This study was carried out to find out the age, sex, mode of injury, localization, clinical presentation, CT findings, operative measures and outcome of extradural haematoma in the patient population at Dhaka Medical College. 610 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 6th October 2008 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Out of 610 cases 86.32 % were male and 13.78 % were female. The male and female ratio was 6.27: 1. Age ranged from 2.5 to 83 years. Commonest age group was 21 to 30 years. Commonest mode of injury was Road traffic Accident 53.45%, followed by Assaults. Most common clinical presentation was headache / Vomiting 63.61 %, followed by altered sensorium 60.66 %. In this present prospective study of 610 cases of EDH, temporo parietal site was involved in 33.45 % followed by frontal region in 23.28 %. Sixty five patients (10.66 %) died; 19 of these had associated brain injuries and 28 cases were deeply unconscious. Extradural haematoma is a neurosurgical emergency where early surgical intervention is associated with the best prognosis. Many factors affects the outcome of extradural haematoma surgery and the most important one is the duration of time between incident/accident and operation in neurosurgical operation theater; mortality can be close to 0% if this time interval can be minimized.

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods: Seventy patients presented with VS who had undergone operative procedures performed in our unit from 2017 to 2019. The facial nerve function and hearing assessment was done according to House-Brackmann [HB] grading and pure tone audiometry (PTA) respectively. All patients were operated by retro-mastoid suboccipital approach. Results: Most patients had large tumors and had no useful hearing (85%), had disabling cerebellar ataxia (92.86%) and presented with features of raised intracranial pressure (48.57%). Large sized tumors were in 32.86% and giant sized tumors were in 57.14% cases. Complete tumor excision was carried out 92.86% and anatomical preservation of facial nerve was achieved in 73.85% cases. Hearing preservation was achieved in 4 patients. Cerebrospinal fluid leak with or without meningitis and transient lower cranial nerve paresis were common complications. The mortality rate was 7.14%. Conclusions: Complete tumor excision with good facial nerve preservation can be achieved in large vestibular schwannomas. Hearing preservation is difficult in larger tumors. Primary microsurgical resection is an appropriate management option for large VS. In our experience, this goal can be achieved safely and successfully by using the retrosigmoid approach. Bang. J Neurosurgery 2021; 10(2): 175-181

Background: Anterior cervical discectomy is a common procedure for treating patients for cervical disc prolapse. This study was conducted to evaluate the surgical outcome and demographic characteristics of patients who were treated for anterior cervical disc prolapse. Methods: Study was conducted in the Department of Neurosurgery-spine, National Institute of Neurosciences and Hospital, Dhaka. Study interval was 5 years from January, 2014 to 31st December, 2019. Total numbers of patients were 215. Males were 183 (85.1%) and females were 32 (14.9%). All the patients had undergone the procedure of anterior cervical discectomy and fusion (ACDF) with RABEA Rectangular Titanium Cages (RTC). All the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse. Surgical and Clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), for Myelopathy, overall Odoms outcome scores, postoperative surgical complications, and fusion and subsidence rates. Results: Total 215 patients underwent ACDF; the mean age of these patients was 44.66 years, and their preoperative VAS and NDI, scores were 8.09 and 35.38 respectively. Sixty seven percent of patients had one level, 25.1% had two-level, and 7.9% had three-level procedures. On preoperative Magnetic Resonance Imaging(MRI), foraminal stenosis was present in 68.4% of patients, whereas medullar stenosis was present in 43.7%. The rate of complications was 2.8%: two patients had postoperative implant migration (0.93%), three patients had postoperative transient dysphagia (1.4%) and one patients had temporary hoarseness of voice. Mean postoperative follow-up time was 6.7 months; postoperative VAS and NDI scores were 1.10 and 14.4, respectively. Postoperative fusion rate was 93.5%, and subsidence rate was 5.6%. Conclusion: Results with Rectangular Titanium Cages are expectedly good. Symptoms resolved and fusion rate was 93.5% at 1 year follow up. Bang. J Neurosurgery 2021; 10(2): 137-147

Traumatic brain injury is a significant public health problem. Objective: This study was aimed to clinical characteristics of traumatic brain injury patients by collection of detailed data on demography, clinical, injury patterns, co-morbidities, laboratory findings, and outcome of mild and moderate TBI. Methodology: This cross-sectional study was conducted from September 2019 to June 2020. Patients attending Department of Trauma Neurosurgery of National Institute of Neurosciences & Hospital, Dhaka, Bangladesh and Department of Neurosurgery of Dhaka Medical College Hospital, Dhaka, Bangladesh with a history of having mild or moderate traumatic brain injury and patients of 18 years and above irrespective of their sex were included in the study after informed written consent. The study included socio-demographic information and history of injury, mechanism of injury, information of physical examination, clinical features including cognitive change and co-morbidities were recorded. Results: A total number of 210 patients were included in this study. Motor vehicle related accident was 56.2% cases. About 21.4% cases of them were assaulted (physically), 12.9% cases of them were fall from the height. About 58.0% patients were normal cognition; 22.0% cases were mild cognitive impairment; 17.6% cases were moderate cognitive impairment and only 2.0% cases were severe cognitive impairment during discharge. Glasgow Coma Scale (GCS) during admission after resuscitation around 78.0% cases were moderate head injury and 22.0% cases were mild head injury. About 47.14% patients had single or multiple cerebral hemorrhagic contusion; 13.8% patients had traumatic subarachnoid hemorrhage; 8.6% cases had thin layer of subdural hematoma; 6.2% cases had epidural hematoma; Conclusion: Traumatic brain injury patients have mostly due to road traffic accidents and are presented with cerebral hemorrhagic contusion, subarachnoid hemorrhage and subdural hematoma Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):105-111

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160