Introduction: Hydrocephalus is the accumulation of excess cerebrospinal fluid (CSF) in the ventricular system of the brain. Objectives: The main objective of this study is to find the surgical outcomes of third ventriculostomy in patients of obstructive hydrocephalus. Material and methods: The data was collected through non-probability consecutive sampling technique. There were 60 patients which were included in the study. A flexible endoscopic telecamera and a Bugbee electrocautery wire and monitor were used for the procedure. The main causes of hydrocephalus have been identified. history of meningitis, ventriculitis, or illness prior to the development of hydrocephalus; x-rays indicating separation or septa within the ventricles; or postoperative residue of hemosiderin or the presence of yellowish deposits were all taken into consideration of post infectious hydrocephalus. Results: There were 49 male and 11 female patients. The mean age of the patients was 39.38 ± 11.2 years. 27 (45%) patients had hydrocephalus due to tumors, 21 (35%) patients had aqueductal stenosis while 12 (20%) patients had benign cysts. Intraoperative bleeding occurred in 24 patients. ETV was successful in 54/60 – 90percent of the patients. A CSF leak was recognised in 09 patients. 07 patient developed a transient gaze palsy which had resolved when he came for his follow up visit on 10th post operative day. Practical implication: Use effective method for treatment of hydrocephalus in hospitals Conclusion: It is concluded that endoscopic third ventriculostomy, in general, is a very effective method of treatment for hydrocephalus. Keywords: Obstructive Hydrocephalus, ETV, Outcome, CSF, Brain, Ventricular

Introduction: Pituitary adenoma resection via the transsphenoidal approach (TSS)is a safe and common neurosurgical procedure that can be done both through microscopic and endoscopic methods. Objectives: The main objective of the study is to find the frequency of CSF rhinorrhoea in patients undergoing endoscopic transsphenoidal surgery (ETSS) for pituitary macroadenoma. Material and methods: The study data was collected from 1st Oct to 1st Nov 2022, in the departments of Neurosurgery of Hayatabad Medical complex, Khyber Teaching Hospital, Lady Reading Hospital, Peshawar. The data was collected through non-probability consecutive sampling technique. There were 315 patients which were included in the study. The surgical procedure is done under general anesthesia. All patient data was collected and a standardized form was filled by the attending surgeon caring for the patient. Importantly, the primary end points to be recorded were: (1) techniques of intraoperative cranium base reconstruction used, and (2) postoperative CSF rhinorrhoea biochemically confirmed and/or requiring intervention (CSF diversion and/or operative restoration). Results: Of the 315 consecutive patients diagnosed with pituitary adenomas, a total of 250 patients met the inclusion criteria and were included. The pathology included 187 (74.8%) non-functioning adenomas, 40 (16.0%) GH-secreting pituitary adenomas, 3 (1.2%) PRL-secreting pituitary adenomas, and 20 (8.0%) ACTH-secreting pituitary adenomas. There were 30 (12.0%) cases of microadenomas, 205 (82.0%) cases of macroadenomas, and 15 (6.0%) cases of giant adenomas. Intraoperative CSF leakages were determined throughout surgical procedure in eighty patients (32.0%). Postoperative CSF leaks occurred in 9 patients (3.6%), including seven patients with intraoperative CSF leaks. Practical implication: Practical implications of this study is: (1) easily find the CSF leakage (2) frequency of CSF rhinorrhoea in patients undergoing endoscopic transsphenoidal surgery Conclusion: It is concluded that macroadenoma ETSS surgery should be strictly monitored for post-operative CSF leakage and lumber drain is an effective prophylactic strategy. Keywords: Postoperative CSF Leakage, Pituitary Adenomas, ETSS, Surgery, Lumber

OBJECTIVE: To determine the association of impacted mandibular third molar with skeletal facial types and different anatomical and cephalometric landmarks. METHODS: This cross-sectional study was conducted at Rehman College of Dentistry and Khyber College of Dentistry, Peshawar, Pakistan from October to December 2020. Panoramic and lateral cephalometric radiographs of 800 patients (aged 22-35 years) were retrieved from the records. Third molar impaction was classified by Winter’s classification using IC Measure software. The skeletal facial type was determined by measuring Point A Nasion Point B angle using Viewbox software. An association of third molar impaction with skeletal facial types, cephalometric and anatomical variables was evaluated. RESULTS: The most common mandibular tooth impactions type was Mesioangular impaction (81.3%) and skeletal facial type was skeletal class-I (47.5%). Comparative analysis among different impaction types using One-way ANOVA showed that although these impaction types did not differ significantly in terms of skeletal facies (p=0.07), significant difference in terms of age (p=0.028), Maxillary Mandibular Plane Angle (MMPA) (p=0.007), depth (p=0.000), ramus relation (p=0.000) and inferior dental nerve (ID) canal (p=0.001) were observed. ID canal was found to be positively but weakly correlated (r=0.2) with impaction types. Contrariwise, depth and ramus relation showed moderately negative correlation (r=-0.40 and r=-0.30, respectively) with impacted tooth angulations. CONCLUSION: Although it is difficult to predict the impaction type in patient based on their skeletal facies, associations between other anatomical and cephalometric variables were observed which may help in predicting the degree of difficulty that may be encountered during the surgical procedures.

The trigeminal nerve and optic nerve, cavernous sinus optic chiasm, pituitary gland, and internal carotid artery are all encircled by the sphenoid sinus, which is located in the sphenoid. More than one asymmetrical vertical septa separate the sphenoidal sinus. Because of its position and linkages with important neurovascular and glandular systems, the sphenoid sinus poses a substantial diagnostic and therapeutic challenge. Objective: To look at the relationship between sphenoid sinus septation and the number and position of the internal carotid artery in people from Peshawar, Pakistan. Methods: The prospective study was conducted from November 2019 to April 2020 at the Radiology Department of a Khyber Teaching Hospital, Peshawar, the CT image was performed on 150 patients (100 males, 50 females) of the paranasal sinuses. From the originating axial slices, secondary coronal scans were obtained. Only individuals with no sphenoid sinus problems were included in the research to examine anatomical changes in the septation of the sphenoid sinus. Results: According to CT scans of the participants, 34% of males and 23% of females had more than one sphenoid septum, with 24 men accounting for 20.8 % and 16 female cases (16.8%) having the septum attached to the posterolateral wall of the sinus of the carotid canal. Conclusions: Prior to surgery, a CT scan of the paranasal sinuses is essential to rule out any potential complications caused by anatomical differences.