Introduction: Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Rupture of an intracranial aneurysm (IA) causing subarachnoid haemorrhage (SAH) is a devastating event that is still associated with a 50% case fatality rate, despite major improvements in surgical techniques, diagnosis and interventional treatment. While patient subgroups may clearly qualify for either surgical or endovascular treatment some patients could benefit from multimodal therapy. In this article we will show our team approach experience of management of ruptured intracranial aneurysms. Methods: Cross-sectional descriptive study of 52 patients of ruptured intracranial aneurysm who got admitted into Combined Military Hospital, Dhaka in the period from Jan 2016 to Dec 2018. Patients were evaluated according to their demographic data, analysis of risk factors, radiological location of aneurysms, World Federation of Neurological Surgeon (WFNS) scale, procedural options for aneurysm treatment, post procedural complications. We excluded unruptured cases and those patients who were treated conservatively. General outcome was assessed through the Glasgow out-come (GOS) scale. Data analysis was done by using computer software SPSS version 25.0. Patients studied were mainly middle-aged with mean age 44 ±5.2 years and predominantly female. Most of the patients had previous history of hypertension 45 (86.53%). WFNS scale 2 was observed in 34 (65.38%). Anterior communicating (Acom) artery aneurysm was more frequent which is found in 16 (30.77%) cases. 37 (71.15%) patients underwent microsurgical clipping whereas 13 (25%) patients underwent endovascular intervention and 2 (3.85%) patients needed combined approach. Complications were more in microsurgical clipping group 38 (73.08%) in comparison to endovascular group 13 (25%). GOS scale 5 was observed in 30 (57.70%) cases. Conclusion: Our experience of management of ruptured intracranial aneurysms together with their outcome have been reflected in this small study. For better outcome of ruptured intracranial aneurysms decision can be made on an individual case by case basis. Hybrid treatment option of staged endovascular and open microsurgical proceduresare sometimes needed as a combined approach. Bang. J Neurosurgery 2019; 9(1): 39-43

Introduction: Treatment of Hydrocephalus by placement of Ventriculo-peritoneal (V-P) Shunt is a common neurosurgical practice. But presence of shunt predisposes to increased infection. Objective: To focus on aetiological factors for developing shunt infection. Methods: This prospective observational study was carried out at Neurosurgery Center, Combined Military Hospital, Dhaka during the period of June 2015 to May 2018. A total of 33 patients were included in the study, all of them underwent CSF shunt surgery at this centre. They were followed up for one month after surgery. Age, sex and socioeconomic condition of the patients, types (obstructive or communicating) of hydrocephalus (HCP), aetiology of HCP, duration of surgery, shunt type used and routine or emergency surgery were the factors that were analysed for possible association with infection. Results: Eight (24.2%) patients developed shunt infection, among whom infants and male were predominate. Low socio-economic group, prolonged operation time and emergency surgery were found to have association with increased rate of infection. Conclusion: V-P shunt insertions had unacceptably high infection rate despite the presence of a protocol for the procedure. A protocol should be developed for strict compliance and where possible, alternative procedure Endoscopic Third Ventricullostomy (ETV) or External Ventricular Drain (EVD) should be employed to minimize shunt infection. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 16-18

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

Introduction: Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes. Aim: To assess the relationship between the haematoma volume and early surgical outcome of patients with spontaneous primary supratentorial intracerebral hemorrhage by Glasgow Outcome Scale at the 30th post ictus day. Methods: This prospective study was done from April 2014 to March 2016 in Department of Neurosurgery, Combined Military Hospital (CMH), Dhaka. Forty seven cases were selected by set down criteria. Glasgow Coma Scale (GCS) score was recorded on admission, haematoma volume was calculated from the CT scan immediately after admission by Modified Ellipsoid Method and the surgical outcome of ICH patients was determined by Glasgow Outcome Scale (GOS) by face to face interview or by structured interview over phone at their 30th post ictus day. Correlation between the haematoma volume and the surgical outcome of ICH was done by Chi-square test. Again the correlations of three variables (haematoma volume, admission GCS and ICH score) with GOS was compared by Spearman’s correlation coefficient test. Results: Patients with haematoma volume of 30cc or more were found to have worst outcome. Conclusion: Relationship between haematoma volume and surgical outcome was found statistically very significant. Risk stratification of the patients with spontaneous primary supratentorial intracerebral hematomas basing on hematoma volume may be used to improve standardization of treatment protocols and clinical research studies. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 46-49