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

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 ± 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (≤10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.