Pakistan Journal Of Neurological Surgery

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

Adnan Khaliq — 2026-06-18

Objective: 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.

Materials and Methods: 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.

Results: Mean age was 49.2±8.7 years; 55.2% were male. Significant improvements occurred across all measures (p<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%.

Conclusion: 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.

Outcome Analysis of tPA Administration in Acute Ischemic Stroke Patients at Nishtar Hospital Multan

Muhammad Fahad Saleem — 2026-06-18

Objectives: 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.

Materials & Methods: Retrospective observational study included 115 adults age >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.

Results: 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 > 0.89, p < 0.01).

Conclusion: 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.

Accuracy of T2WI, DWI, & SWI MRI Sequences in The Diagnosis of Diffuse Axonal Injury: A Cross-Sectional Study

Abdul Rauf Memon — 2026-06-18

Objective: To determine the diagnostic performance of T2WI, DWI, and SWI in the diagnosis of DAI in patients with traumatic head injury.

Materials & Methods: The study was a cross-sectional study that involved 116 suspected DAI adults. Each of the participants received CT and MRI (T2WI, DWI, & SWI). The results were recorded on demographic data, clinical parameters, and imaging. Chi-square tests were used to determine diagnostic utility.

Results: 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 < 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.

Conclusion: 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.

Frequency and Determinants of Surgical Intervention in Traumatic Epidural Hematoma Cases: A Retrospective Study

Seema Sharafat, — 2026-06-18

Objective: 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.

Materials and Methods: 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 <0.05 was considered statistically significant.

Conclusion: 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.

Preoperative Cerebrospinal Fluid Diversion in Pediatric Posterior Fossa Tumor–Associated Hydrocephalus: Ventriculoperitoneal Shunt vs. External Ventricular Drainage

Muhammad Ali Noman — 2026-06-18

Objective: Assess the effectiveness of preoperative strategies of cerebrospinal fluid (CSF) diversion in children with posterior fossa tumors and related hydrocephalus.

Materials & Methods: 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.

Results: 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 < 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).

Conclusion: Pediatric patients having hydrocephalus due to posterior fossa tumors will have fewer postoperative complications when the VP shunts are preoperative in comparison to EVD.

Keywords: Pediatric Neurosurgery, Complications, Hydrocephalus, Posterior Fossa Tumors, VP shunt, EVD.

Clinical Outcomes of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus: A Single-Center Observational Study

Kamran Ullah — 2026-06-18

Introduction: 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.

Objective: To perform an exploratory analysis of factors associated with treatment success.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ETV; obstructive hydrocephalus; aqueductal stenosis; CSF; neurosurgery; outcome

Beyond the Sella: Role of Sphenoid Sinus Pneumatization and Anatomical Variations in Determining Outcomes of Endoscopic Pituitary Surgery

Usman Ahmad — 2026-06-18

Objective: 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.

Materials & Methods: 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

Results: 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 >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.

Conclusion: 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.

Correlation Between Polycystic Ovary Syndrome and Neuropsychiatric Manifestations: Clinical and Hormonal Perspectives

Surraya Israr — 2026-06-18

Objective: 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.

Materials & Methods: 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.

Results: 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.

Conclusion: 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.

CT Detection of Subarachnoid Hemorrhage Correlated with Clinical Severity Using Hunt and Hess Grading

Zeenat Adil — 2026-06-18

Objective: 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.

Materials & Methods: 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.

Results: 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.

Conclusion: 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.

Prevalence and Correlates of Obsessive-Compulsive Disorders Among University Students in Peshawar

Ammar Munawar — 2026-06-18

Objective: 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.

Materials & Methods: 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.

Results: 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.

Conclusion: 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.

Association Between Vitamin D Deficiency and Carpal Tunnel Syndrome

Kamran Alamgir — 2026-06-18

Objective: 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.

Materials & Methods: 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.

Results: 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 < 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;
p = 0.005).

Conclusion: 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.

Role of Emergency Medicine in Identifying and Stabilizing Acute Neuroinfections

Hamaad Gul Mohmand — 2026-06-18

Objective: 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.

Materials and Methods: 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.

Results: 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%).

Conclusion: 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.

Comparative Analysis of Percutaneous Full Endoscopic Lumbar Discectomy and Microdiscectomy in Terms of Preservation of Paraspinal Muscle Mass: A Retrospective Analysis

Muhammad Farooq — 2026-06-15

Aim: This study aimed to compare percutaneous full endoscopic lumbar discectomy and microdiscectomy in terms of preservation of paraspinal muscle mass.

Materials and Methods: 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.

Results: 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 < 0.001).

Conclusion: 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

Neurosurgical Procedures in Patients with Liver Cirrhosis

Adnan Salim — 2026-06-18

Idiopathic Intracranial Hypertension with 6th And 7th Cranial Nerve Palsy

Muhammad Usman — 2026-06-18

Background: 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^{1, 2}. The common typical symptoms of IIH are headache, transient blurring of vision, while others are visual loss, diplopia, and pulsatile tinnitus.^3,4We presented a case of IIH with cranial nerve palsies.

Case Report: A 30-year-old female patient presented with nausea, vomiting, headache, visual deterioration, and an uncommon presentation of 6^th and 7^th 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^th cranial nerve palsy and polycystic ovarian disease, that existed in this case of idiopathic intracranial hypertension.