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Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country., Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at <1 year old and underwent surgery for primary CH. The Hydrocephalus Outcome Questionnaire was used to assess outcomes with respect to QOL., Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age <6 months at the time of first surgery was a poor predictor of overall health on the Hydrocephalus Outcome Questionnaire (P = 0.039)., Conclusions: In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Civilian craniocerebral gunshot injuries (CGIs) are rare but increasing in incidence in the developing world and there is scare literature on presentation, injury characteristics, prognostic indicators, and complications of brain trauma due to projectiles., Methods: A retrospective review of 51 civilian patients with CGI who presented to the Aga Khan University Hospital between 1998 and 2011 was carried out. Presentation, injury characteristics, and complications were analyzed with emphasis on outcomes and prognostic indicators., Results: There were 43 male and 8 female patients with an average age of 28.92 (±12.33) years. Twenty-three patients had a Glasgow Coma Scale (GCS) score of 13-15, 6 patients had a GCS score of 9-12, and 22 patients had a GCS score of 3-8 on admission. The overall mortality rate was 22% (n = 11). The most common postoperative neurologic deficits were motor deficits (19 patients) followed by aphasias (11 patients). On univariate analysis, admission GCS score and bi- or multilobar injuries were found to be highly predictive of neurologic outcome. There was no difference in outcomes between penetrating and perforating injuries. We also failed to find a statistically significant correlation between ventricular injury and outcomes in our patients., Conclusion: Admission GCS and number of lobes involved are highly prognostic of outcome. Patients with a GCS score ≥9 and unilobar injury on computed tomographic scans may benefit the most from surgical management., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: To determine the demographics, management, bacteriological spectrum, and outcome of brain abscesses of patients brought to Aga Khan University Hospital (AKUH), Karachi, with a history of neurologic symptoms and to examine the factors associated with it., Methods: This hospital-based descriptive study included 53 patients from both sexes who presented to the neurosurgery section at AKUH from January 1, 2000, until December 31, 2008, with neurologic symptomatology and fulfilling other inclusion criteria. Data regarding their demographic profile and other factors were collected in a well-structured proforma. Data were analyzed using frequencies, proportions, group means, and standard deviations., Results: The male-to-female ratio in our study was 3.4:1, with Staphylococcus milleri (20.7%) being the most common etiologic agent followed by anaerobic bacteria (15.1%). The triad of headache, fever, and vomiting was present in 62.7% of patients at the time of presentation. The most important factors influencing mortality was the neurologic condition of the patient at the time of admission. Chronic suppurative otitis media was the most common predisposing factor for temporal lobe infections, and the frontal lobe was the most common site of involvement in majority of the patients (67.8%). The mortality rate in our study was 11.3%., Conclusion: Findings suggest that patients in the second and fourth decades of life are the most susceptible, both in terms of morbidity and mortality. Early diagnosis and appropriate management, along with rapid access to tertiary care centers, will lead to a better prognosis., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including patient demographics. Failed disc surgery refers to failure of improvement in patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of patients. To date, no study form Pakistan has looked into patient demographics and failed disc surgery rates within the local context., Objective: The aim of this study was to review the demographics of the patient population presenting for surgical treatment of lumbosacral disc herniations and to review our results of lumbosacral microdiscectomy at a university hospital in Pakistan., Methods: This is a retrospective analysis of all adult patients admitted from January 2003 to January 2008 for symptomatic lumbosacral disc herniation requiring microdiscectomy, at the Aga Khan University Hospital, Karachi. Data were collected through our medical records, on a standardized form. Basic information about the patient population, disease process, modes of nonsurgical treatment, and details on surgery and postoperative course were recorded and analyzed using SPSS., Results: Five hundred one patients were studied, based on inclusion criteria. The mean age was 41.2 years; 347 (69%) patients were male and 154 (31%) female. Mean body mass index of the population was 26 and was higher in females. All patients primarily presented with radiculopathy, and the mean duration of these symptoms was 438 days. Mean duration of nonoperative management was 53 weeks. Fifty-one patients (10.2%) had previously undergone spine surgery. A total of 442 (88%) patients were operated at single disc level, and the rest at two levels. Sixty-six (13%) patients were operated for upper lumbar disc herniations. Mean operative time was 94 minutes, and the most common complication was dural tear. Mean length of hospital stay was 5 days (2-12 days). Mean follow-up was 48.3 weeks (4 weeks to 14 years). Complete resolution of symptoms was seen in 360 (71.9%) patients and failed disc surgery was diagnosed in 42 (8.4%) patients. Twenty-six patients (5.2%) were reoperated upon, with gradual improvement. The authors report an overall failed back surgery rate of 8.38%., Conclusions: Overall our results were comparable to published international literature. However, the authors observed significant differences in demographics, especially in terms of age, gender distribution, and mean BMI of patient population as well as frequency of involvement of upper lumbar discs., (Copyright © 2010 Elsevier Inc. All rights reserved.)