Background and Objectives:  To assess the outcome of Endoscopic Third Ventriculostomy (ETV) versus Ventriculoperitoneal Shunt (VPS) in Obstructive Hydrocephalus in terms of infections, foreign bodies, cost-effectiveness, and length of hospital stay. Materials and Methods:  It was a Randomized Controlled Trial study, in which 30 patients with Obstructive Hydrocephalus were divided into two groups one was treated with (ETV) and the other was treated with VP Shunt and the patients were followed up for 1 year. Results:  Patients were divided into 2 groups, 15 were treated with ETV, and 15 were treated with VP Shunt. Length of stay for VP shunt was 7 ± 0.85 days and for ETV mean stay was 2.93 ± 1.1 days. The complication was observed in 4 (26.7%) treated with VP Shunt and in 3 (20%) patients with Endoscopic Third Ventriculostomy. In ETV, 3 (20%) patients had recurrence whereas in VP shunt in 1 (6.67%) had an infection and in 3 (20%) patients had recurrence (upper-end blockage) and the overall success rate was 76% in both the procedures and in VP Shunt 73.3% and ETV 80%. Overall there were no complications found in 23 (76.6%) patients, in 3 (10%) patient’s complications were found at 1st month, in 3 (10%) complications were observed at 3rd month, and in 1(3.3%) complication was recorded at 6th month. Conclusion:  ETV was found better in terms of length of hospital stay, cost-effectiveness as well as minimal complication rate as compared to VP shunt.

Objective:   To compare the effectiveness of Endoscopic (Endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications like infection, recurrence and hospital stay. Material and Methods:  The comparative experimental randomized study was conducted in the Department of Neurosurgery Unit I, PGMI, Lahore General Hospital, Lahore. After approval from ethical committee this study was carried out in our unit. 40 subjects with the history of CSF leak were randomly divided into two groups; one was treated with endonasal trans-sphenoidal repair and another was treated with trans-cranial approach, the subjects were followed up for 1 year. Detailed history, neurological examination, preoperative CT and MRI scans were performed in all patients. Results:  The mean age of patients with CSF leak was 25.58 ± 14.38 years. Among the patients, 17 were females and 23 were male. The mean age of the female was 31.70 ± 14.29 years. The mean age of the male was 21.04 ± 12.95. The recurrence was observed in 2 (10%) of the patients treated with endoscopic technique and 1 (5%) of the patients treated with trans-cranial approach. Those patients were successfully repaired in a second operation. Overall success rate was 92.5%. One patient (2.50%) among the trans-cranial approach develops infection which was treated successfully. Conclusion:  The endoscopic repair of CSF leak is both safe and effective and should be considered as the standard procedure of choice in most of the cases.

Aim: To assess the predictive features of optic neuritis in retinal loss through optic nerve lesion identification. Study design: Prospectively longitudinal study Place and duration of study: Ghulam Muhammad Mahar Medical College Sukkur and Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st January 2021 to 30th June 2022. Methodology: One hundred and ten patients suffering from acute optic neuritis ≤8 weeks were enrolled. Retinal optical-coherence tomography was performed in all patients. Fifty five patients in the whole cohort while clinically isolated syndrome (CIS) 25 patients and relapsing remitting multiple sclerosis (RRMS) as well as neuromyelitis-optica spectrum disorders (NMOSD) and isolated optic neuritis as 20, 3 and 7 respectively. Brain optic nerve magnetic resonance imaging which included three-dimensional double inversion recovery sequence was also conducted at acute phase (M0) and then post 12 months (M12). Results: The mean age of the cases was 30.85±8.9 years. There was a higher frequency of males then females. The duration of the disease was found highest in RRMS cases with 50.31±77.45 months. The variance in estimated and standard error of the ganglion cell-inner plexiform layer volume change was significantly different in whole acute optic neuritis cases as well as the one with CIS and multiple sclerosisat cohort. Conclusion: Optic nerve-lesion length in prediction of retinal-neuroaxonal loss in cases of optic neuritis. The optic-nerve lesion length can also be considered as a biomarker for the process of retinal remodeling as well as visual impairment. Key words: Optic nerve lesion, Acute phase, Optic neuritis (ON), Retinal neuronal loss

Aim: To study the discrepency between disability and reported well-being after traumatic brain injury. Study design: Prospective study. Place and duration of study: Ghulam Muhammad Mahar Medical College Sukkur and S. M. Benazir Bhutto Medical University Larkana from 7th July 2021 to 15th Jun 2022. Methodology: Two hundred and sixty patients suffering from brain injury were enrolled. The patient’s of traumatic brain injury which was represent able through brain computed tomography scan and was reported within 24 hours of the injury and age 10-55 years were included. Scoring tests as Glasgow outcome scale extended and Short Form as well as quality of life scoring was performed in all cases. Functional outcomes were also observed with a follow up of 6 month post traumatic brain injury. There were mild cases of traumatic brain injury as well as moderate to severe cases which for interpretation purposes were divided into two groups. Results: The mean age of these two groups was 36±3.5 and 29±9.7 years and there was more males than females. The satisfaction level for support from hospitalization was seen significantly higher in all cases with no significant variance while it was poorly reported from rehabilitation centers outpatient support to moderate to severe traumatic brain injury cases. The cases with severe disability of upper and lower regions have a very poor functional outcome in cases with moderate to severe traumatic brain injury. The score for quality of life and mental physical well-being was not in normal ranges for moderate to severe cases of traumatic brain injury. Conclusion: There are discrepancies in patients reporting of well-being and disability outcomes in traumatic brain injury cases. Keywords: Discrepancy; Disability; Traumatic Brain Injury

Aim: To observe and analyses the epileptic phenotypes in autoimmune encephalitis ranging from acute symptomatic-seizures to autoimmune related epilepsy. Study design: Retrospective-observational cohort study Place and duration of study: Ghulam Muhammad Mahar Medical College Sukkur and Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st August 2020 to 30th September 2021. Methodology: One hundred and twenty seven patients who were enrolled with a new onset of seizures in reference to autoimmune encephalitis. Clinical as well as through para-clinical tests, including electroencephalogram, cerebrospinal fluid/neuroimaging techniques including magnetic resonance index or fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography was used for confirming the cases. Each patient underwent anti-nuronal antibody test and was grouped as positive or negative for the test and clinically compared. Results: There were 66 (51.96%) females and 61 (48.04%) males with mean age was 54±5.5 years. There were 62.9% cases who were having anti-neuronal antibodies as positive while 37.1% had a negative result. Majority of the positive group had multiple type seizures whereas SE was more common in negative group cases. There were 111 (87.4%) cases were given immunotherapy. Within these 111 cases the immunotherapy was effective in 60% of the cases. There were 81% cases with psychological as well as cognitive disturbances with 43.75% having long term sequel. The most common phenotype for seizure was focal impaired awareness seizures followed by focal bilateral tonic clonic seizures. Conclusion: Early onset of immunotherapy and recognition of seizures may avoid long term irreversible outcomes of sequela. Key words: Epileptic phenotype, Autoimmune encephalitis, Acute symptomatic seizure, Autoimmune associated epilepsy