Spectrum of Posterior Fossa Lesions: Experience at Tertiary Care Unit

Objective: The objective of our study was to evaluate the frequency and surgical outcome of patients with posterior fossa lesions.Material and Methods: This observational, descriptive study was conducted in the department of neurosurgery at lady reading hospital Peshawar and PUMH Nawabshah from Jan 2014 - June 2018. A total of 163 patients were observed during the study period. All those patients who undergone surgery for intra-axial posterior fossa tumors were included in the study. We included patients of both the genders and all age groups. We took approval of the study from the hospital ethical committee and informed consent was taken from the patients or their relatives. The data was entered in a specially designed Performa. Patients’ data was analyzed using SPSS version 21.Results: We had total 163 patients during the study period who fulfilled the inclusion criteria. Most (80.4%) of the patients were in the pediatric age groups and male (57%). Age of the patients ranged from 1-65 years with the mean age 17.4 years. The most common tumors in our study were Medulloblastoma (33.1%), Ependymoma (22.7%) and Astrocytoma (19%) in descending orders. Hemangioblastoma and metastasis were seen in 6.1% cases each. The most common clinical features were headache (87.1 %) and vomiting (64.4%) cases. Most (74.8%) of the patients undergone sub-occipital tumor excision. The most common post-operative complications in descending orders were tumor bed hematoma (6.7%), wound infection (4.9%) and cerebrospinal fluid (CSF) leak (4.9%). Total mortality was observed in 12.3% cases.Conclusion: We conclude from our study that posterior fossa tumors are more common in male children. The most frequent tumors in posterior fossa are Medulloblastoma, Ependymoma and Astrocytoma. Tumors is excision (66%) is the main treatment option. The rest need CSF diversion procedures. The main post-operative complications are tumor bed hematoma, wound infection and cerebrospinal fluid leak. Mortality is high in such patients. Most patients had good and satisfactory outcome after surgery

Neuroendoscopic Management of Hydrocephalus in Children

Objective: To determine the Neuroendoscopic management of hydrocephalus in children.Materials and Methods: The study was conducted at the Department of Neurosurgery, Peoples University of Medical and Health Science for women Nawabshah from January 2014 to May 2015. All of the patients with hydrocephalus diagnosed on history, clinical examination and CT scan included in the study. Subjects with co–morbidities such as uncontrolled diabetes, cardiac diseases or uremia were excluded. Patients with age of 6 months to 13 years either gender were included in the study. Aesculap rigid rod lens neuroendoscope with 0 degree was utilized. Warm ringers were utilized for irrigation, a Fogarty embolectomy catheter was utilized for ETV. Hemostasis was accomplished with irrigation, tamponade or coagulation. Endoscopic third ventriculostomy (ETV) was labeled successfully when characteristics of intracranial hypertension (ICP) clinically improved and the size of ventricular decreased on post-operative CT scan. All the data was recorded in the Proforma.Results: Thirty patients with male to female ration 2.5:1 were administered. Age ranged between 6 months and 12 years with a mean of 22.03 months. There were 15(%) cases of Tri Ventricular Hydrocephalus, 10 cases of Tetra Ventricular Hydrocephalus. Two cases of Dandy Walker Hydrocephalus, one case of Asymmetrical Ventricles Hydrocephalus and postoperative fever occurred in two subjects. CSF leak appeared in one patient who was managed conservatively. No operative mortality was found.ETV worked effectively for Hydrocephalus treatment in 99.9% patients included in the study