Outcome of Suboccipital Decompression with and without Duraplasty in Adults with Chiari I Malformation

Objective: To investigate outcome for Arnold Chiari 1 Malformation (ACM1) patients based on intervention methods, i.e., posterior fossa decompression without duraplasty and with duraplasty in terms of symptomatic and functional improvement Materials and Methods: This study was conducted prospectively over 41 months from January 2013 to May 2016. Patients with confirmed diagnosis of ACM-1 were included in the study. Patients either underwent posterior fossa decompression without duraplasty or with duraplasty, depending upon the severity of tonsillar descent, the presence of syrinx, neurological deficits or hydrocephalous. Data was collected on pre-designed pro forma both pre-operatively and during follow up. Outcome was assessed according to Chicago Chiari Outcome Scale (CCOS). Data analysis was done using SPSS v 22.0. Results: Posterior Fossa Decompression (PFD) without dural opening was performed in 13 patients while in 8 patients duraplasty was performed. Overall mean age was 32.95 ± 5.88 years and mean symptoms duration was 21.62 ± 8.82 months. The most common complaints were headache (76.2%), neck pain (61.9%), hand and arm weakness (47.6%), gait disturbance (47.6%) and cranial nerve dysfunctions (76.2%). The median preop CCOS was 10 ± 1.57 while postoperative CCOS was 13 ± 2.27. There was a significant relief in terms of CCOS improvement in preop and postoperative scores (P = 0.006). The commonest complication was CSF leak in 14.3% of patients. There was no mortality. No recurrent cases were noted during the 41-months study period. Conclusion: Posterior fossa decompression forACM-I is simple and effective. Further studies regarding surgical outcome and development of outcome assessment are required with larger patient cohorts. Abbreviations: CCOS: The Chicago Chiari Outcome Scale. CSF: Cerebrospinal Fluid. CV: Craniovertebral. OPD: Out Patient Department. SD: Standard Deviation. HMC: Hayat Abad Medical Complex. ACM1: Arnold Chain 1 Malformation

Incidence and Management Outcome of Incidental Durotomy in Spinal Procedures in Tertiary Care Hospital

Objective: To know the incidence and management outcome of incidental durotomy in spinal procedures in tertiary care hospital. Materials and Methods: This descriptive study was carried out in Neurosurgery Department, Hayatabad Medical Complex, Peshawar, from 1st July 2015 to 30 June 2017. All those patients in whom lumber spinal procedures were done were included in the study without age or gender discrimination. Exclusion criteria included patients in whom dura was intentionally opened as in cases of intradural tumors or in rare cases of transdural discectomies. Those patients were also excluded in whom procedure was done elsewhere and they were admitted in ward for management. All patients were reviewed by age, sex, indications of surgery and subsequent management of durotomy. Data was analyzed in SPSS version 10. Results: Total 560 patients qualified the selection criteria. There were 342 (61.07) male and 318 (38.93%) female patients. Amongst those operated, 294 (52.5%) patients had lumbar disc herniations, 143 (25.54%) patients were operated for lumbar spinal stenosis, 75 (13.39%) patients were treated for traumatic lumbar vertebral fractures, 38 (6.79%) patients had extradural spinal tumors and 10 were operated for lumbar spondylolisthesis. We noticed incidental durotomies in 50 (8.92%) cases. Of 342 male patients the incidence of durotomy was 20 (3.57%) while of 318 female patients the incidence was 30 (5.36%). All dural tears were recognized during the operation. Forty seven (47) dural tears were repaired primarily. We did re exploration in one patient for persistent leak in whom dural stitches were torn. Kerrisonrongeur was responsible for dural tear in 14. In 11 cases dissector tear the dura. Three dural tears were caused by pituatery rongeur. One tear was caused directly by knife. Air drill was responsible for 4 tears when lamina was being drilled to thin out. We could not find any cause of dural tear in one case. Conclusion: Unintentional duratomy is not an uncommon complication in neuro spinal procedures. This is more common female population and elderly patients with degenerative spinal diseases

Impact of Organizational Culture on Employee's Career Salience: An Empirical Study of Banking Sector in Islamabad, Pakistan

Abstract This study was conducted to inspect the relationship between organizational culture and employee &apos