Outcome of Surgical Resection of Craniopharyngioma:Single Center 12 Years' Experience

Background Craniopharyngiomas (CPs) are rare epithelial tumors arising from the Rathke's pouch remnant located along the path of the craniopharyngeal duct accounting for 1.2-4% of all primary intracranial brain tumors, the primary treatment of which is surgery. Objective Whether radical surgical resection or partial resection followed by radiotherapy is a topic of debate. We presented our 12 years single center experience on surgical resection of craniopharyngioma. Method This was a descriptive cross-sectional study conducted among forty-five patients who underwent transcranial resection of craniopharyngioma during a period of 12 years. Data were collected from medical record archives. Glassgow outcome score (GOS), electrolyte imbalance and visual complications were assessed as outcome measure. GOS > 3 was considered favorable while score ≤ 3 was considered unfavorable. Recurrence of tumors were analyzed. Result Out of 45 patients, 28 patients were male with male to female ration of 1.64. Mean age was 32.22±16.42 years. Supra-sellar craniopharyngioma were the most common location. Gross total resection was accomplished in 32 patients (71.1%) while subtotal resection among 13 patients (28.9%). Post-operative Diabetes Insipidus was developed among 35 patients (77.7%). Adamantinomatous craniopharyngioma was the most common histopathological type. Postoperative MRI with contrast was repeated to ascertain the completeness of resection. All patient with subtotal resection received radiotherapy. Follow up period ranged from 3 months to 8 years with mean of 4.2 years. Favorable outcome (GOS>3) was seen among 41 patients while unfavorable among 4 patients. Recurrence seen among 4 patients (8.9%). Overall mortality was 4 (8.8%). Conclusion Gross total excision of craniopharyngioma has a favorable outcome with acceptable morbidity.

Cheiro-Oral Syndrome

Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers. MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as CheiroOral Syndrome as a result of ischemic stroke and managed.

Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

Background:

Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1^st time in our country.

Materials and Methods:

In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed.

Results:

A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed.

Conclusion:

This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.

Outcome of head injury patients undergoing surgical management: a tertiary level experience

BACKGROUND

Head injury is the major cause of death in a neurosurgical patient.

OBJECTIVE

To find the outcome, and treatment modality affecting the outcome in patients with head injury.

METHODS

Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury.

RESULTS

Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016).

CONCLUSION

Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.

Penetrating Cardiac Injury By A Piece of Metallic Plate

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A Case Of Round Worm In Gall Bladder With Reveiew Of The Literature

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Deodeno-Jejunal Tuberculosis

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Cholecystectomy In Bir Hospital Nepal

SummaryMaterials and MethodsAgeSexGeographical DistributionsSymptomatologyInvestigationsOperative FindingsTypes of StonesComplicationsDuration of Stay In HospitalDiscussionConclusionAcknowledgementsReferences

Sacro-Coccygeal Tumours

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Patterns of Post Operative Wound Infection and their Antibiotic Sensitivity in Bir Hospital

Abstract

Incidence of Wound Infection after cholecystectomy with or without appendicectomy

From the 1st of September 1978 to the end of August 1979 one hundred and one patients undrewent laprotomy for gall-stones and gall-bladder diseases in the Department of Surgery, Bir Hospital, All operations were performed by one team. Among-them seventeen were males (16.8%) and eighty four females (83.2%). Cholecystectomy and appendicectomy were performed in fortyseven patients, among them nine patients underwent choledochotomy as well. Postoperative wound infection after cholecystectomy. cholecystectomy with choledochotomy and removal of the gall bladder with appendicectomy was 5.9, 10 and 10.6 percent respectively. Despite high incidence of wound sepsis after biliary surgery with appendicectomy the later procedure is advocated during routine cholecystectomy, because there are very few hospitals in Nepal where facilities for laparotomy exist, and review of English literature has revealed a number of references to concomitant cholecystic - appendiceal disease. These reports refer to the high incidence of unsuspected pathological process within the appendex as a indication for its removal at the time of elective cholecystectomy.

Neurology and neurosurgery in Nepal

During early 1982 one of the authors (RGL) was privileged to spend two months in Nepal as part of an exchange program between the University of Calgary, Faculty of Medicine and the new medical school at Tribhuvan University in Kathmandu. A short visit of this type does not qualify a Canadian neurologist to comment on the neurological-neurosurgical problems of a country such as Nepal with any degree of expertise. Nevertheless, as a result of a number of discussions between the two authors and interviews with many other physicians, both Nepalese and Western, it was possible to form some general impressions and draw some comparisons between neurologic illnesses in Nepal and Canada.

Disorders affecting the nervous system are common in Nepal. Some of the problems which are seen regularly would be considered rare and exotic in North America. However, despite the vast differences in culture, geography, dietary habits, and socio-economic conditions, there are some surprising similarities between the patterns of neurologic illness in Nepal and Canada. Disorders such as migraine, stroke, epilepsy and meningitis are well known to Nepali physicians. To appreciate the magnitude of health care problems in Nepal and to view neurologic illness in its proper perspective, it is helpful to have a few basic facts and figures concerning the geography and population of the country.

Laparotomy For Abdominal Injuries; Role of Clinical Assessment In The Evaluation Of An Injured Abdomen

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Head injury in Bir HOspital

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