International Journal of Neurology and Neurosurgery

Ventriculoperitoneal Shunt surgery is a common neurosurgical procedure comprises a long list of postoperative complications. Among them, common complications like shunt infection, obstruction, overdrainage or underdrainge, subdural hematoma or hygromas are reviewed extensively in the previous literature.1 With the course of time, improved surgical and technical skill, use of programmable valves, antibiotic impregnated catheters, attempt to improve nutritional status of the child before placement of shunt reduces significant shunt related morbidities. Despite all these precautions and techniques there are some rare complications of this surgery which can leads to catastrophic outcome. In this case series we reported four rare complications of VP shunt surgery and reviewed the previously reported literature. We also focused on the possible risk factors, pathophysiology of each complications so that meticulous attention can be given to prevent these complications to improve surgical outcome.

Keywords: VP shunt; Calcified extradural hematoma; Intracerebral hemorrhage; Ascities, Pseudocyst, SEGA

Introduction: The sellar and parasellar region is an anatomically complex area and the complexity of structures that define this region can produce a variety of neoplastic processes. A multimodal approach for the diagnosis and treatment of the same is frequently necessary. Materials and methods: A total of 60 patients with radiologically confirmed diagnosis of sellar region tumor were included in the study and were assessed in terms of age and sex distribution, location, type, clinical features, treatment approach and complications. Results: Characteristics of a total of 60 patients with sellar tumors were assessed in the study out of which 30 were in the age group of 21 to 40 yrs, followed by 24 patients in age group of 41 and above. Among 60 patients in the study group, 36 patients presented with visual symptoms, 56 with neurological symptoms and 20 patients had hormonal symptoms. Pituitary adenoma was the commonest lesion seen in 44 out of 60 patients. Surgical treatment was offered to all patients and 52 patients out of 60 underwent a transnasal transsphenoidal resection of tumor whereas 6 patients had to undergo microscopic resection and 2 patients had their tumor resected through an open approach. Discussion: Age distribution among 60 patients showed that majority of the cases with sellar tumors were in age group of 21 to 40 yrs. 24 patients were in the age group of 41 yrs and above. Only 6 cases were in the age group less than 20 yrs. Distribution of type of tumor in the study group showed that 44 (73%) patients had pituitary adenoma, 4 had craniopharyngioma and fungal granuloma respectively and 2 patients had lymphocytic hypophysitis, chordoma, suprasellar epidermoid and sellar meningioma respectively. Out of a total of 44 patients with pituitary adenoma operated, 4 patients developed complications whereas 6 patients developed complications among 16 patients with diagnosis other than pituitary adenoma. The difference was statistically non significant. All patients with hormonally active tumors had raised urine output postoperatively but only 3 of them developed true DI. Conclusion: The most commonly presenting clinical features of tumors of sellar region are neurological followed by visual symptoms. Pituitary adenomas are the most common tumors of the sellar region and among them, prolactinomas are most commonly encountered. Thin slice dedicated MRI of the sellar region is the gold standard investigation for diagnosis of sellar lesions and endoscopic transnasal transsphenoidal resection remains to be the surgical treatment of choice wherever possible.

Keywords: Epidemiology; Tumors; Pituitary adenomas; Hormonal symptoms; Craniopharyngioma.

Spinal epidural abscess is a rare pathology which is manifested by a classic triad of pain, fever and neurological deficit. In most cases, the clinical picture is incomplete which makes its diagnosis difficult. In this retrospective study, we report five cases of spinal epidural abscess treated in the neurosurgery department of Hassan II University Hospital of Fez. Four of our patients were admitted due to spinal cord compression, while one patient was admitted for isolated spinal syndrome without neurological deficit. Fever was present in all our patients, nevertheless no point of entry was identified in the initial assessment. MRI was performed on emergency basis in all of our patients, and demostrated an extra-dural hypointense T1, hyperintense T2 lesions with peripheral enhancement after contrast. Four of our patients underwent surgical treatment which involved performing a laminectomy/laminotomy with drainage of the abscess, while one patient received medical treatment alone. The evolution was favorable in 4 of our patients while one patient died postoperatively due to severe sepsis.

Keywords: Spinal epidural abscess; MRI; Laminectomy; Laminotomy.

Context: Patient recovery improves with effective postoperative pain control after spinal surgeries. Pain control is not equivocal by different techniques in spite of all the surgical and non-surgical advances made till date. Aims: This study was aimed at proving the hypothesis that neural root blockade before the onset of noxious stimuli could inhibit or reduce the production of pain. Settings and Design: Prospective, cohort, and single-blinded clinical study from 2016 to 2018 of 150 cases. Methods and Material: One hundred and fifty patients undergoing spinal surgeries were included in the study. In 75 of the patients (Group 2), 0.5 ml lidocaine 2% was applied onto the neural root immediately after the exposure and in 75 patients in the control group (Group 1) no topical application was done. All patients were monitored regarding pain determination using Visual Analogue Scale, and the exact time of analgesic requirement during the first postoperative day was recorded. Statistical analysis used: The Statistical software namely SPSS 18.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables, etc. Results: Topical perineural lidocaine application extended the early postoperative analgesic duration; although, the pain was not completely suppressed, the lidocaine application helped to manage the postoperative pain more effectively. The patients (Group 2) who received lidocaine application intraoperatively onto the neural root had a statistically significant longer duration before analgesia requested (p < 0.001) and also required significantly less analgesic when compared with the control group (p < 0.001). Conclusions: Acute postoperative pain in spinal surgery remains a major concern. The study suggests that lidocaine application onto the dorsal neural sheath immediately before retraction of the root may extend the time before analgesia requested and the total analgesic drug consumption.

Keywords: Nerve root blockade; Noxious stimuli; Pain; Spine surgery.

Background: This study was designed to compare the efficacy of prophylactic ramosetron with ondansetron in preventing PONV after elective supratentorial craniotomy in adult patients on preoperative steroids. Methods: A total of 145 American Society of Anesthesiologists (ASA) I–II patients aged 30–50 years on preoperative steroids scheduled to undergo elective supratentorial craniotomy under general anesthesia were enrolled in the study. A standard anesthesia regimen was followed in all patients. Patients were randomly allocated into two groups to receive ondansetron (4 mg/2 ml; Group O), or ramosetron (0.3 mg/2 ml; Group R) intravenously (IV) at the time of dural closure. The incidence of PONV, need for rescue antiemetics, rescue analgesics and any adverse events were recorded up to 48 hours postoperatively. Results: During 0–24 hours after surgery, complete response (no PONV) was observed in 30 patients of the ondansetron group and in 34 patients of the ramosetron group (p > 0.05). Complete response i.e., no PONV between 24–48 hours after surgery was observed in 31 patients of the ondansetron group and in 45 patients of the ramosetron group and was statistically significant (p < 0.05). During 0–24 hours, PONV requiring rescue antiemetics were comparable in both the groups, whereas between 24–48 hours PONV requiring rescue antiemetics was higher in ondansetron group (18 patients) as compared to ramosetron group (8 patients) and was statistically significant (p < 0.05). Conclusion: Ramosetron was more efficacious than ondansetron in preventing delayed PONV (24–48 hours) in patients on preoperative steroids following supratentorial craniotomy under general anesthesia. However, both the drugs were comparable in preventing early PONV (0–24 hours). The incidence of side effects was similar in ondansetron and ramosetron.

Keywords: Ondansetron; Postoperative nausea and vomiting (PONV); Ramosetron; Supratentorial craniotomy.