Pakistan Journal Of Neurological Surgery

Association Between Benzodiazepine Administration and Respiratory Depression in Acute Seizure Management

2025-07-04T01:24:18+00:00

Objective: To assess the correlation between benzodiazepine use and the incidence of respiratory depression in patients treated for acute seizures at Lady Reading Hospital, Peshawar.

Materials and Methods: This prospective observational study was conducted from May to October 2024 at the Neurology and Emergency Medicine Departments of Lady Reading Hospital. A total of 200 patients, aged 10 years and above, who presented with acute seizures and received benzodiazepines as part of initial management, were enrolled. Respiratory parameters were monitored before and after benzodiazepine administration. Respiratory depression, defined as hypoventilation, oxygen saturation <90%, or the need for assisted ventilation, was recorded and correlated with the type, dosage, and route of benzodiazepine.

Results: Among 200 patients, 44 (22%) developed respiratory depression. The incidence was higher with intravenous lorazepam compared to intramuscular midazolam. Patients aged >60 years and those with chronic obstructive pulmonary disease had a higher risk. Respiratory depression correlated significantly with higher cumulative benzodiazepine doses (p < 0.05).

Conclusion: Benzodiazepines are the cornerstone of acute seizure management due to their rapid action, but they carry a measurable risk of respiratory depression. Careful dosing and vigilant monitoring are crucial to minimize complications. AEDs provide long-term seizure prevention but are not substitutes for first-line emergency therapy.

Transpedicular Screw Fixation and Its Surgical Outcomes In The Management of Lumbar Instability: A Case Series of 107 Patients

2025-09-08T13:26:37+00:00

Objective: Lumbar instability is a predominant pathology characterized by excessive and abnormal movement between two or more segments and is a significant cause of disability. In recent years, the transpedicular screw fixation system has been found to be successful in the management of spinal instabilities. The study aims to find out the surgical outcomes of TPF in radiological lumbar instability.

Materials & Methods: This study was conducted on 107 patients at Ali Institute of Neurosciences, Irfan General Hospital, from June 2018 to December 2021, with a one-year follow-up period. Patients were recruited through non-probability convenience sampling. Inclusion criteria consisted of patients diagnosed with radiological lumbar instability evident on investigation findings. Exclusion criteria consisted of patients who were diagnosed with functional or non-radiological instability and those undergoing any procedure other than transpedicular screw fixation.

Results: A total of 107 patients were treated for radiological lumbar instability through transpedicular screw fixation, out of which the majority of the participants were males (62%), followed by females (38%). The majority of the participants (75%) stated that the back pain was diminished completely or had minor episodes. Mean improvement on the visual analogue scale was observed to be 6 points (Pre-op VAS=8, Post op VAS=2). Neurological symptoms, including sensory and motor, demonstrated improvement in 90% of the patients.

Conclusion: Transpedicular screw fixation (TPF) is a safe, effective surgical procedure associated with significant clinical outcomes. However, the procedure is associated with minor surgical and post-op complications. Postoperative physiotherapy may further enhance recovery in lumbar instability patients

Surgical Outcome of Brain Contusions Treated by Decompressive Craniotomy With or Without Lobectomy

2025-11-25T09:12:00+00:00

Objective: To compare the surgical outcomes of decompressive craniotomy with or without lobectomy for patients presenting with brain contusions in a tertiary care trauma center.”

methods: This randomized clinical trial was carried out in the Neurosurgery department, Allied Hospital, Faisalabad, for 1 year. Patients admitted with severe TBI were enrolled and underwent decompressive craniotomy (DC) with lax duraplasty, or decompressive craniotomy with lobectomy (DCWL) or contusionectomy and lax duraplasty

Results: The mean GCS score at presentation in DC was 5.8±0.755 and in DCWL was 5.64±0.74. At the 3^rd month, 44% patients had GOS-E at vegetative state, 30% had GOS-E at lower severe disability, and 26% had GOS-E at upper severe disability in the DC group. But in the DCWL group, 2% patients had GOS-E at vegetative state, 22% were at lower severe disability 16% were at upper severe disability, 30% had GOS-E at upper moderate disability, and 30% were at lower moderate disability (P<0.05). At the 6^th month, 26% patients had GOS-E at dead state, 34% were at upper severe disability, and 40% were at lower moderate disability in the DC group. But in the DCWL group, 38% had GOS-E at upper moderate disability, 32% were at lower good recovery, and 30% were at upper good recovery (p<0.05).

Conclusion: The surgical outcome of brain contusions treated by DCWL was better compared to DC without lobectomy.

Decoding Brain Metabolism: Diagnostic Accuracy of Magnetic Resonance Spectroscopy Versus Fluorodeoxyglucose Positron Emission Tomography in Neurological Disorders

2025-11-25T09:23:10+00:00

Objective: To compare the diagnostic performance of Magnetic Resonance Spectroscopy (MRS) and Positron Emission Tomography (PET) in the evaluation of brain metabolic disorders, with a specific focus on diagnostic accuracy, lesion detection, and metabolite quantification.

Materials and Methods: This prospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, from January to July 2023. A total of 150 patients with clinical suspicion of brain metabolic dysfunction underwent MRS at LRH and PET at affiliated external centers. Imaging findings were independently interpreted by two radiologists. Diagnostic metrics were calculated, and statistical significance was determined using chi-square and independent t-tests.

Results: Lesion detection rates were 78.0% for MRS and 88.0% for PET. PET demonstrated higher sensitivity (88%) compared to MRS (78%), while MRS had slightly higher specificity (85% vs. 82%). Combined modality uses in concordant cases yielded the highest diagnostic accuracy (AUC = 0.93). Statistical analysis confirmed significant differences (p < 0.05).

Conclusion: MRS and PET offer complementary diagnostic capabilities. Their combined application enhances diagnostic accuracy and clinical confidence, especially in resource-limited or diagnostically challenging scenarios.

Outcomes of Syringosubarachnoid Shunting in Patients with Syringomyelia Following Foramen Magnum Decompression

2025-11-25T09:56:12+00:00

Introduction: Syringomyelia following foramen magnum decompression can develop as a progressive neurological deficit that requires effective intervention. Syringosubarachnoid shunting has been brought to attention as a direct method to relieve syrinx pressure and relieve symptoms. The purpose of this study is to assess clinical and radiological outcomes of syringosubarachnoid shunting in such patients.

Material & Methods: A retrospective study was done of 21 patients of syringomyelia treated by syringosubarachnoid shunting at Hayatabad Medical Complex, Peshawar. The modified Japanese Orthopedic Association score (mJOA) was used to assess clinical recovery, and radiological outcomes included syrinx area change and span. Paired t tests and correlation analysis were performed using statistical analysis with p < 0.05.

Conclusion: Syringosubarachnoid shunting provides a safe and effective surgical option for the relief of syringomyelia after foramen magnum decompression with significant clinical and syringomyelia improvement and low complication rates. Nevertheless, it is still a good intervention when decompression alone is not enough.

Surgical Outcomes of Tethered Cord Release Under Intraoperative Neuromonitoring in Patients with Tethered Cord Syndrome

2025-11-25T10:02:18+00:00

Objective: To analyze the efficacy of intraoperative neurophysiological monitoring (IONM) to keep the patient neurologically functional during surgical management of Tethered Cord Syndrome (TCS).

Material and Methods: The retrospective study was done on 40 patients of tethered cord release in Khyber Teaching Hospital, Peshawar, during March 2024 to February 2025. Transcranial motor evoked potentials (TcMEPs), tibial nerve somatosensory evoked potentials (TNSEPs), and pudendal anal reflex (PAR) were used as intraoperative monitoring. Pre and postoperative evaluations were done on motor strength, sensory, and bladder/anal control. The Fisher Exact Test was used to carry out statistical analysis with a p-value of < 0.05.

Results: The average time of follow-up of patients (mean age: 20.14 +/- 11.96 years) was 8.41 months. The success monitoring was 95 percent in TcMEPs, 72.5 percent in TNSEPs, and 82.5 percent in PAR. In 7.5 percent of cases, transient deficits were reported. TcMEPs had a sensitivity and specificity of 100 percent to predict motor outcomes. TNSEPs were highly correlated with sensory changes (p = 0.049), whereas PAR was not significantly correlated with bladder dysfunction (p = 0.497). There were no significant complications.

Conclusion: Multimodal IONM of tethered cord surgery promotes intraoperative safety and contributes to the maintenance of motor and sensory functions. TcMEPs were very accurate in the determination of motor outcome, whereas TNSEPs were very informative in the determination of sensory activity.

Evaluation of Seizure Disorders in Eclamptic and Pre-Eclamptic Patients: A Prospective Analysis from a Tertiary Care Hospital

2025-11-25T10:22:41+00:00

Objective: To evaluate the types, frequency, and clinical presentations of seizures in patients with eclampsia and preeclampsia, assess neuroimaging findings, including the prevalence of Posterior Reversible Encephalopathy Syndrome (PRES) and other cerebral abnormalities, and analyze maternal and fetal outcomes in relation to seizure characteristics and treatment strategies.

Materials & Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynecology in collaboration with Neurology at Lady Reading Hospital, Peshawar, from January 2024 to June 2025. A total of 134 patients with eclampsia or severe preeclampsia presenting with seizures were enrolled. Clinical data, seizure type, imaging findings, treatment details, and maternal fetal outcomes were documented. The chi-square and logistic regression tests were applied for outcome associations’ assessments.

Results: Of the 134 patients 70.1 percent had eclampsia and 29.9 percent had preeclampsia with seizures Generalized tonic clonic seizures were observed in 88.8 percent focal seizures in 8.2 percent and status epilepticus in 3 percent Neuroimaging was performed in 63.4 percent of patients revealing PRES in 36.5 percent Magnesium sulfate was administered in 96.3 percent ICU admission was required in 24.6 percent and maternal mortality was 3.7 percent Intrauterine fetal demise occurred in 13.4 percent and NICU admission was needed in 16.4 percent of neonates.

Conclusion: Seizures in hypertensive pregnancies are predominantly generalized and associated with PRES Early clinical and imaging assessment with prompt magnesium sulfate administration is essential to improve maternal and fetal outcomes.

Surgical Outcome of Limited Hemilaminectomy Performed for Spinal Stenosis

2025-11-25T10:26:16+00:00

Objective: To assess surgery-related outcomes of limited hemilaminectomy in patients with single-level spinal stenosis of the lumbar spine who did not respond to conservative therapy.

Materials & Methods: The retrospective observational study was done at KTH, Peshawar. 34 patients with a diagnosis of single-level lumbar spinal stenosis were treated surgically by limited hemilaminectomy. Assessments were done by clinical testing of walking capabilities, alleviation of radicular pain, and recovery of motor stiffness. The complications during postoperative were documented. The duration of follow-up was between 6 and 15 months (mean: 11.2 +/- 2.8 months).

Results: Good outcomes were achieved after surgery. The mean increase of walking distance was found in 82.3% of patients, whereas 70.5% percent could travel less than 100 meters before surgery (p=0.001). Radicular pain resolved within 88.2% of the patients at a span of six months (p=0.042). Of the 13 patients 38.2% who had dorsiflexion weakness, the recovery back to full normal was feasible within six months (p = 0.001). The postoperative complications were minor and transient, though it was present in only 8.8 percent of cases.

Conclusion: Limited hemilaminectomy is a potentially beneficial intervention that has a good clinical outcome regarding single-level lumbar spinal stenosis, with restricted functional capacity and a low complication rate. This method stabilizes the spine and eliminates the necessity to fuse or use instrumentation, thus representing a safe alternative to a common open laminectomy.

Effectiveness of Manipulation under Anesthesia in Patients with Chronic Coccydynia: A Case Series with Three-Month Follow-up and Rehabilitation Protocol

2025-11-25T10:32:29+00:00

Objective: To evaluate the effectiveness of MUA with steroid injection in patients with chronic coccydynia and outline a standardized rehabilitation protocol.

Methods: A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurological Sciences, Lahore. Seventy-five patients aged 25–60 years with chronic coccydynia unresponsive to conservative management underwent MUA under general anesthesia. The coccyx was manipulated with a per rectal technique, and 40 mg of methylprednisolone with 10 ml of 0.25% bupivacaine was infiltrated locally. Outcomes were assessed at 3 months using VAS and need for analgesia. Data were analyzed using SPSS v17.

Results: The mean age was 42.5 ± 11 years; 53.3% were male. The mean disease duration was 9.8 ± 3.7 months. Success was achieved in 88% of patients, with only 2.7% requiring analgesia after the procedure. No significant difference was found in outcomes based on age, gender, or disease duration.

Conclusion: MUA with local steroid infiltration is a highly effective treatment for chronic coccydynia, offering substantial relief with minimal morbidity. Incorporation of a post-MUA rehabilitation protocol enhances outcomes and reduces the need for surgical intervention.

Correlation Between Urodynamic Study Findings and Quality of Life in Patients With Neurogenic Bladder

2025-11-25T10:52:36+00:00

Objective: To evaluate the correlation between urodynamic parameters and quality of life in patients with
neurogenic bladder using the Qualiveen-30 questionnaire.

Conclusion: Urodynamic findings, particularly poor bladder compliance and detrusor overactivity, are strongly
associated with diminished quality of life in neurogenic bladder patients. A multidisciplinary, patient-centered
approach addressing both physiological and psychosocial domains is essential for optimal management.

Surgical Outcomes of Single-Level Stand-Alone Cage Use in Anterior Cervical Discectomy and Fusion

2025-11-25T11:00:46+00:00

Objective: To test clinical and radiological outcomes of single-level anterior cervical discectomy and fusion (ACDF) without anterior plating using polyetheretherketone (PEEK) cage as a stand-alone cage.

Materials and Methods: This retrospective study included 24 patients who underwent single-level ACDF between May 2024 and July 2025, with 12 12-month follow-up. All the surgeries were anterior, and PEEK cages were autologous bone-filled. They employed a team that measured the functional outcome of Neck Disability Index (NDI), the Visual Analog Scale (VAS), and Swallowing Quality of Life (SWAL-QOL). Fusion, subsidence, and alignment were the radiological results. An analysis involving 22.0 SPSS was used, and p < 0.05 was the cutoff point.

Results: A complete population was maintained for a period of 12 months. At radiograph- 100 percent in fusion. The NDI and VAS scores improved significantly (21.05, 8.10, and 2.25, 1.12, respectively). The assessment of the level of SWAL-QOL was low, and its expression was through dysphagia during follow-up. Subsidence >2 mm with clinical significance was observed in two patients (8.3%). One case (4.2%) of pseudarthrosis and two cases (8.3%) of transient adjacent level radiculopathy were recorded, and no infections were registered, with no reoperations being observed.

Conclusion: Single-level ACDF with the use of standalone cages gives good fusion, improved clinical results, and a low complication rate. Morbidity can subsequently be reduced after the surgery by foregoing anterior plating.

Predictive Role of Tumor Dimensions and Body Mass Index in The Development of Postoperative Diabetes Insipidus Following Pituitary Adenoma Resection: Analysis of 209 Consecutive Cases

2025-11-25T11:04:26+00:00

Objective: This study examines the outcomes of tumor size, dimensions, and patients’ body mass index (BMI) on the postoperative DI.

Material and Methods: This study was done on 209 patients who met the inclusion criteria. They were counseled and comprehensively informed about the study. The DI was labeled according to the operational definition. The DI was managed as per ward protocol. All the data was recorded. All the surgeries were done by one surgical team, and all the labs were done from one lab, i.e., hospital lab.

Results: Out of 209 patients, 1.9% (n = 4) were between 5 and 30 years of age, and 98.1% (n = 205) were between 31 and 60 years of age. The mean age was 41.45 ± 6.47 years. The distribution of the size of the tumor was 2.69 ± 0.756 cm, and the distribution of BMI was 26.00 ± 1.954 kg/m2. Out of 209 patients, 61.2% (n = 128) were male, whereas 38.8% (n=81) were female. The distribution of DI among patients undergoing endoscopic transsphenoidal surgery was 25.4% (n=53).

Conclusion: We found that DI among patients undergoing endoscopic transsphenoidal surgery was 25.4% (n=53). Therefore, post-operative DI is one of the common complications after pituitary surgery

Role of Intradiscal Gentamycin Wash on Incidence of Postoperative Discitis

2025-11-29T06:50:35+00:00

Objective: Postoperative discitis (POD) is a serious yet uncommon side effect of lumbar discectomy with long-term morbidity, delayed recovery, and high cost of treatment. Local prophylaxis is a viable alternative to systemic antibiotics, which fail to reach a therapeutic level in the avascular disc. This study sought to assess the efficacy of intradiscal gentamycin wash in the prevention of POD.

Material and Methods: A retrospective study was conducted on 160 patients (58% male) who underwent lumbar discectomy between December 2023 and January 2025. The patients were categorized into Group A (n=70), without intradiscal wash, and Group B (n=90), with intradiscal wash (gentamycin 80 mg). All were then clinically and radiographically followed for 12 months. The incidence of POD was the main outcome, and clinical, radiological, and laboratory characteristics were analyzed in patients with POD.

Results: POD occurred in 5 patients (3.1%). Group A had 4 cases (5.7%), whereas Group B had 1 case (1.11%), showing a significant reduction (p < 0.05; RR = 5.14). All POD cases were managed conservatively with intravenous administration of antibiotics, use of bracing, and analgesics, and they had full recovery within 6-12 months without surgery.

Conclusion: Intradiscal gentamycin wash is an easy, safe, and cost-effective adjuvant that has proven to be significantly effective in the reduction of POD after lumbar discectomy. Larger prospective trials are indicated to establish a role for its routine clinical use.

Neurological Outcomes and Helmet Use among Motorcyclists Admitted to a Tertiary Neurosurgical Center in Pakistan

2025-11-29T07:03:41+00:00

Objective: To determine neurological injury patterns, severity, outcomes, and helmet use prevalence among motorcyclists admitted to a tertiary neurosurgical unit.
Results: We enrolled 113 patients (mean age 26.9 ± 17.5 years; 85.0% male). Helmet use was 1.8% (n=2). Drivers
comprised 62.8% and passengers 37.2%. Predominant diagnoses were traumatic brain injury (26.5%), extradural
hematoma (15.9%), brain contusion (15.0%), and subarachnoid hemorrhage (14.2%). On admission, 69.0% had
mild, 18.6% moderate, and 12.4% severe head injury. Conservative management was performed in 86.7% (n=98),
and 13.3% (n=15) underwent surgery. ICU admission was required for 8.0% (n=9). Median hospital stay was 2
days (IQR 1–2). Overall mortality was 8.0% (n=9), all among non-helmeted riders. The two helmeted patients
sustained only mild injuries, required no surgery or ICU care, and were discharged without complications.
Conclusion: Helmet use was rare but associated with milder injuries and zero mortality. Strengthened
legislation, enforcement, and public education are urgently needed to reduce preventable neurotrauma.
Keywords: Helmet use; traumatic brain injury; motorcycle crash; neurosurgical outcomes; Pakistan.

Cognitive Dysfunction in Type 2 Diabetes Mellitus: Correlation with Glycemic Control

2025-11-29T07:19:10+00:00

Objective: The study was conducted to evaluate the association between long-term glycemic control and cognitive function in patients with Type 2 Diabetes Mellitus (T2DM).

Materials and Methods: A prospective observational study was conducted over six months from January to June 2024 at the Departments of Neurology and Internal Medicine, Lady Reading Hospital, Peshawar. A total of 200 patients aged 40 to 75 years with established T2DM were enrolled through non-probability consecutive sampling. Cognitive function was assessed using the Montreal Cognitive Assessment tool after cultural adaptation. Glycemic control was measured by HbA1c levels. Patients with psychiatric illness, stroke, dementia, or medications affecting cognition were excluded. The association between HbA1c and cognitive function was tested using Pearson correlation with significance at p >0.05.

Conclusion: Poor glycemic control was strongly associated with cognitive dysfunction in T2DM. Routine cognitive screening is recommended in patients with poor metabolic control and longer disease duration.

A Systematic Review of Mental Health Disorders and Interventions in Children: Prevalence, Risk Factors, and Treatment Outcomes

2025-10-15T00:42:18+00:00

Objectives: This systematic review sought to: (1) Assess and compare global and regional prevalence estimates of depression, anxiety, ADHD, and ASD among minors aged 0-18 (2) Identify and compare determinants (socioeconomic, family, environment) and protection mechanisms to these conditions; and (3) Analyze the relative effectiveness of cognitive behavioral therapy, school-based programs, medications, and digital therapies.

Materials & Methods: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Scopus, PsycINFO, and Web of Science was conducted for studies published from 2010 to April 2025. Eligible studies included observational and interventional designs involving participants aged 0–18 years. Sixty-four studies meeting the inclusion criteria were analyzed using a narrative synthesis framework.

Results: Prevalence estimates varied widely across disorders: depression (12%), anxiety (9%), ADHD (6–9%), and ASD (1.5%). Socioeconomic hardship, adverse childhood experiences, and parental mental illness emerged as consistent risk factors, while supportive parenting and strong school attachment acted as protective influences. Cognitive-behavioral therapy (CBT), school-based programs, and digital interventions showed significant though variable effectiveness. Recent global data underscore the growing mental health crisis, with the rates of depression and anxiety among adolescents significantly increasing—depression by 60% between 2017 and 2021 and anxiety by 61% between 2016 and 2023.

Conclusion: Childhood mental disorders remain underdiagnosed and undertreated globally. Multisectoral, culturally sensitive, particularly CBT and school-based models, are essential to improve early detection and access.