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Papers by gopal sedain

Asian journal of neurosurgery, Jun 1, 2022

Objective The risk factors, management strategies, and outcomes of patients with multiple intracr... more Objective The risk factors, management strategies, and outcomes of patients with multiple intracranial aneurysms (MIAs) are different compared with that of patients with a single aneurysm. Data are scarce regarding patients with MIAs from developing countries. The objective of this study was to describe the clinical characteristics, management strategies, and outcomes of patients treated microsurgically from Nepal. Methods The clinical records of patients confirmed to have MIAs and microsurgically clipped between July 2014 and December 2019 were retrospectively reviewed. Data on demographic and clinical characteristics, computed tomography findings, multiplicity and location of aneurysms, management strategies, and the 1-year outcome were abstracted and analyzed. Results Two hundred cerebral aneurysms were microsurgically clipped in 170 consecutive patients during the study period. Twenty-six (13.0%) patients harbored 60 aneurysms. The mean age of the patients was 58.5 (43-73) years. Smoking and hypertension were found in 20 (76.9%) and 16 (61.5%) patients, respectively. The majority of patients [17 (65.4%)] were in good grades at presentation. Twenty-one patients had two aneurysms, four had three aneurysms, and one patient had five aneurysms. The middle cerebral artery was the commonest (20) followed by distal anterior cerebral artery (14) and anterior communicating artery (13) involved in multiplicity. A single-stage surgery was performed on 17 patients. Serial clipping was performed in six patients. In three patients, a single aneurysm on the contralateral side was left untreated for various reasons. The favorable outcome was achieved in 23 (88.5%) patients whereas three (11.5%) patients had an unfavorable outcome. One patient died. Conclusion The demographic and clinical characteristics of patients in our series are comparable with those described in the published literature from other countries. With an individualized treatment strategy, an acceptable outcome can be achieved in the majority of the patients.

Nepal journal of neuroscience, May 28, 2018

oubert syndrome is a rare autosomal recessive genetic neurodevelopmental disorderthat affects the... more oubert syndrome is a rare autosomal recessive genetic neurodevelopmental disorderthat affects the area of brain that controls balance and coordination. 6 The common typical clinical manifestations are abnormal respiratory pattern (hyper apnea), occulomotor fi ndings, low muscle tone (hypotonia), lack of muscle control (ataxia), developmental retardation with evidence of neuropathologic abnormalities of cerebellum and

Nepal journal of neuroscience, May 9, 2023

Objectives: To survey Nepali neurosurgeons regarding the practice of managing chronic subdural he... more Objectives: To survey Nepali neurosurgeons regarding the practice of managing chronic subdural hematomas (cSDH). Methods and Materials : A survey questionnaire was sent to all neurosurgeons practicing in Nepal from the database of the Nepalese Society of Neurosurgeons (NESON). Results: 60% (50/84) responded to the questionnaire. There was variation in practice among neurosurgeons regarding the use of drain and the administration of antiepileptics. However, many concurred regarding postoperative computed tomography scan, size of the burr hole, and positioning after surgery. Conclusion: For a common neurosurgical procedure like drainage of cSDH, scientific evidence keeps on changing. Based on the available evidence we need to change our practice for the best possible outcomes. For most of the variables studied, there is concordance with available scientific evidence among neurosurgeons regarding cSDH management in Nepal.

Journal of Institute of Medicine, Dec 30, 2019

The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significant... more The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it.

Nepal journal of neuroscience, Sep 4, 2018

pinal arachnoid cyst is a non-cancerous sac fi lled with cerebro-spinal fl uid (CSF) that is form... more pinal arachnoid cyst is a non-cancerous sac fi lled with cerebro-spinal fl uid (CSF) that is formed due to abnormal separation of arachnoid layer. It is an uncommon pathology and, furthermore, is a rare cause of spinal myelopathy secondary to cord compression.

Cureus, Jun 6, 2023

Background Electrocardiographic (ECG) changes are frequently reported findings in patients with s... more Background Electrocardiographic (ECG) changes are frequently reported findings in patients with subarachnoid hemorrhage (SAH). We conducted a retrospective descriptive study to assess the prevalence of electrocardiographic changes in patients with non-traumatic SAH. Methods In this single-center retrospective cross-sectional study, ECG recordings of 45 patients who presented to Tribhuvan University Teaching Hospital in the year 2019 with SAH were collected and analyzed to detect any abnormalities. Results In our study, 88.8% of patients had some form of ECG abnormality. The most common ECG abnormalities associated with SAH were QTc prolongation, T-wave abnormalities, and bradycardia, which were found, respectively, in 35.5%, 24.4%, and 24.4% of the patients. Other ECG changes we observed include ST depression, large U-waves, atrial fibrillation, and premature ventricular contractions. Conclusion Morphological and rhythm abnormalities are frequently observed in patients with SAH, which may cause diagnostic dilemmas and unnecessary workups. Further studies are required to evaluate their significance and correlate ECG changes with clinical outcomes.

Journal of Nobel Medical College

Intracranial aneurysms are sometimes associated with other vascular anomalies in extracranial loc... more Intracranial aneurysms are sometimes associated with other vascular anomalies in extracranial location. Coarctation of aorta, a congenital vascular lesion can be associated with intracranial aneurysms. In patients with coarctation, evaluation of intracranial vasculature is essential. We encountered a 12-year kid with subarachnoid hemorrhage. On further evaluation, she had anterior communicating artery aneurysm. On further evaluation for secondary causes of aneurysm, she had coarctation of aorta. She was surgically managed successfully by clipping of the aneurysm.

Journal of Society of Surgeons of Nepal, 2021

Scalp arteriovenous malformation (AVM) accounts for only 8.1% of all AVM cases. These lesions are... more Scalp arteriovenous malformation (AVM) accounts for only 8.1% of all AVM cases. These lesions are made up of an abnormal fistulous tangle of tortuous dysmorphic network of vessels “vascular nidus” directly connecting between the feeding arteries and draining veins, without capillary connection, located within the incision subcutaneous layer. With time, these congenital lesions may evolve and enlarge and clinically manifest with variable features. The only effective method of preventing evolution of these malformations is to exclude the lesion completely from the circulation. Involvement of the orbit and face may cause severe facial disfigurement, proptosis, visual obstruction and even facial palsy. These lesions may be complicated by ulceration, infection and profuse bleeding. We present a rare case of 40-year-old female with a recurrent congenital scalp-orbital AVM causing proptosis, visual obstruction on the right eye with severe facial disfigurement. The lesion was successfully e...

Acta Neurochirurgica, 2006

A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physi... more A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physical findings were not remarkable. MRI showed a large, elongated posterior extradural cyst from T12 to L3 with surrounding bony erosion (Fig. 1A, B). Thinned overlying laminas were found on operative field and the cyst was ruptured during laminectomy. There was a hole-like dural defect near to right L1 root sleeve and we performed primary closure of the defect. Some part of cyst wall was also removed. The patient's symptoms were gradually subsided and follow up image taken 1 month after the operation showed complete disappearance of the cyst (Fig. 1C). Case 2 A 51-year-old female patient visited our clinic with left buttock pain and paresthesia for 3 years. Her pain was aggravated on coughing and she also complained of gait disturbance with both sole numbness on walking. MRI showed a large extradural cyst located posterior to the

Kathmandu University Medical Journal

Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) i... more Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used durin...

Journal of Institute of Medicine, 2018

Introduction: The nutritional status among under the age of five in terms of stunting, underweigh... more Introduction: The nutritional status among under the age of five in terms of stunting, underweight and wasting and to find the association between nutritional status with selected variables. A descriptive cross-sectional study was done to determine prevalence of stunting, underweight and wasting among under five children and factors associated with that. Descriptive, univariate indices such as stunting, underweightandwasting determined as Height for Age, weight for age and respectively. Methods: The study was conducted in Manamaiju VDC with 56440 populations with 3742 under 5 children. Research design was descriptive cross sectional. Total sample size was 190 tools used are semi structured and face to face interview. Data collection was within 4 week (23rd chaitra 2070 to 20th Baisakh 2071). Data was analyzed by SPSS version 13.0 for Windows and ENA for SMART. Similarly, Chi square test was applied at 5% level of significance to show the association between nutritional status and se...

Journal of Institute of Medicine Nepal, 2019

The tumor of brain near or within the eloquent brain regions like motor and language cortex requi... more The tumor of brain near or within the eloquent brain regions like motor and language cortex requires excision of tumor and at the same time preservation of the functional area. To achieve the second goal the awake craniotomy is being practiced where the aim is to make the patient awake during resection of tumor so that the motor and speech function can be constantly monitored. We present the anaesthetic management of a case of craniotomy for low grade oligodendroma in frontal region with the awake throughout technique.

Nepal Journal of Neuroscience, 2020

Hydranencephaly is a rare and severe form of congenital disorder in which there is absence of cer... more Hydranencephaly is a rare and severe form of congenital disorder in which there is absence of cerebral cortex which is replaced by fluid. The presentation is in the form of hydrocephalus and developmental delay. There are various reports on possible etiopathogenesis and management. However, the overall prognosis is grim and clinicians especially in low and middle-income countries like Nepal often face a clinical judgement dilemma regarding management options to offer to the patient family. The ethical issue whether to offer cerebrospinal fluid diversion or not is always there. This review is aimed at discussing the various aspects of management of this pediatric neurosurgical problem.

Cureus, 2020

Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phen... more Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phenomenon. Only few cases of postoperative contralateral acute subdural hematomas have been reported in the literature review till date. This case report details a case of a 32-yearold hypertensive male who presented with severe headache, multiple episodes of vomiting, slurring of speech, nystagmus and ataxic gait for one day. Computed tomography (CT) scan of head revealed a right sided cerebellar hemorrhage with effacement of fourth ventricle and upstream hydrocephalus. A right suboccipital craniectomy and hematoma evacuation were performed. A repeat CT scan of head was done at six hours post surgery; which revealed a contralateral (left-sided) subdural hematoma involving the fronto-parieto-temporal region. The patient improved following conservative management. Contralateral acute subdural hematoma following evacuation of hematoma is a rare, but a potentially life-threatening complication; therefore, we should try to detect such contralateral hematoma and prevent clinical deterioration.

Nepal Journal of Neuroscience, 2019

Orbital roof fractures after blunt head trauma are not uncommon. Hernia ion of the brain tissues ... more Orbital roof fractures after blunt head trauma are not uncommon. Hernia ion of the brain tissues into the orbit through a bony defect, so-called post-traumatic orbital encephalocele, is a rare entity. The herniated braint issue causes compression of the intraorbital contents, particularly the optic nerve, extraocular nerves and muscles and compromise the vascular supply. Raisedintraorbital pressure may lead to irreversible damage to the optic nerve. This can be prevented by early diagnosis and timely management. Repair of the orbital roof needs to be performed to avoid transmission of intracranial pressure into the orbit. Early intervention is needed in order to prevent visual loss. We present a case of posttraumatic orbital encephalocele who underwent latesurgical treatment with direct repair of dura opening, reinforcement with temporalis fascia and reconstruction of orbital roof using skull bone graft. Complete resolution of the pulsatile proptosis with excellent cosmetic result w...

Journal of Institute of Medicine Nepal, 2019

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients... more Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involve...

Journal of Society of Surgeons of Nepal, 2017

Introduction: CNS tumor requires intraoperative decision making regarding the extent of tumor rem... more Introduction: CNS tumor requires intraoperative decision making regarding the extent of tumor removal. Clinical examination and imaging studies are not sufficient enough to predict the biological behavior of the tumors. Squash cytology is a quick method of evaluation of cytomorphologic features prepared from smear technique and provide the preliminary diagnosis and aid in intraoperative decision making by differentiating neoplastic from non neoplastic and benign from malignant lesions. The aim of this study is compare the diagnostic accuracy of squash cytology to that of histopathological examination. Methods: This study consists of 36 specimens from both brain and spine subjected to both squash cytology and histopathological evaluation. The squash preparation and histopathological finding were later compared and diagnostic accuracy calculated. Results: Gliomas are the most common tumor encountered and the accuracy of Squash cytology obtained was 71%. In meningioma, 100% diagnostic ...

Journal of Society of Surgeons of Nepal, 2018

Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrha... more Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) for visualizing the vascular pathology. There is some correlation between the pattern (based on Fisher grading) and location of bleed on CT scan and eventual location of cerebral aneurysm(s). Our aim was to assess the correlation between distribution of hemorrhage on the initial CT scan and eventual site of the ruptured aneurysm at our institution. Methods: This retrospective review of prospectively collected data consisted of 50 patients with SAH over 8 months period. CT scan of patients performed within 72 hours after the ictus with suspected SAH were included in the study. Four neurosurgeons, who had at least three years of experience after being qualified, who were blind to the imaging studies, analyzed and scored independently the quantity and distribution of the hemorrhage on CT. Their prediction of the site of the ruptured aneurys...

Nepal Journal of Neuroscience, 2018

Neurocysticercosis is a common parasitic infection of the central nervous system, caused by larva... more Neurocysticercosis is a common parasitic infection of the central nervous system, caused by larvae of Taeniasolium. Cysticercosis of spine is less common compared to that of brain itself. Anatomically, spinal cysticercosis can be classified as extraspinal (vertebral) or intraspinal (epidural, subdural, arachnoid, or intramedullary), where intramedullary type is extremely rare. Isolated spinal intramedullary neurocysticercosis without brain involvement is even rarer. Preoperative diagnosis of cystericosis within the cord maybe difficult; and the clinical and radiographic features may mimick that of more common intramedullary tumor. Here, we present a rare case of cervical intramedullary neurocysticercosis in an adult, presenting with progressive limb weakness, mimicking spinal ependymoma, clinically and radiographically and only diagnosed histopathologically after surgery.

Nepal Journal of Neuroscience, 2018

Head injury is the major cause of death in young adult population worldwide with associated high ... more Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma. All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome. Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorab...

Asian journal of neurosurgery, Jun 1, 2022

Objective The risk factors, management strategies, and outcomes of patients with multiple intracr... more Objective The risk factors, management strategies, and outcomes of patients with multiple intracranial aneurysms (MIAs) are different compared with that of patients with a single aneurysm. Data are scarce regarding patients with MIAs from developing countries. The objective of this study was to describe the clinical characteristics, management strategies, and outcomes of patients treated microsurgically from Nepal. Methods The clinical records of patients confirmed to have MIAs and microsurgically clipped between July 2014 and December 2019 were retrospectively reviewed. Data on demographic and clinical characteristics, computed tomography findings, multiplicity and location of aneurysms, management strategies, and the 1-year outcome were abstracted and analyzed. Results Two hundred cerebral aneurysms were microsurgically clipped in 170 consecutive patients during the study period. Twenty-six (13.0%) patients harbored 60 aneurysms. The mean age of the patients was 58.5 (43-73) years. Smoking and hypertension were found in 20 (76.9%) and 16 (61.5%) patients, respectively. The majority of patients [17 (65.4%)] were in good grades at presentation. Twenty-one patients had two aneurysms, four had three aneurysms, and one patient had five aneurysms. The middle cerebral artery was the commonest (20) followed by distal anterior cerebral artery (14) and anterior communicating artery (13) involved in multiplicity. A single-stage surgery was performed on 17 patients. Serial clipping was performed in six patients. In three patients, a single aneurysm on the contralateral side was left untreated for various reasons. The favorable outcome was achieved in 23 (88.5%) patients whereas three (11.5%) patients had an unfavorable outcome. One patient died. Conclusion The demographic and clinical characteristics of patients in our series are comparable with those described in the published literature from other countries. With an individualized treatment strategy, an acceptable outcome can be achieved in the majority of the patients.

Nepal journal of neuroscience, May 28, 2018

oubert syndrome is a rare autosomal recessive genetic neurodevelopmental disorderthat affects the... more oubert syndrome is a rare autosomal recessive genetic neurodevelopmental disorderthat affects the area of brain that controls balance and coordination. 6 The common typical clinical manifestations are abnormal respiratory pattern (hyper apnea), occulomotor fi ndings, low muscle tone (hypotonia), lack of muscle control (ataxia), developmental retardation with evidence of neuropathologic abnormalities of cerebellum and

Nepal journal of neuroscience, May 9, 2023

Objectives: To survey Nepali neurosurgeons regarding the practice of managing chronic subdural he... more Objectives: To survey Nepali neurosurgeons regarding the practice of managing chronic subdural hematomas (cSDH). Methods and Materials : A survey questionnaire was sent to all neurosurgeons practicing in Nepal from the database of the Nepalese Society of Neurosurgeons (NESON). Results: 60% (50/84) responded to the questionnaire. There was variation in practice among neurosurgeons regarding the use of drain and the administration of antiepileptics. However, many concurred regarding postoperative computed tomography scan, size of the burr hole, and positioning after surgery. Conclusion: For a common neurosurgical procedure like drainage of cSDH, scientific evidence keeps on changing. Based on the available evidence we need to change our practice for the best possible outcomes. For most of the variables studied, there is concordance with available scientific evidence among neurosurgeons regarding cSDH management in Nepal.

Journal of Institute of Medicine, Dec 30, 2019

The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significant... more The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it.

Nepal journal of neuroscience, Sep 4, 2018

pinal arachnoid cyst is a non-cancerous sac fi lled with cerebro-spinal fl uid (CSF) that is form... more pinal arachnoid cyst is a non-cancerous sac fi lled with cerebro-spinal fl uid (CSF) that is formed due to abnormal separation of arachnoid layer. It is an uncommon pathology and, furthermore, is a rare cause of spinal myelopathy secondary to cord compression.

Cureus, Jun 6, 2023

Background Electrocardiographic (ECG) changes are frequently reported findings in patients with s... more Background Electrocardiographic (ECG) changes are frequently reported findings in patients with subarachnoid hemorrhage (SAH). We conducted a retrospective descriptive study to assess the prevalence of electrocardiographic changes in patients with non-traumatic SAH. Methods In this single-center retrospective cross-sectional study, ECG recordings of 45 patients who presented to Tribhuvan University Teaching Hospital in the year 2019 with SAH were collected and analyzed to detect any abnormalities. Results In our study, 88.8% of patients had some form of ECG abnormality. The most common ECG abnormalities associated with SAH were QTc prolongation, T-wave abnormalities, and bradycardia, which were found, respectively, in 35.5%, 24.4%, and 24.4% of the patients. Other ECG changes we observed include ST depression, large U-waves, atrial fibrillation, and premature ventricular contractions. Conclusion Morphological and rhythm abnormalities are frequently observed in patients with SAH, which may cause diagnostic dilemmas and unnecessary workups. Further studies are required to evaluate their significance and correlate ECG changes with clinical outcomes.

Journal of Nobel Medical College

Intracranial aneurysms are sometimes associated with other vascular anomalies in extracranial loc... more Intracranial aneurysms are sometimes associated with other vascular anomalies in extracranial location. Coarctation of aorta, a congenital vascular lesion can be associated with intracranial aneurysms. In patients with coarctation, evaluation of intracranial vasculature is essential. We encountered a 12-year kid with subarachnoid hemorrhage. On further evaluation, she had anterior communicating artery aneurysm. On further evaluation for secondary causes of aneurysm, she had coarctation of aorta. She was surgically managed successfully by clipping of the aneurysm.

Journal of Society of Surgeons of Nepal, 2021

Scalp arteriovenous malformation (AVM) accounts for only 8.1% of all AVM cases. These lesions are... more Scalp arteriovenous malformation (AVM) accounts for only 8.1% of all AVM cases. These lesions are made up of an abnormal fistulous tangle of tortuous dysmorphic network of vessels “vascular nidus” directly connecting between the feeding arteries and draining veins, without capillary connection, located within the incision subcutaneous layer. With time, these congenital lesions may evolve and enlarge and clinically manifest with variable features. The only effective method of preventing evolution of these malformations is to exclude the lesion completely from the circulation. Involvement of the orbit and face may cause severe facial disfigurement, proptosis, visual obstruction and even facial palsy. These lesions may be complicated by ulceration, infection and profuse bleeding. We present a rare case of 40-year-old female with a recurrent congenital scalp-orbital AVM causing proptosis, visual obstruction on the right eye with severe facial disfigurement. The lesion was successfully e...

Acta Neurochirurgica, 2006

A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physi... more A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physical findings were not remarkable. MRI showed a large, elongated posterior extradural cyst from T12 to L3 with surrounding bony erosion (Fig. 1A, B). Thinned overlying laminas were found on operative field and the cyst was ruptured during laminectomy. There was a hole-like dural defect near to right L1 root sleeve and we performed primary closure of the defect. Some part of cyst wall was also removed. The patient's symptoms were gradually subsided and follow up image taken 1 month after the operation showed complete disappearance of the cyst (Fig. 1C). Case 2 A 51-year-old female patient visited our clinic with left buttock pain and paresthesia for 3 years. Her pain was aggravated on coughing and she also complained of gait disturbance with both sole numbness on walking. MRI showed a large extradural cyst located posterior to the

Kathmandu University Medical Journal

Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) i... more Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used durin...

Journal of Institute of Medicine, 2018

Introduction: The nutritional status among under the age of five in terms of stunting, underweigh... more Introduction: The nutritional status among under the age of five in terms of stunting, underweight and wasting and to find the association between nutritional status with selected variables. A descriptive cross-sectional study was done to determine prevalence of stunting, underweight and wasting among under five children and factors associated with that. Descriptive, univariate indices such as stunting, underweightandwasting determined as Height for Age, weight for age and respectively. Methods: The study was conducted in Manamaiju VDC with 56440 populations with 3742 under 5 children. Research design was descriptive cross sectional. Total sample size was 190 tools used are semi structured and face to face interview. Data collection was within 4 week (23rd chaitra 2070 to 20th Baisakh 2071). Data was analyzed by SPSS version 13.0 for Windows and ENA for SMART. Similarly, Chi square test was applied at 5% level of significance to show the association between nutritional status and se...

Journal of Institute of Medicine Nepal, 2019

The tumor of brain near or within the eloquent brain regions like motor and language cortex requi... more The tumor of brain near or within the eloquent brain regions like motor and language cortex requires excision of tumor and at the same time preservation of the functional area. To achieve the second goal the awake craniotomy is being practiced where the aim is to make the patient awake during resection of tumor so that the motor and speech function can be constantly monitored. We present the anaesthetic management of a case of craniotomy for low grade oligodendroma in frontal region with the awake throughout technique.

Nepal Journal of Neuroscience, 2020

Hydranencephaly is a rare and severe form of congenital disorder in which there is absence of cer... more Hydranencephaly is a rare and severe form of congenital disorder in which there is absence of cerebral cortex which is replaced by fluid. The presentation is in the form of hydrocephalus and developmental delay. There are various reports on possible etiopathogenesis and management. However, the overall prognosis is grim and clinicians especially in low and middle-income countries like Nepal often face a clinical judgement dilemma regarding management options to offer to the patient family. The ethical issue whether to offer cerebrospinal fluid diversion or not is always there. This review is aimed at discussing the various aspects of management of this pediatric neurosurgical problem.

Cureus, 2020

Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phen... more Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phenomenon. Only few cases of postoperative contralateral acute subdural hematomas have been reported in the literature review till date. This case report details a case of a 32-yearold hypertensive male who presented with severe headache, multiple episodes of vomiting, slurring of speech, nystagmus and ataxic gait for one day. Computed tomography (CT) scan of head revealed a right sided cerebellar hemorrhage with effacement of fourth ventricle and upstream hydrocephalus. A right suboccipital craniectomy and hematoma evacuation were performed. A repeat CT scan of head was done at six hours post surgery; which revealed a contralateral (left-sided) subdural hematoma involving the fronto-parieto-temporal region. The patient improved following conservative management. Contralateral acute subdural hematoma following evacuation of hematoma is a rare, but a potentially life-threatening complication; therefore, we should try to detect such contralateral hematoma and prevent clinical deterioration.

Nepal Journal of Neuroscience, 2019

Orbital roof fractures after blunt head trauma are not uncommon. Hernia ion of the brain tissues ... more Orbital roof fractures after blunt head trauma are not uncommon. Hernia ion of the brain tissues into the orbit through a bony defect, so-called post-traumatic orbital encephalocele, is a rare entity. The herniated braint issue causes compression of the intraorbital contents, particularly the optic nerve, extraocular nerves and muscles and compromise the vascular supply. Raisedintraorbital pressure may lead to irreversible damage to the optic nerve. This can be prevented by early diagnosis and timely management. Repair of the orbital roof needs to be performed to avoid transmission of intracranial pressure into the orbit. Early intervention is needed in order to prevent visual loss. We present a case of posttraumatic orbital encephalocele who underwent latesurgical treatment with direct repair of dura opening, reinforcement with temporalis fascia and reconstruction of orbital roof using skull bone graft. Complete resolution of the pulsatile proptosis with excellent cosmetic result w...

Journal of Institute of Medicine Nepal, 2019

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients... more Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involve...

Journal of Society of Surgeons of Nepal, 2017

Introduction: CNS tumor requires intraoperative decision making regarding the extent of tumor rem... more Introduction: CNS tumor requires intraoperative decision making regarding the extent of tumor removal. Clinical examination and imaging studies are not sufficient enough to predict the biological behavior of the tumors. Squash cytology is a quick method of evaluation of cytomorphologic features prepared from smear technique and provide the preliminary diagnosis and aid in intraoperative decision making by differentiating neoplastic from non neoplastic and benign from malignant lesions. The aim of this study is compare the diagnostic accuracy of squash cytology to that of histopathological examination. Methods: This study consists of 36 specimens from both brain and spine subjected to both squash cytology and histopathological evaluation. The squash preparation and histopathological finding were later compared and diagnostic accuracy calculated. Results: Gliomas are the most common tumor encountered and the accuracy of Squash cytology obtained was 71%. In meningioma, 100% diagnostic ...

Journal of Society of Surgeons of Nepal, 2018

Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrha... more Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) for visualizing the vascular pathology. There is some correlation between the pattern (based on Fisher grading) and location of bleed on CT scan and eventual location of cerebral aneurysm(s). Our aim was to assess the correlation between distribution of hemorrhage on the initial CT scan and eventual site of the ruptured aneurysm at our institution. Methods: This retrospective review of prospectively collected data consisted of 50 patients with SAH over 8 months period. CT scan of patients performed within 72 hours after the ictus with suspected SAH were included in the study. Four neurosurgeons, who had at least three years of experience after being qualified, who were blind to the imaging studies, analyzed and scored independently the quantity and distribution of the hemorrhage on CT. Their prediction of the site of the ruptured aneurys...

Nepal Journal of Neuroscience, 2018

Neurocysticercosis is a common parasitic infection of the central nervous system, caused by larva... more Neurocysticercosis is a common parasitic infection of the central nervous system, caused by larvae of Taeniasolium. Cysticercosis of spine is less common compared to that of brain itself. Anatomically, spinal cysticercosis can be classified as extraspinal (vertebral) or intraspinal (epidural, subdural, arachnoid, or intramedullary), where intramedullary type is extremely rare. Isolated spinal intramedullary neurocysticercosis without brain involvement is even rarer. Preoperative diagnosis of cystericosis within the cord maybe difficult; and the clinical and radiographic features may mimick that of more common intramedullary tumor. Here, we present a rare case of cervical intramedullary neurocysticercosis in an adult, presenting with progressive limb weakness, mimicking spinal ependymoma, clinically and radiographically and only diagnosed histopathologically after surgery.

Nepal Journal of Neuroscience, 2018

Head injury is the major cause of death in young adult population worldwide with associated high ... more Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma. All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome. Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorab...