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Papers by prakash bista

Post-Graduate Medical Journal of NAMS, Jul 27, 2020

IntroductIon: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and there is n... more IntroductIon: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and there is no treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Method: Records of all patients with acute ICH presenting to Bir Hospital (NAMS), Mahaboudha, Kathmandu during March 1st to June 29th 2017 were prospectively collected. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the age modified ICH Score) was developed with weighting of independent predictors based on strength of association. result: Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (P=0.028), age ≥65 years (P=0.001), ICH volume (P =0.02), and presence of Intraventricular hemorrhage (IVH) (P 0.30). The ICH Score was the sum of individual points assigned as follows: GCS score 3 to 4 (=2 points), 5 to 12 (=1), 13 to 15 (=0); age ≥65years yes (=1), no (=0); infratentorial origin yes (=1), no (=0); ICH volume ≥30 cm3 (=1), ,<30 cm3 (=0); and IVH yes (=1), no (=0). No patient of Age modified ICH score was alive and 83% of the Age modified ICH score of 3 or 4 were dead. Other with the score of 0, 1, 2 were all alive.Thirty-day mortality increased with Age modified ICH Score (P-value< 0.001). conclusIon: The Age modified ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH.30

Journal of College of Medical Sciences-nepal, Oct 1, 2019

Background: Pituitary adenomas are the most common type of pituitary disorder. Compression of ant... more Background: Pituitary adenomas are the most common type of pituitary disorder. Compression of anterior visual apparatus leads to impairment of vision. Visual impairment depends on individual relation between tumor and visual apparatus, duration of compression, timing of operative intervention amongst others. Surgical excision is treatment of choice for tumors causing impairment of vision. Predicting outcome after surgical decompression thus helps both patient and surgeon to make realistic expectations and avoid unnecessary complication from overzealous aggressiveness. Predictors of visual outcome are not well established. This study aims to identify factors that predict visual improvement after resection of pituitary tumor. Methods: A cross-sectional study was conducted to study factors associated with visual outcome and data was collected prospectively. Visual acuity was measured by using snellen's chart and categorized using WHO vision impairment scale for distant vision. Visual field was measured either by Humphrey or Goldmannperimetry. Visual evaluation was done before surgery and after 3 months of surgery. Data was analyzed using SPSS version 23. Results: Twenty-eight eyes of fourteen patients were evaluated. Mean age at presentation was 38 years. Mean duration of impairment of vision at presentation was 13 months. Nonfunctioning pituitary adenoma was the most common pathology. Mean size of tumor was 3.07 cm. Visual acuity improvement was seen in 17 (61%) and visual field improvement in 16 (57%) of patients. Visual outcome was significantly affected by preoperative visual status and size of tumor. Extent of resection, duration of symptom were not associated with visual outcome. Conclusions: Excision of Pituitary tumor from sella provides enough decompression to anterior visual apparatus resulting in improvement of visual acuity and field of vision. Preoperative visual status and size of tumor can predict postoperative visual outcome.

Post-Graduate Medical Journal of NAMS, Jun 1, 2008

Cervical spondylosis is a chronic degenerative condition affecting the vertebral bodies, interver... more Cervical spondylosis is a chronic degenerative condition affecting the vertebral bodies, intervertebral disks, and the spinal canal. This is a retrospective study of anterior cervical discectomy and fusion from 1993 to 2008 and the age, sex ratio, the level of disc prolapse, symptoms, complications of surgery and the outcome was assessed The total number of cases was 101, with predominantly males (78 cases, 77%). The most common age group was between 41 and 60 years with a total of 55 cases followed by the 31 to 40 age group with 17 cases. Spontaneous disc prolapse was the most common case (62%) and the rest was because of trauma (39%).C5-6 was the most often disc prolapse level with 56 cases (55%), followed by C4-5 level with 26 cases (26%).Disc at multiple level was present in only 9 cases (9%). Neurological assessment was done pre and postoperative as defined by Ranawat et al. At presentation majority were in Grade II (66%), followed by Grade IIIA (35%).Postoperatively there was a reduction in weakness from 66% to 25% in Grade II and from 35% to 10% for Grade IIIA. It is interesting to note that although none of them were in grade I before surgery, postoperatively 62.5% of patients improved to that grade. Check x ray was done at 8 weeks and the fusion was assessed. The continuity of the graft and the adjacent spinal curvature was also assessed and there was more than 93% fusion rate. Although there are other options now than to use autograft for fusion, the old Smith-Robinson technique seems to be a time tested method for discectomy especially in developing countries where the cost of implant is a major limiting factor.

Asian journal of neurosurgery, Mar 1, 2020

Objective: Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical... more Objective: Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedures. Complications due to shunt failure are associated with high morbidity and mortality. We report an analysis of risk factors for shunt failure in pediatric patients from a single institution in Nepal. Materials and Methods: A retrospective analytical study with prospective data was designed. All children younger than 15 years, with first time VP shunting, at a tertiary government hospital in Kathmandu during 2014-2017 were followed up. Association of independent variables with the primary outcome variable (complication of VP shunt) was analyzed using Chi-square test. Bivariate logistic regression was performed to identify unadjusted odds ratio (OR) with 95% confidence interval (CI). Multivariate logistic regression model was designed to calculate adjusted OR with 95% CI. Results: Of 120 patients, more than half (55.8%) of the patients were male. Mean age was 62.97 months. Maximum duration of follow-up was 30 months. Most common cause of hydrocephalus was congenital aqueductal stenosis (40.8%) followed by tumors (29.2%). Overall shunt complication was found in 26.7% (95% CI 19.0%-35.5%). Shunt infection was seen in 5% while malfunction without infection was found in 21.7%. Bivariate logistic regression showed duration of surgery more than 1 h (OR 2.67, 95% CI 1.11-6.42, P = 0.028) compared to 1 h or less, experienced surgeon (OR 0.37, 95% CI 0.16-0.89, P = 0.026) compared to residents, and emergency surgery (OR 3.97, 95% CI 1.69-9.29, P = 0.001) compared to elective surgery as significant risk factors, while emergency surgery was the only significant variable for shunt failure on multivariate regression analysis (OR 3.3, 95% CI 1.16-9.35, P = 0.025). Conclusion: Longer duration of surgery, less experience of the surgeon, and the priority of the case (emergency) were independent risk factors for shunt complications.

Nepal journal of neuroscience, Nov 27, 2020

Intracranial infectious aneurysms are rare entities accounting for approximately 1-6 % of all cer... more Intracranial infectious aneurysms are rare entities accounting for approximately 1-6 % of all cerebral aneurysms and have high propensity of rupture associated with mortality. The principal risk factor is infective endocarditis and the management includes antimicrobial treatment with or without obliteration of the aneurysm by microsurgical or endovascular means. We present a young patient with intracranial infectious aneurysm who was successfully treated with endovascular coil embolization. A 20-year-old female with a history of rheumatic heart disease presented with subarachnoid hemorrhage due to rupture of IIA associated with infective endocarditis. Cerebral angiogram revealed right distal posterior cerebral artery aneurysm. Echocardiography showed vegetation in the mitral valve and blood culture was positive for Enterococcus faecalis. Antibiotic treatment was administered for 6 weeks. The follow-up angiogram showed an enlarging aneurysm. So, the patient underwent endovascular coil embolization of the aneurysm preserving the parent artery. There were no post-procedure deficits. Intracranial infectious aneurysm should be considered as a differential diagnosis in a patient with infective endocarditis presenting with focal neurological deficits or altered consciousness. Early diagnosis and individualized approach are the key to successful treatment and endovascular treatment is an effective modality for such lesions.

Journal of Society of Surgeons of Nepal, Jul 25, 2016

Post-Graduate Medical Journal of NAMS, Apr 17, 2015

IntroductIon: Cerebral arteriovenous malformations (AVMs) are one-seventh as common as cerebral a... more IntroductIon: Cerebral arteriovenous malformations (AVMs) are one-seventh as common as cerebral aneurysms. 50% of death of patients with cerebral AVMs are due to intracranial hemorrhage. There are different modalities of treatment of cerebral AVMs which include microsurgery, radiosurgery and embolisation. In experienced hands best treatment option is microsurgical resection that usually makes the patient disease free immediatly and prevents future bleeding. Aim of this study is to discuss the outcome of microsurgical resection of cerebral AVMs in our institute. Methods: Over a period of nearly three years, between November 2009 and July 2012, we performed microsurgical excision of cerebral AVMs on 15 patients under general anaesthesia at Department of Neurosurgery, NAMS, Bir Hospital. Follow up period ranged from 6 months to 3 years and surgical outcome was measured by GOS (Glassgow Outcome score). results: The male female ratio was 1:0.26 and mean age was 30. Twelve patients were presented with intracerebral hematoma (ICH) and 3 patients with seizure disorder. On cerebral angiogram 9 patients had Spetzler-Martin grade II, 5 had grade III and 1 had grade IV. Favorable outcome after surgical excision was achieved in 13 (86.7%), 2 (13.3%) were severely disabled and there was no mortality. This is most probably largest series of intracerebral AVMs surgery produced in Nepal till date. conclusIon: Surgical excision is the best treatment option for cerebral AVMs except giant AVMs which requires multimodality treatment approaches.

Nepal journal of neuroscience, Oct 9, 2016

P revious literature on spinal tumors reveals that 55% of spinal tumors are extradurally located.... more P revious literature on spinal tumors reveals that 55% of spinal tumors are extradurally located. 14 90% of extradural spinal tumors are metastases and they are usually from lung, breast, prostate and kidney. 31 10% of extradural spinal tumors are primary and they are neurofi bromas, Ewing's sarcoma, angiolipoma, aneurysmal bone cyst. Primary extradural spinal tumors can be benign like neurofi bromas, meningioma, Extradural Spinal Tumors: Report of 36 Cases and Review of Literature About 55% of spinal tumors are extradural arising from vertebral bodies, epidural and surrounding neural and soft tissues. More than 90% of extradural spinal tumors are metastatic lesions. Extradural spinal tumors are common cause of back pain, sensory motor defi cit and sphincters dysfunction. The wide range of lesions and varied clinical profi le, make management of spinal extradural tumors a challenging task for any neurosurgeon. Aim of this study is to analyze and discuss the results of extradural spinal tumors after surgical treatment and relevant literature will be reviewed. This is a retrospective study of 36 patients who were operated for spinal extradural tumors between May 1999 and December 2012 in our institute. Follow up period ranged from 3 years to 12 years. Functional neurological outcome was assessed by McCormick's grading. There were 20 male and 16 female and age ranged from 10 to 80 years. 30 patients presented with back pain and 15 had radicular pain. On presentation 18 patients had motor sensory defi cit and 15 had sphincters dysfunction. Most common involved level of spines were thoracic followed by cervical and lumbar. Gross total excision of masses were carried out in all cases. Common pathologies were neurofi bromas (16), Ewing's sarcoma (7), granulomas (3), metastatic lesions (2), angiolipoma (2), chondroma (2), aneurysmal bone cyst (1), plasmacytoma (1), rabdomyosarcoma (1) and neuroblastoma (1). Out of 14 patients who harbored malignant pathology 12 patients received radio and chemotherapy. Post operative wound infection occurred in 5 patients. Regarding post operative neurological status, 18 patients showed improvement, 6 patients remained same and 12 patients had deteriorated neurology. Tumor recurrence occurred in 15 patients; 12 patients with malignant and 3 patients with benign lesions on follow up period. There was no surgery related mortality, however, 11 patients died during 3 years follow up period due to adverse pathology they were having.

Journal of Nepal Medical Association, Jun 30, 2011

A 60-year-old right-handed lady presented with the features of subarachnoid haemorrhage. The CT a... more A 60-year-old right-handed lady presented with the features of subarachnoid haemorrhage. The CT angiogram showed a pair of very rare bilateral, mirror-imaged distal postero-inferior cerebellar artery aneurysms. Both aneurysms were clipped via the midline posterior fossa craniectomy under general anaesthesia. The literatures is reviewed on the incidence, presentation, management and outcome of bilateral distal posterior-inferior cerebellar artery aneurysms.

Nepal journal of neuroscience, Mar 1, 2021

Introduction: Image-guided surgery is the need of time in neurosurgery. The use of neuronavigatio... more Introduction: Image-guided surgery is the need of time in neurosurgery. The use of neuronavigation has a significant impact on various neurosurgical procedures. We report our clinical experience and surgical techniques of neuronavigation assisted intracranial and spinal surgeries. Materials and Method: This is observational longitudinal study of 65patients who underwent surgeries using navigation system in the department of neurosurgery, National Neurosurgical Referral Center, National Academy of Medical Sciences (NAMS) Bir hospital and National Trauma Center, over the period of one and a half year. Description of Navigation techniques, its applications and surgical outcome were studied. Medtronic Stealth station 7 and Brain Lab Curve Neuronavigation system, which can be used as both frame based and frameless image guided system were employed in this study. Results: We used Neuronavigation system in 60 cases of cranial procedures and 5 cases of spinal stabilizing procedures. Among intracranial surgeries we utilized this system to effectively make bone flaps and burr holes, to detect critically located deep-seated, subcortical and skull base tumors and to operate on intra parenchymal lesions with grossly unclear margins. Neuronavigation system was used in 5 cases of spinal procedures for pedicle screw placement. Conclusion: Neuronavigation is a tool that provides numerous advantages to the neurosurgeon like more accurate planning approach, ability to use smaller approaches, higher precision for intraoperative localization of different anatomical structures and offering greater surgical safety. This technique, although apparently very complex in the beginning, becomes very user-friendly gradually and positively appreciated by everyone who uses it, after going through a relatively short learning curve.

Nepal journal of neuroscience, Aug 13, 2020

Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety p... more Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Complete resection is often curative. Objectives: The objective of this study is to give ideas about the descriptive epidemiology, clinical presentation and histopathology of current scenario at National Neurosurgical Referral Center, Nepal. Methods: This is a prospective study from the period of January 2015 to September 2019 in the department of neurosurgery, National Academy of Medical Science, Bir Hospital. Inclusion criteria consists of all the histopathological proven cases of meningioma during the study period. Result: A total of 150 meningioma cases were operated during the study period. The average age of presentation was 42 years. Male to female ratio was 1:2. Most common affected age group was 30-50 years. The most common clinical symptoms for intracranial meningioma were headache followed by vomiting and paresis. Among intracranial meningioma, the most common location was convexity meningioma followed by sphenoid wing meningiomas and parasagittal meningiomas. Most common histopathological variety encountered was transitional meningioma, World health organization grade I. Conclusion: Meningiomas are slow growing, extra-axial tumor, usually benign which are most commonly located along convexities, sphenoid ridge and parasagittal area. Most are cured if completely removed, which is not always possible.

Nepal journal of neuroscience, Dec 31, 2022

Introduction: The treatment of choice for high and low-grade gliomas is primarily surgical resect... more Introduction: The treatment of choice for high and low-grade gliomas is primarily surgical resection, many gliomas of highly eloquent cortical regions still are not operated because of the impending risk of surgery-related deficits. Tumors of eloquent areas like sensorial, motor and language cortex need to be operated carefully so that the symptoms don't worsen after surgery. However, Intra operative computerized tomography (IOCT), neuronavigation including optical as well as EM (electromagnetic), Neuromonitoring, stereotaxy and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of new deficits postoperatively. Materials and Methods: Between 2021 and 2022, a consecutive series of 30 patients who had undergone surgery for tumors on eloquent area of brain, at National Neurosurgical Referral Center (NNRC), National Academy of Medical Sciences (NAMS), Bir hospital were included in this study. Ethical approval was taken from Institutional review board (IRB) of NAMS for the study. Preoperative functional MRI, DTI scan that revelead mass in eloquent brain areas were evaluated.The preformed proforma was used to collect the data including preoperative karnofsky performance score, age, gender, clinical. Manifestations, size and location of tumor, degree of resection, pathological grade. Patient are followed postoperatively for 3 months and postoperative KPS, morbidity and mortality was recorded. SPSS version 22 was used for statistical analysis.. Results: Out of these 30 lesion were 13 (43.3%) were WHO grade IV , 5 (16.6%) were WHO grade III astrocytoma, 3 (10%) were WHO grade III oligodendroglioma , 2 (6.6%) were WHO grade II astrocytoma, 4 (13.3%) were WHO grade I astrocytoma, 2 were tuberculoma and 1 was cavernoma. Majority of the patients (70%) (n=21 out of 30) presented with seizures. The mean age of the patient was 41.7 years (ranging from 21-71 years). Male predilection was observed accounting 60 % of the cases. Conclusion: The surgery of eloquent areas of brain though carries the risk of increased post operative neurological deficit, with assistance of advanced technology and experienced surgeons it still feasible option especially for young patients with good karnosky score and low grade tumors which has improved overall survival.

Nepal Journal of Neuroscience

Background Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervent... more Background Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc. Though it was developed a long time ago as a useful adjunct to brain lesions evaluation, use in Nepal is quite recent. Materials and Methods The study included eight patients who underwent frame based stereotactic biopsy and pathological evaluation of specimen at National Academy of Medical Sciences (NAMS). Results Out of eight patients the results were positive in seven patient and negative in one patient. Conclusions The basic advantages of stereotaxy were realized in our cases with minimal morbidity and no mortality. Craniotomy for biopsy could be avoided.

World journal of surgery and surgical research, Jul 17, 2020

Introduction: Chiari malformations are one of the most controversial topics in neurosurgery today... more Introduction: Chiari malformations are one of the most controversial topics in neurosurgery today. It is a congenital disorder characterized by the anatomical defect of the base of skull with caudal displacement of cerebellar tonsils, through the foramen magnum. The objective of the present series was to study clinical outcome following posterior fossa decompression, C1 laminectomy and duraplasty in type 1 Arnold Chiari malformation. Material and Methods: This study was retrospectively analysis of the Chiari I malformation in the Department of Neurosurgery, NAMS from January 2014 to February 2020. There were 43 admitted patients with Chiari I malformation in our center. OPD follow up or telephonic questionnaires were used to analyze and compare the improvement in neck pain and disability before and after surgery. Results: The most common age group of presentation was 2 nd decade (30.3%) followed by 3 rd decade (30.6%). The male to female ratio was 2.5:1. The age ranged from 5 years to 60 years with median age of 32. Out of them 31 (72%) were females and 12 (28%) were male. The most common presenting complaint was sensory disturbances 26 patients (61%) followed by neck pain in 17 patients (39%). The most common sign was limb weakness in 25 patients (58%). All patients were operated with foramen magnum decompression with duraplasty, subarachnoid dissection of CSF flow and C1 laminectomy except three patients who were undergoing foramen magnum decompression only. Two patients were cervical unstable after operation. One patient was managed with occipitoatlanto-axial fixation. We had mortality one which had cervical unstable and chest infection post operatively. There was one patient with surgical site infection requiring debridement and secondary suturing. Patients showed an overall clinical improvement of 90%. There were no motor aggravation occurred in our study. Foramen magnum decompression with duraplasty, subarachnoid dissection of CSF flow and resection of the C1 posterior arch were found to be associated with favorable results on clinical signs and symptoms. Conclusion: Proper patient selection is critical to prevent unnecessary complication and maximize the outcome. The surgical gold standard consists in three key steps-Foramen magnum decompressions with duraplasty, subarachnoid dissection of CSF flow and C1 laminectomy.

Received, 11 May, 2013 Accepted, 15 May, 2013 The majority of intracranial meningiomas are benign... more Received, 11 May, 2013 Accepted, 15 May, 2013 The majority of intracranial meningiomas are benign and total excision of the tumor should be the aim of treatment which almost cures the vast majority of patients. This is a retrospective study of 87 patients who had intracranial meningioma and underwent excision of tumor under general anesthesia from January 2007 to December 2011 at our Department of Neurosurgery. Aim of this study is to analyze and discuss the surgical results of intracranial meningiomas Pre operative and post operative quality of life was assessed by karnofsky grading scale. There were 27 males and 60 females and age ranged from 10-75 years. On presentation, 60 patients had features of raised ICP, 21 had seizures, 16 had focal deficits and 18 had visual impairments. Nine patients had other cranial nerve palsies and 4 had cerebellar signs. 5 patients were asymptomatic. Total 75 patients had supratentorial and 12 had infratentorial meningiomas. Among supratentorial men...

Nepal Journal of Biotechnology, 2021

Basmati rice, also called the king/prince of rice landraces has very special values in Nepalese s... more Basmati rice, also called the king/prince of rice landraces has very special values in Nepalese society as well as in other countries of Indian Subcontinent. With the objectives of collecting, analyzing and documenting Basmati related information in Nepal, we visited different sites; carried out key informant surveys; organized focus group discussions, online interaction and discussion meetings; requested all relevant offices/ persons/ stakeholders through phone, website, and letter to share information; organized high level official meeting, and Basmati rice expert meeting; documented video documentary and did online as well as library search. Because of its high market value at global level, many countries and organizations have been attempting to get intellectual property rights (mainly patent and geographical indication tag) on Basmati rice. India applied for GI tag to Basmati rice in the European Union (EU) in July 2018, and Nepal submitted opposition letter along with proofs a...

Nepal Medical College journal : NMCJ, 2014

Cervical spinal cord injuries make up more than half of all spinal cord injuries. It affects 2-3%... more Cervical spinal cord injuries make up more than half of all spinal cord injuries. It affects 2-3% of all trauma patients and accounts for 8.2% of all trauma related deaths. Cervical spine surgery has been evolving in terms of surgical technique, equipment, and instrumentation. We have analyzed a series of patients with cervical spine injuries stabilized with various instrumentation techniques. The objective of the study was to evaluate the outcome of instrumentation in cervical spine injury measured on ASIA Impairment Scale. We present prospective observational descriptive analysis, for 36 patients, looking at the clinical and neurological outcomes following instrumentation for cervical spine injuries from Jun 2011 to July 2013. All 36 patients underwent various instrumentation techniques for stabilization and decompression of the cervical spinal cord. The outcome was compared by the ASIA impairment scale. There were 27 (75%) males and 9 (25%) females. The mean age at presentation w...