Aim:The aim of this study was to compare the efficacy of endoscopic versus microscopic excision of pituitary adenoma, and to evaluate the merits and demerits of each approach.Materials and Methods:Prospective data were collected and patients were surgically treated for pituitary adenoma at SMS Hospital, Jaipur, Rajasthan, India. Patients consent was obtained. Age, sex, presenting symptoms, length of hospital stay, pre- and post-operative hormone status, extent of resections of tumors, and intra- and post-operative complication were noted.Results:A total of thirty patients with pituitary adenoma were operated transsphenoidally. Seventeen patients were operated by endonasal endoscopic transsphenoidal surgery and 13 patients were operated by microscopic transsphenoidal surgery. In an endoscopic group, complete tumor excision was achieved in 11 (64.71%) patients, and in microscopic group, it was achieved in 6 (46.15%) patients. In endoscopic group, mean operative time was 111.29 ± 21.95 min (ranged 80–135 min), and in microscopic group, it was 134.38 ± 8.33 min (ranged 120–145 min). In endoscopic group, mean blood loss was 124.41 ± 39.64 ml (60–190 ml), and in microscopic group, it was 174.62 ± 37.99 (100–220 ml). Postoperative sinusitis was present in 1 (5.88%) patient in endoscopic group and in 2 (15.38%) patients in microscopic group.Conclusion:Endoscopic approach provides a wide surgical field and broad lateral vision making easier distinction of tumor tissues. Thus, there is less blood loss, greater extent of tumor removal and it had less operative time, less postoperative complication, and early discharge from the hospital.

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Background: Glioblastoma (GBM) is the most common primary malignant brain tumor in adult. Its incidence increases with age and nearly half of the all newly diagnosed GBM cases are older than 65 years. Management of GBM in elderly is challenging and recurrence poses further challenge. This article aims to review the literature, evaluate the various options, and to decide the treatment plan in elderly cases with GBM recurrence. Methods: A systemic search was performed with the phrase “recurrent GBM (rGBM) in elderly and management” as a search term in PubMed central, Medline, and Embase databases to identify all the articles published on the subject till February 2022. The review included peer-reviewed original articles, review articles, clinical trials, and keywords in title and abstract. Results: Out of 473 articles searched, 15 studies followed our inclusion criteria and were included in this review. In 15 studies, ten were original and five were review articles. The minimum age group included in these studies was ≥65 years. Out of 15 studies, eight studies had described the role of resurgery, four chemotherapy, three resurgery and/or chemotherapy, and only one study on role of reradiotherapy in patients with rGBM. Out of eight studies described the role of resurgery, six have mentioned improved survival and two have no survival advantage of resurgery in cases of rGBM. Conclusion: Resurgery is the main treatment option in selected elderly rGBM cases in good performance status. In patients with poor performance status, chemotherapy has better post progression survival than best supportive care.

Background Glioblastoma is the most aggressive and diffusely infiltrative primary brain tumor. Recurrence is almost universal even after all primary standard treatments. This article aims to review the literature and update the standard treatment strategies for patients with recurrent glioblastoma. Methods A systematic search was performed with the phrase “recurrent glioblastoma and management” as a search term in PubMed central, Medline, and Embase databases to identify all the articles published on the subject till December 2020. The review included peer-reviewed original articles, clinical trials, review articles, and keywords in title and abstract. Results Out of 513 articles searched, 73 were included in this review after screening for eligibility. On analyzing the data, most of the studies report a median overall survival (OS) of 5.9 to 11.4 months after re-surgery and 4.7 to 7.6 months without re-surgery. Re-irradiation with stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) result in a median OS of 10.2 months (range: 7.0–12 months) and 9.8 months (ranged: 7.5–11.0 months), respectively. Radiation necrosis was found in 16.6% (range: 0–24.4%) after SRS. Chemotherapeutic agents like nitrosourea (carmustine), bevacizumab, and temozolomide (TMZ) rechallenge result in a median OS in the range of 5.1 to 7.5, 6.5 to 9.2, and 5.1–13.0 months and six months progression free survival (PFS-6) in the range of 13 to 17.5%, 25 to 42.6%, and 23 to 58.3%, respectively. Use of epithelial growth factor receptor (EGFR) inhibitors results in a median OS in the range of 2.0 to 3.0 months and PFS-6 in 13%. Conclusion Although recurrent glioblastoma remains a fatal disease with universal mortality, the literature suggests that a subset of patients may benefit from maximal treatment efforts.

Abstract:Aims: To determine the current epidemiological trends, clinical presentation and commonest organism of brain abscess in this part of the country. Material and Methods: 104 cases admitted during August 2009 to July 2016 in the Department of neurosurgery of Dr RMLIMS Lucknow were included in the study. Detailed clinical history was taken and detailed neurological examination was done. Relevant laboratory investigations were done as needed along with CT scan and /or MRI brain. Patients were managed by aspiration or surgical excision and aspirated material sent for microbiological examination. Results were collected and analyzed. Results: Chronic suppurative otitis media (CSOM) was the commonest cause of infection in 54.81% cases. Trauma was encountered in 10.58%% cases. Other causes were haematogenous spread of infection, dental caries and immunodeficiency. No source could be identified in 23 patients (22.11%). Conclusion: Chronic suppurative otitis media (CSOM) is still a major cause of brain abscess in developing country like India which is a benign curable disease and should not be neglected. Prompt diagnosis and treatment allows immediate decompression of mass reduces duration of antibiotic stay and minimizes treatment cost.