Endoscopic Third Ventriculostomy: A Comparable Alternative to Ventriculoperitoneal Shunt for Obstructive Hydrocephalus Secondary to Infratentorial Tumors

Objective: To establish ETV  as a comparable alternative to ventriculoperitoneal shunt for obstructive hydrocephalus secondary to infratentorial tumors. Methods: 40 Patients with infratentorial tumors presenting with hydrocephalus were enrolled in a prospective descriptive case series. Symptoms, neurological examinations, CT scan and intra-operative findings were used detect the complications at 03 months. Results:   Mean age = 31.98 ± 15.24 years, female to male ratio of 1:1.2. The KPS score of the participants was ? 70% and ETVSS ?80. Average operative mean time was 21 ± 2.82 minutes. Within first week, the improvement in symptoms was recorded (CI=95%): headache – 87.5% (p < 0.001), nausea vomiting - 84% (p < 0.001), gait disturbance – 59.3% (p=0.442) seizures improvement -100% (p=0.016) and urinary incontinence – 66.7% (p=0.687). Radiological improvement in hydrocephalus on CT scan was seen in one patient within 24 hours – 2.5% (p= <0.001), 12.5% (p<0.001) after two weeks and 87.5% (p= <0.001) after three months post-operatively (CI 95%). Most common of these were decrease in the size of third ventricle and decrease in the size of frontal horns of lateral ventricles.  However, complete resolution of radiologic features was observed in two patients only 5% (p<0.001). However, complete resolution of radiologic features was not observed in any patient. No intra-operative or post-operative complication of ETV was recorded. Conclusion: ETV is a quick and safe method for CSF diversion in obstructive hydrocephalus alleviating the need for placement of VP shunt hardware, thus eliminating foreign body related cranio-abdominal complications

Incidence of Epilepsy and Drug Dependence after Post Traumatic Contusions Managed Conservatively

contusions managed conservatively. Material and Methods:  A prospective observational study was carried out in, Punjab Institute of Neurosciences, Lahore. A total of 97 patients, from 15-65 years, who were diagnosed with cerebral contusions and being managed conservatively were enrolled from July 2019 to December 2019. They were followed-up for 12 – 18 months. Results:  A total of 23% patients developed early post-traumatic seizures (PTS) and 11% of patients developed late post-traumatic seizures with mild to moderate brain injury.6% of patients with early PTS used antiepileptic drugs (AED) for at least three months during follow up and 7% with late PTS used AED. 8% of patients developed late PTS without any early PTS. The results of our study show that among 23% early PTS and 11% late PTS only 3 % actually required to use AED for at least 6months. To prevent this, 3% of the population 44% were using AED supplementary. Conclusion:  In our study, the incidence of early and late PTS is comparable to the other studies. The non-judicious use of the anti-epileptic drug is common in our country which leads to an increase in the risk of drug resistance and cost-intensive for poor patients in developing countries as prophylactic and excessive use of anti-epileptics does not affect the PTE

Single Burrhole Craniostomy with Subdural Placement of Foley Catheter for Drainage of Chronic Subdural Hematoma

Objective:  Chronic subdural hematoma (CSDH) is a common neurosurgical condition of the elderly. The lack of consensus over a single standard surgical procedure for the management of CSDH urges neurosurgeons to evaluate different techniques in terms of a better outcome. Material & Methods:  In this prospective study forty cases of CSDH who had undergone single burr-hole craniostomy and subdural placement of Foley catheter were analyzed. The observations were made concerning clinical, radiological findings, postoperative complications, and mortality rate. Results:  The study included 26 males and 14 females with a mean age of 67 years. The most common presenting symptom was hemiparesis (n=18, 45%). Recurrent hematoma and recurrent evacuation rate was 10%. There was no case of newly developed postoperative seizures, pneumocephalus, intracranial hemorrhage, and wound infection. The mortality rate during the study was 0.0%. The mean Glasgow outcome score (GOS) at the time of discharge was 4.8. Conclusion:  We concluded that single burr-hole evacuation of CSDH with Foley catheter placement appears to be an effective procedure with a significant reduction in postoperative pneumocephalus. Factors such as sudden decompression of hematoma, the air in the subdural cavity, misplacement of drainage tubes, and damage to blood vessels during surgery can be reduced with this technique