(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.

Background: Pott’s disease is a rare form of extrapulmonary tuberculosis that manifests in a variety of clinical patterns. Delays in diagnosis and treatment can lead to serious complications. About 10-40% of patients with spinal tuberculosis may have a neurological deficit. Urgent measures are needed to halt the progression of the disease and deformity, especially to prevent and overcome paraplegia. In regards to management, every case is different and has a unique procedure. It includes simple medical management, simple decompression and debridement, anterior approach, and posterior approach, etc. Surgical decompression of the cord and instrumentation are needed in many cases besides chemotherapy. Although the anterior approach is used for cervical Pott’s disease but this procedure is very time-consuming and technically difficult in the lumbar and dorsal spine, especially in compromised patients and morbidity is more. The posterior approach alone is enough for achieving adequate decompression, debridement, reduction, fusion, reconstruction of the body, and maintaining sagittal alignment in the dorsal and lumbar Pott’s spine. The aim of the study was to describe the treatment modality and observe the outcome of treatment methods and incidence rate of infection sites among the patients of Potts spine. Material & Methods: This retrospective study was conducted at the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh. The study duration was 7 years, from March 2016 to January 2023. During this period, a total of 30 cases of Pott’s disease were included in the study following inclusion and exclusion criteria. Results: 53.33% had been from the youngest age group of 15-34 years, and 80 % were male. Very few participants had been female in the present study. Back pain was the primary complication for 50% of cases, while spinal infection was observed in the cervical region for 16.67% of cases, 43.33% had infections in the dorsal region, and 30 % in the lumbar region. 10.00% of the participants had been treated with non-surgical methods, with only anti-TB medication for 18 months or more. Posterior decompression was the most common treatment method, with 23.33% having only posterior decompression, and 40.00% having posterior decompression with the use of additional instruments. Conclusion: The study observed that Pott’s disease was most common among young adult males, and the most common sites of spinal infections were in the dorsal and lumbar regions in the present study population, contradictory to the general findings. Decompression treatment, with and without additional instruments, was the most common form of treatment among the present study population.

An 11 months old male child, with congenital HCP presented with extrusion of shunt tube form the anus after defecation. He was managed by VP shunt 8 months back; 6 months later lower end was revised for obstruction. Lower end of shunt exteriorized and the distal end was cut and pulled out per rectally. Later ETV done patient discharged uneventfully.Key words: VP Shunt, Trans anal, Extrusion, Management, Outcome. Bang. J Neurosurgery 2022; 11(2): 138-140

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

Background: Brain abscess is a relatively uncommon but life-threatening infection in children. It can originate from contiguous site infections (eg, chronic otitis media, mastoiditis, sinusitis, meningitis), from distant pathologic states (eg, cyanotic congenital heart disease, chronic lung infections), after head trauma or neurosurgical procedures, or from cryptogenic sources. Predominant etiologic microorganisms vary depending on these predisposing factors. Proper selection of antimicrobial agents with good penetration of the central nervous system and with adequate coverage of both anaerobic and aerobic bacteria is critical for the medical management of brain abscess. Delay in surgical drainage can be associated with high morbidity and casefatality rates. Methods: The study was carried out at Department of Paediatric Neurosurgery, NINS&H, Dhaka from November 2017 to till date. Data collection sheet was used to collect the necessary information. Subjects was included from a NINS Pediatrics neurosurgery electronic registry. Structured questionnaire was used to collect the necessary information. Risks and benefits of this study were explained to the patient and patient’s legal guardian/parents in an easily understandable local language. Informed written consent was taken from each guardian before data collection. Results: Most of the patients were within >5 years age group 21 (38.3%). Second large were <2 years age group 19 (34.5%). According to gender. 33 (60%) patients were males and 22 (40%) patients were females. Distribution of subjects among OPD patients and admitted patients. 41 patients were admitted indoor among 55 patients. Predisposing factors were identified in 24 of 41 admitted cases. 11 abscesses developed in a child with cyanotic congenital heart disease (CCHD) and 2 occurred after head trauma. 2 abscesses were secondary to ear infections. In 28 patients, the abscess was drained through a burr hole, without the need for craniotomy; the other 4 underwent open craniotomy. 9 patients improved only with conservative management. Among the admitted patients, 34 patients were discharged from the ward in clinically stable conditions and 7 patients expired. Conclusion: Advances in the diagnosis and treatment of brain abscess and subdural empyema with neuroimaging techniques such as computerized tomography, magnetic resonance imaging, magnetic resonance spectroscopy, the availability of new antimicrobials, and the development of novel surgical techniques have significantly contributed to the decreased morbidity and mortality associated these infections. Bang. J Neurosurgery 2022; 11(2): 70-74