(1) Background: The aim of the present study was to evaluate our institutional outcome in tuberculum sellae meningioma (TSM) patients treated microsurgically using multiple skull base approaches, including a transcranial approach and an extended endonasal transsphenoidal approach. (2) Materials and Methods: This is a retrospective study that includes 34 patients with TSM. The study aimed to observe the efficacy of the different common approaches used by a single neurosurgeon. All the patients were evaluated preoperatively and during follow-up with campimetry, head CT scan, and post-contrast MRI. (3) Results: After a transcranial approach, visual acuity improved in 86.20%, was stable in 10.34%, and deteriorated in 3.45%. Through transsphenoidal surgery, vision improved in 80%, was static in 20%, and deteriorated in 0%. Transcranial approaches included pterional, mini-bifrontal basal, and supraciliary keyhole microscopic craniotomies. Gross total removal was performed in 58.82%, near total in 10.34%, and partial removal in 3.45%. The transcranial/supraciliary keyhole endoscopic-assisted approach showed a gross total removal rate of 80%, and near total in 20%. The transsphenoidal approach showed a gross total removal rate of 60%, near total in 20%, and partial removal in 20%. (4) Conclusion: Endoscopic-assisted keyhole supraciliary mini craniotomy for resection of tuberculum sellae meningioma offers low morbidity and good visual outcome. The endonasal route is preferred for the removal of TSM when they are small and midline placed. The major limitation of this approach is a narrow surgical corridor and the restriction on midline-placed lesions. Gross total removal was better achieved with mini-bifrontal basal and pterional craniotomies.
Between 1996 and 2002, we treated 60 patients (65 hips) by hip resurfacing. The notes and radiographs of these cases were studied retrospectively and the modalities of failure identified. At a mean follow-up of 51 months, 14 of these cases (22%) required revision surgery. One patient had died from unrelated causes and one was lost to follow-up. At the time of primary surgery, the mean age of the patients in our series was 55 years. The commonest mechanism of failure in our series was fractured neck of femur (six cases). Four of these occurred in females over the age of 60. None of the fractured necks of femur were associated with trauma. There were four cases of loose acetabular components and one case of progressive AVN (avascular necrosis). Two patients required revision surgery for ongoing hip pain and one required a twostage revision for early deep infection. (Hip International 2005; 15: 155-8).
Aim: We prospectively recorded the clinical features, radiological features, surgical approaches & findings, postoperative follow up & ultimate neurological outcome of upper cervical spinal schwannomas and then we evaluated the records retrospectively. Materials and Method: 30 upper cervical spinal schwannomas patient who underwent surgery (microneurosurgically) from 2007 to 2014 in the department of neurosurgery Dhaka Medical College and private hospitals are included in this retrospective study. After operation all patients were followed up regularly both clinically and neuro-radiologically. Results: Out of 30 cases 16 male and 14 females. The male to female ratio was 1.4: 1, Age range from 8 to 60 years with mean age 35 Years. Most of the patients are in middle years age group The mean duration of symptoms at the time of presentation was 32 months (range 06 months-5 years). Four schwannomas were completely extradural, fourteen were intradural and rest twelve were intradural or hourglass type (both extra and intradural) as identified during surgery. The posterior midline approach was used in all patients. A C2 hemilaminectomy or C2 laminectomy with or without cutting of posterior arch of atlas was used for most intradural and large in terdural C2 schwannomas. Tumor removal was complete in all cases. Preservation of the nerve root fibers was not possible in 18 cases and was possible only in 12 cases. In one patients CSF leak developed after operation. One patient who had severe myelopathic features with bed sore failed to improve and expired 5 months after operation. Rest of the patients showed postoperative improvement in their preoperative symptoms and returned to their normal life by the end of sixth month. There was one tumor recurrence in any patient till last follow up. Conclusion: Proper 3-D anatomical orientation & physiological knowledge, deep neuro-radiological observation, pathological appreciations and micro-neurosurgical skill and expertization can make the surgical management of these tumors ( in a surgically complex site) simple with gratifying result (i.e.neurological outcome) without extensive bone removal or soft tissue manipulation through a standard midline posterior approach. Bang. J Neurosurgery 2019; 9(1): 44-48
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
Introduction: Many head injury patients have reduced consciousness, are prone to aspiration of oral secretions, and are likely to develop pneumonia. Respiratory tract infection (RTI), especially pneumonia, is a very common disease in Neurosurgical Intensive Care Units (NSICU). Objective: To evaluate the microbial profile of head injury and stroke patients admitted to EMCH, Savar, Dhaka, Bangladesh. Methods: It was a retrospective study conducted at Enam Medical College & Hospital, Savar, Bangladesh from 2017-to 2021. A total of 46 patients admitted with a head injury and stroke patient were enrolled in this study. Data were collected using a structured questionnaire containing all the variables of interest. Data were processed and analyzed with the help of the computer program SPSS for windows version 25. Results: This study shows 84.8% males and 15.2% females. The mean age was 42.54±18.09 years. Pathogens found in culture samples were tracheal aspirate C/S (54.3%), urine C/S (26.1%), catheter tip C/S (13%), and the tip of the ET tube C/S (4.3%). Main attributed pathogens were staph. aureus (47.8%), Klebsiella spp (37%), E. coli (32.6%), streptococcus (2.2%), acinetobacter SPP (2.2%) and pseudomonas SPP (2.2%).Conclusion: This study shows staph. aureus, Klebsiella spp, and E. coli are the most common pathogen isolated. Therefore, careful microbial profile and antibiotic susceptibility testing are necessary for the prevention of pathogens as well as an effective treatment.
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
Background: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after severe traumatic brain injury. Objective: To assess the functional outcome following bilateral decompressive craniectomy (DC) in traumatic head injury based on Glasgow Outcome Scale (GOS). Materials and methods: This is a retrospective study conducted at Enam Medical College & Hospital, from January 2019- December 2020. Data of the patients who had undergone bilateral DC for severe traumatic head injury were reviewed from medical record files. Data were collected pre-designed data collection sheet. Data were analyzed using computer based program statistical package for social science (SPSS) for windows version 25.0 software. Results: This study shows maximum (56.9%) were 16-30 years. The average age was 29.70±14.78 years. Majority were male (94.1%) and only 5.9% were female. Road traffic accidents (RTA) were the most frequent causative event of traumatic injury. Most of the patients (88.2%) were hospital stay 1-5 days then 9.8% were 6-10 days and only 2% were >10 days. The average hospital stays were 3.26±2.43 days. Majority (60.7%) were good recovery, 13.7% were moderate disability, 5.9% were severe disability, 2% were persistent vegetative state and 13.7% were death at home. Conclusion: This study recommends a larger prospective study to assess the longterm functional outcome of bilateral decompressive craniectomy after severe traumatic head injury. Bang. J Neurosurgery 2022; 11(2): 89-93
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