Objectives:  To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading. Materials and Method:  Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented. Results:  Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery. Conclusion:  Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization. Keywords:   Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization.

Background: Intracerebral hematoma affects about 2.5 per 10,000 people each year. The incidence is more in males and older people. The mortality rate is about 44% in the first month. 20% of cases has a good outcome. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often symptoms get worse over time. In many cases bleeding occurs in the brain tissue and the ventricles at the same time. Many procedures and techniques have been introduced for the management of intracerebral hematoma and debate always exist about the management of sizable intracerebral hematomas especially if the conscious level isn't markedly affected. Aim of Study:To evaluate the role of early evacuation of sizable intracerebral hematomas even if the conscious level isn't markedly deteriorated.Method: This is a retrospective study of 30 cases of intracerebral hematoma operated in Kasr El-Aini Hospitals and Bani Suef University Hospitals by evacuation assisted by microscope with a Glasgow Coma Scale more than 10 in most cases with a sizable intracerebral haemorrhage more than 30cc in the volume.Results: This study results was 22 (73%) male patients and 8 (27%) was female patients. The age group was 4 patients (13%) under 30 years, 22 patients (73%) were from 30-45 years and 4 patients (13%) were more than 45 years old. The Glasgow Coma Scale (GCS) on admission was 14-15 in 4 patients (13%) patients, from 10-13 was 14 patients (46%), and from 9 and less was 12 patients (41%). 20 patients (67%) case was diabetics, 23 patients (46%) cases was hypertensive, 2 patients (7%) had chronic renal failure on regular dialysis, 1 patient (3%) case was pregnant. The GCS post-operative was 14-15 in 20 patients (70%), 10-13 in 5 patients (16%), and from 9 and less in 5 (24%) cases. The operation done was evacuation in all cases, decompressive craniectomy in 8 patients (26%), ventriculosubgaleal shunt done (VSG) in 3 patients (10%). The side of the hematoma was left sided in 7 patients (24%), right in 23 patients (76%). Good out come in 25 cases (83%), recollection in 3 (10%) cases, residual hematoma in 2 (6%) of the cases, re evacuation done in 1 patient (3%). Mortality were 4 patients.

Objective:  To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage. Material and Methods:  This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22. Results:  Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months. Conclusion:  ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc disease

Objective: To examine the outcome of Endoscopic Third Ventriculostomy in 80 consecutive patients operated in Irfan General Hospital and Prime Teaching Hospital Peshawar.Materials and Methods: Prospective observational study was conducted in the neurosurgery department of Prime Teaching Hospital and Irfan General Hospital Peshawar. 80 patients (48 male and 32 female) were followed for 3 months. The inclusion criteria all patients with Third ventricular hydrocephalus were included in this study and the exclusion criteria unwilling patients and those who opted for VP shunting rather than ETV. Data was analyzed using SPSS version 22.Results: ETV was performed in 80 patients. With highest success rate inAqueductal stenosis and posterior fossa tumors 88% and 87% respectively. ETV had a lowest success score of 50% in patients with Hydrocephalus TBM. Common post-operative complications were seizures and CSF leakage.Conclusion: ETV is less invasive and effective treatment for non-communicating hydrocephalus.ETV is most effective in treating aqueductal stenosis and posterior fossa tumors. The overall success rate of ETV is 74%. Based on these findings, it is recommended that ETV should be attempted as first line treatment for patients with triventricular hydrocephalus due to various pathologies.

Hydrocephalus in children is either treated by ventriculoperitoneal shunt or Endoscopic third ventriculostomy (ETV) dependingupon specific factors pertaining to clinical and radiological diagnosis. There are many complications of ventriculoperitoneal shuntand migration of peritoneal to scrotum, anal canal, urinarry bladder has been reported. The intra abdominal complications aremanaged by a combined team work of neurosurgeon and Pediatric surgeon.We have reported a case in which patient was diagnosed as congenital hydrocephalus with a lumbar myelomeningocele one yearback, Right sided ventriculoperitoneal shunt was passed initially followed by lumbar myelomeningocele repair. Now patient waspresented by parents with scrotal swelling, clinical examination and shunt series X-rays showed migration of lower end ofventriculoperitoneal shunt to scrotum, pediatric surgeon was consulted in same institution, a single incision at right inguinalligament was used to replace the migrated catheter into abdomen and hernia repair.Key Words: Ventriculoperitoneal shunt, Scrotal migration, Post-operative shunt complications