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Ashraf M, Sajjad F, Hussain SS, Cheema HA, Ali S, Umar H, Gillespie CS, Faiz U, Shahid A, Akmal M, Ashraf N. Long-term outcome of microvascular decompression for typical trigeminal neuralgia with autologous muscle: an analysis of 1025 patients from a developing country. J Neurosurg 2024:1-11. [PMID: 38608302 DOI: 10.3171/2023.9.jns231473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/28/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). METHODS A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. RESULTS In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. CONCLUSIONS MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.
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Affiliation(s)
- Mohammad Ashraf
- 1Wolfson School of Medicine, University of Glasgow & Queen Elizabeth University Hospital, Glasgow, United Kingdom
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Fauzia Sajjad
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Syed Shahzad Hussain
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Sundus Ali
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Hira Umar
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Conor S Gillespie
- 6Department of Clinical Neurosciences, University of Cambridge, United Kingdom; and
| | - Umar Faiz
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Abia Shahid
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Muhammad Akmal
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Sajjad F, Baloch MF, Ashraf M, Gillespie CS, Umar H, Zafar A, Zulfiqar J, Ullah I, Ali S, Ashraf N. Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: A diagnostic challenge in an immunocompetent pediatric patient. Surg Neurol Int 2023; 14:350. [PMID: 37810325 PMCID: PMC10559370 DOI: 10.25259/sni_581_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable.
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Affiliation(s)
- Fauzia Sajjad
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | | | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Hira Umar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Ammara Zafar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Javaria Zulfiqar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Imdad Ullah
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sundus Ali
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
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Ul Huda Maria N, Sajjad F, Siddiq QA, Ul Ain Fatima N. Letter to the Editor. Remission of acromegaly after transsphenoidal surgery. J Neurosurg 2022; 137:1-2. [PMID: 35334456 DOI: 10.3171/2022.2.jns22291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Qurrat A Siddiq
- 3Postgraduate Medical Institute/Ameeruddin Medical College, Lahore, Pakistan
| | - Noor Ul Ain Fatima
- 4Institute of Developmental Sciences, University of Sussex, Brighton, United Kingdom
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Ahmed M, Sajjad F, Khan A, Abass T, Akbar H, Anwar K. Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma. Pak J Neurol Surg 2021; 24:369-375. [DOI: 10.36552/pjns.v24i4.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia.
Material & Methods: A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days.
Results: The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients.
Conclusion: Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma.
Keywords: CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery & Subdural drain.
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