Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Methods: This study was conducted at a tertiary care center from September 2018 to December 2019 and included 133 adult patients with moderate or severe head injury (GCS ≤ 12) diagnosed to have the DAI on the basis of MRI. At 3 months, the result was assessed using the Extended Glasgow Outcome Scale (GOS-E). Results: There were a total of 97 (72.9%) males and 36 (27.1%) females with an average age of 32.4 ± 10 years with a mean GCS of 9 at admission. The most common mode of head trauma was road traffic accidents (RTAs) in 51.9% of patients followed by fall from height in 27.1%. Most patients were admitted with moderate traumatic brain injury (64.7%) and suffered Grade I diffuse axonal injury (41.4%). The average hospital stay was 9 days but majority of patients stayed in hospital for ≤ 11 days. At 3 months, mortality rate was 25.6% and satisfactory outcome observed in 48.1% of patients. The highest mortality was observed in the Grade III DAI. Conclusion: We conclude that the severity of the traumatic head injury and the grade of the DAI impact the outcome. Survivors require long-term hospitalization and rehabilitation to improve their chances of recovery.

associated with considerably lower functional recovery and poor outcomes, in terms of hospital stay and secondary complications (13). A recent review pointed out that these injuries are associated with a major socioeconomic impact and healthcare burden in developing countries (24). Considering the outcome and impact on healthcare system, TSCI prevention is of major importance and relies on an adequate understanding of the population characteristics. However, this is limited by the scarcity of reported data pertaining to our part of the world. The present study, therefore, aimed to understand the epidemiological and clinical variables associated with TSCIs, as well as their outcomes after operative versus non-operative management. The information gathered is the foremost step toward the development of better preventive strategies. █ INTRODUCTION T raumatic spinal cord injuries (TSCIs) are relatively more common in the developing part of the world than in developed countries, with a reported incidence of 25.5 million/year (22). Among younger age groups, TSCI commonly results from gunshot injuries and leads to paralysis (13,17,22). Such patients are likely to endure a physically and psychologically hostile life (1,15). Gunshot injuries are classified as either civilian-or military-sustained, according to the ballistic characteristics, the impact mechanism, and the outcome (5,25,29). Because of increasing violence, the incidence of penetrating injuries such as gunshot wounds has increased over time, currently accounting for 17%-31% of all spinal cord injuries among the civilian population (8,13,26). Compared to other causes, within the younger population (mean age: 27 years), gunshot-related spinal injuries are AIM: To understand the differences between operative versus conservative treatment in terms of the outcome measured according to the American Spinal Injury Association (ASIA) impairment scale (AIS) in patients with gunshot acquired spinal cord injuries. MATERIAL and METHODS: A total of 168 patients were included in this retrospective study. The AIS score was recorded for all survivors who provided consent after emergence from spinal shock. Demographic information and level of injury were also recorded. Patients were categorized according to the management approach, and the outcome was measured at the 6-month follow-up, using the AIS score. Univariate statistics were used for data analysis. RESULTS: Most patients were male (91.6%), with a mean age of 26 ± 4.2 years. A majority of patients (73.2%) had incomplete spinal cord injuries. Among the complete spinal injuries, most involved the thoracic spine (84%). Overall, the thoracic spine was involved in half of the cases (51%). Twenty-six (15.4%) patients underwent surgery. The distribution of AIS score differed between the operative and non-operative groups. In both groups, the AIS score on follow-up differed significantly from admission AIS score (p<0.001). However, no significant differences were found between groups on the AIS score at follow-up (p>0.05). CONC...

Objective: Skull fractures are common in pediatric age group. The surgical management of paediatric patients with a skull fracture differs among institutions and surgeons. Our object of this study was to assess the pattern of skull fractures and outcome in paediatric population. Material and Methods: This study was conducted in the department of neurosurgery of a tertiary care hospital from June 2018 to April 2020. We included 152 children between ages 5 to 11 years who were brought with the head trauma and diagnosed to have skull fracture on computerized tomography (CT) Scan brain. Results: The mean age of patients was 6.91 + 1.84 years. There were 59.8% males and 40.1% females. The most common type of fracture at presentation was depressed fracture in 42% patients, followed by linear (35%) and compound fractures (23%). Parietal fractures were the commonest (63.1%) in our study. Associated intracranial hematomas were seen in 37.5% patients, epidural hematoma being the most common. Surgically treated patients were 36%. Good recovery was seen in 73% patients while mortality was 10.5%. Conclusion: Isolated skull fractures are overall benign conditions. Linear parietal skull fractures have good outcome amongst all fracture types.

Objective: The objective was to use the Rotterdam score, which is based on a CT scan, to assess the outcomes of traumatic brain injury patients.Material and Methods: This research, which included 319 head trauma patients, was carried out at the neurosurgery department of a tertiary care hospital between June 2019 and December 2020. The Rotterdam score was calculated for each patient on the basis of the first CT scan after the head injury. The Glasgow Outcome Score was used to assess the results three months following the injury.Results: In our research, there were 270 male patients (84.6%) and 49 female patients (15.4%). The mean age was 37.4 ± 15.4 years and road traffic accidents were observed in 275 people (86.2%). Severe traumatic brain injury (TBI) was seen in 123 patients (38.6%). The most common Rotterdam score was 2 in 86 (27.0%) patients, while it was score 3 in 72 (22.6%), score 4 in 59 (18.5%), score 5 in 41 (12.9%), score 1 in 31 (9.7%) and score 6 in 29 (9.1%). The mortality rate was 33.5% in our patients and good recovery was seen in 150 (47.0%) patients. Conclusion:The Rotterdam score is a useful tool to evaluate and predict outcomes in head trauma patients.

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material & Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of > 93%

Objective:  Diagnosis of supratentorial space occupying lesion is a frequent dilemma in neurosurgical practice. MR spectroscopy that is an advanced MR imaging sequence can prove to be decisive in such cases. The objective of the study is to determine diagnostic accuracy of MRS in differentiating supra-tentorial brain space occupying lesions taking histopathology as gold standard Material and Methods:  The cross sectional study was conducted at Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from August 2018 to July 2019. A calculated sample size of 156 patients aged between 18-50 years after informed consent. All patients underwent MR Spectroscopy pre-operatively. Surgery was performed and histopathological findings were compared with spectroscopic findings. Results:  The average age of the patients was 32.41 ± 10.02 years. There were 84 (53.84%) males and 72 (46.15%) females. The sensitivity of MRS was 90.69% with a specificity of 97.34%. Conclusion:  MR Spectroscopy is an accurate diagnostic tool for establishing pre-operative differentiation between neoplastic and inflammatory lesion. It should be performed in all cases where contrast MRI is inconclusive in establishing the diagnosis. Keywords:  , Brain Abscess, Supratentorial lesion, Brain Tumor

Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome. Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological and clinical assessment, surgical intervention, and Glasgow outcome score measured at 6 months follow-up. Results: Among patients with cranial gunshot, injuries most were males (76.3%). More than 50% patients aged between 18 and 35 years. About 46.5% of patients presented with moderate traumatic brain injury commonly involving the temporal lobe (36.8%). Of total 114 patients, 84.2% were managed conservatively but wound debridement was done in all patients. At 6 months, the overall mortality in our patients was 33.3%. Patients with good outcome (GOS 4 and 5) were 30.7% and 35.9% patients had bad outcome (GOS 2 and 3). Complication rate was 14.9% and the most common complication was disseminated intravascular coagulation in 5.2%. Conclusion: Surgical intervention has no significant benefit over conservative management on long-term mortality and should be limited to patients with large intracranial hematomas and intraventricular hematomas causing hydrocephalus.

Objectives:  We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours. Material and Methods:  A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months. Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%). Conclusion:  The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction. Keywords:  Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring.