Analysis of Patients Operated For Lumber Disc Herniation

Objectives:  To analyze different variables of patients operated for lumber disc prolapsed. Study Design:  Observational study. Sample Size:  Three hundred and twelve consecutive patients operated for lumber disc herniation. Settings:  Department of Neurosurgery, Postgraduate Medical Institute, Govt Lady Reading Hospital, Peshawar. Pakistan. Duration:  The study duration was nine months from January 2008 to sept; 2008. Results:  Out of 312 patients 208 were male and 104 female with male to female ratio of 2:1. Their ages ranged from 17 to 70 years. Majority (56.1%) of patients were from northern areas. Straight leg raising test was impaired in 295 cases. The ratio between contained and ruptured disc was 3:1. About 44.9% of patients (140 cases) had left side disc prolapse, while right side in 29.5% and bilateral in 25.6% cases. The common level affected was L4-L5. In 225{72.1%} patients modified fenestration Discectomy was suitable and in the rest Laminectomy was carried out.  Conclusion:  From this study we conclude that Lumber disc herniation is common in male gender in 4th decade of their life, which occur commonly due to misuse of back. It usually occurs in Labourers and drivers. Left side and L4-5 level is involved in majority of patients. Sciatica with backache, and impaired straight leg raising test are important clinical features. Contained disc is more common than ruptured disc. Minimal invasive procedures like modified fenestration Discectomy gives good results.&nbsp

Success and Complications of Microsurgical Over-Top Decompression for Lumbar Spine Stenosis: Experience in a Limited Resource Center

Objective:  The overtop decompression is also called the outside-in technique or bilateral decompression from the unilateral approach. The objective of the study was to evaluate the success and complications of microsurgical over-top decompression for single-level lumbar spine stenosis. Material and Methods:  This observational study was conducted at the Neurosurgery unit at Lady Reading Hospital Peshawar from Jan 2018 to December 2021. All those patients who had undergone over-top decompression for single-level degenerative lumbar spine stenosis irrespective of age and gender were included in our study. Results:  We had a total of 187 patients who underwent microscopic over-top decompression for lumbar spine stenosis. Four patients lost their final follow-up. The mean age of the patients was 46 years (ranging from 18 – 68 years). Spinal stenosis was more common in men (58.3%) and at L4/5 (51.87%) level. The mean duration of surgery was 56 minutes (range 35-86 minutes). Leg pain improved in 83.1% of the cases with overall patient satisfaction after surgery in 82.5% of the cases. The most common (6.95%) complication of the procedure was iatrogenic durotomy. Most of the complications were minor and treated conservatively. Conclusions:  Overtop decompression is a safe and effective minimally invasive procedure for lumbar spine stenosis. It has good results in symptomatic improvement. There is minimal soft tissue and bony dissection. Therefore, mobility and stability of the spine are preserved. Moreover, the learning curve for microscopic overtop decompression is shallow and surgery time is short

Patterns, Frequency and Gender Dominance in Paediatric Neuro-trauma in a Tertiary Care Hospital in Peshawar

Objective:  To determine the patterns, frequency and gender dominance in pediatric trauma presenting to Neurosurgery Department in a tertiary care hospital. Material and Methods:  This retrospective study was conducted in Department of Neurosurgery, Lady Reading Hospital, Peshawar. The medical records of all patients (0 – 15 years) with trauma admitted in our unit were analyzed retrospectively.Demographic details of the included subjects were noted down. Results:  A total of 448 patients were included in our study; 308 males and 140 females. Patients with 0 – 5 years were 40%, 6 – 10 years were 38% and 11 – 15 years were 22%. Extradural hematoma (28.12%) preceded depressed skull fracture (20.08%), followed by linear fractures (17.85), subdural hematoma (7.58%), contusions (5.80%) and subarachnoid hemorrhage (5.35%). Patients with diffuse axonal injury accounted for about 4.91%. Only 2 cases of cervical injury were noted. Conclusion:  The number of boys was comparatively greater than girls. Most of the patients were in the age group of 0 – 5 years. Ratio of extradural hematoma was the highest among all the injuries

Posterior Fossa Reconstruction for Chiari Malformation Type I: Experience with 17 Cases

Objective: To assess the results of posterior fossa reconstruction in patients with Chiari I malformation.Material and Methods: This observational study was conducted at the department of Neurosurgery, medical and teaching institute (MTI), Lady Reading Hospital Peshawar from July 2013 to June 2015. A total of 17 consecutive patients with Chiari I malformation who undergone posterior fossa reconstruction and fulfilled inclusion criteria were included in the study irrespective of their age and gender. The patients were assessed postoperatively for clinical and radiological (syringomyelia) improvement and post operative complications for a period of 6 months.Results: We had total 17 patients who underwent posterior fossa reconstruction for Chiari I malformation. There were 41.2% males and 58.8% females. Age of the patients ranged from 10 – 52 years with the mean age of 31 years. The most common clinical features were headache (64.7%) and sensory impairment (58.8%). We had syringomyelia in 70.1% and scoliosis in 47.1% cases. After surgery headache improved in 81.1% patients, sensations in 70% cases and syringomyelia in 91.1% cases. The overall morbidity in the form of complications was in almost 47% cases. One patient (5.9%) died after surgery.Conclusions: We conclude that posterior fossa reconstruction is a safe and effective procedure for the manage-ment of Chiari I malformation. This results in improvement in patients symptoms with acceptable complications. These complications respond to conservative treatment most of tim

Frequency of External Ventricular Drain Related Infection

Objective: To evaluate the frequency of external ventricular drain (EVD) related infections. Material and Methods: This observational study was conducted at the department of Neurosurgery / pathology, Postgraduate medical institute, Lady Reading Hospital Peshawar from July 2014 to December 2014. A total of 18 consecutive patients, who undergone EVD, irrespective of their age and gender were included in the study. Those who had intracranial infection, Cerebrospinal fluid leak (CSF) or revision of EVD (external ventricular drain) were excluded from the study. Results: We had total 18 patients who underwent EVD in the study period. There were 44.4% males and 55.6% females. Their age range was from 1-69 years with the mean age of 40years. Main indication for EVD was intracranial hemorrhage in 55.6% cases. Post EVD infection was observed in 16.6%. Conclusions: We conclude that external ventricular drainage is an effective and quick technique for the management of acutely raised intracranial pressure with dilated ventricular system. The incidence of EVD related infection is significant (16.6%). Early diagnosis is made on the basis of CSF culture, gram staining and routine evaluation for increased white cell count, increased proteins and decrease glucose level. This will help to permit immediate and specific treatment

Frequency of Wound Infection after Single Level Anterior Cervical Discectomy without Bone Grafting

Objective: To determine the frequency of wound infection after anterior cervical discectomy without bone graf-ting in patients with single level degenerative cervical disc herniation diagnosed on magnetic resonance imaging.Material and Methods: This observational study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from April 2009 March 2010. Sixty five (65) con-secutive patients who undergone single level anterior cervical discectomy without bone grafting for degenerative cervical disc herniation were included in the study irrespective of their age and gender. The patients were obser-ved for post-operative wound infection including superficial wound infection and discitis recorded.Results: Out of 65 cases, 64.4% were males and 35.4% females. Majority 27.7% cases were in the age range of 41 – 50 years, 24.6% in the age group of 31 – 40 years and 18.5% in the age range of 21 – 30 years. We also had patients in other age groups. Majority of women, 30.8% of the total, were house wives, followed by (27.7%) those having sedentary life style as teachers, students and bankers. Mean duration of the symptoms was 5.53 months and mean duration of hospital stay was 6.95 days. Postoperative superficial wound infection was in 3.1% cases and discitis in 1.5% patients.Conclusions: Age group of 41 – 50 years affected more than other age groups. Cervical disc herniation was common in men. Postoperative superficial wound infection was observed in 3.1% patients and discitis in 1.5% cases. Age group of 41 – 50 years affected more than other age groups. Cervical disc herniation was common in men. Postoperative superficial wound infection was observed in 3.1% patients and discitis in 1.5% cases. From the results of this study it is concluded that Cervical disc herniation is more common in male and the common age group affected is 41 – 50 years. Postoperative superficial wound infection was noted in 3.1% cases and Post-operative discitis was observed in 1.5% cases. Postoperative wound infection was common in males than females and was evident within 6 weeks of surgery

Management of Pediatric Brain Abscess: Experience with 21 Cases

Objective: To evaluate clinical presentation, diagnosis and treatment of brain abscess in pediatric age group.Material and Methods: This observational study was conducted at the department of Neurosurgery / pathology, Post-graduate medical institute, Lady Reading Hospital Peshawar from Jan 2011 to December 2013. A total of 21 consecutive patients who undergone surgery (aspiration / excision) for brain abscess with age less than 14 years were included in the study irrespective of their gender. Those treated conservatively or age more than 14 years were excluded from the study.Results: We had total 21 children who underwent surgery for brain abscess in the study period. There were 62% males and 38% females. Most of the patients presented with fever (66.7%) and headache / vomiting (61.9%). Otitis media (33.3%) and cyanotic heart disease (23.8%) were the common predisposing factors. CT brain with contrast was done in all the patients with brain abscess. Most of the children (52.4%) with brain abscess were offered bur-hole aspiration. In 57.1% patients the culture report was positive. The commonly identified orga-nisms were streptococci in 41.7 % cases and staphalococci in 25%.Conclusions: We concluded from this study that otitis media and cyanotic heart disease were the common pre-disposing factors for pediatric brain abscess. The common presenting features were fever followed by headache / vomiting. CT brain with contrast is the investigation of choice to diagnose brain abscess. Most of the children with brain abscess needs aspiration. Culture was positive in most but not all the cases

The outcome of Posterio-lateral Decompression and Transpedicle Fixation for Thoracic Spine Tuberculosis

Objective:  The study assessed the outcome of posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis. Materials and Methods:  An observational, cross-sectional study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. All those patients who had undergone posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis were included. Both genders with ages more than 14 years were included in our study. Ethical committee approval was taken. Pre-designed proforma was used for data entry. Patients’ data were analysed through SPSS software. Results:  A total of 31 patients with tuberculous spondylodiscitis were studied. The age ranged from 15 – 57 years with a mean of 37.74 ± 10.07 years. Most of the patients with thoracic TB were male 54.8% (17/31). Pain improved in all the patients and neurology improved in most of the cases. The dural tear was in one patient and one patient had a wound infection. There was no mortality. Conclusions:  We conclude from the study that posterior-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis is a safe procedure. It has good results in terms of pain relief and neurological improvement. This procedure has an acceptable complications rate. Therefore, it can be considered as a better alternative to other surgical procedures for thoracic spine tuberculosis

Central Nervous System Complications in Civilians’ Blast – Induced Head Injuries

Objective: To evaluate the frequency of central nervous system complications in civilians with explosive related head injuries.Material and Methods: This observational study was conducted at Neurosurgery Department, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar – Pakistan, from January 2009 to December 2011 (3 years). We included all the patients with explosive related head injuries who were hospitalized, of all age groups and both genders, and excluded those patients who died before hospitalization. We also excluded patients with head injuries having neurovascular complications or had neurological deficit.Results: We had total of 191 patients with bomb blast head injuries treated in Lady Reading Hospital. One sixty six (86.9%) patients were male and 25 (13.1%) female with male / female ratio of 6.6:1. Their age ranged from 2 months of 71 years. Almost 65% of the patients were in their 2nd, 3rd and 4th decades of life. The common CNS complications in our patients were infections (12.04%), cerebrospinal fluid (CSF) leak (8.38%), epilepsy (5.2%) and post-traumatic hydrocephalous (3.7%). Mortality rate was 11%.Conclusion: We conclude from this study that central nervous system infections are the common (12.04%) complication of civilian explosive related head injuries followed by cerebrospinal fluid leak, seizures and hydro-cephalous respectively. Over all morbidity is 29.32% and mortality rate is 11% in those head injured patients who reach to hospital

Frequency of Early Complications of Trans-sphenoidal Surgery

Objective: To determine the frequency of early complication of trans-nasal trans-sphenoidal surgery for pituitary adenoma.Material and Methods: This observational study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from June 2009 to December 2010. A total of 63 consecutive patients who undergone Trans nasal trans-sphenoidal surgery for pituitary adenoma with age more than fourteen years were included in the study irrespective of their gender. These patients were followed up to 7 post op days for early complications and frequency of these complications was calculated.Results: Out of 63 patients, there were 52.4% males and 47.6% females. Majority (34.9%) of patients were in the age range of 31 – 40 years, followed by 28.6% patients in age group of 21 – 30 years. Among early post-operative complications diabetes Insipidus was noted in 7.9% cases, Postoperative CSF leak was recorded in 4.8% cases and meningitis was observed in 1.6% case.Conclusions: We conclude that most of our patients with pituitary adenoma were males in their 3rd or 4th decades of life. Diabetes Insipidus was the most common early post-operative complication followed by CSF leak and meningitis