Craniopagus is a condition of conjoined twins that are fused at the cranium. After birth, 25% of craniopagus twins survive and can be considered for surgical separation. It is a complex multistage, multidisciplinary team involvement exercise needing detailed evaluation, planning and preparation beforehand. A harmonious collaboration from the clinical, administrative as well as logistic point of view is mandatory for successful management of such complex condition. The honorable prime minister of Bangladesh picked up “Rabeya and Rukaiya”, a craniopagus twins, the first ever case in the history of Bangladesh and handed them over to an expert team from Hungary and Bangladesh for successful management. The noble joint exercise known as “Operation Freedom” took place in home and abroad through multiple procedures/interventions in different institutions by a group of experienced panels of medical and non-medical professionals. In this article we will highlight the events of this monumental achievement. J Bangladesh Coll Phys Surg 2022; 40: 121-125

Introduction: Treatment of Hydrocephalus by placement of Ventriculo-peritoneal (V-P) Shunt is a common neurosurgical practice. But presence of shunt predisposes to increased infection. Objective: To focus on aetiological factors for developing shunt infection. Methods: This prospective observational study was carried out at Neurosurgery Center, Combined Military Hospital, Dhaka during the period of June 2015 to May 2018. A total of 33 patients were included in the study, all of them underwent CSF shunt surgery at this centre. They were followed up for one month after surgery. Age, sex and socioeconomic condition of the patients, types (obstructive or communicating) of hydrocephalus (HCP), aetiology of HCP, duration of surgery, shunt type used and routine or emergency surgery were the factors that were analysed for possible association with infection. Results: Eight (24.2%) patients developed shunt infection, among whom infants and male were predominate. Low socio-economic group, prolonged operation time and emergency surgery were found to have association with increased rate of infection. Conclusion: V-P shunt insertions had unacceptably high infection rate despite the presence of a protocol for the procedure. A protocol should be developed for strict compliance and where possible, alternative procedure Endoscopic Third Ventricullostomy (ETV) or External Ventricular Drain (EVD) should be employed to minimize shunt infection. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 16-18

Brain arteriovenous malformations are type of intracranial high-flow vascular malformation that can present with incidental finding in asymptomatic patients, seizures, headache, ischemic events due to vascular steal from normal brain, hemorrhage. Pulsatile tinnitus is the result of blood flow related sounds transmitted to the inner ear and coincides with heartbeat. AVMs are a rare cause of pulsatile tinnitus which contributes to less than 1% of published cases in the literature. We report a case of morbid tinnitus due to brain AVM which was resolved completely by endovascular embolization of the lesion. J Bangladesh Coll Phys Surg 2022; 40: 128-131