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Permanent Pre-Operative Cerebrospinal Fluid Diversion In Paediatric Patients With Posterior Fossa Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

Role Of Palliative Csf Diversion In Patients With Intracranial Metastatic Disease And Symptomatic Hydrocephalus, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Hydrocephalus, unless treated, is one of the terminal manifestations of intracranial metastatic disease. Single lesions causing obstructive hydrocephalus are amenable to surgical resection, but in the setting of multiple lesions and communicating hydrocephalus from leptomeningeal disease, the approach to treatment is much less defined. The use of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) has been described, but data is limited. In this review, we summarize the sparse data available in literature describing the use of CSF diversion for patients with metastatic disease presenting with hydrocephalus and neurological decline.

Quality Of Life In Individuals Surgically Treated For Congenital Hydrocephalus During Infancy: A Single-Institution Experience, Saad Akhtar Khan, Muhammad Faheem Khan, Saqib Kamran Bakhshi, Omar Irfan, Hamza Abdur Rahim Khan, Asad Abbas, Safia Awan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country.
Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at QOL.
Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, …

Paediatric External Ventricular Drains: Experience From A Tertiary Care Hospital Of A Developing Country, Abbas Qalab, Rayaan Asad, Mahnaz Hakeem,, Maria Ahmad, Anwar Haq, Aneela Darbar

Department of Surgery

Abstract

The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial …

Long-Tunneled Versus Short-Tunneled External Ventricular Drainage: Prospective Experience From A Developing Country, Muhammad Zubair Tahir, Zain A. Sobani, Muhammed Murtaza, Ather Enam

Section of Neurosurgery

Background: External ventricular drains (EVD) are commonly utilized for temporary diversion of cerebrospinal fluid (CSF). Many neurosurgeons prefer long-tunneled EVDs in their routine practice. However, it is still unclear whether this extended tunneling helps in reducing CSF infection. Keeping this in mind, we decided to compare infection rates in long-tunneled versus short-tunneled EVDs in the setting of a developing country.
Materials and methods: A prospective study of 60 patients was conducted. Consenting patients who underwent short-tunneled (Group A) or long-tunneled (Group B) EVDs between January 2008 and June 2009 were followed during the course of their inpatient care. All operational …

Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients, Farid Khan, Abdul Rehman, Muhammad Shahzad Shamim, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.
Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests …

Management Of Myelomeningocele, A Sattar M. Hashim, Shahid Ahmed, Rashid Jooma

Section of Neurosurgery

Objective: T To find out best possible protocol to provide productive life to children born with myelomeningocele.
Study design: Descriptive study.
Place & Duration of study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006.
Patients and Methods: The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical & medical management protocol used for different sites of myelomeningocele was studied.
Results: The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All …