Eastern Green Neurosurgery

Women in Neurosurgery

Karuna Tamrakar Karki — Sat, 31 Dec 2022 00:00:00 +0000

No abstract available.

Incidence and Patterns of Major Complications Following Spinal Instrumentation- A Retrospective Descriptive Study from a Tertiary Care Center in Nepal

Sunil Munakomi, Saugat K.C., Dipak Chaulagain, Giovanni Grasso — Sat, 31 Dec 2022 00:00:00 +0000

Background: With the continuous uprise of spinal instrumentations within the global front, the complications they harbinger may have multispectral effects upon the patients as well as their caretakers. These are of prime significance in the context of low and middle-income nations. There is however drought of studies pertaining to the same in our subcontinent.

Materials and methods: A retrospective descriptive study was undertaken to study the incidence and patterns of early and late major complications among 300 patients undergoing spinal instrumentation from the hospital database of the College of Medical Sciences (CMS), in Bharatpur, Chitwan, Nepal.

Results: Trauma comprised 63.33% of cases in the study. 40% of the study cohorts were either in the American Spinal Injury Association (ASIA) ‘A’ or ‘B’ neurological status. The incidence of major complications in our study cohort was 20.33%. The posterior-only surgical approach was undertaken in 200 (66.67%). Surgical site infection was the most common type of complication observed (6.67%). Hardware-related complications were observed in 5.67%) of cases. The incidence of re-operation was 2.67%. The mortality rate observed in our study was 2%.

Conclusion: Adequate preoperative planning, proper optimization of the patient, and adoption of procedure-specific, risk-adjusted predictive models may be pivotal for nullifying complications adherent to spinal instrumentation.

Bovine Arch Variation Detected During Cerebral Digital Subtraction Angiography in Nepalese Population: A Retrospective Study

Karuna Tamrakar Karki — Sat, 31 Dec 2022 00:00:00 +0000

Background:Anatomical variation of aortic arch play’s significant role in diagnosing and planning further therapeutic intervention of cerebrovascular diseases. Objectives: Aim of this study was to review the neck vessels arising from the aorta and to determine the prevalence of aortic arch variation in digital subtraction angiography.

Materials and methods: after ethical clearance from institutional review board, study was conducted retrospectively in 129 patients who underwent digital subtraction angiography for various reasons from December 2020 to December 2021. Age ranged between 21-87 years old. 88 were males and 41 were females. Mean age was 57.89.

Results: bovine arch variations were found in 2.3% in our study population. Classic branching pattern was demonstrated in 97 % of studied cases.

Conclusion: Determining bovine arch variation though rarely detected, is essential for diagnostic and therapeutic intervention of cerebrovascular conditions for uncomplicated navigation of catheters and guide wires.

Practice of Tracheostomy Decannulation among Neurosurgery Patients: Single Center Study

Dinesh Kumar Thapa, Ayesha Khadka, Arzoo Prasai, Karuna Tamrakar Karki — Sat, 31 Dec 2022 00:00:00 +0000

Background: A tracheostomy is a surgical procedure in which trachea is opened below the larynx from which a tube is placed in trachea to facilitate mechanical ventilation, removal of tracheo-bronchial secretions and to protect upper airway. The aim of this study is to find out the current status of decannulation following institutional guideline.

Materials and methods: A cross sectional study was done among patients in neurosurgery with tracheostomy who were successfully decannulated. This study was conducted in department of neurosurgery B&C Medical College Teaching Hospital, Jhapa, Birtamode. Total 47 patients were included in this study those underwent decannulation. Various demographic data including gender age diagnosis, days of tracheostomy and decannulation started day were recorded and entered in SPSS and version 20.

Results: Among 47 patients, male were 81% (38) and females 19 %( 9). Road Traffic accident is the most common diagnosis 66% (31) among tracheostomy patients. The average days with Tracheostomy were 24. And after decannulation process, the successful tracheostomy closure in 83% (39) patients was achieved.

Conclusion: Patients with tracheostomy tube could be decannulated successfully by following strict institutional guidelines, adequate medical and nursing care in a center with limited resources.

Calcified Chronic Subdural Hematoma: A Case Report

Dipak Chaulagain, Sunil Munakomi, Binod Bhattarai, Sashi Bhushan Shah — Sat, 31 Dec 2022 00:00:00 +0000

Calcified Chronic Subdural Hematomas (CCSDH) are uncommon subdural hematoma (CSDH). It is believed that they account for between 0.3% and 2.7% of all CSDH. Increased intracranial pressure, seizures, and nerve damage are all possible clinical manifestations. We present the case of a 65-year-old man who, three months before he began experiencing motor function issues in his left limbs, had a history of a fall injury. In the right cerebral hemisphere, CT scans revealed a sizable subdural collection surrounded by a calcified inner membrane. The patient's clinical and radiological symptoms improved after this collection was successfully and totally eliminated. Subdural hematomas rarely calcify. This odd lesion was surgically removed, and the patient's symptoms progressively and totally subsided, restoring his neurological state. Based on published examples and our personal experience, we feel that surgical therapy in symptomatic patients is important and viable, often resulting in patient improvement.

Locked In Syndrome, a Rare Clinical Presentation: A Case Report

Nischal Bhattarai, Karuna Tamrakar Karki, Dinesh Kumar Thapa — Sat, 31 Dec 2022 00:00:00 +0000

Locked in syndrome is a rare neurological entity which is usually misdiagnosed as a spinal pathology. Here we report 70 years-old hypertensive and diabetic gentleman presented with quadriplegia without upsetting his conscious level.

Hemolacria in severe Migraine – Case report

Dinesh Kumar Thapa, Ashma Prasai, Niraj Yadav — Sat, 31 Dec 2022 00:00:00 +0000

Bloody tears or hemolacria mostly occurs in bleeding disorders, infections, and malignant condition of the eyes and surrounding structure. It is very rare to have it in migraine headache. Hereby, we report a case of Hemolacria in a 47 years lady during acute attack of migraine.

Isolated Eight and Half Syndrome, a Rare Neuro-ophthalmic Presentation: A Case Report

Karuna Tamrakar Karki — Sat, 31 Dec 2022 00:00:00 +0000

Eight and half syndrome is one of the rare neurological disorders, which is usually overlooked in our clinical practice. Here I report 58 years-old hypertensive Indian gentleman presented with horizontal gaze palsy and facial weakness.

Organophosphorus Poisoning Induced Delayed Poly-axonal Motor Neuropathy: A Case Report

Pratik Prasai, Jitendra Thakur, Karuna Tamrakar Karki — Sat, 31 Dec 2022 00:00:00 +0000

Organophosphate being the lethal compound and easily available insecticide in the developing countries has significant potential health risk. The morbidity related to organophosphate poisoning as delayed peripheral neuropathy, extra pyramidal syndromes and neuropsychiatric manifestations are still the major consequences of secondary neuronal damage. Herein, we present a case of 23 year old lady who ingested organophosphate in the context of suicidal attempt and presented with motor neuropathy after 4 weeks.

Phantom Tooth pain, is it Often a Trigeminal Neuralgia?

Rekha Yadav — Sat, 31 Dec 2022 00:00:00 +0000

Toothache, buccal pain, facial pains are common presentations in dental clinics. Among them, phantom tooth pain always hits as a trigeminal neuralgia. Though classical picture of trigeminal neuralgia usually does not present with solo toothache, which may sometime masks the whole scenario.