Browsing by Author "Kafle, Prakash"
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Publication Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal(Institute of Medicine, 2020) Khanal, Babita; Kafle, Prakash; Singh, Sandip K; Yadav, Sunil K; Neupane, Bishomber; Shakya, Ipsa; Yadav, Dipak KABSTRACT Introduction: Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal. Methods: This is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS). Results: The study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome. Conclusion: This study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome. Keywords: Head injury, Glasgow outcome score, pediatric, surgeryPublication Intraoperative Neuromonitoring in Predicting Neurological Deficits in Patients with Intramedullary Lesions in a Tertiary Care Center in Nepal(Institute of Medicine, 2022) Bhandari, Binod Raj; Kafle, Prakash; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan RABSTRACT Introduction: Intramedullary spinal cord lesions (IMSCL) constitute 20%–30% of all spinal cord lesions. There is still uncertainty regarding the usefulness of intraoperative neuromonitoring (IONM) during spinal surgery. The purpose of this study is to determine the effectiveness of IONM in patients undergoing intramedullary spinal surgery. Methods: Twenty-three patients who underwent surgery at the Department of Neurosurgery, Tribhuvan University Teaching Hospital from January 2017 to December 2020 were included. Somatosensory evoked potential, transcranial motor evoked potentials and electromyography were recorded. Patients were divided into three groups based on IONM parameters: 1. one with no drop 2. one with a decrease and a recovery during surgery, and 3. one with a decrease but no recovery. The duration of follow-up was six months. Results: Neurological improvement was noted in 14 patients, stable in 4, and worse in 5. Out of 14 patients with clinical improvement, 9 had no decrease in IONM, while 5 had a temporary decrease. Among 4 patients whose postoperative status remained unchanged, 2 had no decrease in IONM, while one had a temporary decrease and one has a sustained decrease. Among 5 patients who deteriorated postoperatively, 1 had no decrease in IONM, and 4 had a decrease without recovery. During surgery, patients who demonstrated monitoring alterations but reverted to baseline had better neurological outcomes than those who did not (p=0.045). Conclusion: Our findings support that IONM is an effective tool for the safe resection of IMSCL. Further multi-centric larger studies are recommended to gain more insight into IONM. Keywords: Electromyography, intramedullary spinal cord lesions, intraoperative neuromonitoring, somatosensory evoked potential, transcranial motor evoked potentialPublication Pediatric Intensive Care Unit in a Developing Nation: Exploring Acute Neurological Illnesses and Their Clinical Course(Institute of Medicine, 2023) Khanal, Babita; Singh, Sandeep K; Mishra, Rajnish; Kafle, Prakash; Sharma, Mohan RABSTRACT Introduction: The burden of neurological illnesses is high in pediatric age group. Both primary neurological illnesses and neurological complication of systemic illness are commonly seen in pediatric intensive care unit (PICU). Neurological illness prolongs the length of PICU stay and also increases the mortality and morbidity.To assess the burden and describe the spectrum of acute neurological illness in a pediatric intensive care unit and analyze the early outcome. Methods: This was a prospective observational study conducted in Department of Pediatrics intensive care unit from January 2022 to December 2022. All children from 1 months to 16 years of age with neurological illness being admitted to PICU were included in the study. Basic demographic characters, diagnosis, treatment modalities and outcome were analyzed. Results: During study period, 237 (24.89%) were admitted to PICU with neurological illness. Mean age was 66 ± 42 months and 138 (58.22%) were male. Out of 237 children, 196 (82.70%) had primary neurological illness and 41 (17.30%) neurosurgical diagnosis. In primary neurological illness, 102 (52.10%) had primary CNS infection, followed by status epilepticus (21.52%), septic encephalopathy (11.70%), neuromuscular illness (8.16%), and metabolic encephalopathy (4.08%). In neurosurgical cases, 32 (78.04%) had Traumatic Brain Injury and 9 (22%) were shifted to PICU postoperatively. Mechanical ventilation was required in 156 (65.82%) and 88 (37.13%) required inotropic support. The mortality rate in neurological cases was 24 (10.12%) as compared to overall mortality rate of 6.8% in PICU. Conclusion: Neurological disorders are common in PICU and are associated with higher mortality rate. Primary central nervous system infection, severe traumatic brain injury and status epilepticus were common cause of PICU admission in our cohort. Keywords: Mortality; neurological illness; outcome; pediatric intensive care unitPublication Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors(Institute of Medicine, 2023) Kafle, Prakash; Rufus, Phelix; Paudyal, Nabin; Joshi, Narendra P; Khanal, Babita; Jonathan, Edmond; Bhandari, Binod R; Sharma, Mohan RABSTRACT Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes. Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed. Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes. Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery. Keywords: Brain tumor; preoperative KPS (Karnofsky performance status score); preoperative mRS (Modified Rankin scale score)