Craniosynostosis: Clinical Presentation and Outcome of Surgical Treatment

Objective:  Craniosynostosis presents sclerosis cranial sutures, ossification and fusion involving the vault of the base, sutures involved can be one or more sutures. This study aimed to determine the surgical outcome of craniosynostosis. Material and Method:  The prospective study was conducted at the neuro spinal and cancer care institute, Karachi. Patients presented with sagittal, metopic, unicoronal, lambdoid, bicoronal craniosynostosis were included in the study, while patients with coagulopathy, previously operated cases were excluded from the study. Results:  We had 26 children in our study, age range about 1–3 years. Patients were cleaved into groups depending on their age. Most of the children 15 (57.6%) were in 1–2 years age group and 11 (42.3%) were in 2-3 years of age. Boys were 18 (69.2%) and girls were 8(30.7%). Coronal 11 (42.3%) was the most common suture involved, followed by sagittal 9 (34.6%). Lambdoid suture 3 (11.5%), metopic 2 (7.6%) and 3 (11.5%) case presented with raised intracranial pressure with multiple sutures closed involved. Strip craniectomy was done in all cases. We did bicoronal flap and Scalp flap turned into a supraorbital region while in metopic suture Fronto-orbital advancement and remodeling approach were used. No major complication was observed. Conclusion:  Cases which are managed early age have given good acceptable results in follow up, proper surgical expertise, perioperative management of temperature, blood loss, relieving the restriction of sutures and normalizing raised intracranial pressure can decrease the morbidity and mortality

Framed Stereotactic Brain Biopsy Outcome – Single Center Study

stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi. Material and Methods:  After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided. Result:  The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case,  and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient. Conclusion:  Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods. &nbsp

Management of myelomeningocele

Objective: T To find out best possible protocol to provide productive life to children born with myelomeningocele.Study design: Descriptive study.Place & Duration of study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006.Patients and Methods: The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical & medical management protocol used for different sites of myelomeningocele was studied.Results: The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal (VP) shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis All 16 patients with ruptured myelomeningocele (3.8%) were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases (5.3%). The postoperative follow up for all patients was 1- 2 years.Conclusions: Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results

Cervical Spine Discectomy, Osteo-facetectomy by Noble Art of Cloward Procedure and Its Modification- A Single Centre study

Objectives: To analyze the surgical outcome of cervical spine osteo-facetectomy discectomy, and modified Cloward procedure.Materials and Methods: A prospective study was conducted at the Neurospinal & cancer care institute, Karachi. The duration of study was from 1st June 2017 to 25th November 2019. Patients having prolapsed intervertebral cervical discs included in the study, while those with trauma, cervical radiation, previous cervical surgery andmultiple level involvement were excluded. Pre and post-surgical data was collected. Titanium Hashmi cage was used in all operated patients at single level instrumentation.Results: A total of 113 patients satisfied the inclusion criteria and were considered in the study. Among them, 77 patients were male and 36 were female. The age range from 26 to 65 with a base age of 53 years ± 2.5. C5 – C6 was the commonest level for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. For the outcome of theprocedure Odom’s criteria, was followed the results showed excellent improvement in 88 (77.87%), Good results in 18 (15.9%), fair in 5 (4.42%) and 2 patient had Poor (1.76%) results. Fusion was seen in 86 patients, superficial infection in two cases.Conclusion: Patients with single-level degenerative disc and treated with modified titanium Hashmi cage provided a good fusion with the relief of upper limb pain without donor site morbidity at anterior iliac spine

Multimodality Treatment of Craniopharyngioma: Aspiration of Cystic Contents and Placement of Ommaya Reservoir Stereotactically Followed by Gamma Knife Radiosurgery – Single Center Study of 81 Cases

Objective:  The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi. Material and Methods:  After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided. Result:  The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case,  and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient. Conclusion:  Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated method

Outbreak of Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Population Following the Use of Contaminated Peritoneal Dialysis Fluids

Introduction: Most cases of peritonitis during continuous ambulatory peritoneal dialysis (CAPD) are attributed to breaches of the aseptic technique. In this report, we describe an outbreak of CAPD related peritonitis that followed the use of potentially contaminated PD fluid. Outbreak report: CAPD was introduced in the adult nephrology unit at Soba University Hospital in December 2008 with fairly satisfactory functioning and results. In June 2009, we obtained a new supply of PD fluids and started using it. Soon afterwards, a mould was found inside a new unused dialysate bag. During the following days, six patients were diagnosed to have PD related peritonitis. All patients in the unit were immediately shifted to another brand of PD fluids. Enquiry revealed that this supply of PD fluid was stored in a warm and humid environment. We surveyed the 1469 bags in the hospital stock and found another three bags (0.2%) that contained visible mould by the naked eye. The four contaminated bags contained 2.5% dextrose and were from different batches. All of them had lost the negative vacuum between the inner bag and the outer plastic envelope, but had no obvious tears in the envelope and no obvious fluid leakage. Our peritonitis rate before the outbreak was one episode in 21.7 patient-months. This sharply rose to one episode in 2.5 patient-months during the month of the outbreak, and dropped down to one episode in 17.8 patient-months in the 6-months following the outbreak. Conclusion: Contamination of PD fluids can occur during handling and storage. Patients should meticulously examine each bag before usage. Any bag that has lost the vacuum between the inner bag and its outer envelope is potentially breached and should not be used. Keywords: Contamination; Fungal peritonitis; Outbreak; Penicillium spp.; Peritoneal dialysi

SIRCAUR: Safe inspection of reinforced concrete structures by autonomous robot

Designing climbing robots for industrial applications, has been proven to be an egg and chicken problem. The more the payload the more adhesion force needed. In order to move a robot upwards with such a force, motors with bigger torque are required and thus, increasing the payload. Similarly, increasing the adhesion force is likely to increase the payload. This paper presents an improved climbing robot specifically designed to climb on structures with 30~35mm of reinforced concrete (R/C) cover, while deploying a precision noncontact GPR sensor for the detection of rebar corrosion and related defects. Furthermore, it carries a system for visual inspection and detection of concrete cover deterioration. It works autonomously under UWB controlled trajectories, adjustable by GPR sensor feedback for avoidance of rebar-poor regions. The inspection NDT data is transmitted wirelessly to a ground-based CPU for processing and monitoring