Meningitis in Closed Head Injury 2 Years Experience at Lahore General Hospital

During the time period of January 2006 till December 2007 there were 114300 patients with closed head injuries admitted at The Department of Neurosurgery Lahore General Hospital Lahore. The patients with closed head injury who developed meningitis were 17 and presented with headache, vomiting and neck stiffness. Headache was the commonest symptom. Diagnosis was made with the help of post contrast CT scan brain and CSF examination. Majority of patients admitted with head injury were adults while among patients who developed meningitis predominantly were children. Road traffic accident was the commonest cause of trauma. Majority developed meningitis within 6 weeks of trauma. There was no patient who developed meningitis after 12 weeks. Glasgow coma score at admission was above 8 in most of the patients. All patients were treated with combination of antibiotics for 6 to 12 weeks. Clinically outcome was moderate disability and good recovery in most of the cases. Conclusion:  Meningitis may occur following closed head injury. Its incidence is more in children than in adults. Responsible organism is not commonly identified on CSF examination. Outcome is reasonably good after proper management. Prophylactic antibiotics to all patients with closed head injury are not required

A Rare Case of Nasal-Orbital-Cranial Aneurysmal Bone Cyst

case of aneurysmal bone cyst involving ethmoidal sinuses, maxillary sinuses, frontal sinuses, sphenoidal sinuses, basisphenoid bone, and left orbit with intracranial extension in a 9 year old female. The diagnosis was confirmed using CT, MRI-brain, CT-angio brain imaging. The finding of nasal-orbital-cranial aneurysmal bone cyst was confirmed on Histopathology. Two staged surgical excision planned and done, i.e. trans-cranial and trans-nasal excision

COVID-19 Pandemic: Influences on the Practice of Neurosurgeons all over Pakistan

Objective:  The aim of this survey was to observe the impacts of COVID-19 pandemic on neurosurgery practices during this pandemic, assess various types of adaptations taken by them, protective measures during patient examination and effects on their health, family and socioeconomic life. Material & Methods:  A Questionnaire comprising 32 questions was circulated among practicing Neurosurgeons of Pakistan by social media, e-mails for 8 weeks (January-February 2021) and their responses were analyzed. Results:  108 participants were involved from all over Pakistan. 32% respondents stated reduction in clinical practice to a level of less than 25%. While, 10% reported complete closure of outpatient services during pandemic. There were varied responses on the use of protective measures and most used N95 mask only (31%). Pandemic also affected the research work, finances and leisure time activities. Conclusion:  Our study showed that neurosurgical practice was influenced by COVID-19 pandemic in many aspects in Pakistan. Proper method of protective measures and COVID testing of patients were lacking among them. Neurosurgeons should follow standard guidelines according to institutional directives in local neurosurgical practices so as to avoid being influenced by such crisis.

Five years Review of Failed Back Surgery Syndrome (FBSS) at Dept of Neurosurgery Unit-I, Lahore General Hospital Lahore

Objective:  To report our data of cases of failed back surgery syndrome (FBSS) and surgical and non surgical etiologies. Materials and Methods:  A review of cases of Failed back surgery Syndrome (FBSS), from 2003 to 2008 man-aged at The Neurosurgery Department Lahore General Hospital Lahore/PGMI, was conducted. The inclusion criterion was Re-admission within one year of their previous lumbar disk surgery at our department or other teaching institutes. 39 patients were found and included in the review. Two groups of patients were created on the basis of whether patient managed conservatively or re-explored. Important Data was recorded, analyzed and is presented. Results:  Out of the total 39 patients 15 (38.46%), were managed conservatively and included in group A. Twenty four 61.5% patients who were managed surgically with re-exploration and were grouped as B. 26 patients were male and 13 were female. Group A:  In this group 15 (38.46%), were included. These patients did not have a radicular element in their history of recurrent backache, and symptoms were vague.  Group B:  In group B, 24 (61.5%) patients were included. All these patients presented at re-admission with backache and radiculopathy. The time since previous surgery was not more than One year in all these patients.  Conclusion:  The failure of back surgery remains a challenge for the surgeons. There is a constant search for the causes and the pathogenesis of this syndrome and the best method of treatment. Recurrent disc is the commonest cause of failed back syndrome which responded well with reexporotive

Normal Pressure Hydrocephalus; Outcome after Ventriculoperitoneal Shunt

Background: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. Hakim and Adams des-cribed for the first time the symptoms and signs of NPH which include ataxia, progressive memory loss and uri-nary incontinence. In properly diagnosed cases, ventriculoperitoneal (VP) shunt leads to good outcome.Material and Methods: This study comprised of 40 patients with NPH. The duration of study was 5 years from January 2009 to December 2013. The duration of illness before presentation ranged from one year to 6 years. The patients were diagnosed clinically and CT scan brain was done in all patients (MRI in some patients). All patients underwent Folstein Mini-Mental State Examination. In cases of possible NPH, drainage lumbar puncture (LP) was done and their response was noted. In 35 patients whose families gave consent for surgery, VP shunt was done while families of 5 patients refused surgery. The patients who underwent VP shunt were followed up, which ranged from one to 5 years.Results: The age of the patients was between 52 and 70 years. The majority of patients (25) were between 61-70 years. Out of the 35 patients, 26 (75%) were male while 9 (25%) were female. The initial symptom in all these patients was gait ataxia and the duration of illness ranged from one year to 6 years.Conclusion: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. In properly diagnosed pat-ients, ventriculoperitoneal shunt gives good results

Community Awareness Level Regarding Brain Tumours and Reasons of Delay in Total Diagnostic Interval

Objectives: This study was conducted to determine the awareness in the Pakistani community regarding Brain tumors and exploring the reasons for the delay in Total Diagnostic Interval (TDI).Material and Methods: The methodology used to determine community level of awareness by anonyms, questionnaire based descriptive study. The duration of the study was 4 months and data was taken from the patients operated in Neurosurgery Unit I of Punjab Institute of Neuroscience (PINS).Results: A total of 102 patients were recorded, of which sixty five (63.7%) were male patients and thirty seven (36.2%) female patients. Immense delay was noted in getting the first basic radiological investigation, i.e., more than one year in 33 cases (32.35%) after the appearance of their first symptom. The study revealed that 46 cases (45.00%) got treatment from Quack, 38 cases (37.00%) from spiritual healer/Hakeems and 8 cases (07.00%) had homeopathic treatment. It was noted that 35 (34.30%) of the patients were unaware of their disease, and 67patients (65.00%) were aware of their disease. The awareness group revealed that 28 cases (27.45%) know about their disease, but reluctant to get surgery, while 30 cases (29.00%) were considered quacks treatment. Seventy five cases (73.52%) presented after 12 weeks of their initial symptom in our series.Conclusion: Awareness regarding brain tumors is insufficient that is resulting in delay of Total Diagnostic Interval, moreover the scenario was further complicated by adopting alternative methods of treatment like Hakeems/quacks/homeopathic and spiritual healers

Outcome of autologous bone graft versus polyetheretherketone cages in anterior cervical discectomy and fusion surgery

Objective:To compare the outcome of autologous bone graft versus PEEK cages in ACDF surgery in terms of clinical performance and radiographic features. Methodology:This study was conducted at Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan from April 2020 to December 2022. In this study patients were randomized into two equal groups i.e. Group A (autologous bone graft)  and Group B (PEEK cage). Results: Total of 98 patients was included in the study. The mean age of cases was 49.88 ± 17.83 years. There were 58(59.18%) male and 40(40.82%) female cases. 25(25.51%) cases who had C3-C4 involved, 48(48.98%) patients had C5-C6 and 25(25.51%) cases had C5 region involved. The mean disc height at 6th months in PEEK group was 6.71 ± 0.46 mm and in bone graft group was 6.33 ± 0.47 mm, p-value < 0.05. The mean operative time in PEEK group (2.07 ± 0.42) was statistically less than bone graft group (3.23 ± 0.36), p-value < 0.05. The average blood loss was also statistically less in PEEK group as compared to bone graft.  The mean hospital stay in PEEK group was 2.92 ± 0.61 days as compared to bone graft was 5.48 ± 1.90 days, p-value < 0.05. Conclusion:Outcome of ACDF surgery PEEK cages are better than autologous bone graft in terms of clinical performance and radiological features. Hence PEEK cages can be opted in future to have better outcome and higher patient’s satisfaction. &nbsp

Six months Analysis of Posterior Fossa Surgery in Neurosurgery Unit-I, Punjab Institute of Neurosciences (PINS)

Objective: This is a prospective study. Posterior fossa tumors are a common entity presented in our tertiary care neurosurgical setup. Although the treatment of posterior fossa tumor has underwent a lot of changes over the period of last two decades but unfortunately in the developing countries the Neurosurgical facilities are still not up to the mark.Materials and Methods: We analyzed the posterior fossa surgery done for the last six months (Feb. 2017 – Aug. 2017) in Neurosurgery Unit I of Punjab Institute of Neurosciences.Results: A total of 15 cases were operated from Feb 2017 to Aug 2017. Immediate outcome was seen at the time of discharge. Nine out of 15 patients were female (60.00%), 6 patients were male (40%). Maximum 6 cases (40.00%) were seen in 3rd decade of life. Main presenting complain was headache 3 cases (20.00%) followed by vomiting 7 cases (46.66%), vertigo in 5 cases (33.33%), hearing and visual loss in 4 cases (26.66%) and balance disturbance was observed in 3 cases (20.00%). Regarding location 6 cases (40.00%) were tumor midline posterior fossa SOL, 5 cases (33.3%) were CP angle lesions, 3 cases (20.00%) were in cerebellar hemisphere and 1 case (06.60%) was noted in the 4th ventricle. Nine of procedure (60.00%) remained continued for 4 – 8 hours and remaining 6 took up to 4 hours (40.00%). Gross total excision was achieved in 5 cases (33.33%), Maximum debulking (more than 80 percent tumour removal) was achieved in 10 cases (66.66%). Associated procedure V-P Shunt was done in 8 cases (53.33%) and EVD in 4 cases (26.6%).Complications: CSF leakage and re-exploration for dural repair was needed in 1 case (06.60%).Outcome: Ten patients were discharged on different status (66.66%) while mortality was noted in 5 cases (33.33%)

Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease

Objective:  To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results:  The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion:  Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome

Use of Closed Drainage System for a Period Between 3 To 7 Days, Under Antibiotic Cover is Safe in Chronic Subdural Hematoma Treatment

Chronic subdural hematoma is a common neurosurgical problem in the elderly. There has been interest in the use of closed system drainage after initial irrigation. This may lead to infection. The objective of our study was to assess the risk of infection with the use of drain over a period of 7 days. In 27 patients closed system drainage was used. It was removed whenever drainage became less than 25 ml/24 hours. The upper limit for keeping the drain was 7 days. None of the patients required the drain for more than 7 days. The risk of meningitis was assessed. There was no patient who developed local wound infection or meningitis. Conclusion: It is safe to use closed drainage system for continued drainage of chronic subdural hematoma under antibiotic cover for 7 days