Introduction: Meningiomas of the tuberculum sellae and planum sphenoidale represent a subgroup of anterior skull base tumors that comprise approximately 5%–10% of all intracranial meningiomas. Most of the patients report with failing vision, so early surgical decompression either transcranial and/or endonasal approach is recommended. The endonasal route allows for direct coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without encountering the optic nerve. This article describes our institutional experience for the endonasal resection of tuberculum sellae and planum sphenoidale meningiomas. Materials and Methods: We retrospectively analyzed eight cases of tuberculum sellae and planum sphenoidale meningiomas who selectively underwent endoscopic endonasal transsphenoidal resection between 2015 and 2018. All patients had ophthalmological, endocrinological, and radiological evaluation both preoperatively and postoperatively. Results: Among the study group, we found age range 22–68 years, male:female 1:2. Among the radiological findings, there were five cases of tuberculum sellae meningioma, while three cases were of planum sphenoidale meningioma. In tumor resection status, we found gross total resection in six cases and debulking in two cases. Postoperative analysis of visual outcome revealed improvement in four cases, constant in three cases, and worsening in one case. We also found the post of nasal complications in four cases, cerebrospinal fluid leak in two cases and transient diabetes insipidus in one case. Conclusion: In this study, we highlighted our experience of a very small group of patients with anterior fossa meningioma specific to tuberculum sella and planum sphenoidale origin.

Background: Spinal instrumentation provides a stable, rigid column that encourages bones to fuse after spinal fusion surgery. Methods: The study was carried out in the Neurosurgery Center, CMH, Dhaka, from 01 January 2013 to July 31 2018. A total of 95 patients were included with unrestricted age and gender, underwent spinal surgery with fixation. Result: Better outcome was observed in spinal surgery with stabilization. Conclusion: Whereas early (within hours) or immediate (within 48 h) stabilization and indirect or direct decompression has excellent outcome, even delayed stabilization of the unstable spine has benefits. Bang. J Neurosurgery 2019; 9(1): 11-15

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

Background: Spontaneous intracranial haemorrhage (ICH) is defined as intraparenchymal bleeding in the absence of trauma or surgery. Spontaneous ICH is most disabling and deadly type of stroke. Meteorologic factors and seasons on the incidence of spontaneous ICH with ambiguous results. Objectives: To determine whether different seasons had any relationship with the rate of primary intracerebral hemorrhage. Methods: Total of 209 patients were diagnosed as spontaneous ICH and they have been first time reported & admitted in Combined Military Hospital (CMH) Dhaka, between Jan 2017 and December 2018. Males were 146(69.85%), females were 63(30.15%) and were aged between 18 and 95 years old. Diagnosis was based on history, clinical examination and non-contrast Computed Tomography(CT) scan of brain. Results: 209 admitted patients in CMH Dhaka from Jan 2017- Dec 2018 are included in our study who full-fill the criteria. Intracerebral haemorrhage rate among age group less than 55years old being 55(26.31%) and 55 years and above 154(73.69%).There were a significant relationship between different seasons and intracerebral haemorrhage. Intracerebral haemorrhage incidence in winter season 61(29.18%) and late autumn 19(9.09%), out of 209 patients. Among them hypertensive patients were 137(65.55%) and non-hypertensive patient 72(34.45%), 170 (81.33%) were nondiabetic & 39(18.66%) diabetic of total 209 patients.Out of 61 patients in winter; 54 (88.52%) hypertensive patients had large sized haemorrhage. Conclusion: The highest rate of intracerebral haemorrhage during December-January. There is a seasonal variation in patient’s age, incidence among hypertensive patients, size of hemorrhage and more in number in winter season. Bang. J Neurosurgery 2020; 9(2): 130-134

Introduction:The endoscopic endonasal approach is a minimally invasive surgical technique for removal of skull base lesions by using nose and sinuses as natural corridors. This study represents our institutional experience with endoscopic endonasal trans-sphenoidal approach for anterior skull base lesions. Objective: To find out surgical outcomes of endoscopic endonasal trans-sphenoidal approach for treatment of anterior skull base lesions. Materials and Methods: Cross-sectional observational study of 38 consecutive patients who underwent endoscopic endonasal trans-sphenoidal surgery for anterior skull base lesions in Combined Military Hospital, Dhaka from July 2013 to June 2017. Results:This study included 16 men and 22 women, ranging from 24 to 68 years of age where median was 38 years. Common presentations were visual disorder (60%), headache (30%), features of pituitary apoplexy (5%), Cushing disease (0.35%), acromegaly (0.7 %), galactorrhoea (0.35%). Radiological evaluation revealed intrasellar (12), sellar and suprasellar (22), sellar and parasellar (1), tuberculum sella and planum sphenoidale (3), clival (1) lesions. Recurrent cases (3/38) were nonfunctioning pituitary macroadenoma, prolactinoma, and growth hormone secreting macroadenoma. The surgical resection in relation to post op imaging were 45% as gross total resection, near-total in 35%, subtotal in 15%, and partial in 5%. We found fifteen patients experienced improvement in visual acuity, while one patient worsened. Common complications were transient diabetes insipidus (53%), new pituitary deficit (35%), endonasal adhesions (20%), and cerebrospinal fluid leak (5%). Surgical mortality was (0.35%). The histological diagnoses included twenty-eight pituitary adenomas, five craniopharyngioma, three meningioma, one Rathke’s cleft cyst and one clival chordoma. Conclusion: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for an anterior skull base lesion. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 66-68