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Objective:  To determine the factors that affects the decision making process of the spine surgery from a patient’s perspective. Material and Methods:  The study was carried on 264 patients admitted for spine surgery in the Department of Neurosurgery, Khyber Teaching Hospital, Peshawar, Pakistan. Data was collected from patients on questionnaire using a Likert scale. Reliability was ensured by Cronbach alpha. Results:  The results for regression analysis revealed that there is a significant negative relationship between previous experiences and decision for spine surgery in patients (β = -0.156, p = 0.001 < 0.05). There is a significant positive influence of emotional and social state (β = 0.193, p = 0.002), information & counselling (β = 0.097, p = 0.011), socioeconomic status (β = 0.131, p = 0.004), severity of disability (β = 0.602, p = 0.000), ineffective conservative treatment (β9 = 0.082, p = 0.013) and intensity of pain (β = 0.527, p = 0.000) on decision for spine surgery in patients. The independent variables, including physical health, gender role and age were found to have an insignificant effect on the decision for spine surgery (p > 0.05). Conclusion:  It is concluded that the factors affecting the decision of patients on spine surgery included previous experience, emotional & social state, information & counselling, socioeconomic status, severity of disability, ineffectiveness of previously taken conservative treatment and intensity of pain.

Objective:  To determine the patterns, frequency and gender dominance in pediatric trauma presenting to Neurosurgery Department in a tertiary care hospital. Material and Methods:  This retrospective study was conducted in Department of Neurosurgery, Lady Reading Hospital, Peshawar. The medical records of all patients (0 – 15 years) with trauma admitted in our unit were analyzed retrospectively.Demographic details of the included subjects were noted down. Results:  A total of 448 patients were included in our study; 308 males and 140 females. Patients with 0 – 5 years were 40%, 6 – 10 years were 38% and 11 – 15 years were 22%. Extradural hematoma (28.12%) preceded depressed skull fracture (20.08%), followed by linear fractures (17.85), subdural hematoma (7.58%), contusions (5.80%) and subarachnoid hemorrhage (5.35%). Patients with diffuse axonal injury accounted for about 4.91%. Only 2 cases of cervical injury were noted. Conclusion:  The number of boys was comparatively greater than girls. Most of the patients were in the age group of 0 – 5 years. Ratio of extradural hematoma was the highest among all the injuries.

Objective: Through this study, we sought to evaluate the management of posterior fossa extradural hematoma (PFEDH). Methods: An observational study was conducted at the Neurosurgery Department of Lady Reading Hospital in Peshawar from January 2015 to December 2020. All patients who had a traumatic acute extradural hematoma (EDH) of the posterior fossa were included, irrespective of age and gender. The clinical predictors and outcomes were assessed, including the CT-scan findings and Glasgow Coma Scale (GCS) score. Results: A total of 104 cases with posterior fossa extradural hematoma were identified from 1252 extradural hematoma patients admitted during the study period. The mean age of the enrolled patients was 18.17 ± 14.31 years. Most of the patients were male (65.39%) and belonged to the pediatric age group, i.e., < 15 years (60.6%). CT scan brain was done in all the cases for diagnosis. In 68.3% of cases, an associated occipital bone fracture was observed. Surgery was done in almost 71.2% of cases, and most of the patients experienced good recovery after surgery, as indicated by the GOS score. Linear regression model revealed that treatment (β=-0.20, p=0.038), time duration between surgery and trauma (β=0.43, p=0.000) and GCS category (β=-0.47, p=0.000) were significantly associated with PFEDH outcomes. Conclusion: In conclusion, PFEDH was frequent among males and the pediatric age group. Serial CT brain is highly recommended in all suspected cases for early diagnosis. doi: https://doi.org/10.12669/pjms.39.1.6408 How to cite this: Sharafat S, Azam F, Khan Z. Posterior fossa epidural hematoma: A 6-year management experience. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6408 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.

Objective:  Hemorrhagic stroke is a common neurosurgical emergency caused by multiple pathological conditions. Brain tumors can also present with acute neurodeficits secondary to hemorrhagic stroke. This study as case series was conducted to report the clinical presentation, radiological findings, causes and management of brain tumors presenting as hemorrhagic stroke. Materials and Methods:  Clinical assessment and radiological investigations were done, including CT brain and MRI brain with contrast. Surgery was done with evacuation of the hematoma and excision of tumor, and the tissue was sent for histopathology. Post operatively patients were shifted to the intensive care unit for monitoring and ventilator support if needed. Adjuvant treatment was guided according to histopathology report. Results:  Total number of patients who were diagnosed to have a bleed in brain tumor were thirteen (n = 13). There were 6 (46%) males and 7 (54%) females. Mean age was 55 years. Among 13 patients, 4 (31%) patients had metastatic brain tumors and 9 (69%) patients had primary brain tumors. Diagnosis was done on CT brain, MRI brain and confirmed on histopathology of tissue obtained during surgery. Out of 13 patients, 5 (38%) patients were asymptomatic prior to hemorrhage and 8 (62%) patients had neurodeficits before and recent episodes of bleeding, which caused deterioration of neurological state. Conclusion:  Malignant primary and metastatic brain tumors can present as acute focal deficits due to brain hemorrhage. Diagnosis is based on clinical presentation, radiological features and histopathology.

Hydrocephalus in children is either treated by ventriculoperitoneal shunt or Endoscopic third ventriculostomy (ETV) dependingupon specific factors pertaining to clinical and radiological diagnosis. There are many complications of ventriculoperitoneal shuntand migration of peritoneal to scrotum, anal canal, urinarry bladder has been reported. The intra abdominal complications aremanaged by a combined team work of neurosurgeon and Pediatric surgeon.We have reported a case in which patient was diagnosed as congenital hydrocephalus with a lumbar myelomeningocele one yearback, Right sided ventriculoperitoneal shunt was passed initially followed by lumbar myelomeningocele repair. Now patient waspresented by parents with scrotal swelling, clinical examination and shunt series X-rays showed migration of lower end ofventriculoperitoneal shunt to scrotum, pediatric surgeon was consulted in same institution, a single incision at right inguinalligament was used to replace the migrated catheter into abdomen and hernia repair.Key Words: Ventriculoperitoneal shunt, Scrotal migration, Post-operative shunt complications