Objective: The purpose of this study is to analyse the complication rate of endoscopic third ventriculostomy for obstructive hydrocephalus. Study Design: Descriptive study Place and Duration: This descriptive study was conducted at Dow International Medical College and Hospital OJHA Campus, Karachi in the period from May, 2022 to October, 2022. Methods: Total 97 male and female patients aged 1-30 presented. Patients had obstructive hydrocephalus were included. With consent, all patients provided age, sex, and BMI. CT and brain MRI were performed. In all reported instances, a third ventriculostomy was done under general anaesthesia after symptoms had become apparent. Two-week follow-up examined post-treatment efficacy and complications. SPSS 26.0 analyzed all data. Results: 66 (68.04%) of the 97 patients were male, while 31(31.96%) were female. The most frequent illness was aqueductal stenosis, which was seen in 64 (65.97%), followed by posterior fossa tumours in 15 (15.5%), blocked VP shunts in 13 (13.4%), and CSF ascites in 5 (5.2%) instances. Frequency of complication was found in 22 (22.7%) cases, most prevalent was CSF leak, followed by meningitis, seizures and bleeding. There were 3 deaths (3.1%) among all cases. Conclusion: In this research, we found that endoscopic third ventriculostomy reduced the risk of complications and death for patients with obstructive hydrocephalus. Keywords: Obstructive Hydrocephalus, Complications, Endoscopic Third Ventriculostomy, Mortality

Objective:To find out the incidence of congenital talipes equinovarus in children presenting at District Headquarter Teaching Hospital, Swabi.Materials and Methods:This study was of one year duration and was carried out at District Headquarter Teaching Hospital, Swabi.The record of 988 children presenting in the orthopedic ward for surgery were studied.Results:A total of 96 (9.7%) children presented with congenital talipes equinovarus or club foot and out of these children 56 (5.7%) patients were males and 40 (4.04%) were female.Conclusion:Clubfoot or congenital talipes equinovarus is one of the most common abnormality of the foot and idiopathic talipes equinovarus is most common in the population of Swabi.It is more common in males and is mostly bilateral. It should be detected at birth and treated early to prevent permanent disability.

Objective: This study aimed to share our experience in treating various types of injection-induced peripheral nerve injuries and explore numerous problems that are related to this category of peripheral nerve injuries. Study Design: Retrospective study Place and Duration: Department of Neurosurgery, Gomal Medical College DI Khan in the duration from October, 2022 to March, 2023. Methods: Total 130 patients of both gender with age 8-70 years were included. Patients with post-operative peripheral nerve injuries were following intramuscular injections, brachial nerves block procedures, subclavian and jugular venous cannulation procedures for central line placements, and routine intravenous injections in the peripheral veins of the limbs. Frequency of peripheral nerve injuries and its management among all cases were assessed. SPSS 22.0 was used to analyze all data. Results: In all 130 patients, 82 (63.1%) cases were males and 48 (36.9%) patients were females. 45 (34.6%) patients had age 8-15 years, 30 (23.1%) cases had age 16-25 years, 33 (25.4%) cases had age 26-35 years and 22 (16.9%) patients had age >35 years. Mean duration of peripheral nerve injury was 2.4±7.38 months. Most common reason was intramuscular injection found in 104 (80%) cases. Most common affected nerve was sciatic nerve in the gluteal region, the radial nerve in the arm and axillary nerve in the shoulder region. Non-functional status among all cases were found in 58 (44.6%) cases. Six (4.6%) of the patients in our series experienced neurological impairment following surgery in the form of motor weakness. The best outcomes, 115 (88.5%), were reported with the repair of the radial nerve after surgery. Conclusion: We came to the conclusion that a quick referral to a specialized peripheral nerve center, an early intervention, and early diagnosis are just a few crucial elements that can lead to a positive outcome and reduce the frequency of medicolegal lawsuits. By having in-depth anatomical understanding and providing patients with adequate counseling before to the treatment, the problem can be avoided in the vast majority of cases. Keywords: Peripheral nerve injury, Surgery, Improvement, Injection

Objective: The purpose of this study was to compare the clinical and radiological results of employing local bone graft with a PEEK cage vs bone graft and plate in ACDF. Study Design: Retrospective study Place and Duration: Department of Neurosurgery, Gomal Medical College DI Khan in the period from June, 2022 to November, 2022. Methods: There were 80 cases of both genders were included for anterior cervical discectomy and fusion. Detailed demographic information on enrolled cases was recorded after receiving informed written consent. Patients were divided in two groups. Group I received ACDF by using bone graft and plate in 40 cases while in 40 cases of group II ACDF was performed by using zero size peek cage filled with bone graft and inbuilt screws. Outcomes among both groups were compared. SPSS 22.0 was used to analyze all data. Results: Among 80 cases, there were 46 (57.5%) males and 34 (42.5%) females. Mean age of the patients was 43±18 years. Perioperative mean pain score was 7.5±6.20, mean NDI was 62.4±2.8, mean SF-36 was 29.8±3.15 in group I and in group II mean pain score was 6.9±5.20, NDI was 64.8±3.10 and SF-36 was 30.5±4.13. Significantly reduction in pain score, NDI and increase in SF-36 among both groups were found while in group II outcomes were better than group I. Mean operative time in group I was higher as compared to group II with p value <0.004. There was no any significantly difference in blood loss among both groups. With a p value of 0.003, group II had higher disc space height and segmental interbody angle at the operative segment than group I. Perioperative complication rates in group I was higher with p value <0.05. Conclusion: In this study, we found that patients undergoing ACDF with local bone graft and a PEEK cage had significantly shorter operating times, fewer perioperative problems, and better radiological outcomes than patients undergoing ACDF with bone graft and plate. A PEEK cage-encased local bone graft seems to be a secure substitute for an ACDF's bone transplant. Keywords: Cervical spine, Anterior cervical discectomy and fusion, bone graft, Local bone graft

ABSTARCT Background: Ventriculoperitoneal (VP) shunt is a common procedure for treatment of hydrocephalus. The objectives of the study were to determine the causes of hydrocephalus and complications of VP shunt in our pediatric population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Neurosurgery, Gomal Medical College, D.I.Khan, Pakistan from January 2018 to January 2019. The sample size was 97 selected through consecutive, non-probability sampling technique using online sample size calculator, the Raosoft. The inclusion criteria were all pediatric patients with hydrocephalus. All those post-operative patient operated for other pathologies of brain and spine without VP shunt were excluded from the study. CT or MRI of brain with and without contrast were done. Post operatively all the patients were followed up till 6 months and any complication which occurred were documented. Demographic variable were sex and age in years. Research variables were causes of hydrocephalus and post-operative complications of VP shunt. All variables except age in years being categorical were analyzed through frequency and percentages. Age was calculated by mean and SD using SPSS version 20. Results: Out of 97 patients, boys were 59(60.82%) and girls were 38(39.17%). The mean age of the sample was 4.5 ±5 ranging from 5 months to 13 years. The most common cause was aqueductal stenosis having 58(59.7 %), myelo-meningocele were 17(17.7%), post meningitis were 12(12.3%) and remaining 10(10.3%) were associated with brain tumors. Out of 21 patients 12(57.2%) developed shunt obstruction, 5(23.8%) shunt infection, 2(9.5%) developed post-operative seizures, 2(9.5%) had exteriorization of lower end of shunt through abdominal incision. Conclusion: The most common cause of hydrocephalus is acqueductal stenosis. The most common complication of VP shunt is shunt obstruction in pediatric population, having pre-school boys as modal group.