Monkeypox, caused by an Orthopoxvirus, poses a significant occupational risk to healthcare workers due to their frequent contact with infected patients and contaminated materials. This risk is increased by potential lapses in infection control protocols in hospitals, such as a lack of personal protective equipment (PPE), improper hand hygiene, and other issues, making hospitals a key site for occupational transmission of monkeypox. The objective of the study was to evaluate monkeypox transmission among healthcare workers and identify critical preventive strategies. A comprehensive literature search was conducted using PubMed, focusing on case reports and series published between 2000 and 2024. Eight studies comprising seven case reports and one case series, documenting a total of nine patients, were selected based on predefined inclusion criteria. Data regarding transmission routes, risk factors, and preventive measures were extracted and analyzed. The primary mode of monkeypox transmission among healthcare workers was percutaneous exposure, notably from needlestick injuries during the care of patients with active lesions. Fomite exposure accounted for 22.22% (2) of cases, highlighting the risk posed by contaminated surfaces and medical equipment. Respiratory transmission was suspected in some cases, though conclusive evidence remains limited. Key risk factors included inadequate use of PPE and breaches in infection control protocols. Post-exposure vaccination was administered to 33.33% (3) of patients, and post-exposure medication was given to 66.66% (6) of patients. Although respiratory transmission is not evident, asymptomatic or mildly symptomatic individuals may contribute to disease transmission. This highlights the need for improved surveillance and enhanced infection control protocols, including PPE utilization, hand hygiene, and avoidance of needlestick injuries. Post-exposure vaccination and antiviral treatment of exposed individuals effectively curb the spread of monkeypox.

Abstract Cerebrofacial metameric syndrome (CMS) is a rare neurocutaneous disorder involving congenital anomalies of facial and cerebral angiogenesis. There are four separate types that differ based on the metameric sequences involved and can involve arterial or venous abnormalities. This retrospective case report is centered around one female patient who presented with right infraorbital edema that progressed over a 2-month period. The edema was nonpulsatile, nontender, and associated with purple discoloration. Further imaging demonstrated a subcutaneous mass that was 2.5 × 2 × 3.2 cm in size with multiple internal flow voids in all sequences that ruled out any soft tissue or malignant features. There was a lack of medullary veins appreciated in surrounding brain regions. Surgery was offered for cosmesis, and the patient exhibits decreased edema with no neurological deficits at the latest follow-up. The presentation of a patient with CMS is rare. While there may be differences in angiographic signatures and involved brain regions, the abnormality's vascular supply is of the utmost importance for surgical planning. Definitive treatment options exist for patients but are determined appropriately on a case-by-case basis. Outcomes are optimized with a multidisciplinary team that maximizes safety and considers cosmesis for those interested.

Among congenital intracranial space-occupying lesions, teratomas, gliomas, and neuroblastomas are more frequently reported. However, primary congenital glioblastoma (cGBM) and congenital anaplastic astrocytoma (cAA) are underrecognized entities. Their detection remains challenging due to nonspecific prenatal findings and limited awareness among pediatricians and obstetric care providers, contributing to delayed diagnosis and worsened outcomes. To summarize the clinical presentations, diagnostic imaging characteristics, reported cases, histopathological features, and neuro-oncological management strategies of primary intracranial high grade congenital glial lesions (PIHGCL). A comprehensive literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in 2025 over PubMed and Google Scholar using keywords and Boolean operators, retrieving 35 studies (44 patients) with PIHGCL published 1985 to 2025. Quality assessment was done using Joanna Briggs Institute (JBI) tool. The data was analyzed descriptively as well as analytically to determine survival outcomes in treatment groups. A total of 28 studies (37 patients) discussed cGBM, and 7 studies (7 patients) described the occurrence of cAA. Most of the patients were infants i.e., 65.9

Neurobrucellosis is a rare and serious complication of brucellosis that can present with a broad spectrum of neurological symptoms, making early detection challenging. The objective of this study was to comprehensively analyze data on neurobrucellosis to characterize its clinical manifestations, diagnostic approaches, and management strategies. This narrative review consolidates the available literature on all cases of neurobrucellosis published between inception and November 30, 2025, using the PubMed Central and Google Scholar databases. The data were stratified using predefined keyword combinations and Boolean operators. All case reports, case series, and original articles with confirmed cases of neurobrucellosis with intracranial involvement were included. After detailed scrutiny of the existing literature, a total of 23 articles were identified with data on 34 patients. Among the 34 patients, 22 (64.70%) were males, and 12 (35.29%) were females. The mean age was 35.7 ± 19.45 years. The most common presenting symptoms were headache in 23 (67.64%), fever in 16 (47.05%), and vomiting in 11 (32.35%) patients. On neurological examination, generalized weakness was present in eight (23.50%) patients, seizures in eight (23.50%) patients, and hearing loss in eight (23.50%) patients. The preferred imaging modality was MRI, which demonstrated hypointense multiloculated lesions on T1-weighted images in 11 (32.35%) patients and hyperintense lesions on T2-weighted images in eight (23.52%) patients. The most frequently involved brain region was the frontal lobe in 11 (32.35%) patients. Serological testing was confirmatory for diagnosis in 30 (88.23%) patients, with positivity on the serum agglutination test. CSF analysis showed elevated protein in 13 (38.23%) patients, leukocytosis in 10 (29.41%) patients, and culture positivity in four (11.76%) patients. The most common species was Brucella melitensis, which was identified in six (17.64%) patients. The average time to diagnosis was 8.83 ± 6.80 months. Approximately 21 (61.76%) patients received medical therapy alone, and 12 (35.29%) underwent combined medical and surgical management. Neurobrucellosis often presents with nonspecific prodromal symptoms, making early diagnosis challenging. Imaging commonly reveals frontal lobe involvement with characteristic hypointense multiloculated lesions on T1-weighted MRI and hyperintense signals on T2-weighted MRI. Diagnosis relies on positive serological testing, particularly serum agglutination tests, in conjunction with clinical and radiological findings. Optimal outcomes require a tailored multimodal management approach incorporating appropriate antimicrobial therapy with surgical intervention when indicated.

Central nervous system (CNS) fungal infections are associated with significant morbidity and mortality globally, especially in immunocompromised patients. This narrative review aimed to characterise the spectrum of CNS fungal infections in Pakistan. Overall, 14 studies with histologically confirmed diagnoses of CNS fungal infection were included, comprising data on 140 patients. The average age was 38.7 years with male predominance. The most common presenting symptom was headache in 58 (41.42%), followed by visual disturbance in 27 (19.28%) and limb weakness in 22 (15.71%). Among all patients, 31 (22.14%) had a history of diabetes mellitus. Aspergillus was the most frequently isolated pathogen in 46 (32.85%) patients, followed by Mucorales in 42 (30%) patients. Combined medical and surgical management was used in 113 (80.71%) cases. The primary antifungal treatment administered was amphotericin B and voriconazole in 82 (58.57%) and 41 (29.28%) patients, respectively. The surgical management included neuronavigation-guided biopsy in 29 (20.71%), endoscopic debridement in 16 (11.42%), and subtotal resection in 15 (10.71%). The combined medical and surgical management resulted in clinical improvement in 57 (50.44%) patients and mortality in 41 (36.28%) patients. Among the patients given only medical therapy, mortality occurred in 17 (65.38%) patients, and resolution occurred in 2 (7.69%) patients. This review demonstrates that CNS fungal infections in Pakistan often present with nonspecific symptoms. Diabetes mellitus was the most commonly reported comorbidity. The management is multimodal, with combined medical and surgical management required in the majority of patients. Despite treatment, mortality remains high, emphasising the need for earlier diagnosis.

Insular gliomas can be resected via a transcortical (TC) or transsylvian (TS) approach. The TC approach avoids injury to the middle cerebral artery (MCA) and is considered suitable for gliomas with opercular spread. The TS approach is limited by bridging veins and a surgical "blind spot" for larger gliomas. We aimed to compare the TC and TS approaches for the resection of insular gliomas. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases from inception to November 20, 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes included the extent of resection (EOR), postoperative deficits, and immediate and delayed complications of both approaches. Summary estimate of proportion, random effects, and confidence intervals (CIs) were calculated using R (statistical package). Sixteen studies with 1,517 patients (56.5% male) were included. The mean age ± standard deviation (SD) of patients was 43.6 ± 6.8 years. The predominant presenting symptom was first-onset seizure (62.8%), followed by headache (∼10%). There was a slight predominance of right-sided gliomas (52.5%). Pathology revealed a slight abundance of low-grade (WHO grade I or II) histology (51.5%) compared with 48.5% high-grade (WHO grade III or IV). A greater pool proportion of 0.44 (CI: 0.28-0.61) for gross total resection and 0.19 (CI: 0.10-0.34) for partial resection was found for the TC approach compared with the TS approach. For subtotal resection, the TS approach had a higher pooled proportion (0.47 [CI: 0.40-0.54]) than the TC approach (0.41 [CI: 0.24-0.60]). Postoperative speech deficits (0.04 [95% CI: 0.02-0.11]) and motor deficits (0.10 [95% CI: 0.07-0.15]) were more frequent with the TS approach compared with the TC approach. Our study confirms that the TC approach results in a higher proportion of gross total resection of insular gliomas compared with the TS approach, with fewer postoperative speech and motor deficits.

Background and objective Tethered cord syndrome (TCS) is an amalgam of neurologic, urologic, orthopedic, and dermatologic dysfunctions with concurrent spinal dysraphism and deformities. Data from Pakistan regarding the surgical management of TCS remain limited. This study aimed to evaluate the clinical and functional outcomes of surgical detethering in patients with TCS and spinal dysraphism. Materials and methods This retrospective study was conducted at the Punjab Institute of Neurosciences (PINS), Lahore, Pakistan. We analyzed the outcomes of 21 patients (12 pediatric and nine adults) with TCS who were operated on between January 2020 and June 2025. Patient records were reviewed using the institution's Picture Archiving and Communication System (PACS), operative notes, and medical charts. Results of the treatment were summarized and analyzed using descriptive statistical analysis. Results Among the cohort, 12 patients were pediatric and nine were adults. Pediatric patients had an average age of 4.95 ± 5.03 years and showed a female predominance (66.66%, n = 8). Adults had a mean age of 23.44 ± 8.84 years and also demonstrated a female predominance (66.66%, n = 6). Lower limb weakness was the most frequent presenting symptom, occurring in 50% (n = 6) of children and in a higher proportion of adults at 66.66% (n = 6). Lipomyelomeningocele was the most frequently observed form of spinal dysraphism in children, accounting for 33.33% (n = 4), whereas thickened filum terminale was most common in adults, seen in 33.33% (n = 3). The conus level was most commonly located at L1 in pediatric patients, observed in 50.00% (n = 6), while in adults it was most frequently at L3, occurring in 55.55% (n = 5). Detethering of the spinal cord was the predominant surgical intervention in both pediatric and adult groups, performed in 91.66% (n = 11) of children and 100% (n = 9) of adults. Postoperative assessment showed neurological improvement in 75% (n = 9) of pediatric patients and 55.55% (n = 5) of adults, with no major complications reported in 91.66% (n = 11) of children and 66.66% (n = 6) of adults. Conclusions Surgical untethering in patients with TCS leads to improvement in neurological function with an acceptable safety profile, highlighting the importance of early intervention.

BACKGROUND:Carotid-cavernous fistula (CCF) is an abnormal communication between the carotid artery and the cavernous sinus. This communication can be either high-flow or low-flow. Depending on the distinct anatomy of the shunt, it has effects on the various neurovascular structures that lie within the cavernous sinus. OBJECTIVE:To evaluate the immediate outcomes of CCF patients undergoing surgical and endovascular management. METHODOLOGY:This is a retrospective observational study conducted at the Departments of Neuroendovascular Surgery and Neurosurgery at Punjab Institute of Neurosciences, Lahore. Consecutive patients diagnosed with CCF, who underwent diagnostic evaluation or treatment at the institution between January 2023 and December 2025, were included. Descriptive statistics were applied to analyze characteristics and outcomes. RESULTS:Of the total 10 patients, the most common clinical presentation was proptosis (90%; n=9), followed by chemosis (40%; n=4), ophthalmoplegia (30%; n=3), and cranial nerve palsy (10%; n=1). The majority of these cases were high flow (80%; n=8), categorized as being Barrow A. Arterial feeders originated exclusively from the internal carotid artery (ICA) in 60% (n=6) of cases, while 10% (n=1) were from the external carotid artery (ECA). Anterior and posterior drainage of CCF was mediated by the superior ophthalmic veins (SOV) (40%; n=4) and inferior petrosal veins (IPV) (20%; n=2), respectively. The majority of patients in our case series underwent stent (PK Papyrus, Biotronik SE & Co. KG, Berlin, Germany) placement, i.e., 70% (n=7), followed by ICA ligation in 20% of cases (n=2). Postoperative imaging revealed a fistulous leak in 60% (n=6), complete obliteration in 10%, and mild flow in 1% (n=1). Clinical outcomes improved in 90% (n=9), and no post-procedural hemorrhage, infarction, or cranial nerve deficit was reported. CONCLUSIONS:Most of the patients had neuro-ophthalmic manifestations. Direct-type CCFs were the common type in our small case series, affecting the male gender predominantly, and most cases were post-traumatic. The endovascular management of CCF using covered stent deployment (PK Papyrus) yields reasonable radiological obliteration of the fistula, improved visual outcomes, and minimal intraoperative and immediate postoperative complications.

Sexual and gender minorities, LGBTQIA+ individuals, transgender individuals, and intersex individuals represent a small proportion of the population and encompass diverse sexual preferences, gender identities, sexual characteristics, and gender expressions. These individuals often present with unique health needs due to biological differences in anatomy, physiology, or genetic sexual characteristics. Despite these differences, education regarding their healthcare is insufficient in medical curricula worldwide, specifically in low- and middle-income countries (LMICs). Medical students are often unaware of the specific needs of these individuals and, hence, show a willingness to learn more so that they are better equipped clinically. Health care providers (HCPs) often lack the required knowledge and may behave unprofessionally toward these patients. This may include marginalisation, discrimination, and non-consensual examinations. Such instances make these individuals less likely to seek medical care. Thus, there is a dire need to integrate content about their healthcare needs into medical education and clinical practice in LMICs to prevent unprofessional conduct and improve health outcomes. This review highlights the existing literature on the educational and clinical preparedness of medical students and HCPs related to the healthcare needs of the LGBTQIA+ population, with a specific focus on intersex/differences of sex development (DSD) individuals, and accordingly puts forward recommendations for improvement.

Abstract Background Among congenital intracranial space-occupying lesions, teratomas, gliomas, and neuroblastomas are more frequently reported. However, primary congenital glioblastoma (cGBM) and congenital anaplastic astrocytoma (cAA) are underrecognized entities. Their detection remains challenging due to nonspecific prenatal findings and limited awareness among pediatricians and obstetric care providers, contributing to delayed diagnosis and worsened outcomes. Objective To summarize the clinical presentations, diagnostic imaging characteristics, reported cases, histopathological features, and neuro-oncological management strategies of PIHCGL. Methodology A systematic literature search was conducted over PubMed and Google scholar according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to retrieve all articles published from 2000 to 2023 reporting congenital high grade lesions by using keywords. Results Of the 35 studies (44 patients) included, 84% (37) had cGBM, and 15.9% (7) had cAA. The mean age at diagnosis was 32.1±4.6 weeks (fetus) and 2.23±2.75months (neonates), with predominance of male (45.4%) and full-term (52.2%). Common symptoms were macrocephaly (27.7%) and tense anterior fontanelle (25%) and motor deficit (22.2%). Most of the lesions were intracerebral (72.7%), with equal left-right laterality. Surgical excision was done in 70.4% patients, with gross total resection in 38.4% patients and CSF diversion surgeries were performed in 25% patients. The most frequently reported positive immunohistochemical marker was GFAP (77.2%). Monosomy 17, tetraploidy, loss of Y-chromosome, translocation t(6;12)(q21;q24.3), and a ZCCHC8–ROS1 gene fusion were identified on genetic testing. Chemotherapy was given in 52.2% patients with favorable response in 43.4% patients. The mean follow-up period was 27.2±38.8 months with a recurrence rate of 18.1% and mortality rates of 50% (42.8% within 24 hours after birth). Conclusion The cGBM and cAA are two rare congenital high grade lesions, predominant in full-term male neonates with high mortality rates in immediate postnatal period. Patients receiving combined surgical and chemotherapy treatment had favorable outcomes. Genetic testing and immunohistochemistry aids in early diagnosis.

Glioblastoma remains the most aggressive malignant brain tumor, with limited survival despite advances in surgery, radiotherapy, and chemotherapy. Current diagnostic modalities are insufficient for early detection and precise monitoring of disease progression, prompting interest in liquid biopsy-based biomarkers. Exosomal microRNAs (miRNAs) have been highlighted as significant biomarkers due to their stability and involvement in tumor progression. This narrative review evaluates current evidence regarding the diagnostic, prognostic, and therapeutic significance of exosomal and extracellular vesicle-associated miRNAs in brain tumors, particularly gliomas. Data were collected from PubMed and Google Scholar, and eight original articles published between 2016 and 2026 were included after careful screening. The findings demonstrated dysregulated expression of exosomal miRNAs, including miR-29b, miR-210, miR-301a, miR-454-3p, and miR-2276-5p, which were significantly associated with tumor grade, recurrence, survival, and treatment response. The majority of studies reported strong diagnostic performance, with receiver operating characteristic/area under the curve values ranging from 0.80 to 0.93, while mechanistic analyses implicated these miRNAs in oncogenic pathways, including PTEN/AKT signaling, hypoxia-mediated progression, autophagy regulation, and angiogenesis. Overall, exosomal miRNAs demonstrate considerable potential as noninvasive biomarkers for prognostication and therapeutic targeting, while their dynamic preoperative alterations further suggest utility in disease monitoring.

Gallbladder paraganglioma (GPG) is a rare neuroendocrine tumour discovered incidentally on final histopathological examination. The objective was to evaluate the clinical findings and management strategies using relevant literature for reported cases of gallbladder paraganglioma. A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided literature search was conducted using data from PubMed, Scopus, and Google Scholar to identify the studies with histopathologically confirmed cases of GPG published between January 2000 and December 2024. Study quality was assessed using the Joanna Briggs Institute checklist, and data analysis was done using descriptive statistics and tabulations. A total of 13 case reports were selected, satisfying the inclusion and exclusion criteria. Among 13 reported cases, 10 (76.3%) were females. The mean age of the patients was 53.8 ± 12.59 years. Right hypochondrial pain was the most common presentation in seven (53.9%) cases, while three (23.1%) cases were asymptomatic. Ultrasound was the initial imaging modality in seven (53.9%) patients, followed by computed tomography scans in six (46.2%). Histopathology showed a nested pattern of chief and sustentacular cells in five (38.5%) cases. On immunohistochemistry, 11 (84.6%) cases were positive for synaptophysin A and nine (69.2%) were positive for chromogranin A. Laparoscopic cholecystectomy was the most common procedure performed in 10 (76.3%) cases. The average duration of follow-up was 66.5 ± 82.10 weeks, which was mentioned for only five patients. GPG should be considered in the differential diagnosis of gallbladder and biliary disorders presenting with features of acute cholecystitis and non-functional tumours. Patients often present with non-specific symptoms aligning with mass effects and cholecystitis. When a growth is suspected, it should be thoroughly evaluated before surgery to rule out other types of invasive gallbladder tumours. If investigations confirm a non-metastatic lesion, proceeding with a simple cholecystectomy is appropriate.

Background: Brain tumours are the most prevalent solid cancers in children and are a significant cause of cancer morbidity. However, there is limited information on surgical outcomes in Pakistan, particularly in newly established paediatric neurosurgery units. This study aimed to determine the incidence, clinical features, imaging findings, surgical treatment and prognosis of supratentorial and infratentorial brain tumours in children.Methodology: This was a descriptive retrospective study conducted at the Punjab Institute of Neurosciences from June 2023 to June 2024, including 92 pediatric patients who underwent surgical resection of brain tumours. The clinical presentation, imaging characteristics, surgical interventions, histopathology and outcomes were recorded and evaluated.Results: Among 92 patients, 63% (n = 58) had supratentorial tumors and 37% (n = 34) had infratentorial tumors. Mean ages were 11.34 ± 4.77 years and 10.94 ± 3.78 years, respectively. Out of 92, 46 (50%) were male, and 46 (50%) were female. Headache was the most common presenting symptom in both groups (n = 46 supratentorial (76.3%) and n = 31 infratentorial (91.3%). Supratentorial tumors were most frequently located in the middle cranial fossa (53.4%, n = 31), with gliomas being the predominant histology. Gross-total resection was achieved in 69% (n = 40) of supratentorial cases and 88.3% (n = 30) of infratentorial cases. Ventriculoperitoneal (VP) shunt placement was more commonly required in infratentorial tumors (42.1%, n = 14) compared to supratentorial tumors (6.9%, n = 4). Pilocytic astrocytoma was the most common histology in the infratentorial group. Postoperative Glasgow Coma Scale (GCS) and Lansky Play-Performance Scale (LPPS) scores were comparable between the two groups.Conclusion: Supratentorial tumors were more common, while infratentorial tumors had higher resection rates and had high VP shunt requirements.

The objective was to conduct comprehensive bibliometric studies which would offer valuable insights into neurosurgery research and training in Pakistan. We conducted a bibliometric analysis for all PubMed-indexed peer-reviewed publications from January 2000 to June 2024, where at least one author was affiliated with any neurosurgical department in Pakistan and the research was conducted in Pakistan. A significant exponential rise was seen during the 2016-20 and 2021-24 periods. Most publications were from Karachi ,651 (56.7%), Lahore, 128 (11.1%), Peshawar, 104 (9.1%) and Islamabad, 79 (6.9%). Most of the contributions were from Dr Muhammad Tariq, 79 (17.8%), Dr Syed Ather Enam, 79 (17.8%), and Dr Salman Sharif, 75 (16.9%). Most of the studies were original articles, 247 (36.2%), followed by case reports, 165 (24.2%) and review articles, 118 (17.3%). The most frequently study design used was cross-sectional, 187 (76.6%), followed by cohort, 59 (22.6%). Amongst the local PubMed-indexed journals, the Journal of Pakistan Medical Association was the most favourite local journal, representing, 154 (24.9%) of the total publications. Amongst the international journals, Surgical Neurology International and World Neurosurgery represented about, 103 (16.7%) and, 91 (14.7%) publications, respectively. The gradually rising trend in neurosurgical publications by Pakistani clinicians is a humble contribution to the global scientific literature. The progressive role of Karachi city as a flag-bearer of neurosurgical research is commendable, but it also raises questions the silence prevalent in other major cities of the country harbouring large neurosurgical setups andteaching programmes. It is imperative to promote research initiatives in neurosurgery, and increase awareness among neurosurgical trainees and practitioners regarding the significance of active research and publications.

Schwannoma is the commonest tumor of the eighth cranial nerve. Presence of a schwannoma intracerebrally is an oncologic enigma. The prime aim of the study was to assess the clinicoradiological manifestations, surgical management and post-operative sequelae of primary intracerebral schwannoma (PIS). Methodology A thorough literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines via PubMed. Case reports and case series published between 2000 and 2025 were included using advanced search and Boolean strategy. Total 32 studies, amounting to 34 patients were included in the review according to set criteria and quality assessment in accordance with Johanna Briggs critical appraisal checklist. A mean age of 29.63± 18.23 years with a clear male preponderance, 67.6% (23) was noted at presentation. Headache in 44.1% (15) and facial weakness in 14.7% (5) were the commonest symptoms and signs at presentation respectively. Front lobe was the most frequent site in 41.2% (14) cases. The lesion was hypointense on T1 weighted images in 35.3% (12) cases and hyperintense on T2 weighted images in 29.4% (10) cases. Metastasis in 8.9% (3) was the commonest differential diagnosis. Gross total resection was achieved in 70.6% (24) cases. Spindle cells were encountered on microscopy in 67.6% (23). S100 was the commonest immunohistochemical marker positive in 82.4% (28) cases. Transient dysphagia, cough and dysarthria were the post-operative complications in 2.9% (1) cases each. About 8.9% (3) cases presented with local recurrences. Average follow up duration was 21.72 months. PIS is a rare entity that is no different from classic vestibular schwannoma. The varying clinical manifestations, radiological and surgical characteristics depend on the location of the tumor within the brain parenchyma. On imaging, it mimics common neoplastic lesions, making histopathology a key diagnostic investigation.

Pediatric brain tumors require specialized multidisciplinary care. In many low- and middle-income countries (LMICs), including Pakistan, access to pediatric neuro-oncology expertise is limited due to a shortage of trained specialists. Collaborative models, such as involving visiting consultants, may help improve diagnosis, treatment, and outcomes. To date, no study from Pakistan has assessed the role of such collaborations in pediatric neuro-oncology. This study aimed to analyze the impact of a visiting consultant pediatric neuro-oncologist on the outcomes of pediatric patients with brain tumors in a healthcare system with no in-house pediatric neuro-oncologist. This retrospective study was conducted at the Punjab Institute of Neurosciences from January 2023 to January 2025. It included pediatric patients with brain tumors who were evaluated by a visiting pediatric neuro-oncologist. These patients were followed for one year to monitor surgical interventions, referrals, and clinical outcomes. A total of 45 pediatric patients were assessed by the visiting pediatric neuro-oncologist. Among them, 82.22% (n=37) underwent craniotomy and excision, while 8.89% (n=4) had a biopsy. On histopathological examination, the most common tumor type was glioma, found in 37.78% (n=17) of patients. Based on the consultant’s evaluation, 24.44% (n=11) of patients were referred for adjuvant therapy. At one-year follow-up, 90.63% of patients were healthy without any new neurological deficits, and 28.89% (n=13) were lost to follow-up. In countries with limited resources and few pediatric neuro-oncology specialists, collaboration through visiting consultants can significantly improve the care, management, and outcomes of children with brain tumors. This approach may serve as a practical model for capacity building in pediatric surgical neuro-oncology in low- and middle-income countries.

Background and Objective: Neoplastic lesions of the brain and spinal cord have been on a steady rise in low- and middle-income countries. In recent years, there has been an uprise in neuro-oncology encompassing surgery, oncology, radiology, infectious diseases, and artificial intelligence. However, a comprehensive bibliometric analysis in this field is scarce. The objective of the study was to analyze neuro-oncology publications from Pakistan and quantify the contributions of Pakistani individuals and institutions. Methodology: A bibliometric analysis of all neuro-oncology research conducted by Pakistani authors or institutions over the last 25 years (2000–2024) was performed using PubMed Central. All relevant case reports, case series, original articles, and review articles were included. The studies conducted in non-Pakistani institutions and collaborative studies were excluded. The data were stratified according to predefined keywords. A total of 210 articles were included in the final analysis. Results: Among provinces, Sindh contributed the most publications 66.67%(152), followed by Punjab 16.67%(38). Aga Khan University leads from the front with 132 publications. Publications ranged from original articles (37.4%) to review articles (31.1%). Gliomas were among the most common tumours discussed (25.8%). The Journal of Pakistan Medical Association was the most significant contributor (34.7%), followed by Surgical Neurology International (7.14%). Maximum number of studies (53) were published in the year 2024. Conclusion: An exponential rise in publications in the year 2024 compared to previous years signifies the growing perception of neuro-oncology. However, the dominance of a single institution underscores the need for broader research development across Pakistan.

Objective: To assess the neurosurgical residents' perspectives on surgical neuro-oncology specialty training in Pakistan. Methodology: A nationwide survey-based observational study was conducted among neurosurgery residents registered with the accredited residency programs in Pakistan. A structured questionnaire assessing knowledge, training, mentorship, and institutional support in surgical neuro-oncology was disseminated via Google Forms (Google Inc., USA). Data collection took place from January to March, 2025 across both public and private sector training institutes. Responses were analyzed using Statistical Package for the Social Sciences, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations. Results: A total five hudnred residents were targeted among whom one hundred residents responded, yielding a response rate of 20%. While 90% (90) rated their knowledge of brain and spinal tumors as good or excellent, only 67% (67) felt confident interpreting imaging studies. Notably, 33% (33) had received no formal training in surgical neurooncology. Exposure to spinal cord tumor surgeries was limited, with only 14% (14) having participated in such procedures. Mentorship and interdisciplinary collaboration were inadequate; only 20% (20) reported access to dedicated neurooncology mentors, and just 12% (12) rated interdepartmental collaboration as excellent. Resources were considered limited or insufficient by 69% (69) of respondents. Despite these challenges, 84% (84) supported the establishment of a dedicated neuro-oncology fellowship, and 67% (67) expressed definite interest in pursuing such training. Conclusion: This nationwide analysis highlights critical insights into the clinical exposure, training quality, and perceptions of neurosurgical residents in Pakistan regarding surgical neuro-oncology. While the majority of residents demonstrated enthusiasm and self-reported strong theoretical knowledge, substantial gaps were identified in hands-on experience, formal training, mentorship, and access to specialized resources, particularly in spinal neurooncology. Limited interdisciplinary collaboration and insufficient institutional support further hinder comprehensive skill development. National-level reforms are essential to align with global standards in neurooncological education and care.