Objectives: To know about the causes of hydrocephalus (HDC) among thedifferent age groups. Study Design: Cross sectional study. Setting: Department of neurosurgeryPGMI/LRH. Period: August 2012 to September 2013. Materials and Methods: The operativerecords and the admission records of all the patients who were admitted and operated duringthe study period were checked. All the patients undergoing surgery for hydrocephalus wereincluded in the study and those patients who had undergone surgery for other reasons wereexcluded from the study. Patient s who had a repeated surgery for hydrocephalus were alsoexcluded from the study as well as those who were re-admitted for shunt related or surgeryrelated complications. The age, gender, and the radiological diagnosis of hydrocephalus wasrecorded on a designed proforma. All the patients were grouped into two that is above andbelow 12 years. Etiology wise HDC was classified as either congenital, post-infectious, tumorrelated, post trauma or miscelenous. The data was entered and analyzed using SPSS version16. Results: A total of 634 admission for Hydrocephalus were reviewed. 387 patients fulfilledthe inclusion criteria. There were 209 males and 178 females. The age range was from 1 monthto 69 years and the mean age was 8±4.6 years. There were 67.67% of the patients in the groupI while 33.33% of patients in the Group II. There was almost equal distribution on in the groupII based on the age difference. The major causes in the group I were the congenital, postinfectious, and tumor related while in the group II the main causes were the PIH, post tumor andthe post hemorrhagic. Conclusion: The most common causes of the HDC in the pediatric agegroup are the congenital, PIH and tumor related. In adults the most common causes of the HDCare the PIH, post Hemorrhagic HDC and tumor related Hydrocephalus.
Objective: To examine the outcome of Endoscopic Third Ventriculostomy in 80 consecutive patients operated in Irfan General Hospital and Prime Teaching Hospital Peshawar.Materials and Methods: Prospective observational study was conducted in the neurosurgery department of Prime Teaching Hospital and Irfan General Hospital Peshawar. 80 patients (48 male and 32 female) were followed for 3 months. The inclusion criteria all patients with Third ventricular hydrocephalus were included in this study and the exclusion criteria unwilling patients and those who opted for VP shunting rather than ETV. Data was analyzed using SPSS version 22.Results: ETV was performed in 80 patients. With highest success rate inAqueductal stenosis and posterior fossa tumors 88% and 87% respectively. ETV had a lowest success score of 50% in patients with Hydrocephalus TBM. Common post-operative complications were seizures and CSF leakage.Conclusion: ETV is less invasive and effective treatment for non-communicating hydrocephalus.ETV is most effective in treating aqueductal stenosis and posterior fossa tumors. The overall success rate of ETV is 74%. Based on these findings, it is recommended that ETV should be attempted as first line treatment for patients with triventricular hydrocephalus due to various pathologies.
Background and Aim: There is a substantial morbidity and mortality associated with traumatic brain injury (TBI). TBI still results in cerebral edema, which increases intracranial pressure (ICP) and reduces cerebral perfusion pressure (CPP) after traumatic brain injury (TBI). The purpose of this study was to evaluate the non-decompressive single stage bilateral craniotomy (SSBC) in traumatic brain injury. Patients and Methods: This prospective study was conducted on 44 TBI cases undergoing non decompressive single stage bilateral craniotomy (SSBC) in Neurosurgery Department of Prime Teaching Hospital, Peshawar from January 2022 to June 2022. All the patients underwent computed tomogram images and those fulfilling the inclusion criteria were enrolled. Demographic details, background parameters, measurement of intracranial pressure (ICP), and outcome were recorded. Results: Of the total 44 TBI patients, 32 (72.7%) were male and 12 (27.3%) were females. Age-wise distribution of patients were as follows: 3 (6.8%) in <20 years, 10 (22.7%) in 21-40 years, 16 (36.4%) in 41-60 years, 11 (25%) in 61-80 years, and 4 (9.1%) in >80 years. Glasgow comma scale at the time of admission and discharge were compared. Bilateral Csdh was the most prevalent diagnosis found in 16 (36.4%) patients followed by Bifrontal contusion 9 (20.5%), Bifrontal Edh with contralateral contusion 6 (13.6%), Bifrontal Edh 6 (13.6%), Bilateral temporal contusion 4 (9.1%), Unilateral Asdh with Contralateral Edh 2 (4.5%), and Bilateral Fronto-parietal Edh 1 (2.3%). Outcome of the non-decompressive SSBC in TBI were as follows: LAMA 5 (11.4%), discharged 28 (63.6%), Chest infection and tracheostomy 5 (11.4%), and expired 6 (13.6%) respectively. Conclusion: Our study concluded that male patients were more vulnerable to traumatic brain injury. Majority of the cases belonged to the age group 41-60 years. Non-decompressive single stage bilateral craniotomy is an effective, reliable, and economical procedure to manage traumatic brain injury patients. Single anesthesia along with single incision, shorter hospital stay, and postoperative management similar to unilateral procedure were the major advantages of non-decompressive SSBC. Keywords: Traumatic brain injury, Surgical treatment, Non-decompressive SSBC
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.
To know about the causes of hydrocephalus (HDC) among the different age groups. Study Design: Cross sectional study. Setting: Department of neurosurgery PGMI/LRH. Period: August 2012 to September 2013. Materials and Methods: The operative records and the admission records of all the patients who were admitted and operated during the study period were checked. All the patients undergoing surgery for hydrocephalus were included in the study and those patients who had undergone surgery for other reasons were excluded from the study. Patient s who had a repeated surgery for hydrocephalus were also excluded from the study as well as those who were re-admitted for shunt related or surgery related complications. The age, gender, and the radiological diagnosis of hydrocephalus was recorded on a designed proforma. All the patients were grouped into two that is above and below 12 years. Etiology wise HDC was classified as either congenital, post-infectious, tumor related, post trauma or miscelenous. The data was entered and analyzed using SPSS version 16. Results: A total of 634 admission for Hydrocephalus were reviewed. 387 patients fulfilled the inclusion criteria. There were 209 males and 178 females. The age range was from 1 month to 69 years and the mean age was 8±4.6 years. There were 67.67% of the patients in the group I while 33.33% of patients in the Group II. There was almost equal distribution on in the group II based on the age difference. The major causes in the group I were the congenital, post infectious, and tumor related while in the group II the main causes were the PIH, post tumor and the post hemorrhagic. Conclusion: The most common causes of the HDC in the pediatric age group are the congenital, PIH and tumor related. In adults the most common causes of the HDC are the PIH, post Hemorrhagic HDC and tumor related Hydrocephalus.
Objective: The present study examined the epidemiology, clinical features, and outcome of pediatric traumatic brain injuries (TBI) in tertiary care hospitals in Khyber Pakhtunkhwa (KPK) . Duration and Place of the Study: Duration of study was From February 2020 to February 2022.It was conducted in Neurosurgery Department, Khyber teaching hospital MTI, and Hayatabad medical complex Peshawar. Material and Methods: A total of Six hundred and forty-three pediatric patients, ages 01 to 11years, who had suffered traumatic brain injury were included in the study. All children were first seen at an emergency room, where they had a series of diagnostic tests and a physical examination. All necessary radiological studies were carried out under the watchful eye of the senior consultant neurosurgeon. In addition to demographic information, the pattern, treatment, and outcome of children with head injury were also recorded. Results: Among the 643 kids examined, 411 (or 65%) were boys, and 232 (or 35%) were girls. At presentation, the average age was 4.062 years. Among the children surveyed, 525 (82%) lived in an urban setting, while the remaining 117 (18%) lived in a rural region. Three hundred and seventy-eight (60%) of the children suffered a head injury secondary to fall, whereas just 207 (33%) had been involved in automobile accidents. 58% (374) had mild head injury and 185 29% had moderate head injuries, 84 (13%) had severe head injury. 12% (74) of patients underwent craniotomy for extra-dural hematoma. 46 (7.1%) of the children had depressed skull fracture which was surgically treated. 23 (3.5%) patient had acute sub-dural hematoma for which craniotomy was done. Rest of the 27(4.1%) children had traumatic sub-arachnoid hemorrhage and intracerebral bleed which were treated. Out of the total 76(11.6%) children did not recover and died, most of them presented with severe head injuries Conclusion: Most common cause for head injury in our setup was fall from height which was followed by motor vehicle accidents. Over half of the children presented mild to moderate head injuries. Over half were treated conservatively with good outcome. We had mortality of 11.6% with most having severe head injuries. Keywords: Mortality, Brain Injury, fall, Car Accidents, depressed skull fracture, extra-dural hematoma, acute sub-dural hematoma.
Objectives: The purpose of this study was to compare the radiological and clinical results of transpedicular decompression in spinal TB (also known as Pott's spine) patients who had anterior reconstruction using a polyetheretherketone (PEEK) or mesh cage with those who did not. Little study has been conducted on the long-term effects of transpedicular decompression with and without global reconstruction in Pott's spine. PEEK cages for Pott's spine have also not been shown effective. Methods: This Multicenter study was conducted in the department of neurosurgery MMC Mardan between May 2019 and May 2022. Patients who had surgery for Pott's spine and satisfied the inclusion criteria were retrospectively examined using data from hospital records and an imaging database collected. Results: One hundred and fifteen patients were involved in the research, and their mean age was 45.0617.01 years (55 males, 60 females). These individuals showed improvements on the Visual Analog Scale, the Oswestry Disability Index, and the Cobb angle, all statistically significant improvements (p 0.002). The Cobb angle was corrected more in patients who received anterior reconstruction after surgery (p = 0.041), but they also experienced more blood loss (p = 0.03).
Objective: To Ascertain the outcome of microsurgical resection of intracranial dermoid and epidermoid tumors.Materials and Methods: This prospective study was carried out in Neurosurgical Department, Lady Reading Hospital (LRH) Peshawar and followed for 3 years after microsurgical resection. All the patients with suspected intracranial Dermoid and epidermoid tumors (IDETs) on imaging study pre-operatively and later confirmedpostoperatively (after histopathology) were enrolled. Patients having recurrent tumor, opting for nonsurgical management and those deem unfit for surgery were not included in the study.Results: 27 patients were included in the study with 12 (44.4%) males and 15 (56.6%) female. Age of the patients rangefrom 11 to 58 years.Mean age was 38.6 years. Epidermoid tumors were 19 (70.3%) in number and dermoid 8 (29.7%) in number. The most common presentation was increased intracranial pressure (ICP) and cranialnerve deficit. The lesion was located in infratentorial location in 15 (56.6%) patients, 12(44.4%) were supratentorialy located. Gross total removal (GTR) was performed in 21 (77.8%) patients, while in six patients (22.2%) subtotal removal (STR) was attempted. 1 (3.7%) patient died while 2 (7.4%) patients had permanent morbidity post operatively, all other patients (89%) improved. Recurrence occurred in 9.5% of GTR patients while in STR patients, 33.3% patients were noted with increase in residual tumor on neuroimaging.Conclusion: Microsurgical resection with GTR is possible for most IDET and gives good results with minimalcomplications.
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