Objective: Conventional methods for anterior upper dorsal spine are not devoid of intra-operative complications due to anatomical constraints, a major blood vessel and vital organs. We analyzed the details of Trans- axillary approach without muscle cutting in tuberculosis, tumor, and traumatic lesions of T2 to T6 and upper limb causalgia.Materials and Methods: A prospective quasi-experimental study was conducted for 3 years included 30 patients presented with dorsal myelopathy due to D2 to D6 vertebral body involvement. Right and left sided approaches were utilized. Medical Research Council grading was used to assess neurological status.Results: Mean age was 32 ± 15 years, which included male 18.60% and female 12.40%. T4 vertebrae were commonly involved. Others were T5, T3 and T6 respectively. The majority of lesions were tuberculosis of the spine (n = 14), tumor (n = 8), trauma (n = 5) and causalgia of upper limb (n = 3). No intra-operative complications occurred, estimated blood was 80-100 ml and operative time was 120-160 minutes. Postoperative complications included pneumonia (n = 1), superficial wound infection (n = 3), death (n = 1). Serial follow up was for 2 years, Patients were discharged with improved neurological status and causalgia patients got immediate post-operative relief.Conclusions: Transaxillary approach is a unique anatomical corridor which is safe, feasible with promising results. It provides optimal decompression, reconstruction with better fixation and alignment in various pathologies of upper dorsal spine.
Sir,Aneurysmal bone cysts (ABCs) are multi-cystic, osteolytic growths. The classic or standard form (95%) has blood filled spaces among bony trabeculae. Osteoid tissue and osteoclastic giant cells are found in the stromal tissue. The solid form (5%) shows fibroblastic proliferation, osteoid production and degenerated calcifying fibromyxoid elements. 1 ABCs are usually seen in younger patients. Around 80% of the patients are less than 20 years of age, more frequently in females. ABCs occurring de novo are called as primary ABCs. Secondary ABCs have accompanying tumors like chondroblastoma and giant cell tumor in 30% of patients. Other associated tumors or non-tumorous conditions include ossifying fibroma, osteosarcoma, chondrosarcoma, non-ossifying fibroma, chondromyxoid fibroma, unicameral or solitary bone cyst or trauma. 2 ABCs are commonly found in long bones, membranous bones of the thorax, pelvis and vertebra. In long tubular bones, these tend to be eccentrically located in the metaphysis. However, these can occur in any location, including the diaphysis and epiphysis, rarely, involving multiple bones simultaneously. 3 Skull is rarely affected. 4,5 The treatment modalities include selective arterial embolization, irradiation, intralesional curettage, intraoperative adjuvants, bone grafting, marginal resection or wide excision. Tumor has to be excised and all cystic lining curetted. Cryotherapy, phenol or cauterizations (intraoperative adjuvants) are used to remove microscopic tumor cells. Resulting bony defects may be replaced with homologous bone or cadaveric bone. We, herein, present a 50-year patient who was admitted with the complaints of headache, and rapidly enlarging swelling in the right temporal and mastoid area elevating the auricle. There was serosanguinous ear discharge and loss of hearing from right ear. There was no history of trauma. Swelling was non-tender, firm to hard and pulsatile. Cough impulse was negative and no bruit was audible. Right seventh nerve was paralysed with lower motor neuron features. No other body part was involved. CT scan brain with contrast and CT-angio brain revealed a vascular mass with bony outgrowth and cystic spaces involving right temporal petrous and mastoid area with midline brain shift (Figure 1). Patient underwent operation and lesion was excised and surrounding bony area was cauterised. Attached dura was coagulated with bipolar diathermy. Histopathology report confirmed the diagnosis of chondroblastoma with secondary ABC. Patient remained well for one year, however, he had recurrence of same growth after one year. Second operation was performed in the same way. He was then referred for radiotherapy. This case is unique as it presented at advanced age and in an unusual location. As mentioned above, skull is very rarely the primary site for this lesion. Both the primary tumour and the associated secondary ABC are rare at this age. Moreover, this case recurred after one year. Recurrence is not rare in ABCs. Most commonly, it results from incomplete removal of the...
Objective: To assess the shunting rate and the results of control measures in patients having central neurocytoma who underwent total and subtotal resection. Study design: A cross-sectional study Place and Duration This study was conducted in People's University of Medical and Health Sciences for Women Nawabshah from Septmeber 2016 to Septmber 2020 . Methodology: In this study, overall 15 patients were included. Every patient had a follow-up of 2 years. The age of participants was between 13 to 49 years. The data of every patient was recorded which included the demographics (age, gender), early mortality and morbidity, presentation of clinical factors, and radiological findings. The radiological findings include features, tumor location, hydrocephalus, recurrence, and residual. A transcortical approach was used for the treatment of individuals for both, total or subtotal excision. EVD (External Ventricular Drain) was installed which was later replaced by a shunt. For confirmation of diagnosis and guidance of the follow-up, the MIV index and histopathology were used. For residual tumor and recurrence, radiosurgery of Gamma knife or adjuvant radiotherapy was used. Results: There were 3 patients who died due to sepsis and thalamic infarction after the total and subtotal excision. There were 9 patients who had a total excision and 6 patients who had a subtotal excision. Among the 9 patients with a total excision, 3 of them showed small recurrence at 1 year and 18 months follow-up along with a high MIB index. A total of 2 of them needed a shunt. In the remaining participants,the shunt was not placed. Among the 6 patients who had a subtotal excision, 2 of these patients had an early shunt insertion. Five patients were controlled by radiotherapy while one was controlled by radiosurgery. One patient, who was controlled by radiotherapy, failed radiotherapy in his second treatment at 18 months of follow-up. Practical implication : total excision has better results for central neurocytoma and should be considered procedure of choice Conclusion: Central neurocytoma may have a better chance of recovery than other intraventricular tumors if treated with total excision, with a lower incidence of shunt insertion throughout its course. Keywords: neurocytoma, shunt insertion, excision, radiotherapy, total excision
Objectives: The aim of study to know the pattern of injury in terms of severity & outcome in patients with head injuries admitted in trauma unit of a tertiary care Centre. Study Design: Descriptive Study. Setting: Trauma Centre, Peoples medical university hospital Nawabshah. Period: From June, 2018 to May, 2019. Material & Methods: This included 385 patients admitted in trauma unit of Neurosurgery Department of Peoples medical university hospital Nawabshah, through emergency Department with head injury sustained due to road traffic accident, fall, sports related injuries or Assault etc as evident on CT scan brain (plain) with bone window. Patients with poly trauma, bleeding disorders, previously operated and those who failed to turn up in OPD for follow up were excluded. Glasgow Coma Scale (GCS) was used for categorizing the subjects with head injury into mild (GCS 14-15), moderate (GCS 9-13) and severe injury (GCS 3-8). CT scan brain with bone window was done in all patients. These were then managed accordingly according to the severity of the injuries. Follow up Glasgow Coma Outcome scale was used to assess the outcome in these patients. Results: Regarding nature of traumatic injuries in these patients commonest were contusion (21.8%), extradural hematoma (27.5%), subdural hematoma (22.3%), diffuse axonal injury (13.2%), and subarachnoid hemorrhage (4.2%). This was followed by skull fracture (7.3%) and intracerebral hemorrhage (3.6%). Majority of the patients were with severe head injury. Glasgow Outcome Scale of Patients at Follow- up reveled complete recovery in 106 (27.5 %), Mild disability in 81(21.0%), Moderate Disability in 64 (16.6%), Severe Disability in 72 (18.7%), Persistent Vegetative state in 36 (9.4%), and death in 26 (6.8 %). Conclusion: Good outcome is observed in patients who are properly treated by continuous monitoring & timely surgical intervention in a tertiary care hospital.
Objective: To determine the frequency of causes of space occupying lesions of brain in patients admitted in Neurosurgery ward PUMHS Nawabshah over a period of one year Methodology: This descriptive case-series study took place at department of Neurosurgery of Peoples University of Medical and Health Sciences, for Women Shaheed Benazirabad. Study duration was one year from July 2019 to June 2020. All the patients with space-occupying lesion of brain either of gender were enrolled in this study. All study subjects were assessed for the causes of space-occupying lesion. Data was collected vis study proforma and analysis of the data was done by using SPSS version 20. Results: A total of 80 patients were selected, their mean age was 31.76 years and females were in majority 66%, with female to male ratio of 1.96:1. Glioma was found in 23% cases which was highest among all type of lesion followed by abscess 10%. Supratentorial was observed in 73% patients which was highest among all site of lesion followed by third ventricular & Infratentorial 10% each. Conclusion: The increased prevalence of infectious lesions can be linked to our population's low socioeconomic level and inadequate hygienic conditions. The rate of metastasis was found to be lower than previously reported. This might be attributed to cases not being referred following a metastatic lesion has been diagnosed. For early detection of brain tumours, advanced diagnostic equipment such as CT scans and MRI are desirable. Keywords: SOL, Central Nervous System, Metastases
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