Objective?Meningioma is a common intracranial tumor that predisposes patients to hydrocephalus which may require a permanent cerebrospinal fluid (CSF) diversion procedure such as ventriculoperitoneal (VP) shunts. We reviewed our long-term experience with VP shunts for the management of hydrocephalus in patients with meningioma. Methods and Materials?A total of 48 Patients with meningioma who underwent VP shunt insertion for hydrocephalus from 1990 to 2013 was included in our case series. The study population was evaluated clinically and radiographically after VP shunt placement. Results?Overall shunt failure was seen in 13 (27%) patients. Single and multiple shunt revisions were required in eight (16.7%) and five (10.4%) patients, respectively. The overall shunt revision within 6 months, 1 , and 5 years was 19, 23, and 27%, respectively. Male patient was significantly associated with the longer survival after shunt placement. Revisions free survival after 3, 5, 10, and 15 years of VP shunt placement were 70, 46, 30, and 20%, respectively. Finally, in regression analysis, age greater than 65 years (p?=?0.02, 95% confidence interval (CI)?=?0.1?0.13), tumor in posterior fossa (p? 5 cm) (p?=?0.3, 95% CI?=?0.01?0.19), and Simpson resection grades II to IV (p?=?0.04, 95% CI?=?0.07?0.2) were identified as positive predictors of requirement of CSF flow diversion Conclusion?The findings of the present study reveal that VP shunting is an important treatment option for the management of hydrocephalus in patients with meningioma. Further studies using less invasive techniques are warranted to compare the benefits of VP shunt for the management of hydrocephalus.

Introduction: Frontonasal fracture and concomitant craniofacial injuries carry the significant potential for mortality and morbidity mainly in young adults. This study analyses the characteristics of frontonasal injuries and associated facial injuries, the management option, and its outcome. Methods: This retrospective study was performed at the Department of Otolaryngology and Head and Neck Surgery and Neurosurgery, Gandaki Medical College, Pokhara, Nepal. Patients who had undergone surgery for cranial and midline facial bone fracture between January 2018 to June 2020 were included in this study. The variable examined were age, sex, alcohol consumption, any chronic diseases, time from accident to surgery, duration of hospitalization, and postoperative complication. Continuous variables were expressed as mean± standard deviation, and categorical variables were expressed as number or percentage. All analyses were performed using SPSS software 26.0. Results: The majority of patients were in the 3rd to 4th decade (67.1%). The most common cause was Road traffic accidents 45(59.2%). Twenty Five (32.9%) patients had consumed alcohol at the time of the accident. Among midline anterior fracture most common finding was nasal bone fracture 42(55.3%). Frontal bone fracture was seen in 9(11.8%) cases. Closed reduction of nasal bone was performed in 43(56.58%) cases. Craniotomy and elevation of depressed frontal bone was done in 10.53% of cases. Conclusion: Road traffic accidents were found to be the commonest mode of frontonasal trauma and males in young adult age group were the most common victim. The most common injuries were nasal bone fracture which was managed by closed reduction.

Background: Duraplasty refers to the neurosurgical process of reconstructing dural defect. Variety of materials is used for such reconstruction, including natural, semisynthetic, and synthetic materials. Although synthetic materials are readily available and easy to apply, these are associated with foreign body reaction which may lead to serious consequences in some cases. We describe one such rare instance of extradural abscess after polypropylene synthetic fabric duraplasty. Case Description: Our patient is a 33-year-old lady who suffered road traffic accident leading to massive brain laceration, contusion of bilateral frontal lobes, and anterior skull base fractures. Emergency craniotomy was carried out and dural defect repaired with polypropylene (G-Patch; G. Surgiwear® Ltd.) synthetic fabric as the duraplasty material. Three months later, the patient presented with discharging wound at the incision site. Neuroimaging showed ring enhancing lesion in frontobasal extradural space with cutaneous extension. The lesion failed to heal despite intravenous antibiotics and surgery was planned. Intraoperatively, abscess was found between G-Patch and dura. Histopathology showed granulomatous foreign body reaction. The lesion healed after synthetic dura removal and abscess drainage. Conclusion: Although various materials are used for duraplasty, there is no clear consensus on what material should be used for dural repair. Synthetic materials are bio-inert, offer good handling and malleability. Polypropylene has been used safely for both single- and double-layered duraplasty. However, foreign body reaction may occur and very rarely present as extradural abscess. Randomized trials should be done to establish the safety and efficacy profile of commonly used duraplasty materials.

BACKGROUND Providencia rettgeri is a rare cause of nosocomial infection in humans. These organisms are capable of biofilm production and are intrinsically resistant to commonly used antibiotics, leading to high rates of morbidity and mortality. P. rettgeri may very rarely cause postneurosurgical infection. OBSERVATIONS In this report, the authors describe two patients in whom P. rettgeri infection complicated the postoperative course. Both the patients underwent craniotomy at approximately the same time under similar environments. The organism isolated was resistant to most of the commonly used antibiotics, and therapy tailored to the results of susceptibility testing led to resolution of infection in both cases. LESSONS P. rettgeri is a rare cause of postneurosurgical nosocomial infection. Timely identification and early tailoring of antibiotic therapy based on susceptibility testing is the key to treatment. Every effort should be made to identify the source of infection and rectify it so that mortality, morbidity, and financial burden are reduced. Contact isolation and use of sterile gloves after each patient contact are effective in preventing its spread, as in most cases of nosocomial infection.