Browsing by Author "Khadka, Namrata"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication Factors Influencing Intraoperative Rupture of Intracranial Aneurysms(Institute of Medicine, Tribhuvan University, 2024) Khadka, Namrata; Rajbhandari, Binod; Aryal, Sameer; Bhattarai, Sushil Mohan; Shrestha, Rajendra; Jha, RajivAbstract: Introduction Intraoperative rupture (IOR) is the most anticipated yet dreaded complication during intracranial aneurysmal surgery, leading to severe adverse outcomes. This study aims to analyze various risk factors contributing to IOR. Methods It was an analytical study of 46 cases of intracranial aneurysms treated at Department of Neurosurgery, Bir Hospital including both ruptured (n=43) and unruptured (n=3) aneurysms. Incidence of IOR, demographic data, preoperative grading scales, aneurysm morphology, phases and severity of IOR along with postoperative complications and outcomes were assessed. Results IOR occurred in 28.26% (13/46) cases of intracranial aneurysms. Most common aneurysm was anterior communicating artery aneurysm (43.5%, 20/46) with majority of IOR (65.1%).Younger patients and males had higher rates of IOR, and early surgical intervention (within 72 hours) was associated with increased incidence (69.2%,9/13). Although preoperative factors showed no direct correlation with IOR, aneurysm size and morphology-dome width and height ratio (W/H) and irregular shapes of aneurysm emerged as critical risk factors (p<0.05). Temporary clipping during surgery appeared to reduce IOR, mostly mild (13.04%, 6/13) and occurred in second phase (17.39%; 8/13, during microdissection and neck preparation). However, IOR did not have adverse effects on postoperative complications and Glasgow Outcome Scale Extended (GOSE) at discharge. Conclusion Incidence of IOR was 28.65%. Younger age, males, higher Fisher score, early timing of surgery of aneurysms and larger size increased the risk, while use of temporary clip reduced the risk. Dome H/W ratio and irregular shapes of aneurysm were important factors predicting IOR in this study.Publication Long-level Intramedullary Spinal Cord Tumor: A Case Series(Nepal Medical Association, 2025) Khadka, Namrata; Suryabanshi, Anil; Shrestha, Apurva; Paudel, Kumar; Aryal, Sameer; Jha, Binit; Bhattarai, Sushil Mohan; Rajbhandari, Binod; Shrestha, Rajendra; Jha, RajivAbstract Spinal cord tumors, though uncommon, pose significant challenges due to their potential for neurological disability and mortality. Intramedullary spinal cord tumors, particularly Long-level intramedullary spinal cord tumors, present challenging clinical scenarios. Contrast-enhanced Magnetic resonance imaging remains pivotal for radiological evaluation and surgical planning. Notably, aggressive resection is advocated to enhance prognosis, with meticulous attention to preserving neurological function. Advancements in spinal surgery techniques, coupled with intraoperative monitoring, offer promising avenues for improved patient outcomes. We presented three cases of long-level intramedullary tumors, emphasizing the significance of tailored management and presented details, including clinical presentations, radiological findings, and histopathological results.Publication Postoperative C-Reactive Protein as a Predictor of Postoperative Pancreatic Fistula after Pancreaticoduodenectomy(Institute of Medicine, Tribhuvan University, 2025) Khadka, Namrata; Maharjan, Narendra; Bhandari, Ramesh Singh; Lakhey, Paleswan JoshiAbstract: Introduction Postoperative pancreatic fistula (POPF) has adverse effects on the outcomes of patients after Pancreaticoduodenectomy PD. Thus, an accurate predictor of POPF is essential. This study aimed to identify C-Reactive Protein (CRP) on the first postoperative day (POD1) as a predictor of clinically relevant postoperative pancreatic fistula (CR-POPF). Methods It was a prospective observational study performed at Tribhuvan University Teaching Hospital, Nepal, from March 2019 to November 2019. Forty-nine patients who underwent PD were enrolled in the study. Demography, clinicopathological characteristics, postoperative complications, and CRP on POD1 were recorded. Statistical analyses were performed to identify the association of POD1 CRP with CR-POPF. Results The mean age was 56.94 ± 10.10 years, with a nearly equal gender distribution. Clinically relevant postoperative pancreatic fistula (CR-POPF) occurred in 13 patients (26.5%). Patients with CR-POPF had higher mean postoperative day 1 serum C-reactive protein (CRP) levels (123.84 ± 42.90 mg/L) compared to those without CR-POPF (93.35 ± 67.02 mg/L); however, the difference was not statistically significant (p = 0.134). No significant associations were found between CR-POPF and preoperative or intraoperative variables, including pancreatic duct diameter, gland texture, and operative time. Conclusion Although serum CRP levels on postoperative day 1 were higher in patients who developed clinically relevant POPF, the difference was not statistically significant in this study. Therefore, CRP alone may not be a reliable early predictor of CR-POPF.