Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Complete resection is often curative. Objectives: The objective of this study is to give ideas about the descriptive epidemiology, clinical presentation and histopathology of current scenario at National Neurosurgical Referral Center, Nepal. Methods: This is a prospective study from the period of January 2015 to September 2019 in the department of neurosurgery, National Academy of Medical Science, Bir Hospital. Inclusion criteria consists of all the histopathological proven cases of meningioma during the study period. Result: A total of 150 meningioma cases were operated during the study period. The average age of presentation was 42 years. Male to female ratio was 1:2. Most common affected age group was 30-50 years. The most common clinical symptoms for intracranial meningioma were headache followed by vomiting and paresis. Among intracranial meningioma, the most common location was convexity meningioma followed by sphenoid wing meningiomas and parasagittal meningiomas. Most common histopathological variety encountered was transitional meningioma, World health organization grade I. Conclusion: Meningiomas are slow growing, extra-axial tumor, usually benign which are most commonly located along convexities, sphenoid ridge and parasagittal area. Most are cured if completely removed, which is not always possible.

Spontaneous regression of cerebral arteriovenous malformation is rare and less than hundred cases have been reported in literature. The authors report a case of 64 year/male who was diagnosed with cerebral arteriovenous malformation which was found to undergo spontaneous regression on repeat imaging. Spontaneous regression of a cerebral arteriovenous malformation is a rare phenomenon.

Introduction: The treatment of choice for high and low-grade gliomas is primarily surgical resection, many gliomas of highly eloquent cortical regions still are not operated because of the impending risk of surgery-related deficits. Tumors of eloquent areas like sensorial, motor and language cortex need to be operated carefully so that the symptoms don’t worsen after surgery. However, Intra operative computerized tomography (IOCT), neuronavigation including optical as well as EM (electromagnetic), Neuromonitoring, stereotaxy and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of new deficits postoperatively. Materials and Methods: Between 2021 and 2022, a consecutive series of 30 patients who had undergone surgery for tumors on eloquent area of brain, at National Neurosurgical Referral Center (NNRC), National Academy of Medical Sciences (NAMS), Bir hospital were included in this study. Ethical approval was taken from Institutional review board (IRB) of NAMS for the study. Preoperative functional MRI, DTI scan that revealed mass in eloquent brain areas were evaluated. The preformed proforma was used to collect the data including preoperative karnofsky performance score, age, gender, clinical. Manifestations, size and location of tumor, degree of resection, pathological grade. Patient are followed postoperatively for 3 months and postoperative KPS, morbidity and mortality was recorded. SPSS version 22 was used for statistical analysis. Results: Out of these 30 lesion were 13 (43.3%) were WHO grade IV, 5 (16.6% ) were WHO grade III astrocytoma, 3 (10% ) were WHO grade III oligodendroglioma , 2 (6.6% ) were WHO grade II astrocytoma, 4 ( 13.3%) were WHO grade I astrocytoma, 2 were tuberculoma and 1 was cavernoma. Majority of the patients (70%) (n=21 out of 30) presented with seizures. The mean age of the patient was 41.7 years (ranging from 21-71 years). Male predilection was observed accounting 60 % of the cases. Conclusion: The surgery of eloquent areas of brain though carries the risk of increased post operative neurological deficit, with assistance of advanced technology and experienced surgeons it still feasible option especially for young patients with good karnosky score and low grade tumors which has improved overall survival.

Introduction and importance: Epidermoid cysts are benign, slow-growing tumors. They account for 0.2–1.8% of all intracranial tumors and rarely appear as intraparenchymal masses. The most prevalent symptom in people of middle age is an insidious-onset headache. Case presentation: We present a 20-year-old college student who presented with memory disturbances. The imaging revealed a left thalamic mass. The tumor was excised and diagnosed histopathologically as an epidermoid cyst. Clinical discussion: Epidermoid cysts resemble epidermal skin cells in histology. The lesion of the thalamus involving the ventrolateral and anterior regions is involved with memory and language. Of note, to our knowledge, no cases of memory issues associated with thalamic epidermoid cysts have been reported in the literature. Conclusion: The ideal treatment is cystic component removal with complete capsule excision. Sometimes, in cases of incomplete excision, radiotherapy can be another option.

Introduction: Sodium imbalance in post-traumatic brain injury is not uncommon. It’s early detection and treatment is vital as it increases morbidity and mortality if not treated on time. We study the effect of Sodium imbalance as a predictor of outcome in these patients. Methods and Materials: Patients diagnosed with traumatic brain injury (TBI) admitted to Neurosurgery department were included in this study. Traumatic brain injury cases managed between 1st Baisakh 2074 B.S. and 29th Chaitra 2074 B.S. were analyzed prospectively.  Glasgow Coma Scale, Computed Tomography scan of head, duration of hospital and Intensive Care Unit (ICU) stay, and Glasgow Outcome Scale in relation to sodium imbalance measured within 24 hours of injury were assessed. Mortality and morbidity were measured using Glasgow Outcome Scale (GOS). Results: A total of 100 patients with traumatic brain injury admitted in the Neurosurgery department of Bir Hospital were included in this study. Sixty seven cases were categorized as mild, 18 as moderate and 15 as severe according to the severity of TBI. The maximum serum sodium level observed was 168 and lowest was 110 mmol/l. The association of sodium imbalance with severity of head injury was found to be statistically significant. The sensitivity of sodium imbalance measured within 24 hours of injury in prognosticating outcome of patient till death or before discharge from hospital on the basis of GOS and Neuro ICU stay day is significant with p value <0.05. Conclusion: Sodium imbalance is an independent prognostic factor outcome in TBI. Continuous monitoring of sodium level in the neurosurgical ICU setting is mandatory to manage patients with head injury with or without undergoingneurosurgical intervention as it has prognostic value with outcome measures like GOS and ICU stay days.