Delay in diagnosis of brain tumors: a dilemma for neurosurgical community due to spirituality and quackery in a developing country

Objectives: Primary and metastatic brain tumors are a significant cause of mortality and morbidity. The complex pathway to a cancer diagnosis is not human error and the achievements of better outcomes solely depend on the early diagnosis and management of symptomatic tumors. The estimated time between the first presentation to any health care professional and diagnosis is approximately 3 times longer in the UK as compared to other developed countries. Material and Methods: It was a descriptive study and included 52 patients who were admitted to the Neurosurgery department at Jinnah hospital Lahore. The required data were collected either directly from the patients or from the hospital record of discharged patients. Our study compares the time interval difference of presentation of a patient to a local care provider (Quacks, Hakeem, and spiritual healers) and Neurosurgeon as well as delay in surgical intervention even after diagnosis and radiological investigations. Results: 54% of patients presented with supratentorial lesions and out of these, parietal lobe lesions were more common (39%) while 29% of lesions were infratentorial. Around 50% of patients presented to a Local Care Provider within 20 days. However, only 42% of patients presented to a neurosurgeon after 6-9 months of the onset of symptoms. Conclusion: Public awareness is the key to timely diagnosis, proper management, and better outcomes. The availability of specialists in peripheral hospitals can bring a change in this regard

Impact of Intracranial Pressure-Monitored Therapy on Mortality in Patients with Severe Traumatic Brain Injury

Objective:  To assess the impact of intracranial pressure (ICP) monitored therapy on mortality in patients with severe traumatic brain injury. Materials and Methods:  A randomized controlled trial was conducted at the Department of Neurosurgery, Jinnah Hospital Lahore. Forty patients of both genders, aged between 15 to 60 years were randomly selected and divided into two groups (Control & Experimental). Patients injured within 24 hours with a Glasgow Coma Scale (GCS) of 8 or less and showing radiological evidence of raised intracranial pressure were included. Patients with extradural hematoma, penetrating injury, or those requiring any surgery were excluded from the study. Data were analyzed using SPSS version 20. Results:  No significant difference was found in mean age and gender among the two groups. The GCS of the control group was 6.2 ± 1.6 while that of the experimental group was 6.7 ± 1.6. The mean of the maximum ICP of the experimental group was 25.31 ± 8.48 mm of Hg. There was a significant difference in the mean duration of ventilation between the two groups. In the control group, 10 (50.0%) patients expired whereas in the experimental group, 8 (40.0%) patients expired. The proportion of mortality was higher in the control group but the difference was not statistically significant between the two groups (P value: 0.525). Conclusion:  Intracranial pressure-monitored therapy was effective but statistically showed no significant superiority over unmonitored management.&nbsp