Management Outcome of Extradural Hematoma

Objectives: To determine the frequency, clinical presentation and surgical outcome of extradural hematoma in head injury patients admitted in tertiary care hospital.Material and Methods: This descriptive study was conducted in neurosurgery department of Hayatabad Medical Complex, Peshawar from 1st February 2010 to 30th January 2012. A total of 367 patients of head injury, from both genders without age discrimination were included. EDHs caused by bleeding diatheses or vascular malformations, post surgical EDHs and those requiring conservative treatment were not included in the present study. Diagnosis of EDH was confirmed by CT scan brain. Patients' data was documented in a structured proforma and analyzed in SPSS version 17. Frequency and percentage was calculated for categorical variables. Mean ± SD was calculated for age. Results were presented as graphs and tables.Results: Total 367 patients were included out of which there were 238 (64.85%) males and 129 (35.14%) females. The mean age was 31 ± 1.3 years SD. EDH was most common in the age range of 21 – 30 years (28%). Most of the patients179 (48.77%) had Glasgow coma scale (GCS) in the range of 13 to 15. The commonest presentation was headache i.e. 242 patients (73.11%) and 210 patients (63.44%) had vomiting as presenting complaints. The most common location for EDH in the present study was temporo-parietal region i.e. 113 (30.79%) followed by frontal region i.e. 99 (26.97%).Glasgow outcome score was used to measure the outcome. Outcome was good in 229 patients but predominantly these patients were in GCS 14 – 15 on presentation. Death occurred in 29 (7.90%) patients and 3 (.817%) patients remained in vegetative state. These patients had very low GCS and coning or associated parenchymal or systemic injuries were already present before their operations

Clinical Manifestation of Brain Abscess

Objective: To determine the clinical presentations of brain abscess.Study design: Descriptive study.Place and Duration of Study: Hayatabad Medical Complex Hospital Peshawar Khyber Pakhtoonkhawa from 1st February 2001 to 31st July 2011.Material and Methods: A total 31 patients with symptomatic brain abscess confirmed on CT scan were included in this study. Both gender (male and female) and patients in the age range of 01 – 70 years were included in this study. The patients’ demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11.Results: Out of 31 patients, there were 17 (54.8%) males and 14 (45.2%) females. The age of patients ranged from 01 to 70 years. In this study the overall mean age was 32.38 years. Majority of patients 13 (41.9%) were in the age range of 31 – 40 years. Most common clinical presentation of patient were headache in 29 (93.5%) vomiting 22 (71%) and fever 13 (42%) patients.Conclusions: Brain abscess commonly occurred in the third decade of life. Headache vomiting and fever were the most common clinical presentation of brain abscess

The Effectiveness of Surgery for the Symptomatic Prolapsed Lumbar Intervertebral Disc

Aims and Objective: To know the effectiveness of surgery for the symptomatic prolapsed lumbar intervertebral disc in patients admitted in tertiary care hospital.Materials and Methods: Subsequent to the approval from the ethical review committee, this descriptive study was conducted in neurosurgery department, Hayatabad Medical Complex, Peshawar from April 2009 to March 2012. All the patients were consented before enrolling into the study. Only those patients were included in whom straight leg raising sign was less than 60 degree and prolapsed disc was at L4-5 or L5 – S1 MRI. Those patients in whom the disc was at multiple levels or there was previous history of spine surgery, evidence of lumbar stenosis and higher level discs patients were excluded from this study. History, examination and MRI lumbosacral spine was done in all patients. Procedure was done in prone position under general anesthesia. Laminectomy and discectomy was performed .Patients were allowed to sit and mobilized after 12 hours of surgery and discharged mostly on 2nd postoperative day. The collected information was analyzed in statistical package of social sciences (SPSS) version 16.Results: Out of 226 patients, 144 (63.72%) were male and 82(36.28%) were female. Mean age was 33.67 years with age range from 18–64. Most of the patients presented with leg pain i.e. n = 210 (92.92%) followed by back pain n = 190 (84.07%), numbness n = 181 (80.08%), motor deficit n = 30 (13.27%) and cauda equine n = 16 (7.07%). Post operatively only 14 (7.96%) patients had sciatica, backache was present in 110 (48.67%) patients, numbness in 150 (66.37) patients, motor deficit in 6 (2.65%) and cauda equine persisted in 7 (3.09%) patients. Commonest complication of the surgery was CSF leak which was present in 15 (6.64%) patients followed by discitis i.e. in 8 (3.53%) patients. Foot drop in 2 (0.88%) patients. Recurrent disc was seen in 18 (7.96%) patients.Conclusion: Surgery in appropriately selected patients gives excellent results. It gives early and rapid pain relief. Conservative trial should be exhausted before embarking on surgery

The Role of Decompressive Craniectomy in Traumatic Cerebral Contusions; A Prospective Observational Study

Background: To investigate the role of decompressive craniectomy in traumatic cerebral contusions in terms of factors affecting outcome and the various surgical strategies which can be taken into consideration for contusion resection and cerebral decompression.Material and Methods: The study was conducted from July 2013 to June 2014 at Department of Neurological Surgery Hayatabad Medical Complex Peshawar. A total of 35 patients were enrolled. The criteria included patients with traumatic cerebral contusion(s) who were eligible to undergo surgical decompression. The surgical procedures for intervention were classified according to the individual patient needs. Demographic data, inclu-sion parameters, surgical procedures, post-operative outcome and complications were recorded and analysed.Results: Thirty five patients were included with a mean age of 37.8 ± 13.8 years, 23 (65.7%) males and 12 (34.3%) females. The median Glasgow coma score at arrival was 8 ± 2.4, median Glasgow comma score at discharge was 9 ± 5. The median Glasgow outcome score at 3 months was 4 ± 1.6 and a mean total hospital stay of 10.9 ± 8.1 days.Conclusion: Cerebral contusions comprise one of the most serious kind of traumatic brain insult with long term physical, mental and economic sequelae while imparting a heavy load of hospital inpatient mortality and mor-bidity

Management of Cervical Neurofibroma Type

Objective: To determine the clinical presentation and postoperative outcome of cervical neurofibroma type 1.Study design: Retrospective study.Place and Duration of Study: Hayatabad Medical Complex Hospital Peshawar Khyber pakhtoonkhawa from 1st February 1999 to 31st July 2011.Material and Methods: A total 41 patients with symptomatic cervical spine neurofibromas who underwent surgical decompression and tumor resection were included in this study. Both gender (male and female) and patients in the age range of 20 – 70 years were included in this study. These patients were operated through posterior approach of the cervical spine and then followed for six months for postoperative outcome .The patients’ demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11.Results: Out of 41 patients, there were 22 (53.6%) males and 19 (46.3%) females. The age of patients ranged from 20 to 70 years. In this study the overall mean age was 39.2 years. Majority of patients 19 (46.3%) were in the age range of 31 – 40 years. Most common clinical presentation of patient were quadrapresis in 23 (56.1%) pain neck 9 (22%) paraparesis 9 (22%) patients. Postoperatively most of the patients recovered from their preoperative symptoms.Conclusions: Quadraparesis and pain neck were the common clinical presentation of cervical cord neurofibroma type 1. Surgical outcome of cevical neurofibroma type 1 is good