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Background: Chiari malformations (CMs) encompass a range of clinicopathological conditions that exhibit diverse etiology, pathophysiology, and clinical characteristics. This study was done to compare the resolution of syringomyelia after posterior fossa decompression with and without duraplasty in Chiari malformation-1 (CM-1). Methods: This Quasi-experimental study was conducted at the Department of Neurosurgery, Mardan Medical Complex, Mardan, from January to November 2023. A non-probability, consecutive sampling technique was adopted. Thirty-two children of either gender, aged below 16 years, presenting with CM-1, and planned to undergo either posterior fossa decompression with duraplasty (PFDD) or posterior fossa decompression without duraplasty (PFD) were analyzed. Duration of procedure (minutes) estimated intra-operative blood loss (ml) and post-surgical complications were noted. Outcomes in terms of resolution or improvement in syringomyelia along with syrinx diameter were compared after 6 months. Qualitative variables were compared using chi-square or Fisher's exact test, and quantitative variables were assessed using independent sample t-tests with p

OBJECTIVES This study aimed to evaluate the clinical outcomes of Anterior Cervical Discectomy and Fusion (ACDF) treatments for cervical disc degenerative disease (CDDD) using a Zero Profile cage. METHODOLOGY A retrospective study of 26 patients with cervical disc disease treated with a zero-profile cage was designed and followed up for an average of 12 months in descriptive research. For arm and neck pain, the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) scores were used to assess function. Nurick’s myelopathy classification scheme based on gait impairments was also documented. RESULTS The average age of the 26 patients was 48.96 13.13 years (mean SD), with 44 percent falling into the 40-60-year age bracket. The male/female gender distribution was 21 (84%) and 04 (16%) male/female. Radiculomyelopathic symptoms were detected in 11 (28%) of the patients, with radicular pain occurring bilaterally in seven (28%) of the patients and on the left side in four (16%). A radiological examination of fusion was performed at six months and one year. The fusion had a success rate of 95 percent at six months (19 patients) and 100 percent at one year. CONCLUSION A zero-profile device provides biomechanical stability and fusion rates with excellent outcomes for one- and two-level ACDFs. Advantages include low rates of dysphagia, decreased operative time, restoration of cervical lordosis and disc height, and lack of cage subsidence or screw back out.

OBJECTIVES To evaluate the efficacy of Occipitocervical Fixation (OCF) in patients with craniocervical instability in two tertiary care hospitals. METHODOLOGY This retrospective case series study was conducted at Hayatabad Medical Complex, Peshawar, from April 2017 to December 2020. A non-probability sampling technique was used, and size was calculated via online software with a 95 % confidence level and 5% margin of error. All patients with craniocervical instability were included in our study, and those having occipital bone fractures or previously operated patients with the same technique were excluded from the study. The Nurick score was used to assess neurological function pre-and postoperatively. The demographic details of the patients, clinical features, radiographic findings (pre- and postoperative), and clinical outcomes using the Nurick myelopathy grading system were noted and entered into a structured proforma. All data were entered into SPSS Version 18 and analyzed. The results were presented in tables and pictures. RESULTS A total of 26 cases with craniocervical instability underwent OCF. The mean age of the patients was 40.5 + 1.2 SD years. There were 10 male patients and 16 female patients. The majority of patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.0. At the end of follow-up after surgery, the mean Nurick score was 2.1. There was a total of 7(14.28%) cases having complications, of which 4 (8.16%) patients had wound infection, 2 (4.08%) patients had implant failure, and 1(2.04%) had vertebral artery injury. However, no postoperative neurological deficit was observed. CONCLUSION Occipitocervical fixation is a reasonable option to have spinal stability, achieve bone fusion and get neurological improvement. Certain conditions complicate the procedure, but experienced hands can safely handle these.

OBJECTIVES To explore Neurosurgical postgraduate residents perceptions of their learning environment in operating rooms. METHODOLOGY From March 2022 to August 2022, this cross-sectional study will be carried out in the Department of Neurosurgery Hayatabad Medical Complex, Peshawar, Lady Reading Hospital Peshawar, and Ayub Teaching Hospital Abbottabad. The STEEM survey examined how surgical theatres were perceived as educational environments. After receiving informed consent, a printed questionnaire was provided to 32 surgical residents. SPSS 24 was used to conduct descriptive and inferential data analyses. RESULTS Thirty-one (31) of the 32 surgical residents that were surveyed (or 98.3%) answered. Residents' average age was 29.27 years (2.37); 27 were male, and 05 were female. Most residents were in their third (34.4%) and fourth (21.3%) years of residency. 147.66 (18.57) was the overall mean score. Participants' age and gender did not affect the mean scores; nevertheless, responses were statistically more favorable for residents in their first or fifth year of residency. Fifty-three locals responded favorably or positively overall. CONCLUSION Overall, residents had positive opinions of their training, their supervisors, the opportunities for learning in the operating room, the environment, and the monitoring they received.

OBJECTIVES: In developing countries, road traffic accidents are common and primarily affect middle-aged men. The aim of this study was to evaluate the frequency of epidural hematoma in people of various ages owing to road traffic incidents on computed tomography scan brain. METHODOLOGY: From February 2018 to January 2021, a cross-sectional descriptive study was done in the Department of Neurosurgery. A total of 460 individuals were chosen from emergency room visits due to traffic accidents. Individuals who had suffered a head injury and had an epidural hematoma on a computed tomography scan were included in the study. The frequency of epidural hematoma in different ages was determined. RESULTS: A total of 460 patients were enrolled in the trial, with 196 (42.60%) having epidural hematomas and 264 having no epidural hematomas (57.39%). Males accounted for 152 (77.55%) of the 196 epidural hematoma cases, while females accounted for 44 (22.45%), with an average age of 19 years and a range of 2-55±9.59 years. All the people who had a head injury were divided into three groups. The prevalence of epidural hematoma varied by age, with 75.51% (15-44 years), 20.40% (14 years), and 4.08% (>45 years) being the most common. CONCLUSION: It was concluded from this study that epidural hematoma determined by computed tomography scan brain is more frequent in middle age.

OBJECTIVES: To determine the frequency of cerebellopontine angle tumors in patients presented with trigeminal neuralgia. METHODOLOGY: This descriptive study was conducted in Neurosurgery Department, Hayatabad Medical Complex, Peshawar from 01-01-2016 to 31-12-2019. Patients with either gender and above 18 years of age diagnosed to be having trigeminal neuralgia and being symptomatic from a minimum duration of 03 months were included in the study. All the patients were subjected to a detailed history, thorough physical and neurological examinations and magnetic resonance imaging for the diagnosis of cerebellopontine angle tumors. RESULTS: The mean age group was 43 ± 2.37 years of which 37% were male and 62% were female patients, respectively. Cerebellopontine angle tumors were present in 3% of the patients. CONCLUSION: This study concluded that the frequency of cerebellopontine angle tumors was 3% among patients with trigeminal neuralgia.

OBJECTIVE The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. MATERIAL and Method This cross-sectional study was conducted in department of Neurosurgery Pakistan institute of Medical Sciences Islamabad from January 2010 to December 2011. All patients of either gender with depressed skull fracture above one year of age were included in the study. CT brain with bone window done in all patients. Per-operative dura in the region of depressed skull fracture was closely observed for any dural tear. The data collected on pre designed proforma. and analyzed using SPSS version 20.0 RESULTS A total of 96 patients were recruited in the study out of which 58(60.4%) were male and 38(39.5%) were female. Male to female ratio was 1.5:1. And mean age was 19.23 + 2.54 years. The most common location of depressed skull fracture was parietal 37(38.5%), followed by frontal in 27(28.1%), 15(15.6%)in temporal region,13(13.5%) in occipital region and only 4(4.1%) located in posterior fossa. Dural tear was present in 33(34.3%) while in 63(65.6%) it was absent. Other finding associated with depressed skull fracture per operatively were extradural hematoma in 16(16%), subdural hematoma in 11(11.4%), contusion in 16(16.6%) and pneumoencephalus was observed in 20(20.8%) cases. CONCLUSION The frequency of dural tear in DFS is quite high, so one should be vigilant to identify the defect and repair it properly to minimize post operative complications.

BACKGROUND Women eligible for vaginal birth after cesarean section (VBAC) have lower morbidity rates than women who undergo subsequent elective cesarean sections. Objective: To identify the obstetric parameters those influence the success of vaginal delivery in women with previous cesarean section. METHODOLOGY This descriptive cross sectional study was conducted at Gynaecology and Obstetrics Department of Khyber Teaching Hospital, Peshawar from 1st May 2015 to 31st April 2016.Inclusion criteria was all women of any age or parity presenting at >36weeks gestational age, with singleton pregnancy, vertex presentation, estimated fetal weight of 2.5 -3.5kg and documented previous lower uterine segment cesarean section for a non recurrent cause. Five predictors of success of vaginal birth after previous cesarean including maternal age, gestational age, and history of vaginal delivery, onset of labor and bishop score were evaluated in each patient. RESULTS Out of 100 women, 64 had VBAC and 36 had cesarean section. Fifty five were booked and 45 were non booked. Total women with history of VBAC were 24, out of these 16(66%) had VBAC and 8(33%) had repeat cesarean section. Ninety three had spontaneous onset of labor whereas 7 were induced,88 patients had Bishop score >5,out of these 61(69%) ended in VBAC and 27(30.6%) had cesarean section. The most common age group where VBAC occurred in majority was 25- 35 years. Thirty nine (61%) women had period of gestation between 38weeks to 39weeks+6days. Mean maternal age was 29.42 + 3.54 years CONCLUSION History of vaginal delivery, spontaneous sonset of labor and Bishop score >5 are the factors which are associated with more chances of vaginal delivery after cesarean section.

OBJECTIVE To determine the frequency of pyrexia in patients with prelabor rupture of membranes METHODOLOGY This descriptive (cross sectional) study was conducted in Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar from 12th January 2016 to 13th July 2016.Sample size was 369,keeping 4% proportion of pyrexia among women with PROM,95% confidence interval and 2%margin of error under WHO sample size calculation. All women with any age or parity who presented with prelabor rupture of membranes were included in the study. RESULTS In this study, 369 women with PROM were observed.41(11.1%) patients were less than 20 years,139(37.7%) were in 21-30years age range,179(48.5%) were in age group 31-40years and only 10(2.7%) were more than 41 years age. Average age was 29.53+6.3SD.The pyrexia among women with PROM was observed in 39(10.57%)women, being more common in 31-40 years age group where it was noticed in 20(11.2%),followed by 21-30years age where 14(10.1%)patients were pyrexial. CONCLUSION Pyrexia is an enormous public health problem, accounting for the majority of cases of PROM in this part of the country.

OBJECTIVE To determine the efficacy of disc excision in the treatment of herniated lumbar intervertebral disc. METHODOLOGY This study was conducted at Neurosurgery Department of Naseer Teaching Hospital, Peshawar from February 2015 to January 2016.The study design was descriptive case series in which consecutive non probability sampling technique was used. Clinical outcome of patients undergoing discectomy was determined using Stauffer-Coventry criteria and patients rated as excellent, good, fair and poor RESULT A total of 88 patients were recruited with 64% males and 36% females. Mean age was 39 years+4.68 SD.70% patients had L4-L5 and 30% had L5-S1 level disc herniation. Laminectomy was performed in 58%,fenestration in 34% and hemilaminectomy in 8% patients. Postoperatively at four weeks, satisfactory pain relief reported by 85% and unsatisfactory pain relief reported by 15% patients. CONCLUSION Conventional laminactomy, fenestration or hemilaminectomy is a feasible, safe and effective treatment in patients with lumbar disc herniation. Relief of pain is faster for patients assigned to early surgery.