Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions

Objective:  To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute. Material and Methods:  We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach. Result:  Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage. Conclusion:  This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach. Keywords:  Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma

Lipoma at Conus Medullaris without Spinal Dysraphism causing Neurological Deficit: A Rare Occurrence

It's uncommon to have an intradural lipoma without spinal dysraphism. The majority are asymptomatic, however, neurological impairments might occur. For the past six months, a 35-year-old man had been experiencing growing weakening in both lower limbs. The L1 intradural space-occupying lesion was detected during a clinical examination and radiological workup. The patient underwent surgery to address a worsening neurological impairment. The patient had fully recovered neurologically after a six-month follow-up. If the neurological damage is progressive, intradural lipomas should be surgically removed. The surgical treatment produces positive results

Short-Term Complications of Microscopic Trans Nasal Transsphenoidal Pituitary Adenomectomy

Background/Objective:   The commonest of pituitary gland tumors is pituitary adenoma which may be excised transcranially or trans nasal trans sphenoidal using either microscope or endoscope, in this study, the microscope was used. The objective was to see the short-term outcome of patients after microscopic transnasal trans-sphenoidal pituitary adenomectomy. Material & Methods:  This was a descriptive prospective study carried out from July 2019 to July 2021. 80 cases were included. All patients were investigated by contrast brain MRI, hormonal assay for pituitary gland & visual perimetry. Patients were evaluated for complications at 48 hours and 7 days. Results:  Mean age of the study population was 41.78 ± 11.75 years. There were 61 (76%) men & 19 (24%) women. 55 (68.8%) patients had functioning and 25 (3.3%) patients had nonfunctioning adenoma. Among 33 (41.3%) patients size of the adenoma was < 0.9 cm and 47 (58.8%) patients had adenoma > 1.0 cm. 12 patients had CSF leaks within 48 hours of surgery and 5 had a persistent leak on the 7th day. No statistically significant association was seen between age, gender, and size of adenoma and persistent CSF leak (P > 0.05). Diabetes insipidus was found in 9 patients. 3 had post-operative hematoma, 01 patient had meningitis and 2 patients died. Conclusion:  microscopic transnasal trans-sphenoidal surgery is a safe procedure yet associated with significant complications

Outcomes of Cranioplasty after Craniectomy

Objective:  Craniectomy is a widely used procedure in neurosurgery that results in more cranioplasties to repair skull defects. The complication rate after cranioplasties seems to be higher than elective craniotomies so this study was conducted to determine the outcome of cranioplasty after craniectomy. Materials & Methods:  The patients included in this study had craniectomy and cranioplasty for any indication. Patients included had variables, such as age, sex, underlying pathology, craniectomy and cranioplasty dates, the material used for cranioplasty (autologous bone or methyl methacrylate), and methods of cranioplasty flap fixation (sutures or titanium plates and screws) follow up period and complications. Results:  It was concluded that patients in the age group of 41 – 60 years (5 cases), males (7 cases), cranioplasty performed after 6 months (5cases) with autologous bone graft (8cases) were associated with more complications. Conclusion:  The overall rate of complications associated with cranioplasties is not negligible, however, early cranioplasty in young patients with the use of polymethyl methacrylate may be associated with less complication rate. Keywords:  Decompressive, Craniectomy, Cranioplasty, Autologous, Polymethyl Methacrylat

Predictors of Surgical Outcome Following Cerebral Contusion in Severe Head Injuries

Objective:  There are controversies regarding the management of Cerebral Contusion. The study sought to identify parameters influencing the surgical outcome of individuals suffering from a brain contusion. Methods:  A quasi-experimental study was conducted at the Department of Neurosurgery, Mayo Hospital Lahore, and 37 patients were included. The information on the mode/mechanism of injury, time of presentation, clinical presentation, and contusion type/location was collected. GCS (at 1st, 2nd and 6th weeks) and GOS were used for the neurological assessment of pre-operative and post-operative status. Results:  The average age of presentation was 42.57 years. There were 21.6% female and 78.4% male patients. 64.9% presented with road traffic accidents. 4% of patients presented to the hospital within 12 hours of injury, 16.2% between 12 to 24 hours, and 5.4% between 24 to 48 hours. 29% had seizures and upgoing plantar. 18% had hemiparesis or hemiplegia. Light reflex was absent in 40.5% of patients. The GCS kept improving postoperatively. GCS at admission was averaging 8 which improved to 10, 12, and 13 after surgery. The presenting mean GCS at 1st-week, 2nd-week, 6th-week, and mean GOS at 30th PAD. Counter coup injury improved to 15/15 right in 1st week. Mean GOS was 5 at 30th PAD. The most improvement was seen in the frontoparietal, temporoparietal, and fronto-temporo-parietal locations. The mean GOS at 30th PAD was 4. Conclusion:  The outcome following cerebral contusion depends upon the initial presenting GCS and GOS. Therefore, the better the presenting GCS and GOS better is the prognosis of the patient

Role of Anterior Cervical Decompression Fusion (ACDF) and Plating in Patients with Lower Cervical Caries Spine

Objective:  We assessed the neurologic status of patients with cervical spine caries after anterior cervical decompression fusion and plating in terms of muscle power measured by MRC (medical research council) grade and functional status measured by Nurick grade. Materials and Methods:  A descriptive case series study was conducted and 36 subjects with lower cervical spine (C3 – C7) were included with cervical spine caries who needed anterior cervical decompression and plating operated by the department of Neurosurgery, KEMU/Mayo Hospital. The cervical spine TB was confirmed using an MRI plain and contrasted cervical spine. Post-surgical neurological examinations were performed on the 1st, 7th, 21st, and 42nd days and the 3rd and 6th months after surgery. The neurological state was measured in terms of muscle power measured by MRC grades and functional outcome was assessed from Nurick grades. Results:  The mean age of the patients was 37.0 ± 14.4 years. The majority of patients had C5 caries spine (28%) and the least had C7 caries spine (14%). Most of the patients had pre-operative MRC grade 3 (41.7%). The majority had Nurick’s grade 5 (55.6%). 17% of patients had post-operative hoarseness of voice. 31% of the patients had post-operative dysphasia which improved by 3 weeks. 3% developed a new neurological deficit in the form of deterioration of muscle power measured by MRC grade during 6 months’ follow-up time. Conclusion:  All follow-up improvements were statistically significant in terms of pre-operative status