Introduction: Meningiomas of the tuberculum sellae and planum sphenoidale represent a subgroup of anterior skull base tumors that comprise approximately 5%–10% of all intracranial meningiomas. Most of the patients report with failing vision, so early surgical decompression either transcranial and/or endonasal approach is recommended. The endonasal route allows for direct coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without encountering the optic nerve. This article describes our institutional experience for the endonasal resection of tuberculum sellae and planum sphenoidale meningiomas. Materials and Methods: We retrospectively analyzed eight cases of tuberculum sellae and planum sphenoidale meningiomas who selectively underwent endoscopic endonasal transsphenoidal resection between 2015 and 2018. All patients had ophthalmological, endocrinological, and radiological evaluation both preoperatively and postoperatively. Results: Among the study group, we found age range 22–68 years, male:female 1:2. Among the radiological findings, there were five cases of tuberculum sellae meningioma, while three cases were of planum sphenoidale meningioma. In tumor resection status, we found gross total resection in six cases and debulking in two cases. Postoperative analysis of visual outcome revealed improvement in four cases, constant in three cases, and worsening in one case. We also found the post of nasal complications in four cases, cerebrospinal fluid leak in two cases and transient diabetes insipidus in one case. Conclusion: In this study, we highlighted our experience of a very small group of patients with anterior fossa meningioma specific to tuberculum sella and planum sphenoidale origin.

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

Background: Spontaneous intracranial haemorrhage (ICH) is defined as intraparenchymal bleeding in the absence of trauma or surgery. Spontaneous ICH is most disabling and deadly type of stroke. Meteorologic factors and seasons on the incidence of spontaneous ICH with ambiguous results. Objectives: To determine whether different seasons had any relationship with the rate of primary intracerebral hemorrhage. Methods: Total of 209 patients were diagnosed as spontaneous ICH and they have been first time reported & admitted in Combined Military Hospital (CMH) Dhaka, between Jan 2017 and December 2018. Males were 146(69.85%), females were 63(30.15%) and were aged between 18 and 95 years old. Diagnosis was based on history, clinical examination and non-contrast Computed Tomography(CT) scan of brain. Results: 209 admitted patients in CMH Dhaka from Jan 2017- Dec 2018 are included in our study who full-fill the criteria. Intracerebral haemorrhage rate among age group less than 55years old being 55(26.31%) and 55 years and above 154(73.69%).There were a significant relationship between different seasons and intracerebral haemorrhage. Intracerebral haemorrhage incidence in winter season 61(29.18%) and late autumn 19(9.09%), out of 209 patients. Among them hypertensive patients were 137(65.55%) and non-hypertensive patient 72(34.45%), 170 (81.33%) were nondiabetic & 39(18.66%) diabetic of total 209 patients.Out of 61 patients in winter; 54 (88.52%) hypertensive patients had large sized haemorrhage. Conclusion: The highest rate of intracerebral haemorrhage during December-January. There is a seasonal variation in patient’s age, incidence among hypertensive patients, size of hemorrhage and more in number in winter season. Bang. J Neurosurgery 2020; 9(2): 130-134

Background: Cytotoxicity is the toxicity to cell. Any type of brain oedema producing raised intracranial pressure (ICP) which may be a fatal pathological state. Corticosteroid is contraindicated in cytotoxic brain oedema but in vasogenic oedema, it is beneficial. Cytotoxic oedema in its consequences induces vasogenic oedema where the corticosteroid may helpful. Objectives: To determine the effects of corticosteroid on tertiary vasogenic brain oedema from cytotoxic edema. Methods: Total of 328 patients was diagnosed as brain oedema and they had been first time reported & all were admitted in Combined Military Hospital (CMH) Dhaka, between Jan 2017 to Jun 2019. Out of 328 patients, brain oedema due to spontaneous ICHs was 219 (66.77%) and traumatic ICHs were 109(33.33%). Diagnosis was based upon history, clinical examination and non-contrast Computed Tomography (CT) scan of brain. Results: Total 328 admitted patients in CMH Dhaka from Jan 2017-Jun 2019 were included in our study who full-fill the criteria. Males were 231 (70.43%); females were 97(29.57%) and were aged between 1 to 95 year. Intracranial haemorrhage rate among age group less than 55 years old being 76 (34.70%) and 55 years or above 143 (65.30%) of total 219 patients. Traumatic ICHs were 109 and 1 to 44 years age is most vulnerable, 69(63.30%) and 45 years and above 40 (36.70%) patients. Corticosteroid was used after vasogenic brain oedema formation following cytotoxic oedema which was diagnosed mainly radiologically. Cytotoxic oedema induced by 24 hours and vasogenic oedema in two to four days of brain insult. Vasogenic oedema developed in 24 -48 hours, 65 (19.82%) patients and 117 (35.67 %) by 48-72 hours and above 72 hours rest 146 (44.51%) patients after brain insult. After vasogenic oedema formation, out of 164 patients that is 50% patients were treated with corticosteroid and GOS was assessed- GOS 4,5 -103(62.80%), GOS 3-34 (20.73%), GOS 2- 23(14.02%) and GOS 1-4(2.44%) whereas without corticosteroid treatment of rest vasogenic oedema 164 (50%) , GOS was- GOS 4,5 -85(51.83%), GOS 3-43 (26.22%), GOS 2- 27(16.46%) and GOS 1-9(5.49%) at 30 days of incidence. There is more than two times mortality without corticosteroid therapy than with steroid therapy. Conclusion: Cytotoxic brain oedema is contraindicated for steroid but we observed that corticosteroid gives better GOS in vasogenic oedema which develops after cytotoxic brain oedema. Outcome in cytotoxic oedema followed by vasogenic oedema is beneficial for corticosteroid. Bang. J Neurosurgery 2020; 10(1): 45-51

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