Background: Tuberculum sellae (T.S.) meningiomas accounts for 5–10% of all intracranial meningiomas. The primary goal of surgery is to improve or at least maintain visual function, but this objective poses a formidable surgical challenge, because of the risk of postoperative visual impairment. The aim of the present study was to evaluate outcome in TSM patients treated microsurgically using multiple skull base approaches such as transcranial approach and extended endonasal transsphenoidal approach. Materials and Methods: This is a retrospective study of 34 patients was aimed to observe the efficacy of the different common approaches by a single neurosurgeon. The approaches were minipterional approach, superciliary keyhole microscopic approach, superciliary keyhole endoscopic assisted approach, bifrontal basal approach and extended endoscopic endonasal approach. All the patients were evaluated preoperatively by visual field analysis and contrast MRI. Postoperative follow-up was done by visual field analysis and by contrast MRI or contrast CT scan of brain. Result: Through transcranial surgery vision improved in 86.20%, static in 10.34% and deteriorated vision in 03.45%. Through transsphenoidal surgery vision improved in 80%, static in 20% and deteriorated in 0%. Through transcranial microscopic approaches (minipterional, minibifrontal basal, superciliary keyhole microscopic) gross total removal was done in 58.82%, near total in 10.34% and partial removal in 03.45%. Through transcranial/superciliary keyhole endoscopic assisted approach, gross total removal was done in 80% and near total in 20%. Through transsphenoidal approach gross total removal was done in 60%, near total in 20% and partial removal in 20%. Conclusion: Now a days endoscopic assisted key hole superciliary mini craniotomy for resection of tuberculum sellae meningioma is commonly used because of less morbidity and good visual outcome and this can be done without microscopic set up. The endonasal route is preferred for removal of T.S. meningioma when they are mostly sellar and directing towards third ventricle. The major limitation of this approach is a narrow surgical corridor. The gross total removal was better achieved with minibifrontal basal and minipterional craniotomy. Bang. J Neurosurgery 2022; 11(2): 80-88
Background: Spontaneous pyogenic spondylodiscitis is an uncommon clinical condition. But in our country it is not infrequent. High level of clinical suspicion is necessary for diagnoses of spontaneous pyogenic spondylodiscitis. There is no study regarding this issue in Bangladesh. Objective: The objective of this study was to see the epidemiological feature and types of surgical treatment of spontaneous pyogenic spondylodiscitis in Bangladesh Materials and Methods: This is a retrospective observational study. This study was done in the Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. The study period was January, 2016 to July, 2021 for a period of 5.5 years. 17 patients who were undergone surgery included in the study. The data were collected from questionnaires and hospital records and analyzed. Results: In our study the highest incidence was found in 4th (23.52%) and 6th (29.42%) decade of life which was around 53%. The male to female ratio was about 2: 1.The present study showed the most common involvement was in lumbar region (35.31%), in dorsal and sacral region it was 23.52% and the cervical region in 17.65%. Regarding surgical treatment in cervical region both anterior (with fixation) and posterior approach was done, in dorsal, lumbar and sacral region posterior approach with or without fixation was done. Conclusion: In Bangladesh the incidence of Spontaneous pyogenic spondylodiscitis is relative high. It is more common in advance age with male predominance. Most frequently affected region was lumber. Surgical technique was individualized for every case. Bang. J Neurosurgery 2022; 11(2): 64-69
Background: Brain abscess is a relatively uncommon but life-threatening infection in children. It can originate from contiguous site infections (eg, chronic otitis media, mastoiditis, sinusitis, meningitis), from distant pathologic states (eg, cyanotic congenital heart disease, chronic lung infections), after head trauma or neurosurgical procedures, or from cryptogenic sources. Predominant etiologic microorganisms vary depending on these predisposing factors. Proper selection of antimicrobial agents with good penetration of the central nervous system and with adequate coverage of both anaerobic and aerobic bacteria is critical for the medical management of brain abscess. Delay in surgical drainage can be associated with high morbidity and casefatality rates. Methods: The study was carried out at Department of Paediatric Neurosurgery, NINS&H, Dhaka from November 2017 to till date. Data collection sheet was used to collect the necessary information. Subjects was included from a NINS Pediatrics neurosurgery electronic registry. Structured questionnaire was used to collect the necessary information. Risks and benefits of this study were explained to the patient and patient’s legal guardian/parents in an easily understandable local language. Informed written consent was taken from each guardian before data collection. Results: Most of the patients were within >5 years age group 21 (38.3%). Second large were <2 years age group 19 (34.5%). According to gender. 33 (60%) patients were males and 22 (40%) patients were females. Distribution of subjects among OPD patients and admitted patients. 41 patients were admitted indoor among 55 patients. Predisposing factors were identified in 24 of 41 admitted cases. 11 abscesses developed in a child with cyanotic congenital heart disease (CCHD) and 2 occurred after head trauma. 2 abscesses were secondary to ear infections. In 28 patients, the abscess was drained through a burr hole, without the need for craniotomy; the other 4 underwent open craniotomy. 9 patients improved only with conservative management. Among the admitted patients, 34 patients were discharged from the ward in clinically stable conditions and 7 patients expired. Conclusion: Advances in the diagnosis and treatment of brain abscess and subdural empyema with neuroimaging techniques such as computerized tomography, magnetic resonance imaging, magnetic resonance spectroscopy, the availability of new antimicrobials, and the development of novel surgical techniques have significantly contributed to the decreased morbidity and mortality associated these infections. Bang. J Neurosurgery 2022; 11(2): 70-74
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