Objective:  To document the outcome of transpedicular fixation for degenerative spondylolisthesis in terms of relief from backache. Materials & Methods:  This retrospective observational study was conducted in Mardan Medical Complex, Mardan. Static and dynamic spinal X-rays were used to diagnose degenerative spondylolisthesis. This research looked at how patients' pain levels, neurological state, and union improved after surgery. Patients with grade 5 spondylolisthesis, having congenital spinal anomaly, or who had previous spinal surgery were excluded from the study. Results:  In total 35 patients were included, 54.3% were male and 45.7% female. The primary reason for surgery was severe backache with 24 individuals having normal neurological status and 11 patients having some neurological abnormality. L5–S1was the most commonly involved level in 24 patients. Meyerding grades were used to determine the slip grade. The average duration of follow-up was two years and five months, with a maximum of five years and a minimum of six months. 83 percent of patients had pain reduction, whereas neurological improvement was achieved in 64 percent of instances and surgical union was achieved in 91 percent of cases. There was no neurological impairment in the patients treated with transpedicular fixation. Significant differences exist between preoperative and postoperative GRS scores in the following pain categories: no pain, mild, server and excruciating. Conclusion:  Transpedicular fixation is a protected, simple, and successful procedure for patients with spondylolisthesis for pain relief in backache. It also contributes to surgical union and improvement in the neurological status of the patients.

Objective:  To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications. Material and Methods:  This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study. Results:  A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year. Conclusion:  VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period. Keywords:  Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC).

Durotomy (Incidental dural tears or ID) is a very rarely occurring disorder when decompressive surgery (spinal surgery) of the patients takes place. This disorder has severe effects on patients. During different surgeries of the spinal cord, the chances of this durotomy vary greatly. Objective: The main objective of this research work is to evaluate the main reasons for the incidence of this durotomy disease. During different surgeries of the spinal cord surgeries (decompressive and compressive) within the different regions, many factors play their role in the initiation of this durotomy disease. It is the target of this work to find the initiation factors of the disease so that effective methods of treatment can also find out. Methods: It was a retrospective study with a statistical approach. This study was conducted in Neurosurgery unit, Mardan medical complex / Bacha khan medical college, Mardan for the Duration of one year August 2020 to July 2021. To proceed with this study, 30 patients were selected with posterolateral and posterior compressive and decompressive surgeries within the different regions of the spinal cord. The patients were randomly selected from December 2020 to December 2021. Results: The incidence of this durotomy disease was investigated within all groups and the probability of this disease was only 12.65%. The occurrence of this disease also depends upon the type of surgery. Patients suffering from spinal trauma, stenosis of the spinal, different tumors, and vertebral disc herniation had exaggerating role in the incidence of durotomy in patients having some spinal surgery. Conclusion: The durotomy disease should be considered a serious issue with a number of other complications. For the treatment of this disease, prevention is the best method and to know about the complications is important because all of the factors involved in the incidence of durotomy should be considered while performing any kind of surgery

Objectives:  To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading. Materials and Method:  Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented. Results:  Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery. Conclusion:  Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization. Keywords:   Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization.

Objective: To examine intracranial hypertension patients' spectrum, clinical features, and etiologies. Study Design: A Cross-sectional study. Place and duration of study: In the Department of Neurosurgery MMC Mardan from January 2019 to July 2020. Methodology: We used specific selection criteria to reduce the pool of IH patients from 67 to 32. Statistics and frequency distributions explain patients' demographics, clinical traits, and underlying reasons. Results: According to statistics, females (n = 30; 82%) with ages ranging from 21 to 35 (n = 13; 36%) and obesity (n = 2; 9%) were over represented. The most common clinical sign was headache (n = 18; 69%). On the other hand, idiopathic intracranial pressure had the greatest occurrence (44%). Conclusion: Women between the ages of 21 and 35 who are overweight or pregnant have an increased risk of developing idiopathic intracranial hypertension (IH).