Introduction: Modified transcorporeal anterior cervical microforaminotomy is a motion preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in transuncal approach there is chance of vertebral artery injury and it also decreases disc height hence may alter the motion of that segment. Purpose: Aim is to assess the outcome of surgery and its effectiveness.
Method: Total 40 patients were observed prospectively of which 33 were male and 7 were female. A single prospective study of modified transcorporeal anterior cervical microforaminotomy was analysed in a private hospital (Comfort Hospital), Dhaka, Bangladesh.Patients having pure brachialgia who was not relieved by conservative treatment over 6-8 weeks in cervical disc prolapse was included in the study.Patients having more than one level disease, features of myelopathy or instability were excluded from the study.
Anterior communicating artery aneurysm is the most common form of intracranial aneurysm. We present a rare case of a rare case of internal carotid occlusion with anterior communicating aneurysm of a 33 years male patient. The male patient presented with sudden severe headache with transient visual loss in right eye and double vision with squint on right eye for 26 days. All the symptoms subsided within 12 days except headache which persists till to date. On neurological examination patients higher psychic function was normal. Cranial nerves were intact, Optic disc-Pailloedema on both sides. In the investigations, CT scan of brain revealed subarachnoid hemorrhage. CT angiogram of brain showed subtotal occlusion in extra and intracranial part of right internal carotid artery with a small aneurysm in anterior communicating artery (2.2 x2.18 mm). The period of 14 days, the CT angiogram of brain revealed the same radiological findings. Some EC-IC collaterals through petrosquamous artery were found to middle cerebral artery on right. Arteriographic evaluation of the anterior communicating artery region is necessary so that preexisting aneurysms may be documented and treated.
Introduction: Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for hydrocephalus of children over six weeks of age. Multicenter results from the Hydrocephalus Clinical Research Network (HCRN) to provide the most accurate determination of morbidity, complication incidence, and efficacy of ETV in children and to determine if intraoperative predictors of ETV success add substantially to preoperative predictors. Method: Thirty-four pediatric patients with hydrocephalous were analysed. The patient's age limit is between 2.5 months and 14 years. Among them 7 patient had VP shunt, 6 patients had communicating hydrocephalus (HCP). Results: The surgical result is quite substantial. Of the 34 surgeries, 28 patients recovered successfully and 6 were unsuccessful.
We report a case of a patient with pituitary tumor with psychiatric disorder, which posed a significant diagnostic dilemma and management challenge for the treating teams of neurosurgery, endocrinology and psychiatry. A more comprehensive endocrine work-up of atypical presentations can be considered in some cases. The criteria for determining when endocrine work should be considered should be investigated further.
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Background: Objective: To assess the surgical outcome of the unilateral approach in Lumbar Spinal Stenosis. Methods: This prospective observational study was conducted in the private hospital, Dhaka from February 2010 to December 2014. Sixty two patients of 40 years and above underwent a unilateral approach for lumbar spinal stenosis, were included in this study. Patients having Cauda Equina Syndrome or spinal instability were excluded from the study. All patients were followed up postoperatively. Result: Mean age of the patients was 52.16 ± 6.87 years within the range of 40-68 years. Maximum (43.5%) patients were in age group 50 – 59 years followed by 40.3% and 16.1% in age group 40-49 years and 60-68 years respectively. Males (77.4%) were predominant than female (22.6%) and male to female ratio was 3.4:1. Mean follow up was 4.15 ± 2.08 years, 53.2% patients were followed up ≤ 5.0 years and 46.8% patients were followed up >5.0 years. In our study, 88.7% patients had no complication. Only 11.3% patients were found to have complications, of which 1.6% had CSF leak, 1.6% had discitis and, 8.1% had no improvement at all. Conclusion: Unilateral approach showed good outcomes in patients with Lumbar spinal stenosis. Postoperative complication rate was infrequent and the success rate was satisfactory.
Introduction: Traumatic spondylolisthesis of C2 (Axis) which is also known as hangman fracture was initially noted in 1965 by Schneider et al. There are two kinds of it, i.e. (i) one of a hyperextensive- distractive mechanism with the very severe neurological lesion leading to the classical injury due to hanging and (ii) one of a hyperextensive-compressive mechanism without neurological lesion of current traffic injuries or with slight neurological symptoms. The latter more often occurring type of injury encompasses a relatively wide range. The optimal therapy for traumatic fractures of the neural arch of the axis is still controversial. Indications for surgery depend on the type of hangman’s fracture and/or additional injuries of the intervertebral disc or ligaments. Here we shall share our experience of surgical management of hangman’s fracture with review of literature. Method: 29 patients with hangman’s fracture were treated between 2004 and 2015. All patients presented with neck pain and 7 with neurological deficit.3 patients with stable fracture were treated by rigid collar. Of the 17 surgically treated patients 16 were managed with screws, placed on the C2 pedicles. Of them 7 required additional fixation with rod & screw on the lateral masses of C3 and another with C4 pedicle screw as he had associated C3 body fracture. 1 patient underwent anterior discectomy and fusion with internal fixation. Results: All the patients had good post surgical outcome with satisfactory fusion of the fractures. Conclusions: Surgery provides plausible results. Compared to conservative treatment, it can offer significant benefits: 1) immediate, better and stable reposition; 2) high fusion rate; 3) shortening of the treatment period with better quality of life. Though technically difficult, transpedicular screw fixation is the best option as it preserves the motion more than other techniques.
Introduction: Osteoporotic fracture is common among the elderly people. It occurs following minor trauma like slipping on the floor or due to jolt while travelling in a vehicle on an uneven road. It is usually associated with severe crippling local pain which aggravates on movement, sitting or standing. Objective: Our goal in this study is to find out the outcome of percutaneous cement vertebroplasty & kyphoplasty for osteoporotic vertebral fracture. Methodology: This cross sectional study was carried out at Department of Neurosurgery, BMSSU, Dhaka from January 2017 to June 2018 where 28 patients data were evaluated on the basis of their history, clinical examination. Among the cases Per. Vertebroplasty was 23 and Balloon kyphoplasty was 5. 60% patients were female and 40% patients were male. The entered data were cross-checked and confirmed. Results: Percutaneous vertebroplasty is a minimally invasive procedure with very good results for the treatment of severe pain due to vertebral compression fracture. It provides significant pain relief with the potential for improving functional outcome.
Background: Surgical outcome in patients with cervical spondylotic myelopathy may affects by variety of factors. Different study outcome suggest that the number of symptoms and involved levels, symptom duration and posterior approach significantly increased with increasing age, whereas preoperative Japanese Orthopedic Association score decreased among the different age groups. Objective: The goal of this study is to analyze the surgical outcome by comparing younger and elderly patient groups on the basis of preoperative radiological and clinical data. Methods: To find out the surgical outcome the clinical and radiological data of 32 patients who underwent expansive laminoplasty were reviewed after their surgery had been performed. All of the Patients were divided into two groups, group (a): younger patient group (<65 yr of age; n = 13) and an elderly patient group (≥65 yr of age; n = 19). Patients were assessed by use of the Japanese Orthopaedic Association scale (JOA) to know the neurological status of them. Computed tomographic myelography and magnetic resonance imaging examined for radiological feature. Finally, the effects of the clinical and radiological findings on neurological outcome were investigated. Results: The scores of preoperative and postoperative mean of (JOA) in elderly patients were significantly lower than younger patients. In the elderly patients cases, the transverse area of the spinal cord at the level of maximum compression
Background: Arachnoid cysts are present in 1% of the populace and generally found in the temporal, frontal, pineal and posterior fossa, frontotemporal fossa. Clinical and radiologic introductions can vary incredibly. In spite of serious research, it is as yet easily proven wrong which patients will profit by medical procedure. Objective: This study intends to research the pre-treatment parameters impacting the result after neuro-endoscopic treatment of arachnoid cysts. Methods: A review investigation of 14 patients who experienced an endoscopic fenestration of arachnoid cysts between 2012 to 2017. Results: In symptomatic patients, 85.71 percent of cases have improved clinically. The best results in treating symptoms related to intracranial hypertension, acute neurological defects and macrocrania and seizure were found. Conclusion: The clinical outcome and complication rate vary by technique and symptomatology, although the outcome after the endoscopic cysto cysternostomy is satisfactory.
Introduction: A lot of controversies are there in treating Acom aneurysm surgery. Proximal control, timing of surgery, Sylvian fissure dissection, approach and patient selection are few of those. Avoiding major disasters such as perforator injury is mandatory, proximal control of both A1 in intraoperative rupture is worth living. The technique of arachnoid dissection to prevent injury to AcoA complex and brain retraction facilitates surgery. In this series, complication avoidance of 16 cases has been discussed. In order to avoid a major disaster such as perforator injury, proximal control of both A1 in intraoperative rupture is deserving of life. The arachnoid dissection technique to prevent injury to the AcoA complex and brain retraction facilitates the surgery. In this series, Complication avoidance of 16 cases was discussed. Material and Method: A retrospective study of 16 cases of which 9 were male and 7 were female was observed. Prevention of complications has been studied in Acom aneurysm surgery. Results: Of 16 patients-2 died 1 developed 3rd nerve paralysis which was recovered after 3 months, 1 developed hydrocephalus. Conclusion: The complexity of the location means that complications in Acom neurysm surgery must be avoided. The learning curve to avoid complications is a step in the right direction. Collection of larger series will contribute further to society.
Kidney disease is one of the world's major public health problems and the prevalence of kidney failure is rising day by day. The structure and function of the kidney changes with advancing age. This study is to find out the histological architecture of kidney in Bangladeshi people related to age. The study was descriptive type of cross-sectional study carried out in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from July 2006 to June 2007. For this study 30 pairs of postmortem human kidneys of age ranging from 3 years to 60 years were selected. The kidneys were collected from dead bodies autopsied in the morgue of Mymensingh Medical College.
Abstract: Anterior Cervical Discectomy and Fusion (ACDF) is generally performed for brachalgia and is linked with significant complication such as spinal cord injury recurrent laryngeal palsy, infection or swallowing issue. The Anterior cervical microforaminotomy (ACMF) approach includes for the immediate evacuation of the compressive variation from the norm and the conservation of the movement fragments without bone combination or post-agent immobilization. The general aim of the study is to assess the surgical outcome between Anterior Cervical Discectomy and Fusion with Transcorporeal Anterior Cervical Microforaminotomy. Single institutional retrospective analysis. The outcome of both interventions were compared through statistical method. A total 60 ACDF and 40 ACMF were performed. There were no difference in the preoperative neck and VAS score. A single prospective study of modified transcorporeal anterior cervical microforaminotomy was analysed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who was not relieved by conservative treatment over 6-8 weeks in cervical disc prolapse was included in the study. Patients having more than one level disease, features of myelopathy or instability were excluded from the study. In the investigation, ACMF the Vas Score 7, 8 and 9 was among 52.5 percent, 42.5 percent and 5 percent of the aggregate patients individually after the medical procedure. Besides, Preop/Postop was 0 and 1 in the 20 and 80 patients respectively. On the other hand in ASDF the Preoperative VAS Score 7 among 51.67% patients followed by 8 and 9 were among 45%, and 3.3% respectively. On the other hand Post operative VAS Score 0 among 75% patients followed by 2 were only 11.67% and 1 were 13.33%. Bath ACDF and ACMF delivered significant improvement in VAS neck and Arm scores. Degree of improvement of VAS neck and VAS arm are almost similar between both groups with a trend favoring the ACMF group. In ACMF Immediately after surgery all patients were pain free, but 2 out of 40 patients developed brachialgia after one to two months and needed anterior cervical discectomy and fusion. ACMF can be in important alternative to ACDF in treating patients with brachalgia without a significant risk for ACDF revision surgery at the index level. With astute patient selection an ACMF is a safe operation, giving good results in over 90 %. The advantages of the operation include preservation of the motion segment, direct removal of the compressive abnormality, avoidance for the need for fusion and faster recovery. Keywords: ACMF, Surgery, Cervical brachialgia, ACDF.
