OF NEUROSURGEONS, PAKISTAN SOCIETY

English

Pakistan Journal Of Neurological Surgery

Pak. J. of Neurol. Surg. – Vol. 23, No. 4, Oct. – Dec., 2019         http//www.pakjns.org i PAKISTAN JOURNAL OF NEUROLOGICAL SURGERY  OFFICIAL JOURNAL OF PAKISTAN SOCIETY OF NEUROSURGEONS (QUARTERLY) Published by the Department of Neurosurgery, Punjab Institute of Neurosciences/LGH, Lahore (Since July 1998) Volume 23, Number 4 No. PC(PB)/J-275 Oct. – Dec., 2019   EDITORIAL BOARD Chief Editor and Publisher    Associate Editor: Dr. Saman Shahid, Ph.D. Associate Professor, NUCES, Lahore Members Editorial Board: Prof. Junaid Ashraf, Ex-VC, DMU, Karachi Prof. Rashid Jooma, AKU, Karachi Prof. Salman Sharif, LNH, Karachi Prof. Athar Enam, AKU, Karachi Prof. Aizaz Ali Shah, AKU, Peshawar Prof. Ahmad Ali Shah, AKU, Karachi Prof. Naqibullah Achakzai, VC, BMU, Quetta Prof. Shabbir Lehri, Principal BMU, Quetta Prof. Nazir Ahmed, Ex-Principal PGMI/AMC/LGH, Lahore Prof. Anjum Habib Vohra, Ex-Principal PGMI/AMC/LGH, Lahore Prof. Shehzad Shamas. KEMU, Lahore Prof. Dr. Asif Bashir, Diplomate American Board, PINS/LGH, Lahore Prof. Dr. Kamran Hussain, Ex-Principal, SZH, Evercare Hospital, Lahore Prof. Abdul Hameed, FJMU, Lahore Prof. Abdullah Haroon,– SIMS, Lahore Dr. Fauzia Sajjad, Associate Prof. PINS/LGH, Lahore Dr. Hafiz Abdul Majid – Associate Professor PINS/LGH, Lahore Dr. Azam Niaz, Associate Professor KEMU, Lahore Prof. Attique-ur-Rehman,– GMC, Gujranwala Members International Editorial Board: Prof. Franco Servadei, Milan Italy (President WFNS) Prof. Gail L. Rosseau, Vice President (American Association of Neurological Societies) & George Washington University USA. Prof. Alberto Sufianov, Tyumen, Russia Prof. Dr. Majid Samii, Hannover, Germany Prof. Russel J Andrews, (American Association of Neurological Surgeons) Advisor NASA, USA Prof. Ghous Malik, U.S.A. Prof. Dr. Asim Mahmood, Detroit, USA Prof. Tetsuo Kanno Nagoya, Japan Prof. Yoko Kato Nagoya, Japan Prof. Peter L. Reilly AB, Australia Prof. Mehmet Zileli, M.D, Izmir, Turkey Prof. Hiroshi Okudera, M.D., Toyama, Japan Dr. Kiran Niraula, Maldives Dr. Scott C. Robertson, Laredo Spine & Neuro Associates, Texas, USA. Dr. Carlo Giussani, PhD. Associate Prof. School of Medicine Ospedale San Gerado Monzo, Italy Dr. Yonghong Wang, Shanxi Dayi Hospital, China Peer Reviewers (PAK) Prof. Khalid Mahmood, Director PINS/LGH, Lahore Prof. Tariq Salah-ud-Din, Ex-Principal PGMI/AMC/LGH, Lahore Prof. Rizwan Masood Butt, PINS/LGH, Lahore Prof. Khaliq-uz-Zaman, Rtd. PIMS, BNSMU, Islamabad Prof. Sajid Nazir Bhatti, PIMS, BNSMU – Islamabad Prof. Mumtaz Ali, Peshawar Prof. Shahid Ayub, Hayatabad Medical Complex, Peshawar Prof. Naveed Ashraf, AIMC, Lahore Prof. Azhar Javeed, Lahore  Gen. Nisar M. Khan, Rawalpindi Brig. Nazir Qureshi, Rawalpindi Prof. Muhammad Arif Malik, Rawalpindi Prof. Nadim Akhtar, RMU, Rawalpindi Prof. Muhammad Yasin, Bahawalpur Prof. Muhammad Arshad, QMC, Bahawalpur Prof. Hamidullah Buzdar, Quetta Dr. Muhammad Akmal, Assist Prof PINS/LGH, Lahore Dr. Nauman Ahamd, SZH Lahore Dr. Nabeel Chaudary, Assistant Prof, JH, Lahore D. Babar Butt, Sharif Medical City, PINS, Lahore Dr. Khawar Anwar, PINS, LGH, Lahore Dr. S. A. Siddiqui, ZMU, Karachi Dr. Syed Shahzad Hussain, JHL, Lahore Dr. Muhammad Shahzad, JHL, Lahore Dr. Amir Aziz. Assistant Prof. PINS/LGH, Lahore Dr. Muhammad Irfan Sheikh, Asst Prof, KEMU, Lahore Dr. M. Ajmal Khan, Asso Prof. SIMS Lahore Dr. Shaharyar Sheikh, SZH, Lahore Dr. Muhammad Adil, JH, Lahore Dr. Talha Abbas, Faisalabad Dr. M. Rizwan Sarwar, Mayo Hospital, Lahore Dr. Usman Haqqani, Nowshera Med. College. Dr. Habib Sultan, Asst. Prof. PINS, Lahore Dr. Sundas Ali, Asst. Prof. PINS, Lahore Dr. Ijaz Wadd, Asst. Prof. PINS, Lahore Dr. M. Usman, Asst. Prof. Lady reading Hosp Peshawar Dr. Zahid Khan, LRH, Peshawar Dr. Seema Sharafat, LRH, Peshawar  International Peer Reviewers Prof. Dr. Amjad Shad, UK Dr. Muhammad Masood Hussain, Hull, UK Dr. Nikolay Angelov Peev, Consultant Neurosurgeon. Belfast HSC Trust, Belfast Northern Ireland. UK Prof. Haung Hongyun, Beijing China Prof. Murad Bavbek, M.D., Ankara, Turkey Prof. Ismail Hakki Aydin, Turkey Prof. Atul Goel M. Ch., Mumbai – India Prof. Lutf-ur-Rahman, Bangladesh Dr. Ibrar Bukhari, Dubai –UAE Dr. Salman Raza Jaffary, Dubai – UAE Dr. Nauman Shakeel, Dubai – UAE Dr. Abdul Karim Msaddi, Dubai, UAE Dr. Rajesh Kumar, Dubai – UAE Dr. Debora Garozzo, UAE Dr. Abdul Rehman Sababb, Jeddah, KSA Dr. M. Adil, King Faisal Specialist Hosp, Jeddah, KSA Dr. M Tariq. Consultant Neurophysiologist, King Faisal Specialist Hosp, Jeddah, KSA Dr. Kostas N. Fountas, Professor, University of Thessaly School of Medicine, Greece Dr. Aftab Ahmad, Kuwait Dr. Carlo Giussani,. Associate Prof. School of Medicine Ospedale San Gerado Monzo, Italy Dr. Mohammad Naser Habib, Afghanistan Dr. Salman Yunas, Kabul, Afghanistan Dr. Azam Ahmed, Kabul Afghanistan Prof. Dr. Muhammad Anwar Chaudary, M.S. Professor, PINS / LGH, Lahore ii http//www.pakjns.org         Pak. J. of Neurol. Surg. – Vol. 23, No. 4, Oct. – Dec., 2019 Pakistan Journal of Neurological Surgery is the official journal of the Pakistan Society of Neurosurgeons published by the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore. This was published Quarterly then Biannually and now again Quarterly publication. It contains original research articles, review papers, case reports and updates in Neurosurgery. The Editorial board makes every effort to ensure the accuracy and authenticity of material printed in this journal. However, conclusions and statements expressed are views of the authors and do not necessarily reflect the opinion of the editorial board.  Prospective authors should consult instructions to the authors and PMDC Guidelines before sending their articles and other material for publication. The Pakistan Journal of Neurological Surgery accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere.    Paper Quality: This Journal is printed on fine quality Acid Free Paper according to the International standards     Printer: DOT Fine, Lahore Contact Associate Editor Dr. Saman Shahid E-mail: drshahidsaman@gmail.com Mobile: 0332-6253363 Composed by: Zercon Graphic’s, Lahore zercon2010@gmail.com zercongraphics@hotmail.com    Subscription Fee Draft / Cheques are payable to “Pakistan Journal of Neurological Surgery National Bank of Pakistan, New Muslim Town, Lahore. C. A. No. 400 3291 465.  IBAN  PK29 NBPA 160 700 400 3291 465 Annual: In Pakistan:   Rs.  10,000 (Ten Thousands). Abroad: US$: 200    Acknowledgements  I am extremely thankful to our International Editorial Board and Dr. Saman Shahid, Associate Editor, for the pivotal role for plagiarism check-up and paper review process. We are also thankful to all peer reviewers for their valuable contributions. Our members Editorial Board helped us a lot for publishing this issue. We are grateful to Postgraduate residents of Department of Neurosurgery, PINS, L.G.H. Lahore for their cooperation and support to us. We are thankful to Pakistan Society of Neurosurgeons and Pharmaceutical companies for their financial support to this Journal. I appreciate Mr. Syed Aftab, for his great help for indexing the journal with reputed indexing agencies.    Prof. Dr. Muhammad Anwar Chaudary Chief Editor and Publisher Department of Neurosurgery, PINS, Lahore General Hospital, Lahore Mailing Address: 204 – F Johar Town, Lahore – Pakistan Cell: +92 321-4333004.   E-mail: dranwarchaudary@yahoo.com Submission of Articles by E-mail: chiefeditor.pjns@gmail.com admin@pakjns.org; drshahidsaman@gmail.com dranwarchaudary@yahoo.com http://www.pakjns.org.  

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Pakistan Journal Of Neurological Surgery