Surgical Outcome & Cost Analysis of Single Stage Anterior Decompression and Cage Fixation in Patients with Thoracic and Lumbar Tuberculous Spondylitis: A Single Centre Experience Over Six – Years with Comprehensive Literature Review

Objective:  For Tuberculous spondylitis (TS) the optimal mode of management for extensive tuberculous spondylitis is still a subject of debate. We determined the outcome for single stage anterior decompression and cage fixation for dorso-lumbar TS. Material and Methods:  This prospective study was conducted between 2012 and 2018. Worsening or new onset neurological deficit, increasing deformity, large paraspinal abscess and those not responding to anti-tuberculous drug therapy were included. Patients with severe comorbidities (> ASA class III) and recurrent cases were excluded. Demographics, clinical features, radiological characteristics, intraoperative details, postoperative complications and follow-up condition were recorded. Results:  One patient with mean age of 45.6 ± 14.9 years with 17 (54.8%) males and 14 (45.2%) females. Mean symptoms duration was 71.9 ± 29.4 days. 41.9% had spasticity & 25.8% had sphincter dysfunction on presentation. Half (48%) of patients had a Frankel grade 3 or less bilaterally. Mean length of the procedure was 137.4 ± 19.9 minutes. 19.4% (n = 6) had postoperative pulmonary complications, 16.1% (n = 5) wound infection, 9.7% (n = 3) had worsening of neurologic deficit and one (3.2%) remained static. Graft extrusion and cage subsidence were noted in one (3.2%) patient each. Favorable outcome was observed in 83.9% (n = 26) while 16.1% (n = 5) had unfavorable outcome. Mean out-of-pocket cost was 164677.4 ± 11469.9 rupees (USD: 1187 approx). Conclusion:  Timely spinal decompression with stabilization at the onset of the Pott’s disease in patients who fulfil the criteria as surgical candidates carries a promising outcome

Primary Decompressive Craniectomy – Salvation in Closed TBI

Objective: To evaluate the role of early Decompressive Craniectomy in closed traumatic brain injury in relation to functional outcome.Material and Methods: A study was conducted at the Department of Neurosurgery, Northwest General Hospital and Research Centre Peshawar Pakistan. 09 months Data from 22/06/2011 to 21/03/2012 was collected, and all the consecutive cases of closed head injury that required Decompressive Craniectomy (Primary Decompression) based on clinical an radiological findings were included in the study.Results: Out of 23 patients, 13 showed moderate to good recovery making this procedure one of the priority treatment options in closed traumatic brain injury.Conclusion: The promising outcome in our study suggests that an early Decompressive Craniectomy should be considered in severe closed head injury to improve the outcome

The Efficacy of Surgery for Supra-Tentorial Gliomas in Preventing Seizures

Objectives:  The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution. Material and Methods:  A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender. Results:  The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender. Conclusion:  The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management. Keywords:  Seizures, Supratentorial gliomas

Outcome of patients operated for depressed skull fracture with dural tear

Objective:  The objective of this study was to determine the outcome of patients operated for depressed skull fracture with a dural tear. Material and Methods:  A descriptive case series (n = 155) was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months. Results:  The mean arrival GCS was 10.64 ± 2.33. About 21.9% (n = 32) patients presented with a GCS of ? 8, while the remaining 78.1% (n = 123) presented with a GCS of ? 8. About 8.4% (n = 13) patients died due to the complications of the brain injury. The most common postoperative complication was found to be progressive neurologic deficit (PND) occurred in 21 (13.5%) patients. Penetrating injury to the head was also associated with unfavorable outcomes after surgery (p = 0.046), which shows that penetrating injury is associated with increased brain damage and hence consequently poor outcomes. Conclusions:  The neurologic status as denoted by the Glasgow coma scale is one of the most important factors which predicts the outcome. Surgical management of depressed skull fractures with dural tear has favorable outcomes in about two-thirds of patients. The remaining one-third patient remains in the severely disabled group. Every effort should be made to reduce the occurrence of complications as they are directly related to postoperative functional outcomes

Epidemiology of Traumatic Brain Injury (TBI_ in UAE – A Review

Objective: To evaluate the causes and pattern of Traumatic Brain Injury (TBI) in Dubai, UAE.Material and Methods: This descriptive study was carried out at Rashid Hospital, Dubai UAE from June 1, 2008 to August 27, 2008. All the patients admitted to neurosurgical unit referred from A&E were included and the total no. was 96 patients in this short study. Demographic data, causes and pattern of injury and presentation with clinical and radiological findings were recorded.Results: Most of the patients were young males (7.7:1) in the age range of 21 – 30 years. RTA being the most common (45%) cause in non-Arab expatriate population and 49 patients had minor injuries only with the rest included in moderate to severe category. The results were consistent with the international studies.Conclusion: Traumatic Brain Injury (TBI) is a potentially preventable cause of mortality and morbidity in young population world over and still there is a need for formulating new strategies to avoid it

Outcome of Topical Epidural Methylprednisolone Versus Control in Lumbar Disc Surgery Patients

Objective:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities. The study determined the outcome of topical epidural methylprednisolone. Materials & Methods:  60 patients included with diagnosed cases of the herniated lumbar disc with ASA Grade 2 and below. Group A was for patients who had to receive topical methylprednisolone while group B was the control group where no topical methylprednisolone had been used. The outcome was measured from OLBI and VAS scores. Results:  In Group A, the mean hospital stay was 2 days, mean OLBI score was 35%, mean VAS score was 3, mean time to resumption of ADL was 7 days, mean dose of paracetamol (per day) was 3 mg, mean dose of Ketorolac (per day) was 90 mg. Whereas Group B, mean hospital stay was 3 days, mean OLBI score was 45%, mean VAS score was 5, mean time to resumption of ADL was 10 days, mean dose of paracetamol (per day) was 4 mg, mean dose of Ketorolac (per day) was 100 mg. In Group A, 91% of patients had a favorable outcome and 9% of patients had an unfavorable outcome. Whereas in Group B, 83% of patients had a favorable outcome and 15%of patients had an unfavorable outcome. There existed insignificant results in outcomes concerning diabetic/non-diabetic, and hypertension/non-hypertension. Conclusion:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities as compared to without the use of topical methylprednisolone. Keywords:  Outcome, Epidural Methylprednisolone, Lumbar Disc Surgery, OLBI (Oldenburg Burnout Inventory), ADL (Activities Of Daily Life)

Dysfunction of the temporalis muscle following pterional craniotomy: Analysis of 20 cases

Background & Objectives: Temporalis muscle dysfunction following pterional approach for skull base approaches is commonly encountered which is very discomforting for patients however, literature regarding its management is insufficient. This study presents 20 cases over the course of 4 years and discuss the pitfalls in the management of temporalis muscle dysfunction following pterional craniotomy for various lesions.Materials and Methods: Sixty patients were operated using the pterional craniotomy, out of which 20 patients were included in the study. In these cases we used three methods of temporalis muscle dissection namely, the submuscular, subfascial & interfascial. Postoperatively, patients were followed for a median of 8 months. Detailed description of the follow-up findings and their statistical associations is presented.Results: Twenty patients with 12 (60%) males & 8 (40%) females with mean age of 43.8 ± 10.9 years were operated. Twelve (60%) patients were operated using the submuscular approach, 6 (30%) by the subfascial method and 2 (10%) by interfascial technique of temporalis muscle dissection. Of the 20 patients, 8 (40%) reported trismus, 10 (50%) had temporal region and jaw pain and 14 (70%) complained of difficulty chewing. For these patients, we employed local heat therapy (n = 14, 70%), chewing exercises (n = 12, 60%) and oral range-of-motion exercises (n = 9, 45%). 78.5% of patients responded with resolution of pain after local heat therapy, 80% with jaw range-of-motion exercises. The temporal hollowing was assessed by plastic surgeon, but none of the patient pursued plastic surgery intervention.Conclusion: Temporalis muscle dysfunction following pterional craniotomy occurs in about one-third of patients. It is a cause of significant patient concern. Physiotherapy and oral analgesics can alleviate the common symptoms. Patients must be informed about this complication to avoid undue psychological distress. Early diagnosis & management leads to better patient response

The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction. Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25. Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%). Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes