NepMed Repository :: Browsing by Author "Rajbhandari, Binod"

Browsing by Author "Rajbhandari, Binod"

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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, Rajiv
Abstract: 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.
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, Rajiv
Abstract 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.
Major Spinal Surgery Between Two Documented COVID-19 Infections in an Elderly Female: A Case Report Authors
(Nepal Medical Association, 2021) Sharma, Bishruti; Paudyal, Nabin; Rajbhandari, Binod; Pradhanang, Amit; Dwa, Nikita; Pradhan, Ajay; Sharma, Mohan Raj
Abstract: Documented re-infection of COVID-19 is uncommon and doing a major spinal surgery in an elderly patient right after the recovery from the first event is itself a major undertaking. Re-infection after successful surgery points to the possibility of COVID-19 infection being a post-surgical complication. Here, we report a case of a 72-years-old elderly female who had presented to us with features of COVID-19 infection confirmed by reverse transcription polymerase chain reaction assay and unstable spinal fracture who underwent a pedicle screw fixation for the fracture of the third and fourth thoracic vertebrae after two consecutive negative serology assays. A month after discharge from the hospital, she presented with severe symptoms of COVID-19 again confirmed by two consecutive polymerase chain reaction assays. She was managed conservatively and was discharged without significant respiratory and neurological complications. We described this case in detail in addition to reviewing the pertinent literature.
Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Phuyal, Suman; Rajbhandari, Binod; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center. Methods: A single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications. Results: Out of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%. Conclusion: The shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available. Keywords: Complications congenital hydrocephalus, ventriculoperitoneal shunt
Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Sah, Hemant K; Shrestha, Dipendra K; Rajbhandari, Binod; Sedain, Gopal; Pradhanang, Amit B; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal. Methods: This is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed. Results: A total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients. Conclusion: Our study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal. Keywords: Burden, Nepal, spine trauma, spine pathology
Recurrent Sacral Chordoma: A Case Report
(Nepal Medical Association, 2020) Shrestha, Abhash; Nakarmi, Prami; Vaidya, Animesh; Raut, Sumit; Rajbhandari, Binod; Sharma, Mohan Raj
Abstract: Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the axial skeleton and is the most common primary malignant tumor of sacrum. The mainstay of treatment is wide surgical excision but there is a risk of recurrence due to the infiltrating nature of the tumor. Here, we report a case of a 56-years male who complained of pain over his sacral region for the past two years along with episodic urinary symptoms, constipation, and weakness of both legs. Seven years after undergoing surgery and radiotherapy for his sacral chordoma, he was diagnosed with recurrent sacral chordoma and planned for reoperation. Subtotal excision of the chordoma was done which significantly alleviated his symptoms postoperatively. Timely intervention helps to improve the quality of life in patients with either primary or recurrent sacral chordomas.
Vein of Galen Aneurysmal Malformation Presenting with Obstructive Hydrocephalus: A Case Report
(Institute of Medicine, 2019) Khanal, Nischal; Rajbhandari, Binod; Sedain, Gopal; Shilpakar, Sushil K
ABSTRACT The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it. Keywords: Complications, obstructive hydrocephalus, vein of Galen aneurysmal malformation, ventriculoperitoneal shunt
Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study
(Institute of Medicine, 2019) Shrestha, Dipendra K; Rajbhandari, Binod; Pradhanang, Amit; Sedain, Gopal; Shilpakar, Sushil K; Pradhan, Saurav
ABSTRACT Introduction Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP. Keywords: Intensive care unit, neurosurgical patient, ventilator-associated pneumonia

Browsing by Author "Rajbhandari, Binod"

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