TORCH infection is associated with Toxoplasmosis, Treponema pallidum, Rubella, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Hepatitis viruses, Human immunodeficiency virus (HIV), and other infections such as varicella andparvovirus B19.Paediatric age group with congenital hydrocephalus present with different presentation and has different etiology associated too. TORCH infection is associated with increase morbidity and mortality in pediatricsmainly in prenatal and infant age groups. Clinical presentation varies with type of infection involved and clinical outcome varies too. We report our experience with the management of 4 patients with hydrocephalus associated with TORCH infection, its presentation, its sequelae and management.
Bang. J Neurosurgery 2019; 8(2): 119-124
Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates. Abbreviations: DCR: dacryocystorhinostomy, PL: Perception of light, PR: Projection of rays
Some lesions in the brain are difficult to approach through a single common route / trajectory. For those, dual approach combined together may ensure easier safe removal with better outcome as we had lesions like left petroclival meningioma & large craniopharyngioma. Methods Two patients, one left petroclival meningioma and one suprasellar craniopharyngioma with intraventricular extension underwent surgery with dual approach at the Neurosurgery department, BSMMU. After detailed clinical and radiological evaluation, the left petroclival meningioma patient was planned for a combined pre and post sigmoid petrosectomy and retromastoid retrosigmoid route. These were accomplished in two stages, three months apart. The craniopharyngioma patient with intraventricular extension underwent surgery through pterional transsylvian and frontal anterior trans-callosal approach in a single sitting.
Bang. J Neurosurgery 2020; 10(1): 111-118
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