Cerebellopontine Angle (CPA) Tumors Presenting with Trigeminal Neuralgia (TN): A Study from LRH, Peshawar

Background/Objective:  The cerebellopontine angle (CPA) is the most prevalent site for brain tumors, accounting for 10% of all cases. CPA tumors can have a direct or indirect pathogenic impact on the auditory nerve and brain stem. The study aimed to quantify the prevalence of cerebellopontine angle tumors in patients with trigeminal neuralgia. Material and Methods:  A cross sections study was conducted and 100 patients were included from the Neurosurgery department of LRH, Peshawar. Magnetic resonance images (MRI) were used to look for CPA tumors. The data on CPA tumors were stratified for age and gender. Suboccipital retromastoid craniectomy was performed. Results:  The mean age of the patients was 43 years. 38 patients were male and 62 were female. CPA tumors were seen in three percent of trigeminal neuralgia patients. There existed a significant difference (p < 0.00001) between the presence and absence of CPA tumors. A maximum number of patients (n = 37) were not having CPA tumors from the age group of 51-60 years. An insignificant association was reported for CPA distribution concerning age and gender. Conclusion:  According to our findings, 3% of trigeminal neuralgia patients had cerebellopontine angle tumors. We urge more investigation and screening of trigeminal neuralgia patients for CPA tumors based on the findings of this study

Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan

Objective:  The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods:  This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results:  80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion:  Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern. 

Hemorrhagic Stroke May Be the Sequelae of Brain Tumors

Objective:  Hemorrhagic stroke is a common neurosurgical emergency caused by multiple pathological conditions. Brain tumors can also present with acute neurodeficits secondary to hemorrhagic stroke. This study as case series was conducted to report the clinical presentation, radiological findings, causes and management of brain tumors presenting as hemorrhagic stroke. Materials and Methods:  Clinical assessment and radiological investigations were done, including CT brain and MRI brain with contrast. Surgery was done with evacuation of the hematoma and excision of tumor, and the tissue was sent for histopathology. Post operatively patients were shifted to the intensive care unit for monitoring and ventilator support if needed. Adjuvant treatment was guided according to histopathology report. Results:  Total number of patients who were diagnosed to have a bleed in brain tumor were thirteen (n = 13). There were 6 (46%) males and 7 (54%) females. Mean age was 55 years. Among 13 patients, 4 (31%) patients had metastatic brain tumors and 9 (69%) patients had primary brain tumors. Diagnosis was done on CT brain, MRI brain and confirmed on histopathology of tissue obtained during surgery. Out of 13 patients, 5 (38%) patients were asymptomatic prior to hemorrhage and 8 (62%) patients had neurodeficits before and recent episodes of bleeding, which caused deterioration of neurological state. Conclusion:  Malignant primary and metastatic brain tumors can present as acute focal deficits due to brain hemorrhage. Diagnosis is based on clinical presentation, radiological features and histopathology.&nbsp

Outcome Comparison of Endoscopic (Endonasal Trans-Sphenoidal) Repairs of CSF Leak vs. Transcranial Approach

OBJECTIVES: To compare the effectiveness of Endoscopic (endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications.  METHODOLOGY:   This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. Total of 40 patients diagnosed according to inclusion criteria were enrolled and were divided into two groups. One group was treated with endonasal trans-sphenoidal repair, and another was treated with a trans-cranial approach. All patients were followed for 1 year.  RESULTS:  The mean age of enrolled patients was 35.4±11.6 years. There were 62.5% male and 37.5% female. In the endoscopic group the recurrence rate was observed in 3 (15%) of the patients while in the trans-cranial group the recurrence rate was observed in 2 (10%) of the patients. The overall recurrence and success rate was 8% and 92% respectively. About 4 patients developed an infection, which was treated successfully.  CONCLUSION:  It is concluded that the endoscopic approach is safe and effective. The endoscopic approach should be considered as standard procedure for treatment

Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement. Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ≤3) was considered after 12 months. Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement. Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF

Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach

Objective:  In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach Material and Methods:  This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus. Results:  CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications. Conclusion:  Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications

Symptom Outcome of Walant Technique for Carpal Tunnel Release – A Prospective Study in the Tertiary Care Hospital, Nowshera

OBJECTIVES The study aims to determine the outcome of the WALANT technique for Carpal Tunnel Release CTR.METHODOLOGY A descriptive study was done in the Neurosurgery department at Qazi Hussain Ahmad Medical Complex, Nowshera, from 15th September 2020 to 15th March 2021. A total of 29 consecutive patients of carpal tunnel syndrome (CTS) were undergoing carpal tunnel release (CTR) under wide awake local anaesthesia no tourniquet (WALANT) technique, using a mixture of lidocaine and epinephrine for local anaesthesia, and the outcome was assessed for patient satisfaction by Boston Carpal Tunnel Questionnaire (BCTQ) (symptom severity scales (SSS)) at pre-operatively and six weeks postoperatively.RESULTSWide awake CTR was done in 29 patients; 86.2% were female and 13.8% male. The mean age was 47.3 years. The average time of return to daily activity was three weeks. No complications were noted, like wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at six weeks postoperatively. 86% significantly reduced the symptom severity score (SSS). Mean SSS improved from preoperative 3.2 points to 1.7 points postoperatively. There was a significant decrease in distal latencies (p <0.01).   CONCLUSIONWide awake surgery is an excellent technique with favourable outcomes and good satisfaction rates for CTR. The study shows that clinical symptoms resolve rapidly after CTR. Without the need for monitored anaesthesia, the cost could decrease dramatically

Post-Operative Neurological Outcome of Intradural Spinal Tumors in Terms of Improvement In Mccormick’s Classification Scheme

OBJECTIVES: To determine the post-operative neurological outcome of intradural spinal tumors in terms of improvement in McCormick classification scheme.METHODOLOGY:  Total of 95 patients diagnosed as case of intradural spinal tumor as per operational definition with any McCormick grade were analyzed. After admission and complete neurological examination, pre-operative McCormik’s grades of each patient were determined and followed for one month after surgery. During their stay they were assessed for neurological improvement as per McCormick grade.RESULTS:There were total 95 patients presenting in OPD with the mean age of 45±12.36 years. There were 42% male and 58% female. There were 62% patients who were improved in neurological outcome while 38% patients were not improved. CONCLUSION:Surgical removal of spinal tumor is beneficial to the affected individual and has positive effect on his life

Synthesis, antibacterial activity and docking studies of chloroacetamide derivatives

Structural modification of lead compounds is a great challenge in organic synthesis. Introduction of different functional groups not only modify the structure of starting material but also improve their biological activeness. Small synthetic molecules are favored in spite of the reality that majority of drug molecules derived from natural sources, are in vogue. In the present work, acetamide derivatives were synthesized using chloroacetyl chloride. After synthesizing targeted series of acetamide derivatives these compounds were further modified using different amines including 2-aminobenzene thiol, benzyl amine, benzene 1,4-diamine, 4-amino-1,5-dimethyl-2-phenyl-1H-pyrazol-3(2H)-one, 4-aminophenol, hydrazine and 4-amino-N-(5-methylisoxazol-3-yl)benzenesulfonamide. All of these synthesized compounds were characterized by FT-IR, 1H NMR, 13C NMR and X-ray crystallography. The compounds were assessed for their anti-bacterial activity using disc diffusion method against Staphylococcus aureus and Escherichia coli. The compounds were found to exhibit comparable activity to the standard drug used. This was further supported by molecular docking studies using bacterial DNA gyrase and Topoisomerase II targets causing bacterial death as they are major bacterial proteins known to be involved in transcription and replication process. Results proved that the compound 2b was the most efficacious antimicrobial compound among the synthesized set of compounds. To tackle the growing drug resistance acetamide based functionalities can be regarded as the active lead compounds to target different drug resistance microorganism