Browsing by Author "Bohara, Sandeep"
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Publication Clinical Characteristics and Outcome of Patients with Distal Anterior Cerebral Artery Aneurysms(Nepal Health Research Council, 2024) Bohara, Sandeep; Pradhanang, Amit Bahadur; Sedain, Gopal; Sharma, Mohan RajBackground: Distal anterior cerebral artery aneurysms account for 3% to 7% of intracranial aneurysms. They have increased risk of premature rupture during surgery and tend to have a higher morbidity. We aim to determine the clinical characteristics, management strategies and outcomes of patients with these aneurysms who underwent microsurgical clipping at a major university hospital in Nepal. Methods: This is a retrospective study of patients with distal anterior cerebral artery aneurysms who underwent microsurgical clipping between 2012-2022. Demographic data and clinical-radiological factors like Hunt and Hess grade, aneurysm location, and modified Rankin scale score at three, six, and 12 months were collected. Results: A total of 26 aneurysms were microsurgically clipped in 20 patients in ten years. Most patients presented with Hunt and Hess grade II. Of the 26 aneurysms, 16 (62%) were in A3 segment. Six patients had associated anterior communicating artery aneurysm, two patients had middle cerebral artery aneurysm and two patients had associated arteriovenous malformation. Sixteen patients (80%) had a favorable outcome (modified Rankin scale ?2) at 12 months follow-up. Conclusions: Aneurysms in the distal anterior cerebral artery locations are a challenging subset of aneurysms to treat. The majority of the patients had aneurysms in A3 segment and 80% patients had a favourable outcome at 12 months follow up period. Keywords: Aneurysm; distal anterior cerebral artery; outcome; subarachnoid haemorrhage.Publication Clinico-Radiological Presentation and Outcome of Brain Abscess in Congenital Cyanotic Heart Disease(Institute of Medicine, Tribhuvan University, 2024) Sedain, Gopal; Bohara, Sandeep; Shrestha, Dipendra Kumar; Pradhanang, Amit Bahadur; Shilpakar, Sushil Krishna; Sharma,Mohan RajAbstract: Introduction Patients with congenital cyanotic heart disease (CCHD) are at increased risk of developing brain abscesses. Having a brain abscess is itself a risk for the patient and concomitant cyanotic heart disease makes it a double jeopardy. The management of brain abscesses depends on the size, number, stage, and location of the abscess and can be medical and surgical. Methods This retrospective chart review was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal of patients treated between January 2018 and December 2022. Demographic and clinical profiles, imaging studies, treatment modalities, and outcomes were analyzed. Results Out of 17 patients, 11 were males and six were females. The mean age of the study population was 13.41±11.08 years. The most common associated cardiac problem was Tetralogy of Fallot seen in six (35.3%) patients and the most common abscess site was the parietal lobe (38%). The most common presenting symptom was vomiting, seen in 76%. Twelve patients underwent burr hole and aspiration and 17.6% of patients underwent surgical excision of the abscess wall whereas 11.7% of the patients were managed conservatively. Positive culture was seen in 33.3%. S. aureus was the most common organism grown. There was no mortality. Conclusion Majority of patients were male with Tetralogy of Fallot as the most common associated congenital cardiac condition. Most of the patients were managed with Burr hole and abscess aspiration with re-aspiration in three patients. Suspicion of brain abscess should be high in patients with congenital cyanotic heart disease.Publication Early Experience of Minimally Invasive Tubular Lumbar Microdiscectomy at a Tertiary Care Centre in Nepal(Institute of Medicine, Tribhuvan University, 2024) Pradhanang, Amit; Sedain, Gopal; Karki, Anjan Singh; Bohara, Sandeep; Shrestha, Dipendra Kumar; Sharma, Mohan Raj; Shilpakar, Sushil Krishna; Jha, PrabhatAbstract: Introduction Lumbar disc herniation is a leading cause of low back pain and radiculopathy. Open microdiscectomy, though effective, involves muscle dissection and longer recovery. Minimally invasive tubular microdiscectomy aims to reduce these drawbacks. This study evaluates its early outcomes in Nepal. Methods Our observational study included patients who underwent MIS tubular lumbar microdiscectomy at our hospital from August 2023 to July 2024. Data on operative duration, blood loss, and return to work time were collected. Functional outcomes were assessed at three months using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for spinal and radicular pain. Results A total of 22 patients were included. The mean operative duration was 121.5 ± 31.67 minutes, and mean intraoperative blood loss was 60 ± 20.17 mL. The mean return to work time was 1.86 ± 0.2 weeks. At three months, the mean ODI score significantly improved from 54.36 ± 8.8 to 0.91 ± 1.47 (p < 0.001). VAS scores for spinal pain decreased from 3.05 ± 0.84 to 1.5 ± 0.3 (p < 0.001), and radicular pain from 4.91 ± 0.86 to 1.36 ± 0.65 (p < 0.001). No major complications occurred, and 5% of patients had transient paresthesia, which resolved spontaneously. Conclusion MIS tubular lumbar microdiscectomy is an alternative procedure for lumbar disc herniation, offering short-term functional improvement. Long-term comparative studies are needed to assess its durability against open microdiscectomy.Publication Postoperative Acute Submandibular Sialadenitis: A Case Report(Nepal Medical Association, 2023) Sharma, Mona; Bohara, Sandeep; Manandhar, Stuti; Manandhar, Lumu; Maharjan, Shyam KrishnaAbstract Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway.