Aim: To assess the accuracy of inserting a pedicle screw percutaneously to fix thoracic and lumbar spinal fractures by minimally invasive procedures. Study design: Prospective observational study. Place and duration: This study was conducted at , Pakistan Institute of Medical Sciences Islamabad, Pakistan from March 2020 to March 2021. Methodology: A total of 50 patients were evaluated, who had suffered from spinal injuries in the form of thoracic and lumbar spine fractures and were admitted for spinal surgery. Extensive CT scans were ordered for these patients and on the basis of these scans, the clinicians authorized and assessed the positioning for the percutaneous pedicle screw. However, in cases where the scans were not enough to visualize the exact placement of the pedicle cortex, an approach known as the cortical encroachment was applied. In cases where the need for the screw to be inserted laid outside the boundaries of the pedicle cortex the clinicians utilized a method known as the frank penetration. If placement for this screw was located outside the boundaries of the pedicle these boundaries were categorized in three types. Minor: if the displacement was less than 3 millimeters, moderate: where the placement lay between 3 to 6 millimeters and severe: where the placement was greater than 6 millimeters. Results: At total of 380 screws were fitted percutaneously in 50 patients. A total of 281(74%) of these screws were fitted inside the pedicle, 53 screws (14%) were placed in such a way that they encroached the pedicle and 46 (12%) of the cases showed that the screws penetrated the pedicle. Minor screw penetration was in 32 (8.47%) cases, moderate penetration in 10 (2.58 %) and severe penetration in 3 (0.7%) cases. Among one of severe screw penetration post-operative neurological symptoms were noted. Conclusion: Our study concludes that most of the pedicle positioning of screws were ideally placed, while in few cases there were Encroachment and perforation Keywords: Thoracic spine, lumber spine, spinal injury, pedicel screw

Background Ventriculoperitoneal shunt insertion is widely used in the treatment of different kinds of hydrocephalus. Shunt failure is one of the most common complications; however complete intracranial shunt migration is rarely reported. Case presentation We report a case of an eleven-month-old girl with complete intracranial migration of Ventriculoperitoneal Shunt (Chhabra Shunt). We removed this intracranially migrated shunt with the help of an endoscope (GAAB) and inserted a new Ventriculoperitoneal Shunt (Medtronic Shunt) on the opposite side. She had a good clinical outcome. Conclusion Complete intracranial shunt migration is an extremely rare complication. It is likely due to raised intra-peritoneal pressure, strong head movements, and inadequate shunt fixation. The best possible approach to prevent shunt migration would be better patient handling along with appropriate operative techniques.

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