Background Surgery of the brain tumors near eloquent areas carries the risk of either disabling neurological deficit or inadequate resection with bad prognosis in both situations. Awake surgery is the gold standard procedure for such lesions. However, it requires certain anesthetic drugs, advanced techniques, and trained teams that are not available in every neurosurgical institute. This work aims to evaluate safety, feasibility, and outcome of operating on patients with space occupying lesions near eloquent areas under scalp block being continuously examined by a neurologist through retrospective study of 20 cases with supratentorial lesions related to language or sensorimotor cortex. Results There were 12 males and 8 females with mean age 36.8 years. Forty percent of patients were presented by motor weakness. Tumors were related to motor cortex in 11 patients and to language areas in 9 patients. Mean operative time was 210 min. Gross or near total resection was achieved in 15cases, four cases had subtotal resection and biopsy only was done in 1 case. Two patients suffered from intraoperative seizures and conversion to general anesthesia was required in one patient. Conclusion Operating on tumors near eloquent brain areas under scalp block and continuous neurological examination during tumor resection proved to be effective in early detection and prevention of permanent major deficits especially in the developing countries with limited resources.

Background: Trapped fourth ventricle (TFV) usually develops as a complication of supratentorial ventricular CSF shunting, especially when hydrocephalus is caused by intraventricular hemorrhage and/or infection. This study aimed to assess the feasibility of endoscopic aqueduct stenting using a single refashioned shunt tube to treat cases presenting with both TFV and shunt malfunction. Methods: We retrospectively collected and analyzed data from patients presenting with TFV and supratentorial shunt malfunction who underwent endoscopic aqueduct stenting using a refashioned shunt tube. All cases were treated at our institution between January 2010 and July 2019. The surgical technique is described. Results: Eighteen patients were enrolled in our study. There were ten males and eight females. The mean age was 11.2 years (range = 1–33 years). Headache, nausea, and vomiting were the most common clinical presentations. The mean duration of follow-up was 22.1 months (range = 6–60 months). All cases showed clinical and radiological improvement after surgery. Conclusion: Endoscopic antegrade aqueductoplasty and stenting with the refashioned panventricular shunt catheter are an adequate treatment option for both TFV and supratentorial shunt malfuncion.

Background: Pineal region tumor is considered an ideal indication for endoscopic third ventriculostomy (ETV), with success rate up to 92%. The ultimate advantage is the ability to obtain tumor biopsy for histopathological diagnosis and for further treatment strategy plan design. Objectives: To investigate the safety considerations to minimize tumor biopsy-related bleeding, increase diagnostic accuracy, and establish a successful ETV procedure. Methods: Retrospective study including 25 patients of pineal region tumor with concomitant triventricular hydrocephalus. Preoperative planning to perform ETV and obtain tumor biopsy was achieved either through single more anteriorly located precoronal burr-hole (17 patients) or two separate burr-holes (eight patients). The patients' age ranged from 9 months to 65 years with a mean age of 26.5 years. Preoperative MRI brain with coronal T2-and sagittal T1-weighted images was used to design trajectory. Results: No significant intraventricular bleeding reported. A diagnostic tumor biopsy yield was successful in 22 patients. Ventriculoperitoneal shunt insertion was required in 1 patient failed to improve. Conclusion: Endoscopic tumor biopsy is relatively safe with high diagnostic yield that helps in management protocol plus shunt independent control of associated hydrocephalus.

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