Meningioma is the benign tumor that can also occurs during pregnancy. We are reporting a case of 29 years, 13th weeks pregnant lady, who underwent supratentorial craniotomy using awake through out approach. The case report highlights the challenges we faced during anaesthetic management, which includes psychological preparation, institution of scalp block and successful neurological monitoring. Technique proven to be useful considering pregnancy related physiological and tumor related pathological changes, the impact of which lies directly on maternal & fetal wellbeing. doi: https://doi.org/10.12669/pjms.36.2.1853 How to cite this:Kumar D, Siraj S, Ahsan K, Shafiq F. Utilization of awake craniotomy for supra-tentorial tumor resection during pregnancy: A technique useful for fetal-maternal wellbeing. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1853 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

BackgroundEarly diagnosis and management of raised intracranial pressure (ICP) is essential for preventing brain damage and even death. Invasive monitoring is the gold standard to measure raised ICP but it may not be feasible in a heterogeneous group of patients. Noninvasively, a simple bedside ocular ultrasound can detect elevated ICP. The aim of our study was to evaluate the correlation between optic nerve sheath diameter (ONSD) and direct ICP measurements and to determine sensitivity and specificity of ONSD measurements to detect elevated ICP (>15 cm H2O).MethodsThis prospective study was conducted at the intensive care unit/high dependency units/wards of Aga Khan University Hospital. Patients with external ventricular drain (EVD) for intracranial hypertension were enrolled. Ocular ultrasound was performed with a 7.5 MHz linear probe. For each subject, three measurements on each eye were performed and the mean of the six measurements was determined. EVD was temporarily occluded and the ICP was recorded every minute for five minutes. A receiver operative characteristics (ROC) curve was constructed to determine the optimal ONSD cutoff to detect ICP above 15 cm H2O.ResultsA total of 35 adult patients were included in this study. The ONSD was linearly correlated with ICP in both right and left eyes (r = 0.662, p = 0.0005 and r = 0.449; p < 0.002) respectively. Pearson correlation of ONSD between two eyes (right and left) was 0.749; p = 0.0005 and 0.726; p = 0.005 at day 1 and day 2, respectively. ROC curve was created and observed that AUC of right and left eyes was 0.815 (95% CI: 0.61 to 0.99) and 0.69 (95% CI: 0.37 to 0.99).ConclusionAccording to this study, ventriculostomy measurements of ICP are directly correlated with ultrasound ONSD measurements. Hence, we conclude that ONSD measured by ocular ultrasound is a simple yet effective method to detect raised ICP.

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Introduction: Acute cholecystitis occurs most commonly because of an obstruction of the cystic duct by gallstones. This surgical disease warrants prompt cholecystectomy. Delays in the definitive surgical management result to more complications, longer hospital stays, and overall higher medical expenses. This study shows the disparity between the medical service and the surgical service in the management of acute calculous cholecystitis prior to its definitive intervention. Methods: Sixty-four patients (aged 18 to 74) presented to the emergency room, from January 2011-December 2013, with acute calculous cholecystitis and underwent cholecystectomy during the same admission. Gallbladder disease severity, hospital length of stay, time to surgical evaluation, and time to cholecystectomy were compared between patients admitted to medical service and surgical service. Results: Thirty-three patients (51.6%) admitted under medicine service had more severe gallbladder disease found during cholecystectomy as compared to surgery service (Х 2 = 7.5147, p < 0.001). Patients admitted under surgery service had shorter hospital length of stay (4.06 days vs. 5.03 days, p = 0.059), waiting time to surgical consultation (3.14 hours vs. 16.10 hours, p < 0.001), and time to cholecystectomy (26.16 hours vs. 43.58 hours, p = 0.012). Conclusion: Patients presenting to the emergency room with acute calculous cholecystitis benefit from being admitted to a surgical rather than to a medical team irrespective of age and comorbidities.

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