Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes. This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months after procedure. Other outcomes included 30-day mortality and total length of hospital stay. We included 256 patients in the study. 66 patients (25.8%) developed VAI. EVD was the primary procedure in 21 (31.8%) cases. Most patients, 24 (36.4%), had EVD as a secondary procedure for tumor surgery. Median interval between EVD placement and diagnosis of infection was 3 days. Mean length of stay in VAI patients was 31.85 ± 20.53 days. Seven patients required ICU care. Ten patients (15.2%) expired during hospital stay or within 30 days of discharge and further four had GOS of 2 or 3. A total of 52 patients had a favorable outcome after 6 months. Rate of VAI in this cohort was high. VAI is associated with increased morbidity, mortality, and prolonged hospital stay.

Article: Accuracy of predicted postoperative segmental lumbar lordosis in spinal fusion using an intraoperative robotic planning and guidance system - Journal of Neurosurgical Sciences 2023 Nov 23 - Minerva Medica - Journals

Article: Experience with the utilization of new-generation shared-control robotic system for spinal instrumentation - Journal of Neurosurgical Sciences 2024 Apr 12 - Minerva Medica - Journals

Objective: ‘Neuro-robotic exoscope’ is a recent advance. Reports on the use of this operative visualization system are few. In this study we have described our initial experience with the use of Bright MatterTM system for various neurosurgical procedures. Methods: All patients who underwent neurosurgery using Bright MatterTM (Synapive Medical) at the Aga Khan University Hospital (AKUH) from April 2016 to October 2016 were included in this retrospective study. Data was collected from medical charts. Descriptive analysis was performed using SPSS v 21. Results: Bright MatterTM systems were used for a total of 71 cases. The exoscope was used with neuro-navigation and Diffusion Tractography Imaging (DTI) in 28 cases while in 7 cases it was used without navigation. During the same study period, neuro-navigation alone was performed for 36 additional cases but the exoscope was not used. The exoscope was used for a total of 53 hours while the Operating Microscope (OM) was used for 33.5 hours. A total of 12 cases were completed using the exoscope alone, without the need of the OM. Twenty-four lesions were found to be involving different white matter tracts of the brain. Gross Total Resection was done in 17 (of 30) patients. Perioperative mortality was 0%. Five patients had a new neurologic deficit postoperatively. Conclusion: Early experience with the use of exoscope is promising. Upcoming improvements in the exoscope such as three-dimensional stereoscopic system and angled lenses will further improve the functionality of this system.