Pakistan Journal Of Neurological Surgery
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A Systematic Review of Mental Health Disorders and Interventions in Children: Prevalence, Risk Factors, and Treatment Outcomes
Full text linkObjectives: This systematic review sought to: (1) Assess and compare global and regional prevalence estimates of depression, anxiety, ADHD, and ASD among minors aged 0-18 (2) Identify and compare determinants (socioeconomic, family, environment) and protection mechanisms to these conditions; and (3) Analyze the relative effectiveness of cognitive behavioral therapy, school-based programs, medications, and digital therapies.
Materials & Methods: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Scopus, PsycINFO, and Web of Science was conducted for studies published from 2010 to April 2025. Eligible studies included observational and interventional designs involving participants aged 0–18 years. Sixty-four studies meeting the inclusion criteria were analyzed using a narrative synthesis framework.
Results: Prevalence estimates varied widely across disorders: depression (12%), anxiety (9%), ADHD (6–9%), and ASD (1.5%). Socioeconomic hardship, adverse childhood experiences, and parental mental illness emerged as consistent risk factors, while supportive parenting and strong school attachment acted as protective influences. Cognitive-behavioral therapy (CBT), school-based programs, and digital interventions showed significant though variable effectiveness. Recent global data underscore the growing mental health crisis, with the rates of depression and anxiety among adolescents significantly increasing—depression by 60% between 2017 and 2021 and anxiety by 61% between 2016 and 2023.
Conclusion: Childhood mental disorders remain underdiagnosed and undertreated globally. Multisectoral, culturally sensitive, particularly CBT and school-based models, are essential to improve early detection and access
Effectiveness of Regular Physiotherapy in Enhancing Claudication Symptoms and Functional Outcomes in Patients with Spinal Canal Stenosis.
Full text linkIntroduction: Lumbar spinal stenosis (LSS) causes neurogenic claudication that hinders mainly one’s mobility and quality of life. It is now accepted that physiotherapy is a useful conservative measure especially when surgery cannot be done. This paper aims to assess the impact of an organized physiotherapy intervention on the ability to walk and the level of dependency in LSS patients.
Material and Methods: A physiotherapy program of 6 weeks was carried out on 172 patients with LSS and neurogenic claudication. The manual therapy included core stabilization, flexibilities in the lumbar, and strengthening in the lower limb. Walking ability (Swiss Spinal Stenosis Scale), pain levels (VAS), disability (ODI, RMDQ), and walking distance were assessed. SPSS was used for statistical analysis with a p < 0.05 significance.
Results: Physiotherapy reduced leg pain (VAS 7.9 ± 1.3 to 2.6 ± 0.9, p < 0.001), back pain (6.5 ± 1.4 to 2.9 ± 1.0, p < 0.001) among 172 patients (64% male, mean age 68.4 years). Walking ability and disability improved (SSS and ODI, p < 0.001) and walking distance increased from 215.7 ± 42.5 to 482.3 ± 67.3 meters. Minimal adverse effects were reported.
Conclusion: As a safe nonoperative medical approach physiotherapy demonstrates high effectiveness in treating LSS patients by enhancing their mobility pain relief and independence levels. Surgical procedures have a powerful competitor in this nonoperative treatment that patients select for their conservative options
The Comparison of Outcome of Traumatic Brain Injury in Left and Right Hemispheres of The Brain
Full text linkObjective: Using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), this study compares the clinical presentation, surgical requirements, and functional results of unilateral LH versus RH TBI.
Materials & Methods: Patients with unilateral LH or RH TBI were the subjects of a retrospective observational study. Individuals with bilateral, brainstem, or diffuse axonal injuries were not included. Initial GCS scores, imaging results, surgical procedures, and GOS scores at discharge were among the data gathered. To evaluate the variations in the clinical trajectory between the two groups, a comparison study was conducted.
Results: The findings showed that patients with RH injuries needed surgery more often than those with LH injuries and had substantially lower first GCS scores. Lower GOS scores at discharge were linked to RH injuries, even if the radiological findings were identical. On the other hand, LH injuries could be found more quickly and easily, which frequently resulted in better results and faster medical treatment. RH deficits' mild, frequently nonverbal character may cause a delay in diagnosis and treatment, which could worsen the prognosis.
Conclusion: Hemispheric laterality is important for TBI presentation and results. RH injuries are associated with worse healing, most likely because of delayed diagnosis and care. Understanding these hemisphere-specific variations better could facilitate early detection and direct more efficient, customized treatment plans
Correlation Between Preoperative Tumor Volume and Postoperative Neurological Deficit in Brain Tumor Resections
Full text linkObjective: To evaluate the correlation between preoperative tumor volume and the development of early postoperative neurological deficits in patients undergoing brain tumor resections.
Materials and Methods: A prospective observational study was conducted at Lady Reading Hospital, Peshawar, from January to December 2024. A total of 130 patients undergoing elective craniotomy for brain tumor resection were enrolled. Preoperative tumor volume was calculated using contrast-enhanced T1-weighted MRI via manual segmentation. Neurological status was assessed within 72 hours postoperatively. Data were analyzed using SPSS version 26.0, applying independent t-tests, ROC analysis, and logistic regression.
Results: Out of 130 patients, 38 (29.2%) developed new or worsened neurological deficits postoperatively. Patients with deficits had significantly larger mean tumor volumes (61.8 ± 17.2 cm³) compared to those without deficits (42.7 ± 14.5 cm³, p < 0.001). A tumor volume cutoff of 51.5 cm³ predicted deficits with 81.6% sensitivity and 75.3% specificity (AUC = 0.83). Logistic regression confirmed tumor volume as an independent predictor (OR: 2.06; p < 0.01).
Conclusion: Preoperative tumor volume is significantly associated with early postoperative neurological deficits. A volumetric threshold may serve as a valuable tool for surgical risk assessment and patient counseling in brain tumor surgery
Clinical Outcomes of Transforaminal Full Endoscopic Discectomy in the Management of Upper Lumbar Disc Herniation: A Prospective Study
Full text linkObjective: This study analyzes the clinical effects and possible adverse events that occur after performing Full Endoscopic Lumbar Spine Surgery (FELSS) through the transforaminal approach when treating upper lumbar disc herniation.
Methods: This prospective study recruited patients with Upper Lumbar Disc Herniation (ULDH) who underwent transforaminal full Endoscopic Lumbar Spine Surgery at the Farooq Endoscopic Spine Institute, Afridi Medical Complex, from February 2020 to January 2023, with a 1-year follow-up. Those patients who have Symptoms refractory to at least six weeks of conservative management, including physiotherapy, analgesics, and epidural steroid injections, were included. Visual analogue scale and Oswestry disability index were the main outcome measures used, along with reporting the complications.
Results: During postoperative months 1, 6, and 12, the patients experienced significant VAS and ODI score enhancements, which reached 1.5 ± 0.6 VAS and 12.5 ± 5.0 ODI (p < 0.001). Of the patients, 83.1% managed to return to work, and daily activities were resumed by 89.2% of the population. Three patients (6.38%) showed drastic improvements as they were pain-free and achieved standing position, while preoperatively they were brought on a wheelchair. The surgical procedures resulted in four complications affecting 2.4% of patients through dural tear, as well as 4.2% developing epidural hematomas.
Conclusion: The transforaminal FELSS surgical method represents a reliable and protected strategy to treat upper lumbar disc herniation while producing considerable positive treatment results. Surgeons can expect better patient recovery when medical treatment occurs soon after symptoms start and the patient has no neurological issues
Effectiveness of Manipulation under Anesthesia in Patients with Chronic Coccydynia: A Case Series with Three-Month Follow-up and Rehabilitation Protocol
Full text linkObjective: To evaluate the effectiveness of MUA with steroid injection in patients with chronic coccydynia and outline a standardized rehabilitation protocol.
Methods: A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurological Sciences, Lahore. Seventy-five patients aged 25–60 years with chronic coccydynia unresponsive to conservative management underwent MUA under general anesthesia. The coccyx was manipulated with a per rectal technique, and 40 mg of methylprednisolone with 10 ml of 0.25% bupivacaine was infiltrated locally. Outcomes were assessed at 3 months using VAS and need for analgesia. Data were analyzed using SPSS v17.
Results: The mean age was 42.5 ± 11 years; 53.3% were male. The mean disease duration was 9.8 ± 3.7 months. Success was achieved in 88% of patients, with only 2.7% requiring analgesia after the procedure. No significant difference was found in outcomes based on age, gender, or disease duration.
Conclusion: MUA with local steroid infiltration is a highly effective treatment for chronic coccydynia, offering substantial relief with minimal morbidity. Incorporation of a post-MUA rehabilitation protocol enhances outcomes and reduces the need for surgical intervention
Predictive Role of Tumor Dimensions and Body Mass Index in The Development of Postoperative Diabetes Insipidus Following Pituitary Adenoma Resection: Analysis of 209 Consecutive Cases
Full text linkObjective: This study examines the outcomes of tumor size, dimensions, and patients’ body mass index (BMI) on the postoperative DI.
Material and Methods: This study was done on 209 patients who met the inclusion criteria. They were counseled and comprehensively informed about the study. The DI was labeled according to the operational definition. The DI was managed as per ward protocol. All the data was recorded. All the surgeries were done by one surgical team, and all the labs were done from one lab, i.e., hospital lab.
Results: Out of 209 patients, 1.9% (n = 4) were between 5 and 30 years of age, and 98.1% (n = 205) were between 31 and 60 years of age. The mean age was 41.45 ± 6.47 years. The distribution of the size of the tumor was 2.69 ± 0.756 cm, and the distribution of BMI was 26.00 ± 1.954 kg/m2. Out of 209 patients, 61.2% (n = 128) were male, whereas 38.8% (n=81) were female. The distribution of DI among patients undergoing endoscopic transsphenoidal surgery was 25.4% (n=53).
Conclusion: We found that DI among patients undergoing endoscopic transsphenoidal surgery was 25.4% (n=53). Therefore, post-operative DI is one of the common complications after pituitary surger
Neurological Outcomes and Helmet Use among Motorcyclists Admitted to a Tertiary Neurosurgical Center in Pakistan
Full text linkObjective: To determine neurological injury patterns, severity, outcomes, and helmet use prevalence among motorcyclists admitted to a tertiary neurosurgical unit.Results: We enrolled 113 patients (mean age 26.9 ± 17.5 years; 85.0% male). Helmet use was 1.8% (n=2). Drivers comprised 62.8% and passengers 37.2%. Predominant diagnoses were traumatic brain injury (26.5%), extradural hematoma (15.9%), brain contusion (15.0%), and subarachnoid hemorrhage (14.2%). On admission, 69.0% had mild, 18.6% moderate, and 12.4% severe head injury. Conservative management was performed in 86.7% (n=98), and 13.3% (n=15) underwent surgery. ICU admission was required for 8.0% (n=9). Median hospital stay was 2 days (IQR 1–2). Overall mortality was 8.0% (n=9), all among non-helmeted riders. The two helmeted patients sustained only mild injuries, required no surgery or ICU care, and were discharged without complications. Conclusion: Helmet use was rare but associated with milder injuries and zero mortality. Strengthened legislation, enforcement, and public education are urgently needed to reduce preventable neurotrauma. Keywords: Helmet use; traumatic brain injury; motorcycle crash; neurosurgical outcomes; Pakistan
Cognitive Dysfunction in Type 2 Diabetes Mellitus: Correlation with Glycemic Control
Full text linkObjective: The study was conducted to evaluate the association between long-term glycemic control and cognitive function in patients with Type 2 Diabetes Mellitus (T2DM).
Materials and Methods: A prospective observational study was conducted over six months from January to June 2024 at the Departments of Neurology and Internal Medicine, Lady Reading Hospital, Peshawar. A total of 200 patients aged 40 to 75 years with established T2DM were enrolled through non-probability consecutive sampling. Cognitive function was assessed using the Montreal Cognitive Assessment tool after cultural adaptation. Glycemic control was measured by HbA1c levels. Patients with psychiatric illness, stroke, dementia, or medications affecting cognition were excluded. The association between HbA1c and cognitive function was tested using Pearson correlation with significance at p >0.05.
Conclusion: Poor glycemic control was strongly associated with cognitive dysfunction in T2DM. Routine cognitive screening is recommended in patients with poor metabolic control and longer disease duration
Frequency of CSF Rhinorrhea in Patients with Skull Base Fractures
Full text linkBackground: To determine the frequency of CSF rhinorrhea in patients presenting with skull base fractures.
Material and Methods: This was a descriptive cross-sectional study at the Department of Neurosurgery, PGMI/Hayatabad Medical Complex Peshawar for six months in which patients were included through nonprobability convenience sampling. Included were patients who had radiologically confirmed skull base fractures at presentation. The data on clinical presentations, demographics, and the existence of CSF rhinorrhoea was collected and analyzed through SPSS.
Results: A total of 87 patients were included in the study. The mean age was 41.56±1.35 years. The majority of the patients were males 50(57.5%) as compared to females 37(42.5%). Grade of Head Injury determined showed that patients in the mild category were 30(34.5%), moderate was 39(44.8%) while those in the severe category were 18(20.7%) Prevalence of CSF Rhinorrhea among patients was 56(64.4%).
Conclusion: The results of our study concluded that CSF rhinorrhoea is a prevalent consequence of skull base fractures. Meningitis and other potentially fatal consequences can be avoided with early detection and prompt treatment. Those persisting for more than seven to ten days have a high risk of developing meningitis and are more likely to need surgical intervention