Objective Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for the treatment of hydrocephalus (HDC), especially in children. However, this is prone to many complications, and requires repeated surgeries, which as such increases the morbidity of the patients. It is estimated that majority of the complications occurs in the immediate post-operative period and the rate of complications decreases over the time, with no impunity to these, though. We conducted this study to know about the complications of VPS in the early post-operative period, in pediatric patients with hydrocephalus. Materials and methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, between June 2019 and January 2020 (seven months). All patients with hydrocephalus below 12 years of age, operated for the first time were included after taking an informed consent, while those with repeated shunt procedures and elderly patients requiring shunt were excluded from the study. Patients’ details like age, gender, location, contact number, cause of hydrocephalus, date of shunt placement, type of surgery (elective or emergency) and any follow-up complications like failure, erosion, infections, ileus were noted on a predesigned proforma. After the surgery, patients were followed for a period of one month, and contacted either through the telephone or asked to visit in the outpatients on the specified days, and were evaluated for any shunt-related complications, and any of these complications suspected were further evaluated and noted. The data was analyzed using the statistical program SPSS version 19 (IBM Corp., Armonk, NY). Results are presented in the form of charts, tables and graph. Results During the study period, we evaluated a total of 151 patients; there were 78 (51.65%) males and 73 (48.34%) females with a male to female ratio approaching 1.1:1. The age range was from 22 days to 12 years. The mean age was 38.46 ± 7.53 months. The primary indications for the insertion of VP shunt were: congenital hydrocephalus in 70 (46.4%), post infectious hydrocephalus in 57 (37.7%), hydrocephalus due to tumor in 22 (14.6%), and post traumatic hydrocephalus in two (1.4%) patients. Among the total number of patients, 85 patients (55.6%) were done as elective cases and 66 patients (44.4%) were done as emergency cases. Complications were encountered in 30 patients (19.87%) during the follow-up of 30 days. Complications occurred between day 1 and day 20 of follow-up with a mean of 9.10 ± 1.69 2SD days. Conclusion VP shunt is the most widely used treatment for HDC, but is predisposed to complications and almost every fifth case of VP shunt comes across with complications. Shunt blockage, infections and abdominal wound-related complications are common earlier complications in pediatric patients with hydrocephalus.

Objective: Public hospitals have fixed days with allotted time slots during which to perform neurosurgical elective cases. If emergency operations or other events preempt these scheduled time slots, the patient remains hospitalized, waiting in queue for a new time slot. We conducted this study to determine the number of days patients remained admitted waiting for elective cases in a tertiary care public hospital, which operates on fixed days.Materials and methods: This cross-sectional study was conducted in the Department of Neurosurgery Unit B, Medical Teaching Institution (MTI) -Lady Reading Hospital (LRH), Peshawar. We reviewed the admission charts and discharge slips of all patients who were admitted and underwent operations between September 2018 and August 2019. A form was made and was completed with each patients' records like age, gender, number of days spent preoperatively and postoperatively and the total duration of stay, indication for surgery (spinal, cranial, peripheral nerve), etc. Patients who had undergone elective neurosurgical procedures were included while those who had undergone emergency surgeries or had expired during the hospital stay, had been discharged or referred to other centers were excluded from the study. All the data were entered into the statistical software SPSS version 22 (IBM Corp., Armonk, NY) and were converted into tables and charts.Results: A total of 1818 patients were admitted/discharged during the study period, and of them, 823 patients were admitted for elective neurosurgical procedures. There were 601 (73.7%) males and 222 (26.3%) females with a male to female ratio of approximately 3:1. The age range was from 09 days to 72 years and was further subdivided into six groups. The procedures were broadly divided into cranial, spinal, related to hydrocephalus (HCP)-related, and miscellaneous. Cranial procedures comprised of surgeries for brain tumors, transsphenoidal operations, vascular procedures for aneurysms, and nerve decompressions, and they comprised about 29.43% (n=244) while spinal procedures accounted for 317 (36.63%) procedures, the rest were related to HCP and miscellaneous. Preoperative and postoperative stay durations were calculated and then added to determine the total stay durations and were further stratified for the specific procedures and categorized into days and weeks. About 58.26% (n=143) of cranial cases, and 156 (49.36%) of spinal cases, 37.57% (n=65) of HCP-related cases, and 36.66% (n=41) of cases in the miscellaneous group had a duration of stay between eight days to more than three weeks.

This study was conducted to study the perioperative findings in patients of spinal dysraphism. This observational study was conducted in Neurosurgery Department of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from January 2008 to December 2009. All the patients of spinal dysraphism less than 2 years of age were included in this study, while patients with ruptured spinal dysraphism at the time of presentation and with concomitant established hydrocephalus were excluded. Data was collected and analyzed by descriptive statistics using software SPSS version 17. Out of 96 patients operated for spinal dysraphism; 62 (64.58%) were males and 34 (35.42%) females. Eighty three patients (86.45%) were less than 1 yr, while 13 (13.54%) were above 1 yr. Peri-operative findings were: myelomeningocele in 50 (52.08%) patients, meningocele (MC) in 29 (30.20%), lipomyelomeningocele in six (6.25%), lipoma of cord with tethered cord in five (5.2%), MC with tethered cord in three (3.12%) patients, diastematomyelia in two (2.08%), while dermal sinus was found in one (1.04%) patient. In patients of spinal dysraphism less than 2 yr of age, more than 2/3rd of the patients presented with myelomeningocele and MC, while other features (such as lipomyelomeningocele, lipoma of cord with tethered cord, MC with tethered cord, diastematomyelia and dermal sinus) comprise only less than 20% of the spectrum.

Objectives: To know about the findings on fundoscopic examination in patients complaining of primary headache presenting to the Neurosurgical Outpatient Department (OPD). Study Design: Cross sectional study. Setting: Neurosurgery unit of Govt. Naseer Ullah Babar Memorial Hospital, Kohat Road, Peshawar. Period: December 2016 to December 2017. Materials and Methods: All patients presenting to the Neurosurgical OPD with complaints of headache on whom a fundoscopy was done, were included in the study. The age, gender, duration of symptoms, findings on the fundoscopy, and the need for further studies i.e. CT brain, were noted on a proforma. Any positive findings on fundoscopy were further referred to and evaluated by an ophthalmologist under the slit lamp. All patients with history of recent trauma, focal neurological deficit, and those who had undergone brain imaging were excluded from the study. Consent was taken from all the patients. The data was analyzed by SPSS version 19, and was expressed in the form of tables and charts. Results: A total of 19,000 patients were evaluated in the Neuro-OPD during study period, and 1086 patients were having headache.  Majority of the patients were females with a number of 619 (56.99%), while 447(43.01%) were males. The male to female ratio was approaching 1.38:1. Age range was from 9 to 62 years and the mean age was 37 years. Duration of symptoms was from 20 days to 12 years with a mean duration of 9 months. Positive findings were noted in a minority of patients, 2.5% (n=28); including pappiledema, diabetic and hypertensive changes. Subsequent Brain imaging was done in 93(8.5%) patients, majority of them were on patients' request, and only 7 patients were having an intracranial lesion. Conclusion: A minority of patients with headache without any neurology had intracranial lesion. However, the importance of fundoscopy cannot be overruled, and should be performed in every patient with headache.

Objectives: To know about the efficacy of trigger point injections in low back pain. Study Design: Prospective observational study. Setting: Out-patient Department of Naseer Teaching Hospital, Peshawar, and private clinic of the author. Period: March 2016 to January 2017. Materials and Methods: All patients with low back pain were evaluated. Inclusion criteria was; all patients with low back pain greater than 3 months duration whether operated or not, patients with non-radiating symptoms, patients with acceptable radiology (no listhesis, obvious stenosis/disk, albeit some degree of degeneration was acceptable), further helping points were morning exacerbations and elicitation of tender spot by the patient. The exclusion criteria was Low back pain with less than 3 months duration, obvious pathology on radiological examination, radiating symptoms, generalized low back pain without any point tenderness elicitation. The patients were sent home on medications and asked to avoid strenuous activity for a couple of weeks, they were followed after one month and asked about their pain satisfaction. Results: Approximately 2800 patients were evaluated for low back pain and of them 237 (8.46%) patients were upto the inclusion criteria, only 112 patients had agreed to have a TPI, which showed an acceptance rate of 47.25%. There were 65 males and 58 females, with a male to female ratio approaching almost 1:1. The age range was from 18 to 48 years, and the mean age was 32 years. The minimum duration of pain was 3 months and the maximum duration was 4 years, 4 patients had undergone back surgery. Almost all patients pointed out the pain spot, but a typical trigger point was elicited in 58(51.78%) patients, while morning exacerbation was present in 43(38.38%). Radiological examination was performed on all patients in the form of simple xrays and Magnetic resonance imaging scans, it was acceptable in 67%, as patients with radiating symptoms were already excluded. 10.71% (n=12) patients had some problems. Conclusion: In patients with chronic low back pain due to Myofascial Pain Syndrome (MPS) eliciting the trigger points by either elaboration through history or physical examination and treating them with a TP injection with lignocaine and a steroids has good short term results.