bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Outcome of Sellar Suprasellar Brain Tumors through Retracterless Subfrontal Approach
Authors: Mahmood Rana Zubair , Bajwa Imran , Zunair Sayed Ali , Ahmad Touqeer , Sultan Habib , Mehmood Shoqaib 
Published: January 2022

Objectives: The aim of this study is to see the surgical outcome of Sellar and Suprasellar brain tumors with retractorless modified subfrontal approach.
Material and Methods: We did cohort study of 15 patients who were operated in Neurosurgery Unit 2, PINS. Our study duration is 1 year and follow up duration is of 3 months. Clinical features were related to cranial nerves 2nd, 3rd ,4th, and pituitary gland, dural irritation and temporal lobe compression i.e., diplopia, decrease vision, CSF rhinorrhea, abnormal olfaction, headache, GTCS etc.
Results: In our study, age range was 8 – 62 years with mean age was 35 years. Our 5 patients were male and 10 patients were female. Surgery was performed in all patients through subfrontal approach with retractorless method. In Histopathological report of 2 patients’ findings was Craniopharyngioma, 12 were of pituitary adenoma and 1 was of sellar meningioma. Seven 46.67 percent patients operated successfully with no new neurological deficit. Three 20 percent patients operated but no post op improvement in clinical symptoms, no patients were re-explored postoperatively due to CSF Rhinorrhea. Diabetes Insipidus occurred in 5 (33.3%) patients post-operatively which was managed later on.
Conclusion: Surgery subfrontal approach with retractorless method is the safe corridor for treatment of sellar and Suprasellar brain tumors.
Importance of Simpson/Shinshu Grading in Meningioma’s Excision, Outcome and Recurrence
Authors: Wadd Ijaz Hussain , Naeem Muhammad , Ijaz Sidra 
Published: January 2022

Objective: The study was aimed to determine the recurrence rate and recurrence-free survival of meningioma surgery with reference to Simpson grading of excision.
Material and Methods: The study was conducted in the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. Total 325 patients both male and female of age (13 – 70 years) with supratentorial grade I meningioma operated. The craniotomy with maximum safe excision of the meningioma was done in all patients under general anesthesia. All patients followed-up to one year clinically and radiologically. MRI brain plain and IV contrast were done at 6 months and then annually. The extent of resection was determined with the help of operative notes and post-op MRI and recurrences were studied with help of follow-up MRI.
Results: There were 227 female and 98 male patients in ages 13 – 70 years. The mean age of patients was 53.5 years. 227 (70%) skull base meningioma, 71 (22.0%) convexity meningioma, and 26 (8%) falx or tentorium meningioma were operated. We achieved Simpson grade I excision in 55 (17.45%), grade II in 208 (64%), grade III in 23 (7%), and grade IV in 36 (11%) cases. The median recurrence free survival (RFS) with reference to Simpson grading of excision was 250, 120, 98, 80 months for grades I, II, III, and IV excision; it was statistically significant according to the grading of excision.
Conclusion: Excision of meningioma up to grades I and II had an excellent outcome with minimum chances of complications.
Outcome of the Traumatic Extradural Hematoma on the Basis of Size of Extradural Hematoma
Authors: Tariq Muhammad , Mian Mushtaq ahmad , Ali Muhammad , Ayub Shahid , Dad Khan Waseem , Daud Khan Sohail 
Published: January 2022

Objective: This study aimed to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma.
Materials & Methods: A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months and included 188 patients. The detailed history and clinical examinations were noted through a pre-designed proforma. Patients were followed post-operatively till the time of discharge and for either favorable outcome or unfavorable outcome according to the GOS.
Results: 73% of patients had extradural hematoma volume between 25 – 50 mL, while 27% patients had extradural hematoma >50 mL. 12% of patients had Glasgow Outcome Score (GOS) scores 1 – 3, while 88% of patients had GOS scores: 4 – 5. The mean GOS was 3. Patients with favorable outcomes were 88% while 12% had an unfavorable outcome.
Conclusion: The size of the extradural hematoma has a strong correlation with outcome. The greater the size of the hematoma, the poorer the outcome.
Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.
Authors: Ahmad Kamboh Usman , Mehboob Mehreen , Ashraf Mohammad , Shahid Saman , Sultan Kashif Ali , Asif Raza Muhammad , Hussain Syed Shahzad , Ashraf Naveed 
Published: January 2022

Objective: To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan.
Material & Methods: A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions.
Results: 85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p<0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months.
Conclusion: Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability.
Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis
Authors: Anwar Taimoor , Rehman Muhammad Abdur , Tanveer Ahmad Urwa , Anwer Ammar , Wahab Anum , Tul Ain Tariq Qura 
Published: January 2022

Objective: To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis.
Material and Methods: The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score.
Results: Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value<0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value < 0.0001) observed only in male patients between two surgery groups for the back pain scores.
Conclusion: Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis.
Acute Traumatic Subdural Hematoma: Series of Thirty Cases
Authors: Asif Muhammad , Aziz Rehman Waqar , Sarwar Sumaira , Younas Hamza , Younas Aatika 
Published: January 2022

Objectives: Acute Traumatic Subdural Hematoma (ASDH) is one of the most dangerous and challenging neurosurgical problems faced by neurosurgeons. Road traffic accidents (RTAs) and falls are the most common causes of ASDH. This study focused to evaluate the incidence, mode, and severity of the injury, treatment options, and determine outcomes in patients with ASDH.
Material & Methods: Thirty patients with ASDH were studied over a period of three years. Detailed history, general and neurological examination including GCS were noted, CT scans were done and patients managed according to said protocol.
Results: Twenty-three (76.66%) were male and Seven (23.33%) were female. The common mode of injury were road traffic accidents (66.66%) and falls (26.66%). Out of 30 patients, 53.33% had GCS 3-5. Overall, the mortality rate was 60%. 23.33% of patients survived with severe disability and 10% of patients showed moderate disability and good recovery. The mortality rate was higher in patients above 50 years of age.
Conclusion: Acute traumatic subdural hematoma is still very fatal and has a high mortality. Early CT scanning emergency, surgery and good postoperative ICU care can play a role in improving the outcome in patients with ASDH.
Frequency of Infected Healthcare Workers and Factors Leading to Infection in Emergency Neurosurgical Trauma during COVID-19 Pandemic
Authors: Ahmad Khan Afridi et al. Ehtisham 
Published: January 2022

Objective: The aim of this study was to know the frequency of COVID-19 infection in healthcare workers and to identify the risk factors leading to infection in emergency neurosurgical trauma during COVID-19 pandemic.
Material and Methods: This descriptive cross-sectional study was conducted in the Department of Neurosurgery, Ayub Teaching Hospital. A total of 99 healthcare workers with an age range from 22 – 55 years attending or carry emergency procedures with both male and female gender were included in the study. Age, gender, sign and symptoms, safety measures and COVID PCR reports were recorded.
Results: 12 (12.1%) out of 99 healthcare workers got an infection with COVID-19. 83.3% of the infected healthcare workers were male while 16.6% were females. A maximum of the healthcare workers infected with COVID-19 was in the age range 31 – 40 (50%). Most of them were Doctors (66.6%) followed by nursing staff (25%). Low-grade fever and cough were the most common symptoms. The most important factors which affect the transmission of infection to healthcare workers were improper use of personal protective equipment (PPE), masks, gloves by healthcare professionals, and inability to maintain social distancing with the patients.
Conclusion: To protect healthcare workers from getting infections, proper personal protective equipment should be used. Early recognition of the infected patient and prompt isolation should be done to prevent or minimize the chain of transmission.
Teaching Emotional Intelligence to Undergraduate Students
Authors: Amir et al Sohail 
Published: January 2022

Emotional intelligence (EI) is how well we handle ourselves and our relationship. EI may be a social intelligence that will be learned, developed, and improved. Both IQ and EI are needed for success in life. But literature has proved that we need more EI to be successful. Therefore, it should be taught to undergraduate students in order to increase self-confidence, improve interpersonal and communication skills, improve empathy for better patient care, buffer stress, improve problem-solving skills, developed leadership quality and all these characteristics will lead to success in life. In the literature, there are twelve different strategies; a teacher can apply to students to teach the topic effectively. Problem based learning and role-play teaching strategies will be helpful to teach the Emotional Intelligence (EI) effectively and fulfill the four competencies of EI which includes self-awareness, self-motivation, empathy, and inter/intrapersonal skills development.
Keywords: Emotional Intelligence, Undergraduate Students, Competencies.
Comparison of Early vs. Late Tracheostomy in Subdural Hematoma Operated at GCS Six or Below
Authors: Mahmood Rana Zubair , Ali Dehraj Sikandar , Khan Sarfraz , Mansoor Usama , Wajid Abdul , Ahmad Touqeer 
Published: January 2022

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.
Single Burrhole Craniostomy with Subdural Placement of Foley Catheter for Drainage of Chronic Subdural Hematoma
Authors: Sheikh Faiq , Nasir Jamal , Khalid Adnan , Saleem Rabia , Sheikh Fakiha , Rauf Abuzar 
Published: January 2022

Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical condition of the elderly. The lack of consensus over a single standard surgical procedure for the management of CSDH urges neurosurgeons to evaluate different techniques in terms of a better outcome.
Material & Methods: In this prospective study forty cases of CSDH who had undergone single burr-hole craniostomy and subdural placement of Foley catheter were analyzed. The observations were made concerning clinical, radiological findings, postoperative complications, and mortality rate.
Results: The study included 26 males and 14 females with a mean age of 67 years. The most common presenting symptom was hemiparesis (n=18, 45%). Recurrent hematoma and recurrent evacuation rate was 10%. There was no case of newly developed postoperative seizures, pneumocephalus, intracranial hemorrhage, and wound infection. The mortality rate during the study was 0.0%. The mean Glasgow outcome score (GOS) at the time of discharge was 4.8.
Conclusion: We concluded that single burr-hole evacuation of CSDH with Foley catheter placement appears to be an effective procedure with a significant reduction in postoperative pneumocephalus. Factors such as sudden decompression of hematoma, the air in the subdural cavity, misplacement of drainage tubes, and damage to blood vessels during surgery can be reduced with this technique.
Surgical Outcome of Pure Endonasal Transsphenoidal Approach for Pituitary Tumors
Authors: Bakar Yasin Abu , Khan Rizwan Ahmed , Mahmood Khalid 
Published: January 2022

Objective: To determine the frequency of complete tumor excision by endoscopic skull base (transsphenoidal) approach in pituitary adenoma patients presenting to a neurosurgical department.
Materials & Methods: This descriptive case series was conducted at the Department of Neurosurgery Unit II, Lahore General Hospital Lahore from May 2019 to November 2019. The study included60 patients with pituitary adenoma from the outpatient department who qualified for the inclusion criteria. All patients went through the endoscopic binarial transsphenoidal approach for pituitary adenectomy. All patients were treated according to the department protocols and were followed for 6 weeks to determine the outcome i.e. no residual tumor left as determined by Magnetic Resonance Imaging.
Results: The mean age of pituitary adenoma patients studied was 50.02 ± 8.2 years. 43 patients (71.7%) were male.56 patients (93.3%) showed complete resection on MRI using the endoscopic binarial transsphenoidal approach. The outcome was not affected by patients' gender and age. Tumor size significantly affected the outcome i.e. complete resection.
Conclusion: It is concluded that the endoscopic skull base (transsphenoidal) approach for excision of pituitary adenomas gives desirable results as depicted by 93.3% success rate in terms of complete resection of the tumor. We did not observe a significant effect of patients' gender and age on the clinical outcome in the studied sample of the population.
Minimal Invasive Surgery for Chronic Subdural Hematoma
Authors: Rahman Hanif-ur- , Amir Sohail , Ali Mumtaz , Ayub Shahid , Sundal Anisa , Ishaq Muhammad 
Published: January 2022

Objective: To assess significant improvement in terms of the Glasgow Coma Scale in patients subjected to minimally invasive surgery for a chronic subdural hematoma.
Materials and Methods: A total of 80 patients with chronic subdural hematoma (CSDH) were enrolled in a sequential fashion using a retrospective study design. The patients were treated with minimally invasive surgery (MIS) and assessed at the end of the 2nd postoperative day (POD) for any significant improvement in the Glasgow coma scale (GCS).
Results: There were 76.25% male and 23.75% female patients. A maximum number of patients (42.5%) were found with a GCS ranging from 9/15 – 11/15 (Class B) followed by Class A having GCS 12-13 (36.25%) and then Class C with GCS 5 – 8 (21.25% patients). In 86.2% and 13.7& of the patients, positive and negative outcomes were recorded. Maximum favorable surgical outcome was observed in 51-60 years of age group. In the majority of male patients, a favorable surgical outcome was reported. Similarly, a favorable surgical outcome was observed in Class B (GCS 9-11). There existed an insignificant difference between favorable surgical outcome vs. age groups, gender, and GCS class at baseline.
Conclusion: This study found that CSDH using the MIS approach is linked to a high frequency of positive outcomes in terms of GCS improvement. A lower admission GCS score and older age are linked to a lower frequency of favorable outcomes and a higher likelihood of bad outcomes.
Assessment of Frailty Preoperatively and Loss of Independence in Elderly Surgical Patients
Authors: DIN SHAMS UD , Ahmed Ishfaq Ahmed , Ahmed Ishfaq Ahmed 
Published: January 2022

Objective: This study was aimed to determine preoperative frailty assessment screening on postoperative morbidity and postoperative loss of independence (LOI).
Materials & Methods: A total of 100 patient’s age 65 years and older were included in this study. Edmodium Frail Scale (EFS) was used for the assessment of frailty. The surgical procedure was categorized on operative severity score, and Hierarchical Condition Category (HCC). The Chi-square test was applied to see the significant/insignificant differences between different stratified groups of patients.
Results: The mean age of the patients was 68 years. There were 63% male and 37% female patients. Maximum patients (78%) who had no LOI were in age less than 80 years. 11% of patients who had LOI were only 11%. There existed a significant difference (p-value: 0.004) between age groups (greater than/less than 80 years) of patients and presence/absence of loss of independence (LOI). After EFS assessment, 32% of patients had limited mobility, 22% had weight loss, 19% reported depression, 9% of patients were socially dependent and 18% reported cognitive impairment.
Conclusion: The results suggest that frail patients older than 78 years and OSS > 3 had a more increased risk of postsurgical LOI. The patients with EFS >5 and OSS >3 had more LOI. EFS analysis explained that those patients with restricted mobility, depression, and dependent socially had increased LOI.
Outcome Comparison of Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Obstructive Hydrocephalus
Authors: Ahmed Simair Ishfaque , Jawad Ali Hafiz , Qureshi Amjad , Salah-ud-Din Tarique 
Published: January 2022

Background and Objectives: To assess the outcome of Endoscopic Third Ventriculostomy (ETV) versus Ventriculoperitoneal Shunt (VPS) in Obstructive Hydrocephalus in terms of infections, foreign bodies, cost-effectiveness, and length of hospital stay.
Materials and Methods: It was a Randomized Controlled Trial study, in which 30 patients with Obstructive Hydrocephalus were divided into two groups one was treated with (ETV) and the other was treated with VP Shunt and the patients were followed up for 1 year.
Results: Patients were divided into 2 groups, 15 were treated with ETV, and 15 were treated with VP Shunt. Length of stay for VP shunt was 7 ± 0.85 days and for ETV mean stay was 2.93 ± 1.1 days. The complication was observed in 4 (26.7%) treated with VP Shunt and in 3 (20%) patients with Endoscopic Third Ventriculostomy. In ETV, 3 (20%) patients had recurrence whereas in VP shunt in 1 (6.67%) had an infection and in 3 (20%) patients had recurrence (upper-end blockage) and the overall success rate was 76% in both the procedures and in VP Shunt 73.3% and ETV 80%. Overall there were no complications found in 23 (76.6%) patients, in 3 (10%) patient’s complications were found at 1st month, in 3 (10%) complications were observed at 3rd month, and in 1(3.3%) complication was recorded at 6th month.
Conclusion: ETV was found better in terms of length of hospital stay, cost-effectiveness as well as minimal complication rate as compared to VP shunt.
Early Neurological Outcome of Surgical Repair of Lipomyelomeningocele in Infants
Authors: Iqbal Shahid , Ijaz Lubna , Butt Jamal , Iqbal Mariyum , Nadeem Malik Muhammad 
Published: January 2022

Objective: A prospective cohort study was aimed to evaluate the early neurological outcome of surgery among infants having lipomyelomeningocele.
Material and Methods: The study was conducted at the Department of Pediatric neurosurgery, Children Hospital &The Institute of Child Health, Lahore from January 2019 to June 2019.A total of 50 pediatric patients, both male and female, aged 3 months to 1 year, with lipomyelomeningocele (symptomatic or asymptomatic) who presented to the out-patient department were included in the study. Group A included those cases who were aged <6 months and Group B were aged >6 months. All patients underwent standard surgical procedures for the treatment of lipomyelomeningocele.
Results: Out of a total of 50 infants, there was 32 (64.0%) female. Overall, the mean age was 7.39 ± 2.63 months. The lumbar area having mass on the back was the most frequently seen in 23 (46.0%) infants. Group A included 20 (40.0%) infants while Group-B had 30 (60.0%). Low lying cord was the commonest neurological finding noted among 25 (50.0%). Complete Excision of Lipoma was done among 48 (96.0%) infants. Post-surgery, no significant difference was found on day-3 and day-10 between study groups (P > 0.05). Early outcome at 6-months intervals was found to be associated with significantly improved neurological function grades in Group-A (p = 0.030).
Conclusion: Surgical management of lipomyelomeningocele is a safe procedure. An early treatment approach even in asymptomatic infants is recommended to reduce neurological deterioration.