Objectives: To determine the incidence and outcome of intraventricular tumors treated micro-surgically at the Punjab Institute of Neurosciences, Lahore, Pakistan. Materials and Methods: A retrospective study of a series of 42 patients with the initial diagnosis of intraventricular tumors who underwent microsurgical resection over a period of 04 years. The extent of resection was decided by post-operative imaging (CT Brain), performed on immediate or 1st post-op day, and by MRI on outdoor follow-up after an average of 4 weeks. Post-operative complications and the Glasgow outcome scale were also recorded. Results: The majority of patients presented with nonspecific symptoms. 47.6% patients presented with headache, nausea/vomiting (40.5%), decreased vision (21.4%), fits (19%) and hydrocephalus (9.52%).29patients (72.5%) underwent microsurgical excision through the anterior transcortical approach, followed by 08 (19.05%) via the posterior transcortical approach. GTR was achieved in 33 (78.57%). Based on histopathology reports, 14 (33.3%) were ependymomas, 11(26.2%) meningiomas, 07 (16.67%) sub-ependymomas, 5 (11.9%) central neurocytomas, and 2(4.76%) Choroid Plexus Papilloma. Significant postoperative intraventricular bleed was noted in 04 (9.52%) patients, minor I/V bleed in 06 (14.28%), hydrocephalus in 07 (16.67%), subdural collection in 02 (4.76%), and motor deficit in 03 (7.15%) patients. Based on Glasgow Outcome Scale, 32 (76.2%) had GOS5/5, 7 (16.67%) with GOS 4/5, while 02 patients expired in the postoperative period. Conclusion: Intraventricular tumors require special neurosurgical consideration. Early diagnosis, better preoperative planning, and an adequate microsurgical approach are necessary to achieve maximum safe resection and improvement in patients’ symptoms and overall condition.
Objectives: This study aimed to compare CSF leak in endoscopic endonasal TSS of pituitary adenoma with and without reconstruction of the sellar floor with no intraoperative CSF leakage. Materials and Methods: It was a randomized controlled trial of 116 patients of both genders diagnosed case of pituitary adenoma who underwent endoscopic endonasal TSS over 1 year. The cases were randomized into 2 groups. In Group A endoscopic endonasal TSS and the sellar floor, reconstruction was done while in Group B only endoscopic endonasal transsphenoidal surgery was done without reconstruction. Results: The patient’s mean age in group A was 40.7 ± 9.56 years, and in group, B was 41.9 ± 10.5 years. The gender distribution, for group A, males and females were 29 each (50%) and in group B, the males were 36 (62%) and females were 22 (38%). There were 52 (89.7%) cases of macroadenoma and 6 (10.3%) cases of microadenoma in each group. On the 1st postoperative day, CSF leakage was noted in 2 (3.4%) patients of group A, and CSF leakage was observed in 2 (3.4%) patients of group B. Results revealed no difference in CSF leakage between both groups. There were minor nasal complications in both groups. Conclusion: There is an equal chance of success with endoscopic endonasal transsphenoidal surgery (TSS) of pituitary adenoma with and without reconstruction of the sellar floor, concerning post-operative CSF leak, in patients who have no intraoperative CSF leak which enlarges the pool of options for treatment.
Objectives: The incidence and microsurgical outcomes of intracranial epidermoid cysts in the Department of Neurosurgery III, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan, are described in this case series. Materials and Methods: This study was a data analysis of a case series of 15 patients (mean age, 40 years) of both gender with intracranial epidermoid cysts who had microsurgical surgical excision over five years. Results: This study comprised 11 (73.3%) male and 4 (26.7%) female patients, 11 (73.3%) cases were infratentorial and 4 (26.7%) cases were in supratentorial region. The epidermoid was located in the CP angle in 11 (73.3%) patients, 3 (20%) in the midline supra sellar region, and 1 (6.66%) in the frontotemporal region. The presenting complaints were mainly headache in 11 (73.33%), cranial nerve palsy and cerebellar signs in 8 (53.3%) patients, Trigeminal neuralgia in 3 (20%) patients, Fits and hydrocephalus in 2 (13.3%) patients. There were 14 (93.3%) patients with GTR (gross total resection), 1 (6.6%) patients STR (subtotal resection). According to Karnofsky's performance scoring (KPS), 3 (20%) patients improved, 11 (73.3%) patients had the same KPS, and 1 (6.6%) patient had a lower KPS. Conclusion: The epidermoid cysts in the brain are usually found in the infratentorial region rather than the supratentorial region. Infratentorial lesions typically cause cranial nerve deficits, whereas the supratentorial area symptom is a headache.
Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy. Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.
Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes. Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically. Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery. Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.
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