Objective: Conventional methods for anterior upper dorsal spine are not devoid of intra-operative complications due to anatomical constraints, a major blood vessel and vital organs. We analyzed the details of Trans- axillary approach without muscle cutting in tuberculosis, tumor, and traumatic lesions of T2 to T6 and upper limb causalgia.Materials and Methods: A prospective quasi-experimental study was conducted for 3 years included 30 patients presented with dorsal myelopathy due to D2 to D6 vertebral body involvement. Right and left sided approaches were utilized. Medical Research Council grading was used to assess neurological status.Results: Mean age was 32 ± 15 years, which included male 18.60% and female 12.40%. T4 vertebrae were commonly involved. Others were T5, T3 and T6 respectively. The majority of lesions were tuberculosis of the spine (n = 14), tumor (n = 8), trauma (n = 5) and causalgia of upper limb (n = 3). No intra-operative complications occurred, estimated blood was 80-100 ml and operative time was 120-160 minutes. Postoperative complications included pneumonia (n = 1), superficial wound infection (n = 3), death (n = 1). Serial follow up was for 2 years, Patients were discharged with improved neurological status and causalgia patients got immediate post-operative relief.Conclusions: Transaxillary approach is a unique anatomical corridor which is safe, feasible with promising results. It provides optimal decompression, reconstruction with better fixation and alignment in various pathologies of upper dorsal spine.

The patient is in good health and has no evidence of clinical and radiological tumor recurrence for 22  months.

Sir,Aneurysmal bone cysts (ABCs) are multi-cystic, osteolytic growths. The classic or standard form (95%) has blood filled spaces among bony trabeculae. Osteoid tissue and osteoclastic giant cells are found in the stromal tissue. The solid form (5%) shows fibroblastic proliferation, osteoid production and degenerated calcifying fibromyxoid elements. 1 ABCs are usually seen in younger patients. Around 80% of the patients are less than 20 years of age, more frequently in females. ABCs occurring de novo are called as primary ABCs. Secondary ABCs have accompanying tumors like chondroblastoma and giant cell tumor in 30% of patients. Other associated tumors or non-tumorous conditions include ossifying fibroma, osteosarcoma, chondrosarcoma, non-ossifying fibroma, chondromyxoid fibroma, unicameral or solitary bone cyst or trauma. 2 ABCs are commonly found in long bones, membranous bones of the thorax, pelvis and vertebra. In long tubular bones, these tend to be eccentrically located in the metaphysis. However, these can occur in any location, including the diaphysis and epiphysis, rarely, involving multiple bones simultaneously. 3 Skull is rarely affected. 4,5 The treatment modalities include selective arterial embolization, irradiation, intralesional curettage, intraoperative adjuvants, bone grafting, marginal resection or wide excision. Tumor has to be excised and all cystic lining curetted. Cryotherapy, phenol or cauterizations (intraoperative adjuvants) are used to remove microscopic tumor cells. Resulting bony defects may be replaced with homologous bone or cadaveric bone. We, herein, present a 50-year patient who was admitted with the complaints of headache, and rapidly enlarging swelling in the right temporal and mastoid area elevating the auricle. There was serosanguinous ear discharge and loss of hearing from right ear. There was no history of trauma. Swelling was non-tender, firm to hard and pulsatile. Cough impulse was negative and no bruit was audible. Right seventh nerve was paralysed with lower motor neuron features. No other body part was involved. CT scan brain with contrast and CT-angio brain revealed a vascular mass with bony outgrowth and cystic spaces involving right temporal petrous and mastoid area with midline brain shift (Figure 1). Patient underwent operation and lesion was excised and surrounding bony area was cauterised. Attached dura was coagulated with bipolar diathermy. Histopathology report confirmed the diagnosis of chondroblastoma with secondary ABC. Patient remained well for one year, however, he had recurrence of same growth after one year. Second operation was performed in the same way. He was then referred for radiotherapy. This case is unique as it presented at advanced age and in an unusual location. As mentioned above, skull is very rarely the primary site for this lesion. Both the primary tumour and the associated secondary ABC are rare at this age. Moreover, this case recurred after one year. Recurrence is not rare in ABCs. Most commonly, it results from incomplete removal of the...

Aim: To determine the prevalence of hydrocephalus is in tuberculous bacterial meningitis patients Study Design: Cross sectional study Place and duration: This study was conducted in Pakistan Institute of Medical Sciences Islamabad, Pakistan From September 2019 to December 2020 Methodology: The technique of nonprobability, sequential sampling, was used. After a thorough examination, patients with tuberculous bacterial meningitis (TBM) were included. At the time of admission, a brief history of socio-demographics and the length of the illness was taken. The proforma was filled up with the results. The data were analyzed using SPSS Version 22. Results: Out of 120 patients, males made up 59.16 % cases. The age groups 20-30 years, 31-40 years, 41-50 years, and 51-60 years were represented in the study by 28 (23.33 %), 37 (30.83%), 17 (14.16 %), and 38 (31.66%) patients, respectively. The prevalence of hydrocephalus among TBM was 16.66%, with the 20-30 year age group having the most cases (50 %). Significant differences have been identified (X2= 12.43, P=0.006) in age grouping. Cases with hydrocephalus with symptoms that lasted less than a week were discovered in 70 %, whereas those with symptoms that lasted more than a week were detected in 30% of patients (X2=4.51, P=0.033). Conclusion: Hydrocephalus was seen in a substantial percentage of patients with tuberculous bacterial meningitis. Keywords: Tuberculosis, Meningitis, Hydrocephalus, Prevalence

Introduction: Neural tube defects (NTDs) are serious birth abnormalities of the central nervous system caused by a defect in the embryonic neurulation process. The most common congenital defects are congenital heart defects (CHDs) and neural tube defects (NTDs). Aim: The study’s aim was to figure out the patterns of neural tube defects (NTD) and how to treat them. Methodology: The ages of the mother, the method of delivery, the kind, and quality of neural tube defects (NTDs,) and also the treatment, were all acquired from case reports (medical and surgical). Warmth was provided to the newborn with an open NTD, and the abnormality was coated with a sterile moist saline bandage. To avoid putting strain on the deformity, the patient was placed in a supine posture. Children with breathing difficulties were given supplemental oxygen. In patients with urine dysfunction, clean intermittent catheterization (CIC) was employed. All infants with an open NTD had to have the problem checked right away. Conventional neurosurgical procedures were used to close the wound. Once the NTD was closed, a ventriculoperitoneal shunt was implanted in infants with associated hydrocephalus. Results: A total of 59 patients were involved in this study. Males made up 50.6% of the population, while females made up 49.4%, resulting in a gender ratio of 1.5 in males. The majority of the participants’ parents (57.6%) were socioeconomically poor. The most prevalent kind was myelomeningocele (62.7%), followed by 5.08 percent cases of meningocele and 11.8 percent cases of lipomeningocele. The lumbosacral area was the most frequent site of these abnormalities (55.9 percent). Lumbar (32.2 percent), sacral (6.77percent), and thoracolumbar (5.08 percent) locations were among the others. Conclusion: The most frequent kind of NTD in our area was Lumbosacral Myelomeningocele. The main concern factor was lower economic level.