Objective:  This study explored the effects of octreotide injections in patients with pituitary adenoma pre-operatively. Material and Methods:  A quasi-observational study was conducted on 12 patients in the Neurosurgery department of the Punjab Institute of Neurosciences (PINS) with a diagnosis of pituitary adenoma. To determine the size of the tumor, we did an MRI brain with pituitary protocol and after octreotide medication. The mode of diagnosis was clinical status, MRI brain, and biopsy of the tumor. We gave 14 short-acting octreotide injections to all patients before surgery and monitored their clinical and serum IGF levels. After the completion of 14 injections of octreotide, we planned surgery for the complete excision of the tumor. We performed IGF level 2 weeks after surgery. Then, we gave long-acting octreotide injections to all patients after every 28 days. Results:  The mean age was 43 years. 67% of patients were male and 33% of patients were female. 92% of patients presented with decreased vision. 17% of patients presented to us with complete loss of vision. In 17% of patients, the vision of the patients improved. Serum IGF levels significantly decreased after short-acting octreotide, surgical excision, and long-acting octreotide therapy. Conclusion:  With the use of octreotide therapy clinical status and outcomes of management of pituitary adenoma improve.

Objectives:  The study compared the outcomes of VP shunt at Choudhary’s vs Keen’s point. Material and Methods:  A quasi-observational study was conducted on 50 patients who presented to NS-2, PINS, with the complaint of hydrocephalus. The study was conducted for 3 months from 1st November 2021 to 31th Jan 2022. Results:  Mean age was 40 years. In 25 (50%) patients, VP shunts were done through Choudhary’s point while in 25 (50%) patients VP shunts were done through Keen’s point. All patients were evaluated on day 3rd POD, 7th POD, 15th POD, and 90th POD.  All patients were improved on 3rd POD. On the 7th POD, 15 (30%) patients deteriorated and showed signs of raised ICP. In these patients, the upper end of VP shunts is again revised due to blockage. On 15th POD, the upper end of VP shunts was blocked in 3 (6%) patients and their upper end was revised. On 90th POD, 2 (4%) patients were presented with upper-end blockage, and again shunt revision was done.  VP shunts in all these patients were done through keen’s point approach. Blockage of the lower end of VP shunt occurred in 10% of patients in which 8% were operated through Keen’s point approach while resting 2% of patients were operated through Choudhary’s point approach.  Conclusion:  VP shunts through Choudhary’s point approach yield good results as compared to Keen's point approach. This site is described by professor Muhammad Anwar Choudhary, as more convenient for insertion of VP shunt.

Objective:  We hypothesized that if we operate occipital extradural hematoma (EDH) having a volume less than 15 ml by single burr hole evacuation of extradural hematoma (EDH) and placement of drain without doing craniotomy then clinical status of the patients particularly headache improves. Method:  An observational study of 15 patients (with presenting GCS: 8–13) was conducted on patients who were operated in Punjab Institute of Neurosciences (PINS). All patients had acute extradural hematoma less than 15 ml after a road traffic accident (RTA). The age range was 22 – 45 years. All patients were operated on within 12 hours of road traffic accident. The timing of surgery was in the range of 1-2 hours. Results:  In all patients, surgery was performed by a single burr hole at the occipital region at the site of occipital EDH and the drain was placed in an extradural position. Co-morbidities in our patients were DM, polytrauma. Receiving GCS was 9 in 2 (13.33%) patients, was 13 in 10 (66.67%), was 8 in 1 (6.66%) patient and receiving GCS was 15 in 2 (13.33%) patients. All patients were assessed clinically on 5th post-operative day. It was seen headache was relieved on 5th post-operative day in all patients except 1 (6.66%) patient. Our 1 (6.66%) patients came for follow-up with the complaint of headache and vomiting which was managed conservatively. Conclusion: Surgery by single burr hole evacuation and placement of drain is a safe method if occipital EDH is less than 15 ml in volume

Objectives:To compare the outcomes of early tracheostomy vs. late tracheostomy in post-operative patients after acute subdural hematoma at receiving GCS (Glasgow comma scale) of six or below. Method:  A quasi observational study was conducted on 30 patients with acute subdural hematoma after RTA (road traffic accident) and were operated in The Department of Neurosurgery Unit 2, Punjab Institute of Neurosciences, LGH, Lahore. The age range was 20 – 65 years. All patients were operated upon within 12 hours of RTA. Results:  In Group A, 12 (40%) patients, decompressive craniectomy with the evacuation of acute subdural hematoma and early tracheostomy were performed. In Group B, 8 (26%) patients’ craniotomy and evacuation of acute subdural hematoma were done along with early tracheostomy. In 6(20%) patients, decompressive craniectomy and evacuation were done and their tracheostomies were done at the 10th post-operative day. In 4 (13.33%) patients’ craniotomy and evacuation of hematoma done and their tracheostomies were also done at 10th post-operative day. In Group A, on 5th postoperative day GCS of 16 (53.33%) patients with early tracheostomies and fewer comorbidities improved, they were extubated, while 2 (6.67%) patients did not improve and 2 (6.67%) patients died. In Group B, in 30 patients with late tracheostomies, only 4 (13.33%) patients were improved. On 10th post-op day, GCS of 4 (13.33%) patients improved, GCS of 3 (10%) patients not improved and 3 (10%) patients died. Conclusion:  Early tracheostomy in patients with acute subdural hematoma yields good results as compared to late tracheostomy.

Objectives:  Aim of this study is to evaluate the intimal vessel wall thickness in smoker and their co-relation with non-smoker and also surgical management of stenosis. Material and Methods:  It is a prospective study of 55 cases. Study span and follow up duration were 4 months. Our patients were presented with the history of CVA (Cerebrovascular accident), hypertension, diabetes, and headache. Results:  In all patients, the carotid doppler ultrasound was done and their intimal vessel wall thickness was noted. Our 78% patients were smoker and non-smoker was 22%. In our study, 52% patients had CVA, 41% patients had hypertension, 30% patients had headache and 9% patients were also obese. Forty three smokers used to take 15 – 25 cigarettes daily. Among 43 patients, 5 patients were females. In carotid Doppler study, intimal thickness was increased in 87%, the plaque was observed in 49% and stenosis was observed in 38% cases. In 18 % patients, who had stenosis > 70%, carotid endarterectomy was performed and in rest of the patients medical treatment done.Patients who were chronic smokers and had medical co-morbidities showed greater thickness of intimal layer of vessels on carotid Doppler. In 6 patients, post-operative headache occurred. Conclusion:  Smokers had more thickness of intimal layer of carotid vessels. Carotid endarterectomy yields good results in case of stenosis more than 70%. Keywords:  Cerebrovascular accident, Intimal layer thickness, Carotid doppler ultrasound, Cigarette smoking