Functional Outcome of Chronic Subdural Hemorrhage on Glasgow Comatose Outcome Scale Extended

Objectives:  Chronic Subdural hemorrhage is one of the most common neurosurgical disorders, mainly affecting the older population. The main objective is to assess the functional outcome of patients with Chronic Subdural hematoma on GCOSE. Materials and Methods:  This is a prospective cross-sectional study conducted at Liaquat University Hospital Hyderabad with a duration of January to December 2023. Patients presented with CSDH and different management was performed at the time of discharge or death GCOSE scale was recorded on a predesigned questionnaire. Results:  A total of 63 patients were included in the study, the mean age was 58.26, of which 69.8% were males, the most common presentation was One-sided weakness 58.9%, followed by the altered level of consciousness 57.3%. The mean pre and postoperative GCS was 10.98 and 11.87 respectively. Most of the patients had unilateral collection 89% with a few having bilateral CSDH 11%. The outcome GCOSE was such that 50% of the patients were found in grade VIII i.e. upper good recovery, all the patients that underwent through and through drainage had the best outcome with a p-value of 0.001, however, 22% of the patients were found in grade I (dead). Conclusion:  The functional outcome of Chronic subdural hematoma is best delineated with GCOSE as compared to the modified ranking scale and GOS. Keywords:  CSDH, functional outcome, GCS, GCOSE, head trauma, Glasgow outcome scale, Glasgow outcome scale extended, modified ranking scale

One-Year Shunt-Free Survival after Secondary Endoscopic Third Ventriculostomy (ETV) for Shunt Malfunction: Insights from a Tertiary Care Center in a Resource-Constrained Setting

Objectives:  To assess the one-year shunt-free survival rate in patients undergoing secondary ETV for shunt failure. Materials & Methods:  This retrospective study is done to evaluate the one-year shunt-free outcomes of secondary endoscopic third ventriculostomy (ETV) in 32 patients who presented with ventriculoperitoneal (VP) shunt malfunction due to obstructive hydrocephalus in a tertiary care hospital. Post-operative clinical features of raised intracranial pressure and shunt malfunctions were assessed for one year. MRI or CT scan and a history of shunt revision/insertion during the follow-up period were also noted. Results:  We had 32 patients in our study 17 males (53.1%) and 15 females (46.9%) with shunt malfunction treated by secondary ETV. The mean age at the time of ETV was 12 years with standard deviations ranging from 0.7 to 15 years. The one-year shunt revision-free survival rate was 68.8%. No major complications occurred in patients after the endoscopic procedures. Conclusion:  Results show a significant success rate in achieving shunt-free outcomes, especially in younger patients, favoring, secondary ETV as a viable option as compared to shunt revision. Keywords:  Endoscopy, Hydrocephalus, Ventriculoperitoneal Shunt, shunt failure, Ventriculostom

Management of Thoracolumbar Spinal Fracture at Tertiary Care Hospitals: A Retrospective Study

Objective:  This study aimed to evaluate the fracture types, neurological deficits via the ASIA grading system, and to analyze fracture management strategies, post-fracture and surgical complications, in patients with thoracolumbar fractures. Materials and Methods:  A retrospective observational study was conducted on 114 TLS patients aged 16-75 years with known cases of TLS fracture. Data included demographics, mechanism of injury, radiographic investigations, fracture classifications, ASIA grades, treatment types, and outcomes. Descriptive statistics were used for analysis. Results:  The current study found that the majority of patients were male (64%) and aged 20-29 years (36%). Falls from height were the leading mechanism of injury. AO classification revealed a predominance of A1 (26.3%) and A2 (21.9%) fractures. ASIA A (complete neurological deficits) was found in 35.1% of patients, and ASIA E (no neurological deficit) in 31.6%. Conservative treatment was employed in 55.3% while 44.7% of patients underwent surgery, mostly through a posterior approach. Common complications included spinal cord compression (35.1%), pressure sores (21.9%), and neuropathic pain (13.2%). Overall, 70% of patients showed good recovery. Conclusion:  The study concluded that posterior surgical intervention is preferred, yielding favorable outcomes. Hence, early diagnosis and appropriate interventions are also crucial for minimizing complications and improving prognosis

Current Concepts in Cranioplasty: Indications, Materials, Surgical Techniques, and Complications

Objective:  This study evaluates the clinical outcomes, materials used, and complications associated with cranioplasty thus providing a comprehensive analysis based on patient’s data. Materials and Methods:  This retrospective observational study was conducted at Ali Institute of Neurosciences, Irfan General Hospital, Peshawar from November 2023 to December 2024. A total of 55 patients who underwent cranioplasty were included in the study. The study analyzed patient demographics, indications, material selection, surgical techniques, and postoperative complications. Results:  The most common indication for cranioplasty was post-traumatic defects (63.6%), followed by decompressive craniectomy (25.4%), tumor resection (5.5%), and infection-related bone flap removal (5.5%). The materials used included polyetheretherketone (PEEK) (34.5%), bone cement (30.9%)  titanium mesh (18.2%), and acrylic mesh (16.4%). Postoperative infections occurred in 7% of patients and were successfully managed with antibiotics or revision surgery. No cases of implant rejection or resorption were observed. Conclusion:  Cranioplasty plays a crucial role in restoring cranial integrity improving neurological and aesthetic outcomes. Advances in biomaterials particularly PEEK, have enhanced procedural success in our study. While the surgery remains essential for functional and cosmetic rehabilitation optimizing material selection and infection prevention strategies can further improve patient outcomes

Frequency of Functional Outcome Among Patients with Spinal Tumor Visiting Tertiary Care Hospital

Objective:  To determine the frequency of functional outcomes among patients with spinal tumors. Materials and Methods:  This study was conducted at the neurological surgery department, Liaquat University of Medical and Health Sciences, Jamshoro and it was a descriptive study. A total of 145 patients presenting with spinal cord tumors were admitted through the outpatient department (OPD) and subsequently underwent surgical procedures. The diagnosis was primarily based on MRI findings, and the Frankel scale was used to assess neurological progress. Results:  The current study included 145 patients in total, with 65.5% of them being male. The majority (75.2%) were older than 60, whereas the mean age was 65.65±6.43 years. In contrast to the 15.9% of tumors in the cervical spine, 73.8% in the thoracic spine, and 10.3% in the lumbar spine, there were 13.8% intramedullary and 86.2% extramedullary tumors. Eight percent of patients required dorsal stabilization, 9.7% had surgical issues, 11.7% had medical difficulties, 66.2% required perioperative corticosteroid administration, and 11% required neuromonitoring. Upon admission, 11.7% had radiating pain, 34.5% had back discomfort, 82.1% had sensory deficiency, and 71% had bowel/bladder dysfunction. The mean McCormick score was 3.17±0.67 and 2.56±0.92 on admission and discharge, respectively whereas the mean KPS was 49.42±11.78 and 49.42±11.78 receptively.  There were 40% of patients with unfavorable and 60% with favorable outcomes. Conclusion:  Early diagnosis with minimal symptoms leads to better outcomes, whereas delayed presentation and significant neurological deficits are associated with poorer prognosis

Comparative Analysis of MRI DWI/ADC Changes with Clinical Recovery in Stroke Patients

Objective:  To determine the relationship between MRI diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC) changes, and clinical recovery in acute ischemic stroke patients. Materials and Methods:  This prospective observational study was conducted at the Radiology Department of Lady Reading Hospital, Peshawar, from January 2025 to June 2025. A total of 234 patients with acute ischemic stroke were included. All patients underwent MRI with DWI and ADC sequences within 24 hours of symptom onset. Clinical severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional recovery was evaluated using the Modified Rankin Scale (mRS) and Barthel Index at discharge and 30-day follow-up. Statistical analysis included Pearson correlation and multivariate regression to assess the association between imaging parameters and clinical outcomes. Results: DWI reversal on follow-up imaging was observed in 38.6% of patients and was strongly associated with improved functional outcomes (p=0.002). Multivariate analysis confirmed baseline DWI volume, mean ADC value, and NIHSS score as independent predictors of recovery.Conclusion: DWI lesion size, ADC value, and initial NIHSS score are significant predictors of clinical recovery in acute ischemic stroke patients. Incorporation of MRI-based diffusion imaging in routine stroke assessment improves early prognostication and guides management decisions

Effectiveness of Regular Physiotherapy in Enhancing Claudication Symptoms and Functional Outcomes in Patients with Spinal Canal Stenosis.

Introduction:  Lumbar spinal stenosis (LSS) causes neurogenic claudication that hinders mainly one’s mobility and quality of life. It is now accepted that physiotherapy is a useful conservative measure especially when surgery cannot be done. This paper aims to assess the impact of an organized physiotherapy intervention on the ability to walk and the level of dependency in LSS patients. Material and Methods:  A physiotherapy program of 6 weeks was carried out on 172 patients with LSS and neurogenic claudication. The manual therapy included core stabilization, flexibilities in the lumbar, and strengthening in the lower limb. Walking ability (Swiss Spinal Stenosis Scale), pain levels (VAS), disability (ODI, RMDQ), and walking distance were assessed. SPSS was used for statistical analysis with a p < 0.05 significance. Results:  Physiotherapy reduced leg pain (VAS 7.9 ± 1.3 to 2.6 ± 0.9, p < 0.001), back pain (6.5 ± 1.4 to 2.9 ± 1.0, p < 0.001) among 172 patients (64% male, mean age 68.4 years). Walking ability and disability improved (SSS and ODI, p < 0.001) and walking distance increased from 215.7 ± 42.5 to 482.3 ± 67.3 meters. Minimal adverse effects were reported. Conclusion:  As a safe nonoperative medical approach physiotherapy demonstrates high effectiveness in treating LSS patients by enhancing their mobility pain relief and independence levels. Surgical procedures have a powerful competitor in this nonoperative treatment that patients select for their conservative options

Silent Struggles, Resilient Spirits: A Study of Psychosocial Challenges and Quality of Life in Female Brain Tumor Patients at a High-Volume Neuroscience Institute in Pakistan

Objectives:  To determine the psychosocial impact of brain tumours in the female population of Pakistan using the FACT-Br Questionnaire. Materials and Methods:  108 female patients with diagnosed brain tumours between the ages of 13-75 years were enrolled after informed consent from Punjab Institute of Neurosciences, Lahore. After admission, patients were asked to fill out the FACT-Br questionnaire. Demographic data and symptoms were also recorded. Results:  Out of a total of 108 patients, the mean FACT-Br total score was 96.7 (out of 200). This indicated a significant deterioration in the quality of life and psychosocial well-being. Conclusion:  Our results showed that brain tumours had caused major psychosocial and quality of life impairment in our sample. It is advised, based on our findings, that recognition by physicians of these problems is essential, and effort towards a better QOL outcome is required

Autonomic Dysreflexia: Gaps in Awareness and Clinical Preparedness Among Healthcare Providers

Background:  Autonomic dysreflexia (AD) is a potentially life-threatening emergency affecting patients with spinal cord injuries at or above T6 level. Despite its severity, healthcare provider knowledge regarding recognition and management remains understudied, particularly in developing healthcare systems. Objective:  To assess awareness and clinical preparedness regarding autonomic dysreflexia among healthcare providers in tertiary care settings in Pakistan. Materials and Methods:  This cross-sectional study utilized a structured questionnaire administered to 127 healthcare professionals (35 consultants, 92 residents) across three tertiary care hospitals in Rawalpindi and Islamabad, Pakistan. The survey assessed knowledge of AD pathophysiology, recognition, and management approaches. Data were analyzed using SPSS version 25.0. Results:  The mean age of participants was 35.7 ± 7.4 years. Only 25.21% of respondents demonstrated adequate knowledge and preparedness for managing AD. Consultants showed significantly higher competency (48.15%) compared to residents (18.18%). Critical knowledge gaps were identified in first-line interventions, including proper patient positioning, identification and removal of noxious stimuli, and blood pressure management strategies. Conclusion:  This study reveals substantial gaps in awareness and clinical preparedness regarding autonomic dysreflexia among healthcare providers in Pakistan. The findings highlight an urgent need for targeted educational interventions, particularly for residents who often serve as first responders in emergencies

Surgical Outcomes of Endoscopic Transsphenoidal Pituitary Surgery

Introduction: Pituitary adenoma are common benign tumors of the brain and causes significant symptoms due to hormonal imbalances (mostly functional pituitary adenoma) and their mass effect on surrounding structures (majority of nonfunctional pituitary adenoma). The aim of this study was to find out the surgical outcomes of endoscopic trans-sphenoidal approach in terms of safety, effectiveness, per-op and post-op complications and relieve of symptoms. Methodology: This study was conducted at Ali Institute of Neurosciences and Irfan General Hospital, Peshawar, from April 2019 to April 2021. Patients diagnosed with pituitary adenomas (confirmed by MRI) and treated with the endoscopic trans-sphenoidal approach were included. Demographic data was collected, and outcomes were assessed post-surgery and at 6-month follow-up. Data were analyzed using SPSS version-26. Results: The majority of participants were male (65%) with a mean age of  31 years (range 22-28). Most patients presented with headaches (76%) and visual disturbances (60%), while 53% had hormonal imbalances. Post-surgery  100% reported headache relief  87% showed visual  improvements measured by Humphrey perimeter and visual acuity tests, and 97% had favorable endocrinological outcomes based on hormonal profile assessments. Conclusion: When treating pituitary adenoma, the endoscopic trans-sphenoidal approach is a safe and successful surgical technique that is linked to better patient results and satisfaction. Complications from the operation include intercavernous sinus hemorrhage, diabetes insipidus, hypopituitarism and CSF leakage. Keywords: Adenoma, Endoscopic trans-sphenoidal, Microscopic trans-sphenoidal, Pituitary adenom