Aspergillus spinal epidural abscess (ASEA) is a rare entity that may mimic Pott's paraplegia as it commonly affects immunocompromised patients. We present one institutional case of ASEA with concomitant review of the literature. A 58-year-old female presented with intermittent low back pain for 10 years recently aggravated and with concurrent spastic paraparesis, fever, and weight loss. Emergent magnetic resonance imaging (MRI) showed T11–T12 epidural abscess with discitis and osteomyelitis. After empirical treatment with antibiotics, computed tomography-guided, percutaneous biopsy with drainage was performed, showing granulomatous tubercular-like collection. Antitubercular therapy was initiated, but after 1 month, the patient's condition deteriorated. Repeat MRI showed growth of the spinal epidural abscess with significant cord compression and vertebral osteomyelitis. T11–T12 laminectomy and tissue removal were performed with a posterior midline approach. Tissue histopathology showed necrotic debris colonies of Aspergillus spp. Antifungal therapy was started, and the patient rapidly improved. ASEA may mimic Pott's disease at imaging, leading to immediate start of antitubercular treatment without prior biopsy, leading to severe worsening of patients’ clinical status. Cases of ASEA should be considered at pretreatment planning, opting for biopsy confirmation before treatment initiation so to prevent the occurrence of fatal infection-related complications.

Lymphoma of the central nervous system can present with a wide variety of clinical symptoms and imaging characteristics which can be challenging for radiologist as well as neurosurgeons to deal with. Primary CNS lymphoma (PCNSL) accounts for 1% of all primary brain tumors which is a rare variant of extranodal non-Hodgkin’s lymphoma. We report a case primary central nervous system Non-Hodgkins lymphoma presenting a multiple intraventricular and periventricular masses in a 14 years young man with severe headache, convulsion and unsteady gait. The diagnosis was obtained by image guided surgical biopsy. This is an unusual presentation of primary central nervous system lymphoma involving lateral ventricle and 3rd ventricle while the majority of the case presenting as solitary masses. Bang. J Neurosurgery 2021; 10(2): 206-209

Background: Chronic subdural hematoma (CSDH) is an increasingly common neurological disease in daily neurosurgical practice. Despite the wide prevalence of CSDH, there remains a lack of consensus regarding numerous aspects of its surgical management. The diagnosis and treatment are well established but there are different surgical procedures and outcome related to these procedures are not completely understood.Methods: The study conducted was conducted in department of neurosurgery at Ibrahim cardiac hospital and research institute, Dhaka, Bangladesh between January 2019 to July 2020, 105 patients were treated for chronic subdural haematoma This study evaluated the clinical features, radiological findings and surgical outcome by mini craniotomy assessed by modified Rankin scale (mRS) score and Glasgow outcome scale (GOS) score in a large series of patients treated at single institution.Results: At 6 months follow up, only one patient died (0.95%) because of co-morbidities and not directly related to the chronic subdural haematoma, 15 patients (14.3%) improved to mRS 0, 33.33% showed only mild symptoms without any significant disability-mRS 1, slight disability was observed in 28.5% patients, moderate disability was observed in 17.14% patients-mRS 3, moderately severe disability was observed in 5.7%-mRS 4.Conclusions: GOS score at 6 months follow up which shows majority of the patient improved to GOS score 4 (45.71%) and 5 (38.09%). Based on these results, among various method of surgical management, mini craniotomy provides better outcome.

Introduction: External ventricular drain (EVD) usage in patients with intraventricular hemorrhage (IVH) is variable in current practice and clinical trials, and its impact on outcome remains controversial. Aim of this study was to see the outcome of EVD in management of spontaneous IVH of brain assessing by Glasgow outcome scale (GOS) and modified Rankin scale (mRS) score compared with conservative management. Materials and Methods: Between July 2018 and June 2019, a consecutive 125 admitted patients with spontaneous IVH were enrolled in this quasi-experimental study. Among them 56 patient’s relative agreed to surgery who were accepted as case group and had EVDs. Remaining 69 patient’s relative declined authorization for surgery and were accepted as control group and underwent conservative management. Baseline demographics, clinical presentation, and hospital course, Glasgow coma scale score (GCS) for level of consciousness and modified Graeb score (mGS) for severity of ventricular haemorrhage were recorded at baseline and postoperatively. Admission Computed tomography (CT) scans performed within 24 hours of admission were reviewed for IVH type and hydrocephalus. Patients were followed up for 3 months post operatively and assessed using the GOS score and mRS score. Results: Both the groups were similar at baseline in terms of age (mean±SD: 59±14 vs 60±14, p = 0.645), sex and comorbidity distributions. However, patients who received EVDs had lower mean GCS score (p=<0.001) and higher mean mGS score (p= 0.015) than those who did not receive an EVD. Incidence of hydrocephalus was similar in both groups (57.4% vs 46.7%, p = 0.268). Among the 77 survivors at 3 months, there were 23.1% (6/21) patients scored mRSd”2 in case group, while 38.2% (13/34) in control group (P=0.211). After binary logistic regression analysis, EVD placement was independently associated with reduction of 90 days mortality than conservative management (OR: 3.982; 95% CI: 1.3-12.19) but no effect on morbidity and functional dependence. Other independent predictors for mortality were higher age (p=0.002), lower GCS at admission (p=<0.001) and presence of hydrocephalus (p= <0.001) on CT scan. Conclusion:These results suggest that EVD placement may be beneficial for patients with IVH, who have particularly poor prognosis at admission, but our results must be validated in future randomized clinical trial with larger cohorts and longer follow-up periods that are sufficiently powered to control for the heterogeneity of the study population and managements. Bang. J Neurosurgery 2021; 11(1): 3-12