Clinical Pattern and Post-Operative Complications of Post Tuberculous Meningitis Hydrocephalus in Patients Underwent Ventriculoperitoneal Shunt

Objective: To determine the clinical presentation of post tuberculous meningitis hydrocephalus and post-operative complications in patients underwent placement of a ventriculoperitoneal shunt.Study Design: This Quasi-experimental study was conducted at Department of Neurosurgery of Dow University of Health Sciences/ Civil Hospital, Karachi. Study duration was six months from October 2013 to March 2014.Methodology: Total 40 patients were studied who were diagnosed as cases of tuberculous meningitis and hydrocephalus on the basis of history, clinical examination, CSF findings, CT and MRI. Each patient underwent placement of a ventriculoperitoneal shunt. All the data regarding clinical presentation and postoperative complications was recorded in the proformaRESULTS: Total 40 patients having tuberculous meningitis hydrocephalus were selected; their mean age was 16.4+07.8 years. Male were found in the majority 62.50%, as compared to female 37.50%. According to the clinical presentation, most patients 70.0% were presented with a headache and 62.50% with fever, followed by nausea and vomiting was in 37.5% patients, Neck rigidity was in 27.50% cases, extra neural tuberculosis in 25.0% patients, papilledema in 22.50% cases, limb weakness in 10.0% patients, while fits were found only in 5.0% of the patients. Past history of tuberculosis was in 7.50% patients. According to postoperative complications infection was found in 10.0% of the cases, peritoneal pseudo-cyst without infection was in 7.5% cases, while 10.0% patients died. No significant difference was found in the postoperative complications according to gender p-value 0.94.Conclusion: It is concluded that a headache, fever and nausea/vomiting were the commonest clinical features and the Ventriculoperitoneal shunt is relatively simple and suitable for the patients of all age groups with hydrocephalus, its complications are relatively easy to manage

An Emerging Minimally Invasive Ozone Therapy for Spinal Disc Disease and Its Outcome

Objectives:  To analyze the effect and outcome of ozone therapy in herniated cervical and lumbar disc disease. Material and Methods:  A prospective study was conducted in the Neurosurgery Department of Federal Medical, Teaching Hospital Islamabad from March 2015 to December 2019. 310 patients with neck ache, and backache with radiculopathy were enrolled. Magnetic resonance imaging and the computed tomographic scan were done.4 to 6 ml of ozone were inserted in disc space. Periodic follow-up was done for up to 6 months of therapy. A single session of therapy was required in 55%, twice in 22.5%, and multiple in 13% of patients. Results:  Out of 310 patients, n = 220 were male and 90 females. Cervical herniated discs were 30 and lumbar 280, single cervical disc herniation was found in n = 26 and multiple in n = 4 while the single-level herniated lumbar disc was n = 220 and multiple in n = 60. Self-analysis of pain before intervention was assessed by visual analog, scored was VAS 4 in n = 80, VAS 5 – 6 in n = 120, VAS 7 – 9 in n = 70, and VAS 10 in n = 40 patients. Post-intervention prognosis according to Modified Mac nab was Excellent in 54%, good in 29%, Fair in 13%, and poor in 3.2% of patients. &nbsp

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

Role of Dexamethasone in Recurrent and Residual Chronic Subdural Hematoma

Objectives:  To assess the effectiveness of dexamethasone in recurrent and residual chronic subdural hematoma as a monotherapy. Material and Methods:  A prospective Quasi-Experimental study was conducted at the Neurosurgery Department, Peoples Medical College Hospital, Nawabshah from July 2014 to June 2020.Patients were assessed by Markwalder’s neurological grading and intravenous dexamethasone was used as monotherapy and effects were monitored. Results:  Out of 280 patients100 patients had recurrent and 180 patients had a residual chronic subdural hematoma. Male n = 180, female n = 100 with male to female ratio 1.8:1. Patients with Markwalder Grade 0, 1, and 2 were included and Grade 3 & 4 with marked midline shift on plain Computed tomographic scan brain were excluded. Intravenous dexamethasone of 12 mg in three divided doses for 24 hours given for first 2 weeks then shifted on oral dexamethasone and gradually tapered in next 2 weeks. During this period patient was evaluated for fluctuation in blood sugar or epigastric pain. Serial follow-up of patient was done, 16.07% improved from Markwalder Grade – 2 to 0, Markwalder Grade 1 to 0 in 12.14%. Complete resolution of hematoma occurred in 53.57%. Radiological deterioration with increased volume of hematoma in n = 40 and worsening to Markwalder Grad – 3 n = 15 and Grade – 4 n = 25. Death in n = 11.  Conclusion:  Monotherapy with dexamethasone in recurrent and residual chronic Subdural Hematoma results in clinical improvement and reduces the rate of re-operation

Management and Outcome of Ruptured Anterior Circulation Cerebral Aneurysms – An Experience of Neurosurgery Department of Nawabshah

Objectives:  To analyze the management and outcome of ruptured anterior cerebral circulation aneurysm by a variety of procedures including microsurgical clipping. Material and Methods:  A quasi-experimental study, carried out in The Department of Neurosurgery, Peoples’ Medical University Hospital Nawabshah from November 2010 to December 2020.We enrolled 38 patients and 40 aneurysms who presented with ruptured aneurysms. Hunt and Hess grading was used to evaluate the neurological status and ruptured aneurysms were managed by microsurgical clipping, excision, and suture ligation. Results:  Out of 38 patients Male were (23) 61% and females were (15) 39%, with a mean age of 50±25 years with aneurysmal subarachnoid hemorrhage and graded according to Hunt and Hess grade and fissure grading. Middle cerebral artery aneurysm was 45%, Anterior communicating artery 30%, Anterior Cerebral Artery 10%, carotid bifurcation 2.5%. Multiple aneurysms at internal carotid plus anterior communicating artery (n = 2) and internal carotid plus middle cerebral artery aneurysms n = 2. Distal anterior cerebral (n = 1). In 33 patients, the aneurysm was clipped, in 3 patients with fissure grading 4 and huge intracerebral bleed with signs of brain herniation, decompression plus aneurysm clipping was done, suture ligation (n = 1) and excision of a giant aneurysm (n = 3). Conclusions:  Microsurgical clipping is considered an ideal modality to secure a ruptured intracerebral aneurysm. Rarely it can be amendable by suture ligation, or excision. Presenting Hunt and Hess, fissure grading, age, and volume of intracerebral bleed have a direct impact on prognosis