41.18% (n = 7) cases, Staphylococcus Aureus 29.41% (n = 5), Bacteriods fragilis was 17.65% (n = 3) and Peptostreptococcus 11.76% (n = 2).Conclusion: The results of the study reveals frequency of brain abscess is still higher in our population while Viridians streptococci and Staphylococcus aureus are most common bacteria