NepMed Repository :: Browsing by Author "Sedain, Gopal"

Browsing by Author "Sedain, Gopal"

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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 Raj
Background: 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.
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 Raj
Abstract: 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.
Demography and Outcome of Pediatric Traumatic Brain Injury; Experience from a University Teaching Hospital in Nepal
(Institute of Medicine, 2022) Dahal, Sandesh; Shrestha, Dipendra K; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT Introduction: Traumatic brain injury (TBI) is one of the significant causes of disability and death. It is a common cause of emergency neurosurgical consultation. Due to differences in physiology and management strategy, outcomes of pediatric TBI are different. This study purposes to describe the demography, clinical-radiological characteristics, and outcome of patients with pediatric TBI. Methods: A retrospective study of 112 children of age up to 18 years admitted to the Neurosurgical Department in Tribhuvan University Teaching Hospital following TBI from August 2021 to July 2022 was conducted. Variables analyzed were the demographics, clinical characteristics, imaging findings, management strategies, and outcome. Results: Median age was 5.5 years. The male-to-female ratio was 2.3:1. Falls followed by road accidents (RTA) were the most common mode of injury. A significant number of patients (62, 55.3%) presented after 24 hours of injury. Vomiting (67, 59.8%) was the commonest symptom followed by loss of consciousness (60, 53.6%). Post-traumatic seizure was observed in 13 (11.6%) of the children; however, had no association with the outcome. Mild, moderate, and severe TBI were seen in 80.3%, 17.8%, and 1.7% respectively. Extra-axial hematomas (40%) were the most common findings followed by skull fractures (33.9%). Intensive care was required in 13 (11.6%) and 34 (30%) required surgery. Craniotomy (30.3%) was the most common procedure. Good outcome at discharge was seen in 107 (95.5%) of patients. Conclusion: Falls and RTAs were the commonest causes of pediatric TBI. In our study, a significant number of the patients presented after 24 hours of injury. Craniotomy was the most common managment and most of the children had good outcomes at discharge. Keywords: Computed tomography, extra-axial hematoma, Glasgow outcome scale, pediatric, post-traumatic seizure, traumatic brain injury
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, Prabhat
Abstract: 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.
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 R
ABSTRACT 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 potential
Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage in a Tertiary Care Hospital in Nepal
(Institute of Medicine, 2025) Rijal, Deepika; Paudel, Sujan; Luitel, Prajjwol; Rijal, Bishwa Deepak; Sedain, Gopal; Shilpakar, Sushil Krishna; Sharma, Mohan Raj
ABSTRACT Introduction: Aneurysmal subarachnoid hemorrhage (aSAH), caused by a ruptured intracranial aneurysm, results in high mortality and disability rates. The Neutrophil-to-lymphocyte ratio (NLR), a simple yet effective marker, holds potential as a valuable prognostic tool, especially in the context of low and middle income countries. The primary aim of study was to predict the outcomes of aSAH patients by modified Rankin Scale (mRS) in 3 months based on admission NLR. Methods: This observational study was conducted at Tribhuvan University Teaching Hospital from June 2022 to August 2023. Patients with aSAH presenting to the Emergency Department within 72 hours of symptoms were included. Hematological investigations and non-contrast computed tomography of the head were performed. Outcomes were assessed using the mRS after three months. Results: A total of 51 patients were included. The mean age of the study population was 54.1±13.4 years (Range 25 to 80 years). The most common age group was 50-59 years. Female-to-male ratio was 2.9:1 Patients with poor outcomes had significantly higher admission NLR (7.1±4.7) compared to those with good outcomes (3.7±1.9) (p=0.001). Elevated NLR was significantly associated with worse outcomes at three months (p = 0.001). NLR ≥ 3.63 predicted poor prognosis with 87.5% sensitivity. Conclusion: This study highlights the utility of NLR in predicting outcomes in aSAH, providing an easy-to-access prognostic marker for risk stratification. The findings are relevant in developing countries, where financial and logistical constraints limit access to advanced neuroimaging and continuous monitoring. Keywords: Aneurysmal subarachnoid hemorrhage; modified Rankin scale; neutrophil-to-lymphocyte ratio; outcome
Outcomes of Patients with Traumatic Brain Injury between Two-Wheeler and Non-Two-Wheeler Vehicles: A Cohort Study
(Institute of Medicine, Tribhuvan University, 2025) Shrestha, Bishwash; Sharma, Mohan Raj; Shilpakar, Sushil Krishna; Sedain, Gopal; Pradhanang, Amit; Jha, Prabhat
Abstract: Introduction Traumatic brain injury (TBI) is growing public health concern and one of the most devastating types of injury. Pattern of injuries and outcome in two-wheeler and non-two-wheeler vehicular accidents should be evaluated and addressed separately. This study aimed to determine the outcome between two wheeler and Non two-wheeler vehicular Traumatic brain injury (TBI) patients. Methodology This was a retrospective cohort study which include the data from October 2020 to December 2022, of patients with vehicular traumatic brain injuries, admitted in Department of Neurosurgery, Tribhuvan University Teaching Hospital, Nepal. Primary data was collected from emergency records, in-patient files, operative notes and post-operative discharge. Patients were followed up via phone calls and at follow up visits. Results A total of 75 patients with mean age of 39.39 ± 18.3 years and male to female ratio of 3.6:1 were enrolled in the study. 63 patients and 12 patients were included in two-wheeler and non-two-wheeler TBI patients. Among two wheeler patients, 39.68% used helmet whereas 16.6% of non two-wheeler patients used seatbelts. Alcohol consumption was high in 2 wheelers (52.38%) than in non two-wheelers (25%). Majority of the patients had mild head injury,73% among two wheelers and 83.3% in non 2-wheelers. Favourable Extended Glasgow Coma score (4-8) was seen in 98.4% of two-wheeler TBI patients and among all of non two-wheeler TBI patients. Conclusion There are differences in outcomes between TBI of two-wheelers and non-two-wheelers. Favourable outcomes in terms of Extended Glasgow coma score was seen in non-two-wheelers as compared to two-wheelers in our study.
Pituitary Apoplexy Complicated by Cerebral Infarction: A Case Report
(Nepal Medical Association, 2021) Pokhrel, Biraj; Khanal, Shambhu; Chapagain, Parikshit; Sedain, Gopal
Abstract: Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.
Post-traumatic Pseudoaneurysm of the Internal Carotid Artery with Intractable Epistaxis: A Case Report Authors
(Nepal Medical Association, 2022) Phuyal, Subash; Pandey, Anisha; Bishokarma, Suresh; Lamsal, Ritesh; Sedain, Gopal
Abstract: Epistaxis is a common otorhinolaryngology emergency. There are several treatment modalities for epistaxis, but bleeding from the internal carotid artery necessitates a particular treatment technique. We report a case of a 22-years old man who presented to us recurrent episodes of epistaxis and blurry vision in the right eye for one month. The patient had undergone maxillo-facial surgery following a road traffic accident one year back. Bleeding episodes were occasionally severe with blood loss of up to 800 to 1000ml. These episodes were managed conservatively with posterior nasal packing and frequent blood transfusions. A computed tomography-angiography revealed a pseudoaneurysm arising from the cavernous segment of the right internal carotid artery which was managed successfully by embolization of the aneurysm sac with coils. Despite the rarity of internal carotid artery pseudoaneurysm in individuals with a history of trauma, doctors must be aware of the possibility. Timely identification and treatment of a pseudoaneurysm can save a person's life.

Browsing by Author "Sedain, Gopal"

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