Browsing by Author "Pant, B"
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Publication Deep Brain Stimulation in Parkinsons Disease in Nepal(Kathmandu University, 2018) Shrestha, R; Taira, T; Shrestha, P; Rajbhandari, P; Acharya, S; Pant, BABSTRACT Background Parkinsons disease is a central nervous system degenerative disorder affecting motor system and characterized by progressive tremor, rigidity, gait abnormalities. Surgical treatment of Parkinsons disease is based on the changes in the basal ganglio- thalamocortical circuits which is altered in Parkinsons disease. Currently pallidotomy and Deep Brain Stimulation are available modes of surgical treatment of Parkinsons disease. Objective To know efficacy of deep brain stimulation in Parkinsons Disease in Nepal. Method All patients of idiopathic Parkinsons disease who underwent Deep Brain Stimulation in Annapurna Neurological Institute and Allied sciences since 2014 were included. The standard functional coordinates for Subthalamic nucleus and Globus pallidus internus was used. We used Zamarano-Dujovny (ZD) Fisher Frame with its software. Patients’ Unified Parkinsons disease rating score, Modified Hoehn and Yahr Staging and Schwab and England Activities of daily living Scale were evaluated preoperatively as well as postoperatively. Result Ten patients underwent Deep Brain Stimulation. The male is to female ratio was 2:1. The mean age was 55.4±8.9 years and duration of illness was 5.5±2 years. There was a significant improvement in the scores for the main motor manifestations of the disease between the preoperative off-dopa and postoperative off-dopa/on-stim conditions. There was a significant improvement in Schwab and England Activities of daily living scale scores in the off-dopa condition between the preoperative score and the postoperative M6 score. Conclusion Our result of Deep Brain Stimulation is quite promising. However, it is very expensive and requires frequent follow-up for neuromodulation. KEY WORDS Deep brain stimulation, Parkinsons disease, Unified parkinsons disease rating scorePublication Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures(Kathmandu University, 2021) Rajbhandari, P; Gurung, P; Rajbhandari, S; Shrestha, D; Acharya, S; Shrestha, R; Shrestha, P; Shrestha, J; Sharma, U; Mali, S; Rajbhandari, R; Neupane, A; Pant, BABSTRACT Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents. KEY WORDS Digital subtraction angiography, Neurosurgical residents, NeurointerventionPublication Glioblastoma multiforme or brain abscess(Institute of Medicine, 2009) Shrestha, P; Pant, BAbstract Abstract: It is not uncommon for brain abscess and glioblastoma multiforme (GBM) to be confused with one another in neuroimagings. Due to preoperative diagnostic dilemma, treatment strategy and prognosis cannot be explained in advance. In this context, we present a case of 50 year-old male patient with features of raised intracranial pressure (ICP) and left hemiparesis. His computed tomographic (CT) scan and magnetic resonance imaging (MRI) of head showed central cystic lesion with ring enhancement with significant perifocal edema. Provisional diagnosis of GBM was made. Surgery was performed with craniotomy. Intraoperative picture showed a cystic lesion with thick capsule containing pus. Histological report showed plenty of inflammatory cells without any evidence of GBM. There are various neuroimaging techniques to differentiate brain abscess from GBM. However, in Nepalese context, they are hardly applicable. By this article, we intend to emphasize that brain abscess and GBM are very difficult to differentiate and thus thorough evaluation is needed before surgery is contemplated so as to make an appropriate treatment plan. Keywords: brain abscess, GBM, neuroimaging techniquePublication Spinal synovial cyst presenting with radiculopathy(Institute of Medicine, 2011) Shrestha, P; Malla, H; Pant, BAbstract Synovial cyst (SC) is one of the relatively rarer spinal pathology which can lead to radicular feature. The most common differential diagnosis is herniation of intervertebral disc (HID). A 34 year-old male patient presented to orthopedic surgeon with the history of right thigh pain on and off. The case was then referred to us. On examination, he had mild hypoesthesia over fronto lateral aspect of right thigh and knee jerk wasslightly diminished. Repeat magnetic resonance imaging (MRI) of lumbosacral spine was done as previous image quality was poor. New MRI suggested cystic lesion at L2-3 on right side suggesting most likely synovial cyst. With midline incision, right hemilaminotomy was done and thecal sac and nerve root was exposed. When thecal sac and nerve root was retracted, cystic lesion was very clearly seen arising from facet joint. Complete excision was done and sent for histological evaluation which showed features of synovial cyst. Post operatively, thigh pain disappeared and patient went have to normal work after 1 month of surgery. The main purpose of this article is to emphasize that synovial cyst is one of the possible, though rare, etiology of radiculopathy. Though it occurs in older age group it can be found in younger people also as in our case. Surgical exploration and radical resection is the way to cure it. Keywords: synovial cyst, lumbar spine, radiculopathy, surgical resection