Objective:  The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi. Material and Methods:  After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided. Result:  The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case,  and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient. Conclusion:  Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods

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Objective:  Objective of study is to identify the effects of Stereotactic thalamotomy of the nucleus ventral intermediate (VIM) for treatment of essential tremor. Material and Methods:  This is a descriptive study.It was performed at NCCI, Karachi, duration of study was 7 years, from 2-10-2012 to 7-10-2019. Those patients were included who were with tremors refractory to medication, their duration of disease was > 3 years, and with grade 4 tremors. The thalamotomy was performed in all cases, and follow-up was conducted at 3, 6, and 12 months respectively. The success of the surgery was measured in the form of a reduction in medication number and reduction in dose >50% and by calculating the Essential Tremor Rating Assessment Scale (tetras). Results:  Total of 26 patients were included. All patients showed remarkable improvement post-procedure at 12 month follow-up. 20 (77%) patient required no medications. In 6 (23%) patients, the dose of medication was reduced to less than half post-treatment. The tetras score showed marked improvement in all a patient; 4 (15%) patients who had grade 4 tremor, showed the symptoms of minimal tremors graded 0.5 on last visit 3rd visit. Side effect post-procedure were mild transient numbness on the contralateral side was observed in 11 (42.3%) patient, 1 (3.8%) patient had dysarthria. Conclusion:  We concluded that stereostatic Ventral intermedius nucleus thalamotomy was effective in reducing tremor grades and improved all functionality with few mild side effects.

Objectives: To analyze the surgical outcome of cervical spine osteo-facetectomy discectomy, and modified Cloward procedure.Materials and Methods: A prospective study was conducted at the Neurospinal & cancer care institute, Karachi. The duration of study was from 1st June 2017 to 25th November 2019. Patients having prolapsed intervertebral cervical discs included in the study, while those with trauma, cervical radiation, previous cervical surgery andmultiple level involvement were excluded. Pre and post-surgical data was collected. Titanium Hashmi cage was used in all operated patients at single level instrumentation.Results: A total of 113 patients satisfied the inclusion criteria and were considered in the study. Among them, 77 patients were male and 36 were female. The age range from 26 to 65 with a base age of 53 years ± 2.5. C5 – C6 was the commonest level for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. For the outcome of theprocedure Odom’s criteria, was followed the results showed excellent improvement in 88 (77.87%), Good results in 18 (15.9%), fair in 5 (4.42%) and 2 patient had Poor (1.76%) results. Fusion was seen in 86 patients, superficial infection in two cases.Conclusion: Patients with single-level degenerative disc and treated with modified titanium Hashmi cage provided a good fusion with the relief of upper limb pain without donor site morbidity at anterior iliac spine.

Introduction  Based on the level of the thumb loss, phalangization, toe-to-thumb transfer, pollicization, and distraction callotasis of the first metacarpal are the various options available for reconstruction. The aims of the study were to observe the length gained in the distraction process, duration of treatment required, functional recovery in the form of pinch strength, sensations, and patient satisfaction. Patients and Methods  It was a prospective study of 10 patients of thumb amputation, conducted from January 2014 to July 2015. The patients’ age, mode of injury, level of amputation, and advantages and disadvantages of distraction callotasis were evaluated. Results  The most common etiology of thumb loss was domestic accidents while working with a chaff cutter. The total duration of treatment was 124 (93–165) days and the mean gain in length was 25 (20–28) mm. The pinch strength increased from a mean of 0.91 to 2.06 kg, i.e., a 44.17% improvement from preoperative pinch strength. All of our patients retained their sensations of the reconstructed thumb post distraction. Conclusions  Among many options for thumb reconstruction, distraction callotasis is a simple and safer option in the selective group of patients who are not keen on toe-to-thumb transfer which provide a significant improvement. The longer duration of treatment is the disadvantage associated with the need for proper counselling beforehand.