Pakistan Journal Of Neurological Surgery <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=""></a>)</p> <p>Journal Email:</p> <p>Publisher link: (<a href=""></a>)</p> <p>Email:</p> Pakistan Society of Neurosurgeons (PSN). Website: Email, Email: en-US Pakistan Journal Of Neurological Surgery 1995-8811 <p>The work published by PJNS is licensed under a Creative Commons Attribution-<a href="" target="_blank" rel="noopener">NonCommercial 4.0 International (CC BY-NC 4.0).</a> Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).</p> Need for Training of the Young Neurosurgeon for Vascular Surgery Muhammad Anwar Chaudary Saman Shahid Copyright (c) 2023 Muhammad Anwar Chaudary, Saman Shahid 2023-12-01 2023-12-01 27 4 x x 10.36552/pjns.v27i4.947 The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country <p><strong>Background</strong><strong>:</strong> In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction.</p> <p><strong>Methodology:</strong> This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25.</p> <p><strong>Results</strong>: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%).</p> <p><strong>Conclusion:</strong> BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.</p> Faiqa Filza Almas Fasih Khattak Leena Ayesha Khial Jalal Wajid Ali Majid Ayaz Zahid Khan Copyright (c) 2023 Faiqa Filza 2023-12-01 2023-12-01 27 4 437 445 10.36552/pjns.v27i4.899 Frequency of Deranged Lipid Profile in Patients with Stroke <p><strong>Objective</strong><strong>:</strong>&nbsp;&nbsp;This study aims to find out the frequency of patients with strokes at Lady Reading Hospital in Peshawar have abnormal lipid profiles.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;The Department of Medicine at Lady Reading Hospital in Peshawar conducted this cross-sectional, descriptive study. There were 96 patients in all, both genders, who presented with a stroke between the ages of 30 and 70. Individuals with CRF (chronic renal failure), CLD (chronic liver disease), or medications that reduce cholesterol were not included. Blood samples were collected and transferred to the laboratory to measure the lipid profile.</p> <p><strong>Results:</strong>&nbsp;&nbsp;In this study, the age range was 30 to 70 years old, with a mean age of 53 years. The majority of the patients (54.17%) ranged in age from 51 to 70. There were 58.33% males and 41.67% females. 40 (41.67%) stroke patients had a disordered lipid profile. Of the stroke patients, 41.67% had abnormal total cholesterol, 53.13% abnormal LDL cholesterol, 25.0% abnormal triglyceride levels, and 21.88% abnormal HDL cholesterol.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;This study concluded that the frequency of dyslipidemia in stroke patients is very high. With this knowledge, specialized statin drugs could be created, leading to better disease control. Patients with ischemic stroke were more likely than those with hemorrhagic stroke to have abnormalities in their lipid levels.</p> <p><strong>Keywords:</strong>&nbsp;&nbsp;Stroke, Cholesterol level, Dyslipidaemia, Lipid Profile, Cerebrovascular Accidents.</p> Naseem Ur Rehman Muhammad Bilal Syed Ahmad Shah Muhammad Imran Adeela Masood Copyright (c) 2023 Naseem Ur Rehman, Muhammad Bilal, Syed Ahmad Shah, Muhammad Imran, Adeela Masood 2023-12-01 2023-12-01 27 4 507 515 10.36552/pjns.v27i4.943 Association of Hydrocephalus in Children with an Encephalocele <p><strong>Objectives:</strong> To describe the association between the occipital encephaloceles with hydrocephalus and how to improve the outcome of patient.</p> <p><strong>Methodology</strong>: <span style="font-size: 0.875rem;">Our </span><span style="font-size: 0.875rem;">Prospective </span><span style="font-size: 0.875rem;">study collected records of fifty patients diagnosed with posterior encephaloceles. Data were collected on the gender, location of the encephalocele, presence of neural tissue , dandy walker, microcephaly and hydrocephalus.</span></p> <p><strong>Results</strong>: Twenty-nine females and twenty-one males were present. Over half of the lesions were supratorcular, while the remaining eight (16%) were torcular and the remaining seventeen (34%) were infratorcular. Primary encephalocele repair were done at an average of 9 days (range 2.5–120 days). In twenty-five of the instances, a diagnosis of hydrocephalus was made. Twenty-four patients had a ventriculo-peritoneal shunt implanted. The average age of implantation of VP shunt was only 1.2 months (range 0.3–9 months). One patient underwent an endoscopic third ventriculostomy with good results. Hydrocephalus was related with Dandy-Walker and ventriculomegaly before encephalocele surgery was performed (<em>p</em> values 0.01 and 0.05, respectively). For hydrocephalus therapy, </p> <p><strong>Conclusions: </strong>Patients born with encephaloceles frequently suffer from hydrocephalus (50%). This is especially true in cases where the patient also has Dandy-Walker syndrome, CMIII malformation, or pre-existing ventriculomegaly. The severity of large encephaloceles is a limiting factor for the development of hydrocephalus when connected with torcular types and microcephaly.</p> Sagheer Habib Iram Bokhari Tanveer Ahmed Rabail Akbar Raheel Gohar Anas Ahmed Copyright (c) 2023 Sagheer Habib, Iram Bokhari, Tanveer Ahmed, Rabail Akbar, Raheel Gohar, Anas Ahmed 2023-12-01 2023-12-01 27 4 384 393 10.36552/pjns.v27i4.864 The Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM) <p><strong>Objective:</strong> Motor neuron disease (MND) can occur in patients with cervical spondylotic myelopathy. The purpose of this study was to determine the prevalence of motor neuron disease in individuals suffering from cervical spondylotic myelopathy (CSM).</p> <p><strong>Materials &amp; Methods:</strong> A prospective study was conducted at the Lady Reading Hospital. The patients<br />(n = 70) included were between ages 55 to 75 with established clinical and radiological diagnoses of CSM. Motor neuron disease was diagnosed clinically by Awaji criteria. The patients were evaluated with NCS/EMG (Nerve Conduction Studies/Electromyography) and followed for 6 months. The motor neuron disease was confirmed by modified El Escorial criteria.</p> <p><strong>Results:</strong> 40 patients had bilateral upper limb weakness (57%), however, the rest of the 30 patients had unilateral upper extremity weakness (42.8%). Hoffman’s sign was positive in 60% of patients. Lhermitte's sign was also positive in 31% of patients. The majority of patients (55.7%) were found with grade 4 for deltoid followed by 51.4% patients for biceps brachii. MRI showed anterior cord compression at the level of C5 and C6 in 27.14% of patients and C6 C7 in 32.8% of patients. 15.7% of patients were suspected of having both CSM and MND. </p> <p><strong>Conclusion:</strong> CSM and MND can occur in the same patients. The incidence of MND is 5.7% in patients with cervical spondylotic myelopathy, hence in CSM patients, workup must be done for MND as it affects the outcome of surgery in these patients.</p> Sahibzada Haseeb Ahmed Nawaz Khattak Muhammad Kashif Jamal Copyright (c) 2023 Sahibzada Haseeb Ahmed, Nawaz Khattak, Muhammad Kashif Jamal 2023-12-01 2023-12-01 27 4 394 402 10.36552/pjns.v27i4.914 Text Neck Syndrome among Undergraduate Students in Lahore, Pakistan <p><strong>Objective:</strong>&nbsp;&nbsp;To evaluate the frequency, severity, and prevalence of Text Neck Syndrome among undergraduate students using mobiles, tablets, or laptops.</p> <p><strong>Material and Methods:</strong>&nbsp;&nbsp;The descriptive study was conducted in two private colleges in Lahore after approval from the institutional review board of Sharif Medical and Dental College, Lahore, Pakistan. Students with ages greater than 16 years who used mobile phones daily for more than 1 hour were enrolled. Baseline demographic information was collected and questions regarding the duration of phone usage and neck pain were asked. Calculated a sample size of 266 with the help of the WINPEPI statistical program with a confidence of 95% and acceptance difference of 0.06 with an assumed proportion of 0.46.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The age range was 18 – 23 years. Out of 266 undergraduate students, 122 (46%) were male and 144 (54%) were female. 157 (59%) students reported having neck pain: Mild in 88 (56.1%), Moderate in 55 (35%), and Severe in 14 (8.9%) students according to self-perception. 97 (61.8%) students were intermittent, 35 (22.3%) had continuous, and 25 (15.9%) had debilitating neck pain.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;According to this study, Text Neck Syndrome was common in undergraduate students using smartphones, tablets, or laptops.</p> Syed Ali Zunair Babar Butt Farhan Fateh Jang Amna Malik Nasir Raza Awan Copyright (c) 2023 Syed Ali Zunair, Babar Butt, Farhan Fateh Jang, Amna Malik, Nasir Raza Awan 2023-12-01 2023-12-01 27 4 454 463 10.36552/pjns.v27i4.936 Incidence of Ventriculoperitoneal (VP) Shunt Infection In Vancomycin-Drenched VP Shunts <p><strong>Objective:</strong> To determine the occurrence of infection in patients with VP (Ventriculoperitoneal) shunts that were drenched in vancomycin.</p> <p><strong>Materials and Methods:</strong> A descriptive case series study was done in The Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from 10 September 2019 to 31 December 2020 to ascertain the frequency of VP shunt infections in vancomycin-drenched VP shunts. The patients were followed for 06 months.</p> <p><strong>Results:</strong> A total of 100 patients were included in this study. There were 44 (44%) men and 56 (56%) women. Age ranged from birth to 18 years. Patients younger than 1 year were 44 (44%), older than 1 to 10 years were 33 (33%) and older than 10 years were 23 (23%). Congenital hydrocephalus was the most common type observed in 49 (49%) patients. Shunt infection occurred in 7 patients (7%) within 6 months after surgery. Staphylococcus aureus was the most common pathogen identified in 05 of 07 (71%) infected patients. P value &lt;0.05 was observed in Vancomycin-soaked VP shunts and shunt infection, which is significant.</p> <p><strong>Conclusion:</strong> The rate of shunt infection was significantly reduced when 2 mg/mL topical vancomycin was used intraoperatively (intra- and peri-shunt) in conjunction with a multi-step shunt infection prevention program. This treatment may be less expensive than using an antibiotic-impregnated catheter (AIC).</p> Muhammad Nawaz Khan Mudasir Shah Arshad Khan Sajjad Ullah Muhammad Salman Copyright (c) 2023 Muhammad Nawaz Khan, Mudasir Shah, Arshad Khan, Sajjad Ullah, Muhammad Salman 2023-12-01 2023-12-01 27 4 500 506 10.36552/pjns.v27i4.707 Assessment of Neuropsychological Impairment among Individuals with a History of Head Trauma – A Case-Control Analysis <h3>Objective: To determine the frequency of different neuropsychological impairments in traumatic head injury survivors compared to those without a history of head trauma.</h3> <h3>Materials and Methods: A case-control study was done in Karachi, Pakistan, during February 2023 and March 2023, with participants aged 18 and above, of both genders, with or without a history of head trauma forming the case and control groups, respectively. Individuals with a history of head trauma or congenital neurological impairment were not included. Screening tools included the ESS, UNS, GAD-7 scale, and PHQ-9.</h3> <h3>Results: A total of 303 participants were enrolled, out of these 128 (42.2%) were in the case group and 175 (57.8%) were in the control group. The most common source of head injury was Road Traffic Accidents (53.9%, n = 69). 143 (63.8%) out of 224 males had a positive history of head trauma in their lifetime, making the male gender more susceptible. The majority who had a history of head trauma lie in the age group &lt; 21 years (52.6%, n = 110). No significant association was found between the interpretations of screening scales and history of head trauma.</h3> <h3>Conclusion: Traumatic head injuries and their long-term consequences can predispose a person to experience any cognitive impairment in their life. However, in this study, we could not find significant neuropsychiatric deficits in patients with a history of head trauma. Therefore, it is crucial to conduct further large-scale, multi-center, and controlled studies to explore the cognitive and psychological impairment associated with head trauma.</h3> Javeria Khan Zainab Shamim Khudija Tehreem Kiran Abbas Moiz Ahmed Farrukh Javeed Copyright (c) 2023 Javeria Khan, Zainab Shamim, Khudija Tehreem, Kiran Abbas, Moiz Ahmed, Farrukh Javeed 2023-12-01 2023-12-01 27 4 403 411 10.36552/pjns.v27i4.910 Significance of Relationship Between Lumbar Disc Degeneration and Modic Changes in Acute Disc Herniation <p><strong>Objective:</strong>&nbsp;&nbsp;To determine the significance of the relationship between lumbar disc degeneration and Modic changes in acute disc herniation.</p> <p><strong>Materials and Methods:</strong>&nbsp;&nbsp;This study included 323 patients 25 to 42 years of age having acute symptoms of acute single-level lumbar disc herniation. A simple random sampling technique was used to enroll these patients. MRI lumbosacral spine 1.5 tesla was done on all patients. The patients and MRIs were evaluated by a consultant neurosurgeon and anesthetist both having more than five years of clinical experience. The disc herniations, their types, disc degeneration by Pfirrmann grading, Modic changes in end plates, their types, and location were assessed.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The mean age was 34.2±3 years. Males were 185 and females were 138. A total of 1615 discs from L1 to S1 of 323 patients were evaluated. 785 (48.6%) discs had degeneration, 356(22.0%) discs had herniation, 339(20.9%) discs had Modic changes. Out of the 356 herniated discs, 347(97.4%) discs had disc degeneration while 9(2.5%) discs did not have degeneration with a p-value &lt;0.001. Out of the 356 herniated discs, 66(18.5%) discs had Modic changes while 290(81.4%) discs did not have Modic changes with a p-value &lt;0.001.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;We conclude that disc degeneration and Modic changes had a significant association with acute disc herniation.</p> Waqas Noor Chughtai Muhammad Umar Jamal Saeed Ahmad Nauman Ahmed Tahira Fatima Muhammad Umer Farooq Copyright (c) 2023 Waqas Noor Chughtai, Muhammad Umar Jamal, Saeed Ahmad, Nauman Ahmed, Tahira Fatima, Muhammad Umer Farooq 2023-12-01 2023-12-01 27 4 516 532 10.36552/pjns.v27i4.944 incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital <p><strong>Objective:</strong> The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment.</p> <p><strong>Materials &amp; Methods:</strong> A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &amp;sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &amp;dislocations), ligamentous injuries &amp; SCIWORA. The primary outcome was the functional status at 6 months following treatment.</p> <p><strong>Results:</strong> There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery. </p> <p><strong>Conclusion:</strong> Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.</p> sahibzada haseeb ahmed abbas khan Copyright (c) 2023 sahibzada haseeb ahmed, abbas khan 2023-12-01 2023-12-01 27 4 420 429 10.36552/pjns.v27i4.917 Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital <p><strong>Objective:</strong>&nbsp;&nbsp;To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries.</p> <p><strong>Methods:</strong>&nbsp;&nbsp;This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.</p> <p>&nbsp;</p> Aurangzeb Kalhoro Muhammad Hamid Ali Vashdev Khimani Raiz Ahmed Raja Mahesh Kumar Luhano Copyright (c) 2023 Aurangzeb Kalhoro, Muhammad Hamid Ali, Vashdev Khimani, Raiz Ahmed Raja, Mahesh Kumar Luhano 2023-12-01 2023-12-01 27 4 475 481 10.36552/pjns.v27i4.937 Evaluation of the Outcome of Transpedicular Fixation for Thoracic and Lumbar Tuberculous Spine Disease <p><strong>Objective: </strong>Pakistan stands sixth in countries, contributing 60% of new TB cases worldwide. TB can involve a wide variety of organs including the spine which at times need neurosurgical intervention. This study aims to determine the overall clinical and radiological outcomes in patients with dorsolumbar spine TB managed by posterior transpedicular screw fixation. The study focused to evaluate the outcome of transpedicular screws fixation for the thoracic and lumbar tuberculous spine.</p> <p><strong>Materials and Methods: </strong>The study included a total of 60 patients were observed. A complete history and systemic physical examination was done. Pre-operative anteroposterior and lateral view radiographs were taken to measure the height of the vertebral body, kyphotic angulation, and sagittal plane index. Short-segment transpedicular fixation was done under general anesthesia by consultant neurosurgeons. All patients were asked for follow-up after one month. Post-operative anteroposterior plus lateral view radiographs were done to measure the height of the vertebral body, kyphotic angulation, and sagittal index.</p> <p><strong>Results: </strong>In our study mean age was 47 years. 58%patients were males and 42% of patients were female. The mean postoperative vertebral height was 18.93 mm ± 1.17 and the mean postoperative Kyphotic angle was 9.68 degree ± 4.03º. The mean postoperative Sagittal index was 5.83 ± 4.55.</p> <p><strong>Conclusion: </strong>The outcome of transpedicular fixation of vertebral height was 18.93 mm ± 1.17, Kyphotic angle was 9.68 degree ± 4.03º) and Sagittal index was (5.83 ± 4.55) for thoracic &amp; lumbar tuberculous spine.</p> Saad Sultan Ibrahim Amer Zaman Junaid Alam Fizza Gul Copyright (c) 2023 Saad Sultan, Ibrahim, Amer Zaman, Junaid Alam, Fizza Gul 2023-12-01 2023-12-01 27 4 412 419 10.36552/pjns.v27i4.849 Head Injury Due to Fall from Heights in Pediatric Population of a Middle Resource Country <p><strong>Objective:</strong> One of the serious concerns for public health is unintentional injuries<strong>. </strong>Falls rank as the second most common cause of unintentional injury deaths globally, after injuries sustained in transportation accidents. The study's goals were to check the mechanisms and severity of the head injury from falls among children.</p> <p><strong>Materials and Methods:</strong> A non-randomized retrospective study was conducted and children aged 0 – 12 years (n = 228) undergoing cranial CT guidance for head injury were enrolled. All patients were treated under the supervision of the neurosurgery department. Detailed radiological evaluation was done and recorded on specialized proforma.</p> <p><strong>Results:</strong> Among the enrolled patients, mild head injury was noted in 49.1% of children while moderate head injury was noted among 40.4% of children. A total of 72 (31.6%) patients had skull fractures, of which 12 (5.3%) had a thin underlying subdural hemorrhage. Four cases of extradural hemorrhage complicated a skull fracture, and eight cases of isolated Subdural hemorrhage (SDH) were observed without a skull fracture. Of those 48 (21%), radiologically evident diffuse axonal injuries were present, and each of them included high-force injury mechanisms.</p> <p><strong>Conclusion:</strong> When children sustain minor trauma, skull fractures, and focal SDH are rather common, although most of the time there are no long-term neurological effects. On the other hand, patients with an equally severe cause of injury were the only ones who experienced diffuse brain injury with significant neurological disability that followed.</p> Iqbal ahamad Muhammad Hassan Raza Adnan Qasim Eram Abbas Sheraz Ahmad Muhammad Kashif Chishti Copyright (c) 2023 Iqbal ahamad, Muhammad Hassan Raza, Adnan Qasim, Eram Abbas, Sheraz Ahmad, Muhammad Kashif Chishti 2023-12-01 2023-12-01 27 4 430 436 10.36552/pjns.v27i4.912 THE Recurrence Rate After Using Subdural Drain in Patients with Chronic Subdural Hematoma <p><strong>Objective: </strong>One of the most often carried out procedures in the neurosurgical field is the drainage of chronic subdural hematomas (CSDHs). According to Scotti, subdural hematoma was identified radiologically as a subdural collection that was hypodense to parenchyma and manifested 21 days following trauma. This definition was based on the CT scan. In this study, we want to find the effectiveness of subdural drain in managing chronic subdural hematoma from the perspective of recurrence in our setup.</p> <p><strong>Materials and Methods: </strong>After the procedure, the patients were admitted to the ward for 48 hours and the drain was removed after 48 hours. Then the patients were discharged and follow-up was taken one month for diagnosis of recurrence. Recurrence was labeled positive if postoperative symptomatic recurrence of hematoma that needs re-operation of any type within one month of primary surgery.</p> <p><strong>Results: </strong>Among 85 patients mean age was 51 years with a standard deviation ± 7.55. 60(71%) patients were male and 25(29%) patients were female. Moreover s10 (12%) patients had recurrence while 75(88%) patients didn’t have recurrence.</p> <p><strong>Conclusion:</strong> According to our research, patients with Chronic Subdural Hematoma (CSDH) had a 12% recurrence incidence following the placement of a subdural drain.</p> Hameed Ullah Amer Zaman Waseef Ullah Junaid Alam Atta Ullah Bilal Ahmad Copyright (c) 2023 Hameed Ullah, Amer Zaman, Waseef Ullah, Junaid Alam, Atta Ullah, Bilal Ahmad 2023-12-01 2023-12-01 27 4 531 537 10.36552/pjns.v27i4.934 The Outcome of Prolactinoma in the Postpartum Period: a Study from a Tertiary Care Hospital in Pakistan <p><strong>Objective:</strong> Prolactin is an essential hormone secreted by the pituitary gland of pregnant women. The pituitary gland undergoes growth, due to lactotroph hyperplasia in response to placental estrogen during pregnancy. Research on the postpartum outcomes of prolactinomas is less. This study evaluates the prevalence of Prolactinoma and the occurrence of spontaneous resolution of Prolactinomas after pregnancy.</p> <p><strong>Materials and Methods:</strong> A cross-section study was conducted at the Punjab Institute of Neurosciences, Lahore. 200 pregnant women were recruited; their blood samples were collected to evaluate serum prolactin levels. Women diagnosed with prolactinomas exhibiting positive symptoms were given dopamine agonists. The administration of dopamine agonist was discontinued at the 24th week of gestation. All participants were monitored till birth, at 40 days after delivery, and throughout breastfeeding. Their prolactin levels were evaluated, and magnetic resonance imaging (MRI) was conducted to verify the resolution of prolactinoma.</p> <p><strong>Results:</strong> The mean age of females in the study was 29.03 ± 7.20 years. Out of 200, 40 (20%) females had prolactinoma. Out of 40, 13 (32.5%) were given Bromocriptine while 27 (67.5%) were given Cabergoline. At presentation, the mean serum prolactin level was 138.91 ± 149.02 ng/ml, which reduced to 21.38 ± 9.80 ng/ml. The mean tumor size at presentation was 7.23 ± 2.07 mm, which reduced to 0.79 ± 0.66 mm after delivery. Out of 40, 30 (75.0%) had spontaneous resolution.</p> <p><strong>Conclusion:</strong> The occurrence of prolactinoma is low in symptomatic patients and can resolve spontaneously after delivery in the majority of cases.</p> Shirin Gul Suhail Omair Afzal Zahra Safdar Rizwan Ahmad Khan Uzma Zia Copyright (c) 2023 Shirin Gul Suhail, Omair Afzal, Zahra Safdar, Rizwan Ahmad Khan, Uzma Zia 2023-12-01 2023-12-01 27 4 446 453 10.36552/pjns.v27i4.928 Management of intrasellar arachnoidocele <p>Arachnoidocele in its sellar location is not common. The variability of its clinical signs and the lack of standard treatment make the management complex. The authors report a clinical case through which therapeutic modalities will be discussed. We report a case of a 42-year-old patient who complained of intermittent headaches of progressively increasing intensity over the past 2 years. The persistence of the headaches despite analgesic treatment had motivated the performance of a brain CT scan and then an MRI which had objectified the presence of an intrastellararachnoidocele. The endocrine laboratory function was normal. Short-term treatment with morphine and corticosteroids had achieved a rapid and long-lasting course after a 2-year follow-up. Endoscopic surgery is a treatment option for sellar arachnoidocele. The indication must take into account the clinical and radiological elements because some sellar arachnoidocele evolve favorably under drug treatment.</p> Diallo Moussa Tokpa André Valentin Youssouf Traoré Koumaré Izoudine Blaise Youssouf Sogoba Sogoba Boubacar Oumar Diallo Kanikomo Drissa Copyright (c) 2023 Diallo Moussa, André Jaques Valentin Tokpa, Youssouf Traoré, Koumaré Izoudine Blaise, Youssouf Sogoba, Sogoba Boubacar, Oumar Diallo, Kanikomo Drissa 2023-12-01 2023-12-01 27 4 482 487 10.36552/pjns.v27i4.930 Radiological Verses Histological Evaluation of Spinal Space Occupying Lesions <p><strong>Objective:</strong> This study set out to evaluate radiology's diagnostic capacity in accurately establishing a preliminary working diagnosis for various spine tumor types.</p> <p><strong>Materials and Methods:</strong> This is a prospective study carried out and examined patients who had surgical resection with the collection of histopathology samples, regardless of age or gender. A full MRI examination from every angle and contrast-enhanced pictures were required. Inclusion criteria consisted of Patients of all ages of both genders, who underwent surgery a tissue sample was collected for histopathological diagnoses, and a complete MRI study with all views and contrast-enhanced images was available to give a preliminary diagnosis.</p> <p><strong>Results:</strong> Based on the evaluation by the senior radiologists, the lesions were most commonly intradural-extramedullary (50%) in position according to the dura, followed by intramedullary in 14 (26.9%) patients. Despite our series having a total of 16 misdiagnosed cases, the overall diagnostic accuracy of the MRI remained high at 69.2%.</p> <p><strong>Conclusion:</strong> MRI has superior diagnostic accuracy in diagnosing meningiomas as compared to nerve sheath tumors such as meningiomas. It also has good predictive accuracy of intramedullary lesions such as ependymomas.</p> Sabika aftab Rabail Akbar Tanweer Ahmed Lal Rehman Iram Bokhari Sana Akbar Copyright (c) 2023 Sabika aftab, Rabail Akbar, Tanweer Ahmed, Lal Rehman, Iram Bokhari, Sana Akbar 2023-12-01 2023-12-01 27 4 464 474 10.36552/pjns.v27i4.876