https://pakjns.org/index.php/pjns/issue/feed Pakistan Journal Of Neurological Surgery 2026-06-22T17:04:44+00:00 Prof. Dr. Muhammad Anwar Chaudary chiefeditor.pjns@gmail.com Open Journal Systems <p>Pakistan Journal of Neurological surgery (PJNS) is an official Journal of the Pakistan Society of Neurosurgeons (PSN), Department of Neurosurgery, Punjab Insitute of Neurosciences (PINS) Lahore Pakistan. It has been in print since 1998.</p> <p>Journal archives: (<a href="https://pakjns.org/index.php/pjns/issue/archive">https://pakjns.org/index.php/pjns/issue/archive</a>)</p> <p>Journal Email: admin@pakjns.org</p> <p>Publisher link: (<a href="http://www.paksn.org/pjns/">http://www.paksn.org/pjns/</a>)</p> <p>Email: publisher.pakjns@paksn.org</p> <p>Pakistan Journal of Neurological Surgery is a quarterly, double-blind peer-reviewed, open-access, quarterly journal, published in both printed and online versions. The journal is published by the Pakistan Society of Neurosurgeons (PSN) and Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore, by the “Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals” as approved by the International Committee of Medical Journal Editors (ICMJE) in May 2023. </p> <p>https://www.icmje.org/icmje-recommendations.pdf</p> https://pakjns.org/index.php/pjns/article/view/1252 Correlation Between Polycystic Ovary Syndrome and Neuropsychiatric Manifestations: Clinical and Hormonal Perspectives 2026-06-21T13:23:24+00:00 Surraya Israr sundusrahman067@gmail.com Sundus Rahman sundusrahman067@gmail.com Devi Kumari sundusrahman067@gmail.com Romaisa Zeb sundusrahman067@gmail.com Hunniya Ayyaz sundusrahman067@gmail.com Maira Batool Rizvi sundusrahman067@gmail.com <p><strong>Objective:</strong> Polycystic Ovary Syndrome is a prevalent endocrine illness in women of reproductive age, and it is becoming increasingly linked to neuropsychiatric disturbances. Hormonal imbalance, insulin resistance and chronic inflammation are possible contributors to psychological morbidity among the affected women. The study aimed to establish the relationship between Polycystic Ovary Syndrome and neuropsychiatric manifestations, both in clinical and hormonal aspects.</p> <p><strong>Materials &amp; Methods:</strong> This is an analytical cross-sectional study that was done within Lady Reading Hospital. Three hundred women aged from 18 to 40 years were recruited, 150 of whom were diagnosed with Polycystic Ovary Syndrome who met the Rotterdam criteria, and 150 healthy women were age-matched. Clinical and anthropometric parameters, hormonal status, metabolic parameters and inflammatory markers were measured. Psychological scales were used in measuring depression and anxiety.</p> <p><strong>Results:</strong> Females with PCOS had significantly higher BMI, serum levels of T, fasting insulin levels and HOMA IR value compared to the controls. Moderate to severe depressive symptoms were found in 46 percent, and clinically significant anxiety symptoms were found in 52 percent. The score of depression and anxiety was positively correlated with total testosterone and insulin resistance. The mild yet significant association between C-reactive protein and anxiety symptoms was also found.</p> <p><strong>Conclusion:</strong> Polycystic Ovary Syndrome has a strong correlation with the neuropsychiatric symptoms. The imbalance in hormones and dysfunction of the metabolism seem to be a significant factor in psychological distress. It is important to perform an endocrine and mental health evaluation as part of the management.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Surraya Israr, Sundus Rahman, Devi Kumari, Romaisa Zeb, Hunniya Ayyaz, Maira Batool Rizvi https://pakjns.org/index.php/pjns/article/view/1264 Peripheral Neuropathy in Hypothyroid Patients: Clinical and Biochemical Correlation 2026-06-22T17:04:44+00:00 Irfan Ullah Hussain.akhtar31@yahoo.com Akhtar Hussain Hussain.akhtar31@yahoo.com Dur-e-Sameen Hussain.akhtar31@yahoo.com Rimsha Azhar Hussain.akhtar31@yahoo.com Hina Azeez Hussain.akhtar31@yahoo.com Sajjad Ahmad Hussain.akhtar31@yahoo.com <p><strong>Objective:</strong>&nbsp;&nbsp;The purpose of the study was to find the prevalence of peripheral neuropathy in hypothyroid patients and to identify the relationship between the level of thyroid hormone and the neurological symptoms.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;The proposed observational study was carried out at Lady Reading Hospital, Peshawar. Consecutive sampling was used to select a total of 160 patients aged 18 to 70 years who were confirmed to have hypothyroidism. Neuropathic symptoms were clinically assessed by conducting a detailed neurological examination. All patients were measured in regard to serum thyroid-stimulating hormone, free thyroxine, and triiodothyronine. The conduction studies of nerves were conducted in individuals who presented with possible symptoms of peripheral neuropathy. Pearson correlation analysis was used to determine the correlation between the level of neuropathy and thyroid hormones.</p> <p><strong>Results:</strong>&nbsp;&nbsp;A significant number of patients had their peripheral symptoms of neuropathy. Paresthesia was the most common, and then burning sensation and muscle weakness. Conduction studies on nerves indicated that 42.5 percent of patients had neuropathy. There existed a marked positive relationship between high levels of TSH and the severity of neuropathy, and neuropathy had a negative relationship with free T4 and T3 levels.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Peripheral neuropathy is a prevalent neurological complication in patients with hypothyroidism and has a great association with biochemical thyroid dysfunction. Management of hypothyroidism early can help in the prevention of complications of neuropathy and a better neurological outcome</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Irfan Ullah, Akhtar Hussain, Dur-e-Sameen, Rimsha Azhar, Hina Azeez, Sajjad Ahmad https://pakjns.org/index.php/pjns/article/view/1263 Correlation between Perfusion Index and Hypotension Following Spinal Anesthesia during Cesarean Section 2026-06-22T16:38:20+00:00 Muhammad Nawaz sidrahbatool88@hotmail.com Anum Zeb sidrahbatool88@hotmail.com Sidrah Batool sidrahbatool88@hotmail.com Saqib Shehzad sidrahbatool88@hotmail.com Moazzam Butt sidrahbatool88@hotmail.com Aslam Khan sidrahbatool88@hotmail.com <p><strong>Objective:</strong> To explore the predictive strength of baseline Perfusion index (PI) for hypotension during cesarean sections (CS). This study was designed to analyze the relationship between baseline PI &gt;3.5 and the number of episodes of hypotension during cesarean section in spinal anesthesia.</p> <p><strong>Material &amp; Methods:</strong> This correlational study was conducted at the Department of Anesthesiology, Lahore General Hospital. A sample of 65 primigravida women planned for elective CS were included in this study after informed consent. The procedure was performed as per the standard protocol of the hospital. Main variables like PI, mean arterial pressure, systolic blood pressure, and number of episodes of hypotension during surgery were recorded.</p> <p><strong>Conclusion:</strong> In conclusion, this study demonstrates a significant association between baseline PI and the development of hypotension during CS under spinal anesthesia. Patients with a baseline PI &gt;3.5 are at notably higher risk of hypotension.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Muhammad Nawaz, Anum Zeb, Sidrah Batool, Saqib Shehzad, Moazzam Butt, Aslam Khan https://pakjns.org/index.php/pjns/article/view/1262 Correlation Between Clavicle Fracture Patterns and Brachial Plexus Injury: A Clinical and Radiological Study 2026-06-22T16:28:02+00:00 Imran Khan dr_mohammadinam@yahoo.co.uk Muhammad Inam dr_mohammadinam@yahoo.co.uk Waseeq Ur Rahman dr_mohammadinam@yahoo.co.uk Umar Ismail dr_mohammadinam@yahoo.co.uk <p><strong>Objective:</strong>&nbsp;&nbsp;To evaluate the association between different types of clavicle fractures and the occurrence of brachial plexus injury using clinical and radiological assessment.</p> <p><strong>Materials and Methods:</strong>&nbsp;&nbsp;This prospective observational study was conducted at Lady Reading Hospital, Peshawar. A total of 186 patients with radiologically confirmed clavicle fractures were included. Each patient underwent a detailed clinical and neurological examination along with appropriate imaging. Fractures were categorized into medial third, middle third, and lateral third types. Brachial plexus injury was identified clinically and confirmed radiologically when required.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Middle third fractures were the most common (74.2%). Overall, 21 patients (11.3%) had brachial plexus injury, predominantly associated with middle third fractures. A statistically significant association was observed between fracture pattern and nerve injury.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Middle third clavicle fractures are more frequently associated with brachial plexus injury, emphasizing the need for careful neurological and radiological evaluation.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Imran Khan, Muhammad Inam, Waseeq Ur Rahman, Umar Ismail https://pakjns.org/index.php/pjns/article/view/1261 Neuropathic Pain Patterns in Patients with Ureteric Malignancies: A Clinical and Radiological Correlation 2026-06-22T16:04:17+00:00 Muhammad Ilyas drmuhammadseerwan@gmail.com Muhammad Seerwan drmuhammadseerwan@gmail.com Subash Khataumal drmuhammadseerwan@gmail.com Hafeez ur Rahman drmuhammadseerwan@gmail.com Anwar Kamal drmuhammadseerwan@gmail.com Misbah Nazir Ansari drmuhammadseerwan@gmail.com <p><strong>Objective:</strong>&nbsp;&nbsp;To identify patterns of neuropathic pain in patients with ureteric malignancies and determine their association with radiological findings.</p> <p><strong>Methods:</strong>&nbsp;&nbsp;This prospective observational study was conducted at Lady Reading Hospital, Peshawar. A total of 188 patients with suspected or histopathologically confirmed ureteric malignancies were included. Detailed clinical assessments were performed to classify pain into localized flank pain, radiating neuropathic pain, dermatomal pain, and mixed patterns. Pain severity was measured using the Numeric Rating Scale. Radiological evaluation included contrast-enhanced CT urography or MRI to assess tumor location, ureteric obstruction, hydronephrosis, and peri-ureteric infiltration. The associations between neuropathic pain patterns and imaging findings were evaluated using the chi-square test.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Radiating neuropathic pain was observed in 32.2% of patients, while 17.8% presented with dermatomal neuropathic pain. Distal ureteric tumors were the most common, frequently associated with hydronephrosis (62.7%). A significant association was found between neuropathic pain and radiological evidence of tumor infiltration<br>(p = 0.001). Patients with advanced radiological features, particularly peri-ureteric invasion, were more likely to exhibit neuropathic pain characteristics.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Neuropathic pain is a prominent and clinically significant symptom in patients with ureteric malignancies and is strongly associated with radiological tumor invasion. Integrating clinical pain assessment with imaging findings can improve diagnostic accuracy and guide more appropriate management strategies, ultimately enhancing patient care outcomes.</p> <p><strong>Keywords:</strong>&nbsp;&nbsp;Ureteric malignancy, Neuropathic Pain, Urothelial Carcinoma, CT urography, Radiological Correlation</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Muhammad Ilyas, Muhammad Seerwan, Subash Khataumal, Hafeez ur Rahman, Anwar Kamal, Misbah Nazir Ansari https://pakjns.org/index.php/pjns/article/view/1258 Role of Emergency Medicine in Identifying and Stabilizing Acute Neuroinfections 2026-06-21T18:13:44+00:00 Hamaad Gul Mohmand shahsyedahmadali1@gmail.com Syed Ahmad Ali Shah shahsyedahmadali1@gmail.com Sami Ullah Yousafzai shahsyedahmadali1@gmail.com Muhammad Ehtisham shahsyedahmadali1@gmail.com Tehran Khan shahsyedahmadali1@gmail.com Abdul Hadi shahsyedahmadali1@gmail.com Abdul Hadi shahsyedahmadali1@gmail.com <p>Objective:&nbsp;&nbsp;Emergency medicine's contribution to early detection, imaging-based diagnosis, and initial stabilization of patients with acute neuroinfections (meningitis and encephalitis) in the context of tertiary care hospital care.</p> <p>Materials and Methods:&nbsp;&nbsp;For this study, doctors observed patients in the Emergency Department of Lady Reading Hospital in Peshawar. A total of 200 patients who were suspected of having serious brain or nervous system infections were included. Their symptoms were checked, and brain scans using CT and MRI were done. The treatments given to patients were also recorded. The doctors compared the patients’ symptoms with their scan results to see how well they matched. Finally, the findings were also compared with results from other studies in the medical literature.</p> <p>Results:&nbsp;&nbsp;Out of 200 patients, 112 (56%) were male and 88 (44%) females, with a mean age of 34.2 ± 13.8 years. Sixty-one percent (61%) received a CT scan; 29% received an MRI scan, and 10% received both CT and MRI scans. The final diagnoses were bacterial meningitis (36%), viral encephalitis (19%), tuberculous meningitis (17%), brain abscess (14%), fungal infections (8%), and ventriculitis (6%).&nbsp;</p> <p>Conclusion:&nbsp;&nbsp;The early recognition and stabilization of CNS infections play a critical role for EDs. Early management (prompt neuroimaging, high clinical suspicion, and early empiric therapy initiation) is an important part of early management and improved outcomes.&nbsp;</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Hamaad Gul Mohmand, Syed Ahmad Ali Shah, Sami Ullah Yousafzai, Muhammad Ehtisham, Tehran Khan, Abdul Hadi, Abdul Hadi https://pakjns.org/index.php/pjns/article/view/1256 Association Between Vitamin D Deficiency and Carpal Tunnel Syndrome 2026-06-21T15:03:48+00:00 Kamran Alamgir drsajid193@gmail.com Sajid Mehboob drsajid193@gmail.com Muhammad Imran Khan drsajid193@gmail.com Muhammad Shahbaz Tariq Khattak drsajid193@gmail.com <p><strong>Objective:</strong>&nbsp;&nbsp;The most common entrapment of the upper limb neuropathy is carpal tunnel syndrome (CTS). Deficiency of the vitamin may also affect the functioning of peripheral nerves, and it may serve as the etiology of CTS. This paper examined the relationship between serum levels of 25-hydroxyvitamin D and CTS, and how these two relate to the severity of the disease.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;A retrospective case-control study was done using 70 participants consisting of 35 CTS patients and 35 age and sex matched controls. Serum vitamin D was measured. The severity of CTS was measured with the help of clinical assessment, nerve conduction studies (NCS), and high-resolution ultrasonography. T-tests, chi-square, Pearson correlation, and multivariate logistic regression were all done using statistical analysis.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Mean serum vitamin D levels were significantly lower in CTS patients compared to controls (14.0 ± 5.8 vs. 23.2 ± 6.1 ng/mL; p &lt; 0.001), and deficiency was more common among CTS (74.3 vs. 34.3; p = 0.001). A vitamin D deficiency was almost a five-fold risk factor of CTS (adjusted OR = 4.82; 95% 95% CI: 1.60–14.30;<br>p = 0.005).&nbsp;</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Vitamin D deficiency is linked to CTS presence and severity considerably, and it is an independently associated factor. The evaluation of vitamin D, as well as electrophysiological and ultrasonographic studies, can help to improve diagnosis and risk, and determine possible therapeutic solutions.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Kamran Alamgir, Sajid Mehboob, Muhammad Imran Khan, Muhammad Shahbaz Tariq Khattak https://pakjns.org/index.php/pjns/article/view/1255 Prevalence and Correlates of Obsessive-Compulsive Disorders Among University Students in Peshawar 2026-06-21T14:48:29+00:00 Ammar Munawar bkhan37@hotmail.com Bilal Afzal bkhan37@hotmail.com Muhammad Zarak Khan bkhansher@gmail.com Jawad Ali bkhansher@gmail.com Aman Ullah bkhan37@hotmail.com Nazim Hameed bkhansher@gmail.com <p><strong>Objective:</strong>&nbsp;&nbsp;This research aimed to establish the prevalence of the symptoms of obsessive-compulsive disorder among university students in Peshawar. Determining factors associated with these symptoms was also the purpose of the study. The knowledge of these factors can be used to enhance the student support services. This was aimed at having local data to plan mental care.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;This was a cross-sectional survey that was carried out in the universities of Peshawar (public and private). Five hundred and twenty students were involved. Both genders (male and female) were represented. The participants were undergraduate and postgraduate students. A questionnaire of this nature was structured. A confirmed screening device was used to detect likely symptoms of obsessive-compulsive disorder.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Over a quarter of the students were positive on the obsessive-compulsive symptoms. The symptomatic characteristics of most of the affected students were mild or moderate. A smaller number of symptoms were severe. Washing, checking, and unwanted thoughts were usually common. Positivity in screening was higher in female students. The residents of the hostels were more symptomatic than day scholars. There was a strong association between poor sleep and high academic pressure.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Obsessive-compulsive symptoms prevail in Peshawar students. There is a chance that many students will be undiagnosed. Awareness must be done at an early age. Colleges ought to enhance the counselling. Student well-being and academic performance can be facilitated by improving mental health support.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Ammar Munawar, Bilal Afzal, Muhammad Zarak Khan, Jawad Ali, Aman Ullah, Nazim Hameed https://pakjns.org/index.php/pjns/article/view/1253 CT Detection of Subarachnoid Hemorrhage Correlated with Clinical Severity Using Hunt and Hess Grading 2026-06-21T13:41:20+00:00 Zeenat Adil drambareenmuhammad48@gmail.com Ambareen Muhammad drambareenmuhammad48@gmail.com Abdul Majid drambareenmuhammad48@gmail.com Abdul Aziz Zia drambareenmuhammad48@gmail.com Qurat-ul-Ain Zaidi drambareenmuhammad48@gmail.com 3Ahsan Burki drambareenmuhammad48@gmail.com <p><strong>Objective:</strong><strong>&nbsp;</strong><strong>&nbsp;</strong>The objective of this study was to determine the diagnostic accuracy of computed tomography for detecting subarachnoid hemorrhage and to evaluate its correlation with clinical severity using the Hunt and Hess grading system.</p> <p><strong>Materials &amp; Methods:</strong><strong>&nbsp;</strong><strong>&nbsp;</strong>A cross-sectional descriptive study was conducted at the Kuwait Teaching Hospital, Peshawar. A total of 376 patients presenting with symptoms suggestive of subarachnoid hemorrhage were included. Computed tomography scans were performed, and findings were recorded regarding the presence and distribution of hemorrhage. Clinical grading was performed using the Hunt and Hess scale at admission. Data were analyzed to establish a correlation between radiological findings and clinical severity.</p> <p><strong>Results:</strong><strong>&nbsp;</strong><strong>&nbsp;</strong>The mean age of participants was 54.6 years, with a male predominance. Computed tomography demonstrated a high detection rate within the first twenty-four hours after symptom onset. A strong positive correlation was observed between the extent of bleeding on computed tomography and Hunt and Hess grades. Patients with higher grades frequently exhibited basal cisternal and intraventricular extension. Statistical analysis confirmed a significant association between radiological burden and clinical severity.</p> <p><strong>Conclusion:</strong><strong>&nbsp;</strong><strong>&nbsp;</strong>Computed tomography remains a reliable first-line imaging modality for early detection of subarachnoid hemorrhage and provides prognostic information through correlation with Hunt and Hess grading.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Zeenat Adil, Ambareen Muhammad, Abdul Majid, Abdul Aziz Zia, Qurat-ul-Ain Zaidi, 3Ahsan Burki https://pakjns.org/index.php/pjns/article/view/1200 Evaluating the Safety and Efficacy of Stand-Alone Locking Cage in Single- and Multi-Level Anterior Cervical Discectomy and Fusion in the hands of a young Neurosurgeon: A Retrospective Study of 125 Cases 2026-02-11T16:11:13+00:00 Adnan Khaliq dradnankhaliq@gmail.com Mian Iftikhar Ul Haq drmiulhaq@gmail.com Ubaid Ullah Mian ubaidullahkmc@gmail.com Adil Ahmed adilthemyth@gmail.com Suleman Khan dr.sulemandawar@gmail.com Haider Ali drhaideralikhan.haider@gmail.com Alishba Hameed ubaidullahkmc@gmail.com Touba Azeem ubaidullahkmc@gmail.com <p><strong>Objective:</strong> Cervical degenerative spondylosis often requires surgical intervention after failed conservative management. Zero-profile stand-alone cages for anterior cervical discectomy and fusion (ACDF) offer stability with reduced implant bulk. This study evaluates clinical outcomes, fusion success, and determinants of outcomes following single- and multi-level ACDF using this technique.</p> <p><strong>Materials and Methods:</strong> This retrospective cohort Study of 125 patients undergoing ACDF with a zero-profile stand-alone cage was conducted at Swat Medical Complex Teaching Hospital and Swat Medical College, Swat, KPK. Clinical outcomes (Neck Disability Index, Visual Analogue Scale for pain, modified Japanese Orthopaedic Association score) and radiological fusion were assessed preoperatively and at 3, 6, and 9 months. Predictors of fusion failure and functional improvement were identified using multivariable regression analyses.</p> <p><strong>Results:</strong> Mean age was 49.2±8.7 years; 55.2% were male. Significant improvements occurred across all measures (p&lt;0.001). Fusion rates were 90.1%, 80.0%, and 66.7% for single-level, two-level, and three-level procedures, respectively (trend p=0.015). Independent predictors of fusion failure were current smoking (odds ratio 3.35), multi-level surgery (odds ratio 3.74), and osteoporosis (odds ratio 4.66). Multi-level surgery was associated with significantly less Neck Disability Index improvement (3.21 points, p=0.002). The overall complication rate was 17.6%.</p> <p><strong>Conclusion:</strong> Zero-profile stand-alone cage ACDF is effective and safe, yielding high fusion rates and significant clinical improvement. Success is influenced by smoking, multi-level surgery, and osteoporosis, emphasizing the importance of patient selection and preoperative optimization.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Adnan Khaliq, Mian Iftikhar Ul Haq, Ubaid Ullah Mian, Adil Ahmed, Suleman Khan, Haider Ali, Alishba Hameed, Touba Azeem https://pakjns.org/index.php/pjns/article/view/1251 Beyond the Sella: Role of Sphenoid Sinus Pneumatization and Anatomical Variations in Determining Outcomes of Endoscopic Pituitary Surgery 2026-06-21T10:52:16+00:00 Usman Ahmad usmanschemer644@hotmail.com Syed Shahzad Hussain Shah usmanschemer644@hotmail.com Muhammad Irfan usmanschemer644@hotmail.com Mehwish Manzoor usmanschemer644@hotmail.com Omair Afzal usmanschemer644@hotmail.com Hamza Iqbal usmanschemer644@hotmail.com <p><strong>Objective:</strong> To assess whether anatomical variations of the sphenoid sinus (including pneumatization type, extent, course of optic nerve, and septal morphology) have an influence on surgical outcomes of endoscopic transsphenoidal surgery (ETSS) for pituitary tumors.</p> <p><strong>Materials &amp; Methods:</strong> A prospective cohort study was conducted at the Institute of Neurosciences, Lahore. We analyzed the details of 81 patients who underwent ETSS from June 2025 to December 2025. Sphenoid sinus pneumatization (pre-sellar, sellar, post-sellar), the degree of pneumatization (none, lateral extent, clivus extent, and lesser wing), Optic Nerve (ON) type (Type 1–4), and septum (single vs. double) were evaluated on preoperative CT FESS. T</p> <p><strong>Results:</strong> Majority of the patients were male, with a mean age of 46.8 ± 12.7 years, having a tumor exceeding 50 mm in size, in &gt;70% cases, with larger tumor size meaning longer surgical duration, as also seen in lateral and clival extension types. Sellar pneumatization pattern was most common, but pre-Sellar and post-Sellar varieties, along with clival extent and type 3 ON, were associated with a higher incidence of intra- and post-op complications. The inter-sphenoid septum type didn’t have any impact on surgical outcomes.</p> <p><strong>Conclusion:</strong> The anatomy of the sphenoid sinus has a marked effect on safety and ease of ETSS. Preoperative high-resolution CT FESS showing the type and extent of pneumatization and optic nerve variations should be a mandatory step in risk stratification and tailored treatment to avoid neuro-vascular injuries.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Usman Ahmad, Syed Shahzad Hussain Shah, Muhammad Irfan, Mehwish Manzoor, Omair Afzal, Hamza Iqbal https://pakjns.org/index.php/pjns/article/view/1250 Clinical Outcomes of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus: A Single-Center Observational Study 2026-06-21T10:38:20+00:00 Kamran Ullah mijdr1210@gmail.com Muhammad Irfan Javed mijdr1210@gmail.com Saddiq Ullah mijdr1210@gmail.com Muhammad Shafiq mijdr1210@gmail.com <p><strong>Introduction:</strong>&nbsp;&nbsp;Endoscopic third ventriculostomy (ETV) is a well-established treatment for obstructive hydrocephalus and provides a more physiologic alternative to shunt surgery. But there is variability in clinical outcomes.</p> <p><strong>Objective:</strong>&nbsp;&nbsp;To perform an exploratory analysis of factors associated with treatment success.</p> <p><strong>Methods:</strong>&nbsp;&nbsp;We conducted a retrospective observational study of 36 patients who received ETV for obstructive hydrocephalus between February 2023 and December 2025. Patient characteristics, etiology, clinical presentation, and outcomes were reviewed. ETV was considered successful if there was clinical improvement without requiring further cerebrospinal fluid diversion. Chi-square and independent t-tests were used for statistical analysis.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The mean age range was 15 ± 10 years, and 66.7% were men. The most common diagnosis was aqueductal stenosis (50%). The success rate was 80.6% and the complication rate 13.9%. There was no significant correlation between success and age (p = 0.18), sex (p = 0.34), or etiology (p = 0.21), but a trend towards higher rates of success was observed in patients with aqueductal stenosis.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;ETV is a safe, successful method of treating obstructive hydrocephalus with good short-term results. Although no statistically significant associations were found, a trend towards superior outcome in certain etiologies was noted. Further research with larger cohorts and longer follow-up is needed to better characterize factors associated with the outcome.</p> <p><strong>Keywords:</strong>&nbsp;&nbsp;ETV; obstructive hydrocephalus; aqueductal stenosis; CSF; neurosurgery; outcome</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Kamran Ullah, Muhammad Irfan Javed, Saddiq Ullah, Muhammad Shafiq https://pakjns.org/index.php/pjns/article/view/1249 Preoperative Cerebrospinal Fluid Diversion in Pediatric Posterior Fossa Tumor–Associated Hydrocephalus: Ventriculoperitoneal Shunt vs. External Ventricular Drainage 2026-06-21T10:28:21+00:00 Muhammad Ali Noman dr.imran_1984@yahoo.com Imran Khan dr.imran_1984@yahoo.com Muhammad Danial dr.imran_1984@yahoo.com <p><strong>Objective:</strong>&nbsp;&nbsp;Assess the effectiveness of preoperative strategies of cerebrospinal fluid (CSF) diversion in children with posterior fossa tumors and related hydrocephalus.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;The sample size of seventy pediatric patients (1-14 years) with hydrocephalus due to the presence of the posterior fossa tumors was taken. Ventriculoperitoneal (VP) shunting or external ventricular drainage (EVD) was used to treat patients. The complications that were recorded after the operations, and patients were monitored after three.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The mean age was 5.76 ± 3.589 years, and 58.6% were male. In 57.1 and 42.9 percent of patients, VP shunt and EVD were done, respectively. The number of cases of CSF leak was much lower in the VP shunt group (12.5% vs EVD 33.3, P &lt; 0.05). Other complications were also found more common in the EVD group but insignificant: Post-operative meningitis was found 2 times (5.820% ) in EVD compared to non-EVD, with pseudomeningocele, which was found 3 times out of seven patients, and which is an infection rate of 42 percent with no significant difference in both groups (p=0.584).</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Pediatric patients having hydrocephalus due to posterior fossa tumors will have fewer postoperative complications when the VP shunts are preoperative in comparison to EVD.</p> <p><strong>Keywords:</strong>&nbsp;&nbsp;Pediatric Neurosurgery, Complications, Hydrocephalus, Posterior Fossa Tumors, VP shunt, EVD.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Muhammad Ali Noman, Imran Khan, Muhammad Danial https://pakjns.org/index.php/pjns/article/view/1247 Frequency and Determinants of Surgical Intervention in Traumatic Epidural Hematoma Cases: A Retrospective Study 2026-06-21T10:14:51+00:00 Seema Sharafat, neurosurgeonzahid@yahoo.com Tamazar Noor neurosurgeonzahid@yahoo.com Mashal Khan neurosurgeonzahid@yahoo.com Zahid Khan neurosurgeonzahid@yahoo.com <p><strong>Objective:</strong>&nbsp;&nbsp;To determine the frequency of surgical intervention among patients with traumatic extradural hematoma (EDH) and identify clinical and radiological factors associated with the decision to operate.</p> <p><strong>Materials and Methods:</strong>&nbsp;&nbsp;A retrospective review of 141 patients diagnosed with traumatic EDH was conducted at a tertiary care neurosurgical center. Demographic, clinical, and radiological variables, including age, sex, Glasgow Coma Scale (GCS) at presentation, EDH volume, maximal thickness, midline shift (MLS), skull fracture, and the frequency of surgical intervention, were recorded. The chi-square test was used to assess associations, and independent predictors of surgery were identified using binary logistic regression. A p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Surgical evacuation of extradural hematoma (EDH) is required in nearly one-third of patients. Hematoma volume and thickness, together with neurological status at presentation, were the strongest predictors of operative management, which shows the importance of objective radiological parameters in surgical decision-making.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Seema Sharafat,, Tamazar Noor, Mashal Khan, Zahid Khan https://pakjns.org/index.php/pjns/article/view/1202 Accuracy of T2WI, DWI, & SWI MRI Sequences in The Diagnosis of Diffuse Axonal Injury: A Cross-Sectional Study 2026-02-25T04:23:03+00:00 Abdul Rauf Memon raufmemondr@gmail.com Aurangzeb Kalhoro draurangzebkalhoro@gmail.com Haseebullah Qazi alihaseebq@gmail.com Laeebah chaudhary Laeebah.ch@gmail.com <p><strong>Objective: </strong>To determine the diagnostic performance of T2WI, DWI, and SWI in the diagnosis of DAI in patients with traumatic head injury.</p> <p><strong>Materials &amp; Methods:</strong> The study was a cross-sectional study that involved 116 suspected DAI adults. Each of the participants received CT and MRI (T2WI, DWI, &amp; SWI). The results were recorded on demographic data, clinical parameters, and imaging. Chi-square tests were used to determine diagnostic utility.</p> <p><strong>Results: </strong>The average age was 32.6 years with a standard deviation of 10.2, and 67.2% were males. Sixty- three percent of injuries were a result of road traffic accidents. DAI was established in 70.7 per cent of patients. SWI micro bleeds were detected in 55.2 per cent, and they showed a statistically significant relationship with DAI (p &lt; 0.03). In 34.5% of the cases, there was DWI restriction in the corpus callosum, which was significantly related to DAI (p = 0.02). T2WI hyperintensities were common (67.2%), but they did not demonstrate any significant diagnostic association (p = 0.312). CT defects were not predictive of DAI.</p> <p><strong>Conclusion: </strong>SWI and DWI- especially corpus callosum involvement- have the best diagnostic value for the diagnosis of DAI when compared to CT and T2WI. SWI and DWI should be part of the regular imaging of moderate-to-severe TBI, as it significantly improves early diagnosis and clinical decision-making.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Abdul Rauf Memon, Aurangzeb Kalhoro, Haseebullah Qazi, Laeebah chaudhary https://pakjns.org/index.php/pjns/article/view/1201 Outcome Analysis of tPA Administration in Acute Ischemic Stroke Patients at Nishtar Hospital Multan 2026-02-21T20:25:13+00:00 Muhammad Fahad Saleem drfahad@msn.com Ubaid Ullah Ansari ubaidullah0264@gmail.com Sohaib Hassan hassannmc@gmail.com Muhammad Hamza Khan Hamzakhan00716@gmail.com Muhammad Wazir Ali Khan dralivazier@gmail.com Muhammad Wahab Qureshi drwahab@live.com Meer wasiq drmeerwasiq321@gmail.com Mohammad Wasay mohammadwasay@hotmail.com <p><strong>Objectives: </strong>To assess the efficacy (clinical outcome), recovery (disability), and safety of rtPA use through an investigation of patients who were treated at a tertiary hospital for acute ischemic stroke.</p> <p><strong>Materials &amp; Methods: </strong>Retrospective observational study included 115 adults age &gt;18 with an acute ischemic stroke who were treated with intravenous rt-PA at Nishtar Hospital Multan over a year period. Data was obtained from medical record regarding demographics, vascular risk factors, stroke subtype, time to presentation, door-to-needle time, and NIHSS scores at presentation and 90 days after treatment. Data were analyzed using SPSS version 25, ANOVA, and Pearson correlation were used to test for associations between age, stroke severity and outcomes.</p> <p><strong>Results: </strong>Mean age was 55 years and majority of patients suffered from hypertension (62.6%) or diabetes (42.6%). Highest incidence of stroke was as a result of a cardioembolic cause (40%). Majority of patients, 70.4%, still met 10-minute thrombolysis goal, even though they presented late. Majority of patients with 92(80%) showed improvement, recovery and symptoms not worsen during next 72 hours of hospital stay, whilst 14.8% had limited improvement and 5.2% died from stroke. Relationship of age and stroke severity was highly significant at both time of presentation and at 90 days post-stroke (r &gt; 0.89, p &lt; 0.01).</p> <p><strong>Conclusion: </strong>Administration of intravenous rt-PA was linked to a substantial enhancement in neurological function with low death rates even in hospitals with limited resources. Most definitive predictors of success were expedient acute in-hospital therapy (intervention) and adherence to a management protocol.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Muhammad Fahad Saleem, Ubaid Ullah Ansari, Sohaib Hassan , Muhammad Hamza Khan, Muhammad Wazir Ali Khan, Muhammad Wahab Qureshi , Meer wasiq, Mohammad Wasay https://pakjns.org/index.php/pjns/article/view/1217 Comparative Analysis of Percutaneous Full Endoscopic Lumbar Discectomy and Microdiscectomy in Terms of Preservation of Paraspinal Muscle Mass: A Retrospective Analysis 2026-03-17T11:14:39+00:00 Muhammad Farooq farooqendospine33@gmail.com Naeem-ul-Haq farooqendospine33@gmail.com Mumtaz Ali farooqendospine33@gmail.com Ali Shah Jehan farooqendospine33@gmail.com <p><strong>Aim:</strong> This study aimed to compare percutaneous full endoscopic lumbar discectomy and microdiscectomy in terms of preservation of paraspinal muscle mass.</p> <p><strong>Materials and Methods:</strong> This retrospective observational analysis was conducted at Farooq Neurospine Institute. The patient records were analyzed from 2020 to 2022, with a 1-year follow-up period. Adults aged 18-65 years diagnosed with lumbar disc herniation based on clinical and radiological findings and treated with either PEED or MD were included. Preoperative and postoperative CT and/or MRI scans were evaluated to measure the cross-sectional area (CSA) of paraspinal and iliopsoas muscles at affected and adjacent levels.</p> <p><strong>Results: </strong>Of the 480 patients analyzed, 247 underwent PFED, and 233 received MD. The PFED group outperformed the MD group in terms of improvements in muscle cross-sectional area at the one-year follow-up. In PFED, the right and left psoas muscles grew by 94.21 ± 45.0 and 59.28 ± 50.0 mm², but in MD, they decreased by 24.28 ± 50.0 and 41.51 ± 55.0 mm² (p = 0.020 and 0.151). PFED showed better muscle preservation, with paraspinal muscles increasing by 133.84 ± 70.0 and 126.97 ± 68.0 mm² compared to losses of 144.88 ± 75.0 and 112.74 ± 72.0 mm² in MD (p &lt; 0.001).</p> <p><strong>Conclusion:</strong> Radiological findings confirmed the superior muscle-preserving capacity of PFED compared to MD. Enhanced multifidus muscle strength and smaller reoperation incisions further demonstrated its minimally invasive benefits, contributing to reduced postoperative pain, faster recovery, and improved cosmetic outcomes</p> 2026-06-15T00:00:00+00:00 Copyright (c) 2026 Muhammad Farooq, Naeem-ul-Haq, Mumtaz Ali, Ali Shah Jehan https://pakjns.org/index.php/pjns/article/view/1259 Idiopathic Intracranial Hypertension with 6th And 7th Cranial Nerve Palsy 2026-06-21T18:30:45+00:00 Muhammad Usman drusman387@yahoo.com Aneeta Ghazal drusman387@yahoo.com Taimoor Ali drusman387@yahoo.com Naseer Hassan drusman79@hotmail.com Umer Farooq Khawaja drusman79@hotmail.com <p><strong>Background:</strong> Pseudotumor cerebri or Idiopathic Intracranial Hypertension (IIH) is a rare condition noted in children and adults; however, it is more common in females of childbearing age, with a female-to-male ratio of 8:1<sup>1, 2</sup>. The common typical symptoms of IIH are headache, transient blurring of vision, while others are visual loss, diplopia, and pulsatile tinnitus.<sup>3,4 </sup>We presented a case of IIH with cranial nerve palsies.</p> <p><strong>Case Report:</strong> A 30-year-old female patient presented with nausea, vomiting, headache, visual deterioration, and an uncommon presentation of 6<sup>th</sup> and 7<sup>th</sup> cranial nerve palsy, diagnosed as a case of IIH. On further examination and systemic investigation, there was also an associated undiagnosed polycystic ovarian disease. The purpose of this case is to highlight two important and uncommon factors, such as 7<sup>th</sup> cranial nerve palsy and polycystic ovarian disease, that existed in this case of idiopathic intracranial hypertension.</p> 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Muhammad Usman, Aneeta Ghazal, Taimoor Ali, Naseer Hassan, Umer Farooq Khawaja https://pakjns.org/index.php/pjns/article/view/1245 Neurosurgical Procedures in Patients with Liver Cirrhosis 2026-06-18T19:50:11+00:00 Adnan Salim adnansalim1147@gmail.com 2026-06-18T00:00:00+00:00 Copyright (c) 2026 Adnan Salim