Objective: To determine the outcomes of surgical management in patients presented with depressed skull fractures. Study Design:Prospective Study Place and Duration of Study: Conducted at Neurosurgery department of Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 16th January 2019 to 15thJanuary 2020. Methodology: 65patients of both genders with ages were 10 to 60 year were included in this study. Patients were aged between 12-70 years of age. After taking informed written consent from all patient’s/parent/guardians, detailed demographics age, gender,body mass index cause of fracture, type of fracture and site of fracture wererecorded. CT scan was performed on all patients.Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. Patients were held under examination for 12-weeks.Glasgow Coma Scale (GCS) was used for final outcome. Data was analyzed by SPSS 27.0. Results:Out of all the patients, male patients were 45(69.23%) and female patients were 20 (30.76%). 35(53.85%) with ages <30, 20(30.76%) with ages 30 to 50 and 10(15.38%) with ages >50 were reordered in study. Mean body mass index was 20.04±3.14 kg/m2.The most common cause of the injury was road traffic accident 45(69.23%) followed by fall from the height 20 (30.76%). 40(61.53%)were compound fracture and 25 (38.46%) were closed fracture. 55 (87.5%) cases were treated surgically and 10 (12.5%) patients were treated conservatively. 45(69.23%) patients were completely recovered, 10 (12.5%) were moderately disabled and 7(10.77%) were severely disabled and 3(4.61%) were died. Conclusion:If treated promptly most of the cases of compound depress skull fracture revealed good results but outcomes of the depress skull fracture revealed contingent severity of injury and absence or presence of intracranial lesion. Key words: Depressed skull fracture, Non-missile injuries, Compund skull fracture, conservative management

Objective:  This study aimed to report the clinical outcome of anterior cervical corpectomy with cage fixation in patients with cervical spondylotic myelopathy. Material and Methods:  This observational retrospective study included 36 patients from the Neurosurgery department of Lady Ready Hospital MTI, Peshawar from 2014 January to 2015 December. After performing surgery, the patients were followed up for six months for neurological outcome and various post-operative complications such as infection, transient recurrent laryngeal palsy, screw displacement and improvements in paresthesias and gait ataxia. Results:  Most of the patients have no post-operative complications. Seventy-five percent (n = 27) of patients reported an immediate improvement in paresthesia and fine hand movements and gait. The major reported complications were implant failure (5.55%) and recurrent laryngeal nerve transient palsy in two patients (5.55%) each. Conclusion:  In patients with cervical spondylotic myelopathy, with anterior compression, cervical corpectomy with cage fixation is less invasive and an effective procedure with acceptable outcomes.

Objective:  To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus. Material and Methods:  The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death. Results:  Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%). Conclusion:  Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes.

Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence