Background: Median nerve compression in hand at the level of transverse ligament leads to numbness and pain in the hands, which results in discomfort in daily routine work has a psychological impact. The objective of the present study was to evaluate the modified mini-incision at the transverse crease in carpal tunnel syndrome. Methodology: A prospective descriptive study was conducted at Neurospinal & cancer care Institute, Karachi, from January 2012 – February 2020. Patients who were diagnosed with clinical symptoms, positive Phalen and Tinel test and confirmed with EMG finding of carpal tunnel syndrome were included in the study. Patients were operated through modified mini-incision at the transverse crease. The outcome was recorded in the form of pain relief, healing time with restoration of daily life activity and scar adhesion on follow-up. Results: A total of 97 patients were included. The male to female ratio was 1:7.8. The mean age was 40 ± 19.5 years. The right hand was 72.2%, the left hand was 13.4%, and the bilateral was 14.4%. VAS score improved 2 grades in 96%, and pinch grip improved in 98% of patients in one month. Only 2% of patients had stiffness after surgery Conclusion: Minimal incision carpal tunnel release has shown positive outcome in median nerve compression, having limited skin incision, safe, feasible and minimizing the scar assist help in early return to work.

Background: Magnetic Resonance Spectroscopy (MRS) combined Magnetic Resonance Spectroscopic Imaging (MRSI) can diagnose brain lesions and help manage several diseases. It has the advantage of differentiating neoplastic brain lesions from non-neoplastic brain lesions based on metabolic changes of the brain. The present study focuses on Magnetic Resonance Spectroscopy (MRS) assessment accuracy in the diagnosis of brain lesions. Methodology: A prospective, non-probability, consecutive sampling study was conducted at the Neurospinal & Cancer care institute, Karachi-Pakistan, from June 2017 to September 2020. A total of 161 patients with brain space-occupying lesions shown on MRI brain contrast and associated with clinical symptoms of headache, fits, or limb weakness was included in the study. The single voxel method was used for MRS; after contrast. MRI was used to localize the pathology in the brain, and the voxel was used in the area of heed interest. Results Spectroscopy interpretation showed that 114(70.8%) patients were diagnosed with a brain tumour, 41 (25.46%) had a non-neoplastic entity, and 6 (3.72%) were reported as non-specified. MR Spectroscopy reported non-neoplastic entities in 41 (25.46%) patients by spectroscopy. among them, 39(95.12%) patients had decreased choline, NAA and creatinine peaks, raised lactate peak 16(39.02%), lipid peaks 20(48.78%), while in 4 (9.75%) patients the peaks were absent.  Conclusion: This study recommends that MR spectroscopy has a high accuracy for the diagnostic purpose of neoplastic and non-neoplastic, which is 91.33% which can affect the course of the treatment plan and it can help to avoid unnecessary delay in management.

A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°–20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases.

Objective: Aim of current study is to determine and compare the outcomes of surgical versus conservative treatment of traumatic extradural hematoma in the supratentoral region. Study Design: Prospective/ Randomized study Place and Duration: Conducted at Neurosurgery department of Bacha khan Medical College / Mardan Medical Complex Mardan and Frontier Medical and Dental College Abbottabad for duration of six months from April 2021 to September 2021. Methods: There were one hundred and eight patients of both genders with ages 14-55 years were included. Included patients had traumatic extradural hematoma in the supratentoral region. Demographically detailed included cause of trauma, age and gender were calculated after taking informed written consent. CT scan was performed among all the patients to diagnose hematoma. Patients were equally categorized into two groups. Group I received surgical treatment and group II received conservative treatment. Symptoms and complications among both groups were assessed. Glasgow comma score was used. Post treatment outcomes were compared among both groups by using t-test. We used SPSS 21.0 version to analyze complete data. Results: Among 54 patients in group I 31 (57.4%) cases were males and 23 (42.6%) patients were females and in group II 35 (64.8%) were male patients and 19 (35.2%) females. Majority of the patients 65 (60.2%) among both groups were in age group 21-35 years followed by 14-20 years 30 (27.8%) cases. Road traffic accident was the most common cause found in 27 (50%) and 29 (53.7%) in groups I and II. Consciousness loss, vomiting and headache were the most common symptoms. Mean hematoma volume in group I was 29.11±6.38 ml and in group II 22.16±8.47 ml. Mean GCS in group I was 15.07±3.13 and in group II was 16.18±5.38. We found that conservative treatment presented favorable outcomes 53 (98.4%) as compared to surgical treatment in 50 (92.6%) cases. No any mortality found in this study. Conclusion: We concluded in this study that the conservative for the extradural hematoma in supratentoral region was effective and safe treatment as compared to surgical. Most common cause was RTA. There is no any mortality found in both treatments. Keywords: Supratentoral Region, Extradural hematoma, GCS, Outcomes

ABSTRACT: BACKGROUND & OBJECTIVE: To assess the results of pallidotomy in Parkinson’s disease, and its effect on improving the lifestyle of the patients and cost-effectiveness. METHODOLOGY: A descriptive study was conducted at Neuro-Spinal & Cancer Care Institute, Karachi from June 2014 to January 2020. Patients who were known case of Parkinson’s disease refractory to medication and developed side effects to medication were included in the study and patients with previous brain surgery, associated brain disorders like Alzheimer’s disease, basal ganglia lesion, brain trauma were excluded. All patients were treated by pallidotomy on the contralateral side. The significance of the difference between groups to compare between the pre-op or post-op treatments was calculated through non-parametric assessment Kruskal-Wallis tests.   RESULTS: The mean age of the patients was around 57 years. There were 34(81%) male and 8(19%) female patients’ Maximum number of patients who were more than 45 years, were having a left-sided proportion. More male patients were having a left-sided proportion as compared to female patients.  The majority of patients (57.5%) were having dyskinesia as q primary symptom. A significant difference (p-value <0.001) existed in pre & post-operative UPDRS-III scores. A significant difference (p-value <0.001) also existed between on & off medications UPDRS- III (pre-op/post-op) scores. CONCLUSION: The result of pallidotomy is promising especially for unilateral pallidotomy to minimize the risk of cognition and speech disorder and long-term follow-up is needed to prove the statement further. Currently, pallidotomy is associated with minimal complications, more effective, and improving the quality of life of Parkinsonian patients.