Pattern of neurosurgical cases and procedures in Gilgit Baltistan: two-year experience at a newly established neurosurgical department.

BACKGROUND: In Pakistan, there are a total of 160 neurosurgeons that constitute a ratio of one neurosurgeon for a 5.5 million population. Gilgit Baltistan being a backward region does not have a single tertiary care facility. A new department of neurosurgery was established at Regional Headquarter City Hospital (RHQ) Gilgit with only one neurosurgeon. This study aimed to determine which neurosurgical diagnoses are common and which surgical interventions were performed at RHQ. METHODS: This is a retrospective cross-sectional study conducted at Regional Headquarter Hospital (RHQ) Gilgit in which data of patients operated for neurosurgical diseases between January 2020 and January 2022 was collected from patient record books. RESULTS: Of the total of 223 patients, 148 (66.3%) were males and 75 (33.6%) were females. A total of 92(41.2%) belonged to the pediatric age group. The top most diagnosis included Neurotrauma (46.6%), NTDs (13.9%) and CSDH (10.3%) while the most routinely performed procedures were craniotomy & hematoma evacuation (22.9%), debridement & elevation of DSF (20.6%), and burrhole evacuation (13.9%). In the pediatric age group, the top diagnosis was Neurotrauma (43.5%), NTDs (32.6%), and Hydrocephalus (19.6%) while in adults, neurotrauma (48.9%) was the leading diagnosis followed by CSDH (17.6%). In the pediatric age group, repair of NTDs (32.6%) was the most frequently performed procedure. CONCLUSION: This study shows different kinds of neurosurgical cases but because of a lack of diagnostic and therapeutic facilities, very limited operations were performed and many cases were referred to metropolitan cities. The hospitals in the region need further up-gradation to cater to the presenting burden.

Collagen matrix implantation following pterygium excision: outcomes of a preliminary tested hypothesis.

This study was conducted to evaluate the effect of collagen matrix implant on pterygium recurrence compared with a control group following pterygium removal surgery. Following informed consent, twenty eyes of 20 patients (females = 13, males = 7, aged 23-67 years) were randomly allocated into two equal groups. Pterygia of all patients were excised using the bare sclera technique; however, for patients in the intervention group a 1×2 mm collagen matrix graft (iGen™) was implanted subconjunctivally. Patients were followed up for recurrence and complications within six months. Results revealed that only two eyes in the control group and one eye in the intervention group developed recurrence (p=0.50); no dellen formation was observed. In conclusion, the use of biodegradable collagen matrix implants (iGen™) following pterygium excision seems to be associated with a lower risk of recurrence; however, the statistical difference between groups was not significant. Further studies with adequate sample size are recommended.