Postoperative Reduction of Intraventricular
Syed Shahzad Hussain1 Asif Raza1 Saman Shahid2 Hafiz Hamza Asif1,3 Usman Ahmad1
Naveed Ashraf1
1Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan
2 Foundation for Advancement of Science and Technology (FAST),
National University of Computer and Emerging Sciences (NUCES),
Lahore, Pakistan
3National Hospital & Medical Care, DHA, Lahore, Pakistan
J Neurol Surg A
Address for correspondence Saman Shahid, PhD, Foundation for
Advancement of Science and Technology (FAST), National University
of Computer and Emerging Sciences (NUCES), B Block, Faisal Town,
Lahore, Pakistan (e-mail: saman.shahid@gmail.com).
Keywords
► external ventricular
drainage
► intraventricular
hemorrhage
► cerebrospinal fluid
Abstract Background/Aims The use of single/dual external ventricular drains (EVD) for redu-
cing intraventricular hemorrhage (IVH) is under investigation. A randomized controlled
trial was conducted to compare postoperative reduction of IVH volume using single-
and dual-catheter drainage in spontaneous IVH patients. We investigated factors that
may influence an effective hematoma volume reduction by EVDs.
Materials and Methods The average cerebrospinal fluid (CSF) drainage volumes were
analyzed. Computed tomography (CT) scans were performed on admission, 24 hours
and 48 hours after EVD placement, and then on days 5 and 8. Patient group 1 was
treated with a single EVD; patient group 2 was treated with bilateral EVDs. The IVH
volume was calculated in all ventricles. A multivariate analysis was conducted to
investigate variables that can influence the extent of hematoma volume reduction with
a bilateral EVD. Regression followed by a Pearson correlation was performed to observe
the strength of association of cofounders with the IVH volume reduction.
Results The percentage of IVH volume change was found to be significantly higher in
the dual-catheter group compared with the single-catheter group (p 1⁄4 0.0034) after
5 days of EVD. The mean reduction in IVH volume was 17.36 (mL) in patients 45 years
of age and 20.50 (mL) in patients > 45 years. The multivariate analysis suggested the
following significant predictors for IVH volume reduction: age of the patient
(p 1⁄4 0.011) and longer duration (days) of EVD (p 1⁄4 0.028). The age of the patient
had a weak positive association and duration of EVD had a positive association with the
IVH volume reduction.
Conclusion Intraventricular drainage via bilateral EVDs may provide a better draining
of blood-mixed CSF because it led to faster clot clearance. It is suggested that a longer
duration of bilateral EVDs may lead to a greater reduction in IVH volume. Older patients
may experience a greater IVH volume reduction by EVD because the volume of CSF
increases with cerebral atrophy. Read more
OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC LUMBAR DISCECTOMY FOR PROLAPSED PARA SPINAL INTERVERTEBRAL DISC
Syed Shahzad Husain, Usman Ahmed Kamboh, Asif Raza, Muhammad Adil, Naveed Ashraf
Department of Neurosurgery, Jinnah Hospital/Allama Iqbal Medical College, Lahore
Background: Backache is second most common problem presenting to the primary healthcare providers. Lumbar discectomy has been revolutionized from open conventional discectomy to endoscopic removal. Endoscopic procedures are proving their superiority regarding good outcome, less wound site pain and shorter hospital stay, in Neurosurgery as well. Micro discectomy and Endoscopic discectomy is used only in few centres in Pakistan. This study aimed to share our experience of early surgical outcome endoscopic lumbar discectomy in terms postoperative pain improvement and duration of hospital stay Methods: This prospective study was carried out at Neurosurgery Department, Jinnah Hospital, Lahore from Jan 2014 to Jan 2016. During this period, 35 patients of both sexes, aging between 20 and 60 years, with symptoms and signs of lumbago with sciatica were enrolled. Data was collected on a questionnaire after informed verbal and written consent. Results: A total of 35 patients were operated including 10 males and 25 females. Their age ranged from 20 to 60 years with mean age 33.14±8 years. Majority (32, 91%) of the patients had left side prolapsed paracentral disc, and remaining (3, 9%) had right sided prolapsed disc. Regarding the level of disc 19 (54%) patients had L45 while 15 (43%) had L5-S1 and remaining one (2.9%) patients had L3-4 level. The post-op wound site visual analogue score was 1.57±1.1. Twenty-five patients had VAS of 1 (71.4%). Minimum hospital stay was 1 day in 16 (45.75%) patients and maximum was 4 days in 3 (8.6%) patients. Mean hospital stay was 1.83±0.95 days. The only complication encountered was iatrogenic dural tear seen in one patient but with no CSF leak from wound site. No surgical site infections were reported at follow-ups.
Conclusion: Endoscopic Lumbar discectomy is a safe procedure with short hospital stay.
Keywords: sciatica, prolapsed intervertebral disc, microscopic discectomy, endoscopic discectomy Pak J Physiol 2017;13(2):34–7