Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH.   Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS).   Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere.   Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

A full-term female baby presented at 24 hours of life at the emergency department with occipital encephalocele, bilateral cleft lip, and cleft palate. She was born to a second gravida mother with no consanguinity between the parents. On examination, encephalocele was 10centimeters x 7centimeters in size with bilateral cleft lip and palate. It presents the opportunity for healthcare professionals to learn about a group of congenital neurological disorders in the content of a rare case presentation and highlights the importance of ultrasonography in the antenatal period for the detection of neural tube defects in the early stage for proper counselling and management. A compulsory prenatal diagnosis of the suspected family should be done by the intervention of the public sector of any country so that we can prevent and avoid abnormal birth.

Introduction: Rupture of intracranial aneurysm is a catastrophic event with a mortality rate of 25% to 50%. Despite recent advances in endovascular techniques, microsurgical clipping is the standard modality of treatment due to its relative low cost and feasibility. We prospectively analyzed the cases of microsurgically clipped aneurysms with an aim to evaluate the overall outcome and the pretreatment variables predicting outcomes. Materials and methods: This is the prospective study of 15 consecutive microsurgical clippings of ruptured intracranial aneurysms conducted in the Department of Neurosurgery at College of Medical Sciences Teaching Hospital, Chitwan, Nepal from April 2018 to March 2020. Patients were followed up for at least three months and assessed according to modified Rankin Scale (mRS). Results: The mean age of patients was 55.47 years with female predominance. The most common location of aneurysms was Middle cerebral artery bifurcation (53%). Favorable outcome (mRS score 1 to 3) was achieved in 60% of patients whereas 40% had unfavorable outcome (mRS score 4 to 6). Poor Hunt and Hess at presentation and presence of vasospasm/infarction were associated with poor outcome. Overall mortality rate was 27%. Three patients required VP shunt whereas three patients each had vasospasm/Delayed ischemic neurological deficit (DIND) and intra-operative rupture. Conclusion: Microsurgical clipping of aneurysms is a standard treatment modality with good results despite recent advances in endovascular techniques. Favorable outcome can be achieved in patients with good Hunt and Hess grade at presentation and without clinical vasospasm/DIND.

Introduction: Cervical degenerative disc diseases leading to cervical spondylotic myelopathy (CSM) is one the most common cause of disability in elderly population that progresses with age with continuation of degree of degeneration. Objective: To assess the functional outcome following ACDF in single-level cervical degenerative disc disease in terms of improvement in the mJOA scoring system and postoperative complications. Materials and methods: Eighteen patients with single level cervical degenerative disc diseases who presented at the college of medical sciences from May 2018 to October 2019 fulfilling the inclusion criteria (single-level cervical degenerative disc disease with age between 40 to 70 years with progressive neurological deficits, features of cervical spondylotic myelopathy and patients with mild grade who failed four weeks of conservative treatment and progressed to moderate or severe grades) were included in the study. All patients underwent Anterior Cervical Discectomy and Fusion (ACDF); with tricortical iliac crest graft with cervical plate and screws in 13 patients and polyether ether ketone (PEEK) cage placement in five patients. Patients were assessed using mJOA scoring system and graded into mild, moderate and severe myelopathy. Post-operatively patients were assessed for improvement in terms of mJOA scores at four weeks and three months follow-up. They were also assessed for development of any post-operative complications and documented accordingly. Statistical analysis was done using the Statistical Package for the Social Sciences version 20 software. Results: Out of 18 patients, at the time of presentation 12 were in moderate grade and six were in severe grade. During subsequent follow up at four weeks and three months, patients showed progressive improvement. 15 patients improved to mild grade while two remained in moderate grade and one in severe grade during three months postoperative assessment. One patient each developed dysphagia, hoarseness and superficial wound infection that were managed conservatively. Conclusion: Anterior cervical discectomy and fusion is one of the effective and safe treatments for single-level degenerative cervical disc disease associated with cervical spondylotic myelopathy with minimal complications.

Background/Objectives:  Parkinson’s disease is a neurodegenerative disease with cardinal features of tremor, rigidity, postural instability and bradykinesia. Surgery is indicated for the patients not responding to medical management or who develop motor fluctuations and dyskinesia following prolonged levodopa therapy. Stereotactic Subthalamotomy and VIM (Ventralis Intermedius) Thalamotomy is cheap, safe and effective surgical options for the treatment of Parkinsonian tremor. The objective of the study was to compare Stereotactic Subthalamotomy with Ventralis Intermedius (VIM) Thalamotomy, in terms of improvement in Unified Parkinson’s Disease Rating Scale (UPDRS), for the treatment of Parkinsonian tremor. Material and Methods:  This is a randomized control trial (RCT) and 38 tremor predominant Parkinsonian patients were enrolled in the study. Half of the patients underwent Stereotactic Subthalamotomy and another half underwent VIM Thalamotomy. Patients were assessed pre-operatively, immediately post-operatively and followed up at three weeks, six weeks and three months by using UPDRS scores. Results:  The mean age of patients was 59.58 years and they were predominantly male. Post-operative UPDRS score was improved significantly in both STN and VIM groups. However, the improvement was significantly higher in STN lesioning compared to VIM lesioning.On the other hand, the improvement in tremor component score of UPDRS was comparable in the both groups. Moreover, post-operative complications were higher following Subthalamotomy (21.05%) which included dyskinesia, dysphasia, transient weakness and hematoma formation. Conclusion:  Both Stereotactic Subthalamotomy and VIM Thalamotomy are equally effective in relieving Parkinsonian tremor with a lower complication rate following VIM Thalamotomy.