Degenerative spinal diseases of the lumbar region remain one of the leading causes of disability across various age groups, significantly affecting patients’ quality of life. When conservative management fails or when neurological deficits are evident, surgical intervention becomes the mainstay of treatment in such cases.

Introduction: Pituitary tumours are a common heterogeneous group of lesions of the central nervous system. The overall prevalence of pituitary tumour in the general population is estimated to be 16.7%. Pituitary tumours present with a wide range of clinical spectrum. The standard of care for a pituitary tumour involves primary surgical intervention followed by radiotherapy/chemotherapy of the residual or recurrent tumour. Methodology: A retrospective study over a period of ten years (2013-2023 AD) of patients with pituitary tumour admitted to the Department of Neurosurgery was done. Pituitary tumour was confirmed by MRI brain with dynamic contrast whenever needed. Demographic profile of the patients, presenting complaints, radiological information about the tumour, intraoperative event, post-operative event were collected. The patients were followed up either in person or through telephone. All statistical analysis was done using SPSS software version 26. Results: Of the 104 patients identified in the study period, 15 patients were excluded due to incomplete data and conservative management. Of the 89 patients included, there were 43 male patients. The mean age of the population was 47.9 (±13.97) years. The majority of the patients (66.3%) had non-functioning pituitary tumour. Most of the patients (52.8%) were managed with transcranial approach. The majority of the patients showed improved outcome in terms of visual symptoms, acromegaly features and hormone profile at 3 months post-surgery follow up. Conclusion: Pituitary tumours are a heterogeneous group of lesions of the central nervous system presenting with a wide range of clinical spectrum. The management is primarily surgical with recent trend of surgical approach being endoscopic transnasal transsphenoidal.

Introduction: Visual outcomes following surgical resection of pituitary adenomas (PA) are generally favourable with early diagnosis and intervention. However, delayed decompression can result in irreversible visual loss, underscoring the need for prompt surgery. There is limited data from Tilganga Institute of Ophthalmology(TIO), on the demographic characteristics and visual outcomes of patients with PA. This study aims to describe the demographic profile and ocular manifestations of PA with a focus on visual symptoms, field defects, and postoperative outcome. Methods: A retrospective longitudinal study conducted at TIO involving 24 patients(42 eyes) who underwent surgical resection for MRI-confirmed pituitary macroadenomas between April 2015 and March 2018. Visual presentation patterns and outcomes before and after surgery were assessed. Demographic data, clinical presentation, and visual outcomes were analyzed using IBM SPSS v. 20 software. Results: The study included 24 patients (mean age 40.9 ± 13.3 years;range 18–79), with a male predominance (13, 54.2%). Most (11, 45.8%) presented within 1–6 months of symptom onset, with younger patients presenting earlier (p < 0.024). Blurred vision was the most common symptom(23, 95.8%), while bitemporal hemianopia (13, 54.2%) and optic atrophy (34, 81%) were the most frequent signs. Postoperatively, visual acuity improved in 22 eyes(59.5%), and visual fields improved in 15 eyes (62.5%). Conclusions: Timely diagnosis and surgery can significantly improve visual outcomes in pituitary adenoma patients. This study highlighted that early surgical intervention of Magnetic Resonance Imaging(MRI)-confirmed macro adenomas improved visual acuity in nearly 60% of eyes and visual fields in about 63%.

Tuberculous osteomyelitis of skull is a rare entity. It is also reported in healthy person without any evidence of tuberculosis elsewhere in the body, therefore diagnosis is not suspected. However, we rarely come across tuberculous osteomyelitis of right frontal bone following trauma. We present a case of left parietal tuberculous osteomyelitis who presented with headache, scalp swelling and discharging pus from over left parietal scalp region following trauma. Patient was managed by excision of lesion with diseased bone and mesh cranioplasty, and ant-tubercular therapy. Diagnosis of tuberculous osteomyelitis was made on the basis of histopathology report of biopsy specimen.

Introduction: Parkinson’s disease (PD) is a neurodegenerative disorder characterized primarily by loss of dopamine neurons in the Substantia Nigra Pars compacta resulting in various symptoms like bradykinesia, rigidity and tremor. Surgical treatments like lesioning procedure (Pallidotomy) and Deep brain stimulation surgery are well established surgical treatment for drug resistant PD Materials & Methods: All the patients who underwent surgical treatment of Parkinsons Disease in Annapurna Neurological Institute And allied Sciences from 2016 January to December 2022 have been included in this study. Patients undergoing DBS versus lesioning in the treatment of Parkinson disease with more than two years follow up were reviewed retrospectively. Results: Eighty cases were included in this study with 50 cases of Pallidotomy and 30 cases of DBS. The male to female ratio was 2:1 in both groups. There was no difference in mean duration of illness. However, the surgical timing, hospital stay and frequency of follow ups and surgical expenses were more in DBS group. Mean change in Unified Parkinsons Disease Rating Score (UPDRS) III at the immediately after surgery was 70 percent in Pallidotomy group and 65 % in DBS group(P=0.4). However it was not statistically significant. In long term follow up period after two years, we found that the mean change in off period of UPDRS score in Lesioning vs DBS was 46.6 % vs 46.5% .(p=0.8) There was only 10 percent reduction on the dose of dopamine in pallidotomy group whereas there was 30 percent reduction in DBS group. Similarly there was significant reduction in Dyskinesia both in Pallidotomy and DBS group. Conclusion: Both lesioning and DBS procedures are equally effective surgical treatment of Parkinsons Disease. Lesioning procedure are more feasible in our context due to its cost effectiveness and long term benefit.

Introduction: Vein of Galen malformations (VOGMs) are rare vascular entities originating from persistent shunting of primitive choroidal vessels into the median prosencephalic vein of Markowski. They usually present in infancy or childhood as seizures, hydrocephalus or cardiac failure; adult presentations are uncommon. In addition, giant VOGM in an adult is extremely rare to find. Case description: We present an exceedingly rare case of a giant VOGM measuring 3.4 x 3.7 x 3.2 cm in a 20-year-old female presenting as episodes of transient ischemic attack (TIA) which was obliterated successfully using endovascular embolization. Conclusion: VOGMs are associated with poor clinical outcome if left untreated. With advancement in endovascular techniques of obliteration, proper timely management can lead to good outcomes.

Introduction: Pituitary adenomas are common benign tumors located intracranially that arises from the pituitary gland. Depending on their size and endocrine function of the tumor, they can be either asymptomatic or present with symptoms due to hormonal dysfunction or compression of nearby structures. Among the various surgical approaches that exist for the management of pituitary adenomas, the endoscopic endonasal transsphenoidal approach is a widely used technique. The study evaluates the surgical outcomes and extent of tumor resection using this approach. Materials and Methods: The study was conducted at Bir Hospital, Kathmandu, Nepal, which included 38 study participants with pituitary macroadenomas. A non-probability sampling method was used. Results: The most common presenting symptom was visual defects (57.8%), followed by headaches (31.5%) and galactorrhea (26.3%). Preoperative Knosp grading revealed 26.3% of cases as grade 0, 39.5% as grade 1, 21.1% as grade 2, and 13.2% as grade 3. Postoperatively, 78.9% of patients had complete tumor excision. Significant improvement in visual acuity was observed, with 21.1% achieving 6/9 vision in the right eye and 23.7% in the left eye. However, two patients showed no perception of light both pre- and post-operatively. The hormonal level decreased significantly post operatively. Conclusion: Pituitary adenomas often present late, leading to visual and endocrine impairment. The visual and endocrine improvement of the patient was significant following the Endoscopic endonasal transsphenoidal surgery, with most patients achieving complete tumor excision. Surgical outcomes at our center are comparable to existing data.

This study aimed to evaluate the relationship between carotid artery disease, infarct characteristics, and associated risk factors in patients with CT-confirmed ischemic stroke. The study included 50 participants, primarily aged 61-70 years (42%) with a mean age of 60.7 years, and a male predominance (78%). Hypertension, diabetes mellitus, and dyslipidemia were each prevalent in 68% of the sample. Most infarcts were located in the middle cerebral artery (MCA) territory (86%), with the combined cortical and sub-cortical regions being the most frequently affected (58%). A significant association was found between the severity of carotid stenosis and infarct size, with larger infarcts (>2 cm) predominantly occurring in patients with stenosis ≥70% (p = 0.001). The analysis of stenosis by age revealed that the 61-80 age group had the highest frequency of stenosis, primarily in the <50% category on both sides (p = 0.01 for the right side, p = 0.04 for the left side). Higher intima-media thickness (IMT >1) and the presence of plaques were significantly associated with infarcts in the MCA territory and sub-cortical areas. Calcified plaques were particularly prevalent in these regions. Strong associations were also found between carotid lesions and risk factors such as hypertension, diabetes, dyslipidemia, smoking, coronary artery disease, and history of stroke. The <50% stenosis category was more commonly associated with older age, female gender, hypertension, and diabetes, whereas the ≥70% stenosis category was more prevalent among males and linked to dyslipidemia and coronary artery disease. The findings underscore the importance of comprehensive evaluation using duplex ultrasound and the management of modifiable risk factors in ischemic stroke patients.

Alzheimer's disease (AD) is a progressive neurological disorder characterized by memory loss, cognitive decline, and neurodegeneration. Early diagnosis through biomarkers is crucial for improving treatment outcomes and managing the disease. This review highlights invasive and non-invasive biomarkers for AD diagnosis which includes cerebrospinal fluid, blood-based, exosomal, and fluid-based biomarkers. Neuroimaging techniques, such as structural MRI and functional imaging, are also discussed. Recent advancements in blood-based biomarker technology and emerging AI and machine learning techniques offer promising avenues for early AD diagnosis. Future non-invasive diagnostic tools which includes wearable sensors may aid in early detection and personalized treatments.

Introduction: The aim of the study was to compare the frequency of postoperative infection in cerebrospinal fluid shunts performed with and without topical vancomycin at a tertiary care hospital. Materials and Methods: An Observational Cohort Study was conducted from 10th October, 2020 to 9th April, 2021 at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Total 74 patients of both genders with ages in the range of 1-5 years undergoing cerebrospinal fluid shunts were selected. Patients were divided into two groups (Group A and Group B). Patients with meningitis and ventriculitis before the shunt surgery were excluded. Patients in both the groups received cefotaxime 50 mg/kg body weight intravenously within 60 minutes prior to skin incision and underwent standard cerebrospinal fluid shunt procedure. In the study group (Group B), 10 mg of vancomycin was diluted in 8 ml of normal saline and was divided into two halves. One half was injected in the reservoir of the cerebral shunt and the second half was infiltrated subcutaneously around the reservoir and peritoneal catheter. Standard postoperative care was provided to all the patients. Postoperatively, all the patients received intravenous cefotaxime 50 mg/kg body weight repeated 8 hourly for 72 hours. They were monitored for any signs of infection and shunt infection was labelled. Results: Majority of the patients 54 (72.97%) were between 1 to 3 years of age with overall mean age of 2.43 ± 1.28 years. In this study, frequency of postoperative infection was observed to be significantly lower in patients undergoing shunting with versus without topical vancomycin (2.70% vs 29.73%). Conclusion: This study concluded that the frequency of postoperative infection is found to be significantly lower in patients undergoing cerebrospinal fluid shunting with versus without topical vancomycin.