Pakistan Journal Of Neurological Surgery

Comparison of the Efficacy of Peri-Operative Use of Bupivacaine with Corticosteroids Versus Bupivacaine Alone in Lumbar Disc Disease Surgery

2025-03-16T15:15:30+00:00

Objectives: To compare the efficacy of peri-operative use of bupivacaine with corticosteroids versus bupivacaine alone in lumbar disc disease surgery.

Materials and Methods: This randomized controlled study at PIMS Hospital (Nov 2023–May 2024) involved 76 patients (ages 25–65) undergoing lumbar disc surgery. Patients with prior surgery, epidural steroids, spinal trauma, or rheumatoid arthritis were excluded. Group A received Gelfoam soaked in 10 mL of 0.25% bupivacaine + 2 mL dexamethasone, while Group B received Gelfoam with 10 mL of 0.25% bupivacaine only. Efficacy was assessed over 24 hours.

Results: Patients in Group A and B had mean ages of 43.08 ± 10.50 and 42.11 ± 10.22 years, respectively. The majority of the 45 patients (59.21%) were in the 25–45 age range. The male-to-female ratio was 2.16:1, with 52 (68.42%) of the 76 cases being male and 24 (31.58%) being female. The mean baseline VAS score was 6.61 ± 1.03. The mean baseline VAS score in group A (corticosteroid and bupivacaine) was 6.47 ± 1.01 and the mean pre-therapy VAS score in group B (bupivacaine alone) was 6.74 ± 1.06. The efficacy of using bupivacaine and corticosteroids during lumbar disc disease surgery was found to be 30 (78.95%) as compared to 20 (52.63%) in the bupivacaine group only, with a 0.016 p-value.

Conclusion: The study concluded that the efficacy of peri-operative use of corticosteroid and bupivacaine is higher as compared to bupivacaine alone in lumbar disc disease surgery.

Functional Outcomes After Surgery for Acute Subdural Hematoma: A Comparison Between Decompressive Craniectomy Versus Craniotomy in Post-Traumatic Patients

2025-06-10T14:05:57+00:00

Functional Outcomes After Surgery for Acute Subdural Hematoma: A Comparison Between Decompressive Craniectomy Versus Craniotomy in Post-Traumatic Patients

Traumatic Craniocerebral Injury from Axe Strikes: Presentation, Prognosis, and Complications – A Tertiary Care Hospital Study

2025-06-01T11:07:53+00:00

Objective: To evaluate the effects of a brain injury caused by an axe strike, including its presentation, prognosis, and potential complications.

Material and Method: The study was a descriptive, analysis conducted at the Liaquat University of Medical and Health Sciences in Jamshoro, Sindh, Neurosurgery Department. It spanned a three-year from January 2019 to August 2022. Patients were based on consecutive sampling sizes. CT scan brain was done and the brain trauma was categorized. Follow-up was done at 6 months.

Results: A total of 61 cases of Axe injury (hatchet injury) were managed surgically. The female-to-male ratio was 2.8:1. The Average time of surgery was 150±30 mins, wound size due to axe injury was measured it was about 3.5±2.2 cm. The cerebrospinal fluid leak was in 32, and meningitis in 16 patients after repair of neurological deficit. Patients were managed in a high-dependency unit with intravenous antibiotics, anticonvulsants, and mannitol. The Glasgow Coma Scale (GCS) scores of patients on arrival were compared with their scores at discharge.

Conclusion: This study adds a critical view into the presentation, management, and outcomes of patients who suffered brain injuries caused by axe strikes. The severity of injuries varied, with complications such as post-surgical infections, cerebrospinal fluid leaks, and meningitis being common.

Effect of Intraoperative Local Dexamethasone on Dysphagia Incidence and Severity Following Anterior Cervical Spine Surgery

2025-06-01T10:59:15+00:00

Objective: To evaluate the effectiveness of intraoperative local dexamethasone in reducing the incidence and severity of dysphagia following anterior cervical spine surgery (ACSS).

Material and Methods: The retrospective research analyzed 74 patients who experienced elective ACSS (January 2024 to February 2025). The first patient group received 10 mg of local dexamethasone before surgical bonding however the other patient group received no steroid treatment. The Bazaz scale together with the Dysphagia Short Questionnaire (DSQ) served to evaluate dysphagia levels and pain and disability ratings relied on the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). The researchers combined their assessment of failure rates with fusion success to build their analysis. SPSS software analyzed the obtained data and researchers established p < 0.05 as the statistical significance threshold.

Results: The research follow-up included 64 patients for an average period of two years. Interactive dexamethasone medication administration to surgical patients improved their swallowing function evaluation scores during their second postoperative day (Bazaz: 1.16 ± 1.35) versus patients not treated with the steroid (Bazaz: 2.10 ± 1.33; p < 0.0001). Statistics showed that dexamethasone administration in surgery patients did not affect their pain scores or their fusion rates and hospital stay durations. Dexamethasone administration in the research study demonstrated no adverse effects that emerged during the study period.

Conclusion: The surgical application of dexamethasone at the local site achieves effective and safe swallowing discomfort reduction following ACSS interventions without affecting overall surgical outcomes.

Current Concepts in Cranioplasty: Indications, Materials, Surgical Techniques, and Complications

2025-06-01T06:44:03+00:00

Objective: This study evaluates the clinical outcomes, materials used, and complications associated with cranioplasty thus providing a comprehensive analysis based on patient’s data.

Materials and Methods: This retrospective observational study was conducted at Ali Institute of Neurosciences, Irfan General Hospital, Peshawar from November 2023 to December 2024. A total of 55 patients who underwent cranioplasty were included in the study. The study analyzed patient demographics, indications, material selection, surgical techniques, and postoperative complications.

Results: The most common indication for cranioplasty was post-traumatic defects (63.6%), followed by decompressive craniectomy (25.4%), tumor resection (5.5%), and infection-related bone flap removal (5.5%). The materials used included polyetheretherketone (PEEK) (34.5%), bone cement (30.9%) titanium mesh (18.2%), and acrylic mesh (16.4%). Postoperative infections occurred in 7% of patients and were successfully managed with antibiotics or revision surgery. No cases of implant rejection or resorption were observed.

Conclusion: Cranioplasty plays a crucial role in restoring cranial integrity improving neurological and aesthetic outcomes. Advances in biomaterials particularly PEEK, have enhanced procedural success in our study. While the surgery remains essential for functional and cosmetic rehabilitation optimizing material selection and infection prevention strategies can further improve patient outcomes.

Immediate Pain Relief in Patients of Trigeminal Neuralgia After Microvascular Decompression (MVD)

2025-06-01T06:29:20+00:00

Objectives: The study was conducted to observe the pattern of pain relief and analyze the influence of demographic factors and co-morbidities in patients undergoing microvascular decompression for trigeminal neuralgia.

Materials and Methods: This prospective observational study conducted from July 2020 to July 2023 included 50 diagnosed cases of trigeminal neuralgia scheduled for MVD. Data homogenization, including detailed demographics at our institution, preoperative data including American Society of Anaesthesiologists (ASA) status, and Charlson comorbidity index, rigorously documented surgical parameters, The study design was structured follow-ups at 1, 6, and 12 months.

Results: Early postoperative outcome revealed 60% complete pain relief, 30% partial relief, and 10% no relief. Age was a significant correlate of outcomes, reinforcing the need for age-sensitive interventions. Nuances of the surgery, especially revision MVD, were associated with increased recurrence rates, emphasizing the need for precision. This study identifies preoperative variables that may affect long-term relief, well known factors in the literature (including multiple sclerosis) correlate with lower rates of relief and diagnostic tissue confirmation, which underscores the need for individualized metrics and longer-term follow-up in studies.

Conclusions: The data presented offers important information for furthering the knowledge of the clinical outcomes when undergoing MVD, highlighting the need for accurate objective measures in surgical assessments. The correlations identified provide routes to improving protocols and inform the precision of pain relief in patients with trigeminal neuralgia.

Spinal Cord Injury and Pregnancy: Obstetric Challenges and Neonatal Outcomes

2025-04-10T03:34:09+00:00

Objective: Pregnant women with spinal cord injury (SCI) can have severe obstetric and neonatal challenges. However, there is limited literature on this population. Therefore, the objective of this study is to understand the obstetric and neonatal outcomes in these highly specialized individuals.

Materials and Methods: This study was conducted at the Punjab Institute of Neurosciences (PINS) and the Department of Obstetrics and Gynecology, Lahore General Hospital, Lahore (LGH). A sample of 25 women who appeared with SCI during pregnancy at PINS were recruited in this descriptive study for data collection. Later, their pregnancy and neonatal outcomes were observed at the specified department of LGH. Descriptive statistics were computed for quantitative and qualitative variables.

Results: The average age of these SCI patients was 28 ± 5.2 years. Most of the women (72%) got SCI during motor vehicle accidents (MVA). Thirteen women got SCI during their first trimester and faced severe complications like termination (12%) and miscarriages (12%) of pregnancies. Thoracic spine injury is the most common type of injury. Further, a Cesarean section was also adopted in 58% of cases, highlighting the potential challenges associated with SCI. A very high (42%) preterm birth rate was also reported in this unique sample.

Conclusions: This study is a unique combination of gynecological and neurological aspects. The majority of the pregnancy outcomes are successful with medical support, however, a significant number of miscarriages and termination of pregnancies were also observed. Understanding these outcomes can aid healthcare professionals in improving prenatal and postnatal care and such SCI patients.

Effectiveness of Regular Physiotherapy in Enhancing Claudication Symptoms and Functional Outcomes in Patients with Spinal Canal Stenosis.

2025-06-01T06:59:37+00:00

Introduction: Lumbar spinal stenosis (LSS) causes neurogenic claudication that hinders mainly one’s mobility and quality of life. It is now accepted that physiotherapy is a useful conservative measure especially when surgery cannot be done. This paper aims to assess the impact of an organized physiotherapy intervention on the ability to walk and the level of dependency in LSS patients.

Material and Methods: A physiotherapy program of 6 weeks was carried out on 172 patients with LSS and neurogenic claudication. The manual therapy included core stabilization, flexibilities in the lumbar, and strengthening in the lower limb. Walking ability (Swiss Spinal Stenosis Scale), pain levels (VAS), disability (ODI, RMDQ), and walking distance were assessed. SPSS was used for statistical analysis with a p < 0.05 significance.

Results: Physiotherapy reduced leg pain (VAS 7.9 ± 1.3 to 2.6 ± 0.9, p < 0.001), back pain (6.5 ± 1.4 to 2.9 ± 1.0, p < 0.001) among 172 patients (64% male, mean age 68.4 years). Walking ability and disability improved (SSS and ODI, p < 0.001) and walking distance increased from 215.7 ± 42.5 to 482.3 ± 67.3 meters. Minimal adverse effects were reported.

Conclusion: As a safe nonoperative medical approach physiotherapy demonstrates high effectiveness in treating LSS patients by enhancing their mobility pain relief and independence levels. Surgical procedures have a powerful competitor in this nonoperative treatment that patients select for their conservative options.

A Month in Cross Section: A Case Series of Eleven Sphenoid Wing Meningioma’s: A Single Center Experience

2023-09-20T18:18:54+00:00

Introduction: Sphenoid wing meningiomas represent 20% of supratentorial meningiomas. The tumor usually involves the visual pathway, the anterior vasculature, and cavernous sinus invasion. A higher morbidity, mortality, and recurrence are documented in comparison to meningiomas in other locations.

Materials & Methods: 11 cases of joint global sphenoid wing meningiomas were operated in September 2022. Patient demographic, clinical, radiology, and per-operative salient features were noted. Post-operative clinical outcomes included improvement in visual acuity, neural deficit, and headache. The extent of resection on radiology plus survival was noted as an outcome measure.

Results: Patients aged 28 to 65 years, with 9 females and 2 males had giant sphenoid wing meningioma. Complete medial sphenoid wing involvement along with neurovascular structures, post-operatively they had visual deterioration, hence, the extent of resection was limited to prevent greater post-operative morbidity. 3/7 undergoing GTR had complete carotid artery encasement, in which full thickness MCA infarct was noted in 6 hours’ post-operative scan, they were later converted to a full 16 cm decompressive craniotomy. One survived with hemiparesis and aphasia while two died – a male (49y) and, a female (65), both left craniectomies. STR was done in four patients, with cavernous sinus invasion and internal carotid encasement.

Conclusion: Giant sphenoid meningioma involving the medial sphenoid wing and associated neurovascular structures is surgically challenging and must be treated with STR. If GTR is to be attempted, early CT Brain postoperatively to prevent mortality.

Correlation of MRI Findings and CSF Patterns in Children with Bacterial and Tuberculous Meningitis: A Retrospective Analysis from a Tertiary Care Hospital in Peshawar

2025-03-01T09:48:52+00:00

Objective: To evaluate the correlation between MRI findings and CSF profiles for differentiating bacterial and tuberculous meningitis.

Materials and Methods: A retrospective study of 336 pediatric patients (1 month–14 years) diagnosed with meningitis from September to December 2024. CSF biochemical and cytological parameters and MRI findings were analyzed using statistical tests, including the Mann-Whitney U test and Spearman correlation. Ethical approval was obtained.

Results: MRI revealed infarcts (53.6%) as the most common complication, followed by hydrocephalus (22.6%) and tuberculomas (27.7%). Tuberculomas were exclusive to tuberculous meningitis (p = 0.010), infarcts were more common in bacterial meningitis (p = 0.001), and hydrocephalus was more frequent in tuberculous meningitis (p = 0.042). CSF analysis showed elevated protein and lymphocytic predominance in tuberculous meningitis, while bacterial meningitis showed neutrophilic dominance and low glucose. MRI abnormalities correlated with CSF changes, with protein and glucose linked to tuberculous meningitis (r = 0.413, p < 0.001) and infarcts to bacterial meningitis (r = 0.348, p = 0.002).

Conclusion: Integrating MRI with CSF analysis improves differentiation between bacterial and tuberculous meningitis in children, enhancing diagnostic accuracy and treatment. Further research is needed.

Patterns of Radiological Complications in Patients with Spondylodiscitis: A Retrospective Analysis from a Tertiary Care Hospital

2025-02-26T16:44:52+00:00

Objective: To analyze the demographics and other patterns associated with patients diagnosed with spondylodiscitis.

Methods: In this retrospective observational study, data from 96 patients diagnosed with discitis based on clinical and imaging findings at Lady Reading Hospital, a tertiary care center in Peshawar was reviewed. Data collected included demographic information, clinical presentation, and diagnostic imaging findings. Logistic regression analysis was used to assess risk factors, with results presented as odds ratios (OR) and 95% confidence intervals (CI).

Results: Among the 96 patients (57 males, 39 females; mean age 45.5 years), vertebral body involvement was observed in 56% of cases. Cord compression was noted in 36% of patients, significantly associated with advanced age (OR = 1.05; 95% CI: 1.02-1.08, p < 0.01). Decreased disc height was present in 65% of cases, correlating with higher risks of vertebral body abscesses (65%) and psoas abscesses (52%). The lumbar spine was the most commonly affected region, with multilevel involvement observed predominantly in older adults (p = 0.07).

Conclusion: The study highlights the high prevalence of complications in spondylodiscitis and emphasizes the need for timely diagnosis and intervention. These findings can guide improvements in clinical protocols to enhance patient care in low-resource settings.

Clinical Outcome of Microvascular Decompression In The Management Of Trigeminal Neuralgia In A Single Center: A Prospective Study

2025-01-03T07:24:12+00:00

Objectives: In the cases of trigeminal neuralgia unresponsive to medication or conservative measures, microvascular decompression is the preferred surgical technique. The objective of the current study was to evaluate the clinical outcomes of the microvascular decompression technique in the management of TN.

Material & Methods: This prospective, observational study spanned over two years from January 2021 to December 2022. Adults diagnosed with typical TN who were at least eighteen years old, and who were not responding to conservative treatment options, including carbamazepine and gabapentin, were enrolled in the study. The assessment of pain was performed using the Visual Analog Scale (VAS) and the Barrow Neurological Institute (BNI) pain intensity scale.

Results: The mean age of the patients was 52.4 ± 10.2 years, with a range from 32 to 74 years.

Comparative Analysis of Complications in Meningitis Patient Tuberculous vs. Bacterial

2024-12-08T18:54:43+00:00

Objective: This comparative analysis aims to evaluate the patterns of radiological complications in bacterial meningitis against those seen in tuberculous meningitis.

Materials and Methods: A retrospective review of imaging and clinical data was conducted. The frequency of complications such as hydrocephalus, infarcts, tuberculomas, abscesses, and cerebritis was analyzed in both cohorts.

Results: Hydrocephalus was significantly more frequent in TBM (46.9%) compared to ABM (23%, p < 0.001). Tuberculomas were exclusive to TBM (57.3%, p < 0.001), while abscesses (6.3%) and subdural collections (8.4%) were unique to ABM (p < 0.05). Infarcts occurred at similar rates in both groups (27% vs. 28.1%, p = 0.88). Logistic regression identified TBM as an independent predictor of hydrocephalus (OR: 3.4, 95% CI: 2.1–5.8,
p < 0.001) and tuberculomas (OR: 18.7, 95% CI: 11.4–30.9, p < 0.001). These findings emphasize the distinct radiological complication patterns in ABM and TBM, aiding in tailored management strategies.

Conclusion: The use of regression analysis provided new insights into predictors of complications; while cerebral infarcts are common in both ABM and TBM, TBM showed a greater burden of complications, particularly hydrocephalus and tuberculomas. The findings highlight the importance of early diagnosis and tailored treatment strategies to reduce morbidity and mortality in both forms of meningitis.

The Availability and Utilization of Minimally Invasive Techniques (MITs), in Neurosurgery in Pakistan

2024-10-12T13:18:50+00:00

Background: Minimally invasive techniques (MITs) have transformed the landscape of neurological surgery, offering a paradigm shift to patient safety, recovery speed, and surgical precision.

Objectives: This article explores the availability and utilization of these techniques, highlighting their benefits, advancements, and regional variations in practice. The primary goal of this study is to facilitate the adoption of advanced Minimally Invasive Techniques (MITs) in neurosurgery at hospitals in Faisalabad.

Methodology: A complete methodology, keeping the said purpose in mind, is designed to bring a pragmatic shift of advanced minimally invasive techniques in neurosurgery to the healthcare system of Faisalabad for improved patient care and surgical outcomes. A total of two District Headquarters Hospitals, DHQs, and two private hospitals are selected in Faisalabad. The sample of N=100 neurosurgeons, technicians, support staff

and hospital administrators selected randomly.

Results: The study revealed significant differences in the adoption and attitudes towards minimally invasive techniques (MITs) across public and private hospitals, with private hospitals showing higher adoption of advanced surgical methods. Factors such as equipment costs, training programs, and institutional support were key barriers influencing MIT utilization. The statistically significant differences in factors influencing MIT adoption underscore the need for targeted.

Conclusion: The study highlights that while both public and private hospitals show positive attitudes toward the adoption of MITs, various barriers such as high equipment costs, insufficient training, and lack of institutional support hinder widespread adoption. Public hospitals are more reliant on traditional surgeries, whereas private hospitals are leading the adoption of advanced surgical techniques.

Comparison of Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization Combined and Alone in Peadiatric Hydrocephalus – A Randomized Control Trial

2023-10-25T16:39:33+00:00

Objective: To evaluate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) improves treatment outcomes in pediatric hydrocephalus compared to ETV alone.

Materials and Methods: This prospective cohort study was conducted at the Department of Neurosurgery, DHQ Hospital, Rawalpindi, Pakistan, over 6 months. Pediatric patients diagnosed with hydrocephalus and meeting inclusion criteria were enrolled and assigned to two cohorts based on the procedure performed: Cohort A (ETV alone, n=35) and Cohort B (ETV + CPC, n=35). Patients were followed for three months postoperatively to assess treatment success, need for reoperation, and mortality. Relative risks (RR) with 95% confidence intervals (CI) were calculated to compare outcomes between cohorts.

Results: The success rate was significantly higher in the ETV + CPC cohort (85.7%) compared to the ETV-alone cohort (45.7%) (RR = 1.87, 95% CI: 1.31–2.66, p<0.001).** The reoperation rate was lower in the ETV + CPC group (8.6% vs. 34.3%, p=0.009), as was mortality (2.9% vs. 20.0%, p=0.024).

Conclusion: The addition of CPC to ETV is associated with significantly improved outcomes in pediatric hydrocephalus, reducing failure rates, need for reoperation, and mortality. These findings support CPC as an effective adjunct to ETV. Further long-term studies are warranted to confirm these benefits.

A Rare Presentation of Extradural Ewing Sarcoma in the Lumbar Spine: A Case Report

2025-03-20T06:43:41+00:00

Introduction: Ewing sarcoma (ES) is the most prevalent malignant bone tumor in children and adolescents, mainly impacting the axial skeleton and long bones. Extradural manifestations of Ewing sarcoma, particularly in the lumbar spine, are rare and may pose diagnostic challenges. This manuscript describes an unusual case of an epidural lumbar region, Ewing sarcoma, presented with acute neurological symptoms.

Case Presentation: A 14-year-old male patient presented with a history of a fall resulting in paraparesis and urinary incontinence for the last 1 week. MRI revealed an extradural lesion compressing thecal sac at the L4-L5 level. An extradural hematoma or an ependymoma were the initial differentials, and intravenous steroids were commenced, resulting in partial relief of symptoms. Later on, a core needle biopsy and immunohistochemical staining were performed, confirming Ewing sarcoma with positive CD99 and vimentin. Surgical excision of the tumor was performed, achieving clear margins, and there was significant improvement in patient symptoms.

Discussion: Lumbar epidural Ewing sarcoma in the lumbar spine is unusual and can result in acute neurological symptoms, creating a diagnostic dilemma. This case report testifies to the significance of maintaining high suspicion and emergency action for extradural spinal tumors. A complete surgical excision confirmed the diagnosis and improved the patient's neurology.

Conclusion: Recognising a spinal tumor and swift treatment is vital to patient improvement, especially in acute cases. A delay can result in permanent neurological harm to the patient.

Caudal Appendage in Neonate: Case Report and Literature Review

2025-02-19T11:44:34+00:00

The caudal appendage, also called a human tail, is a congenital anomaly located in the lumbosacral region, characterized as a prominent lesion. It is one of the lesions considered a marker of spinal dysraphism and may be classified into 2 groups: “pseudo-tail” and “true tail”. The authors report a case of a newborn baby girl admitted with the complaint of having a 4 cm long tail that had been present since birth. She was referred to us on the eighth day. The clinical examination found a soft, elongated, skin-covered, and non-fluctuating appendage in the lumbosacral region. She had no neurological impairment. A computed tomography scan showed a lumbar appendage associated with a spina bifida. The tail was surgically removed, and both the surgery and postoperative period were uneventful. Histopathological examination of the tail revealed a benign lesion with mature adipose tissue covered by skin. The caudal appendage is a benign congenital anomaly that may be associated with other spinal cord anomalies. Therefore, neurological examination as well as radiological evaluation is recommended to highlight the underlying anomalies.