Meningiomas are the most common benign intracranial neoplasms accounting for 13 to 19% of all intracranial tumors. Only 1.8 to 3.2% arise at the foramen magnum (FM).However foramen magnum meningioma are usually typical meningioma .Atypical meningioma in foramen magnum is very rare. Only one case report was found so far in literature. As they produce delayed symptoms so their development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and diagnosis. We report 2 cases of atypical meningiomas of foramen magnum presenting as rotatory paralysis. We will here discuss clinical as well as operative course of this case in a nut shell

Background: Tuberculum sellae (T.S.) meningiomas accounts for 5–10% of all intracranial meningiomas. The primary goal of surgery is to improve or at least maintain visual function, but this objective poses a formidable surgical challenge, because of the risk of postoperative visual impairment. The aim of the present study was to evaluate outcome in TSM patients treated microsurgically using multiple skull base approaches such as transcranial approach and extended endonasal transsphenoidal approach. Materials and Methods: This is a retrospective study of 34 patients was aimed to observe the efficacy of the different common approaches by a single neurosurgeon. The approaches were minipterional approach, superciliary keyhole microscopic approach, superciliary keyhole endoscopic assisted approach, bifrontal basal approach and extended endoscopic endonasal approach. All the patients were evaluated preoperatively by visual field analysis and contrast MRI. Postoperative follow-up was done by visual field analysis and by contrast MRI or contrast CT scan of brain. Result: Through transcranial surgery vision improved in 86.20%, static in 10.34% and deteriorated vision in 03.45%. Through transsphenoidal surgery vision improved in 80%, static in 20% and deteriorated in 0%. Through transcranial microscopic approaches (minipterional, minibifrontal basal, superciliary keyhole microscopic) gross total removal was done in 58.82%, near total in 10.34% and partial removal in 03.45%. Through transcranial/superciliary keyhole endoscopic assisted approach, gross total removal was done in 80% and near total in 20%. Through transsphenoidal approach gross total removal was done in 60%, near total in 20% and partial removal in 20%. Conclusion: Now a days endoscopic assisted key hole superciliary mini craniotomy for resection of tuberculum sellae meningioma is commonly used because of less morbidity and good visual outcome and this can be done without microscopic set up. The endonasal route is preferred for removal of T.S. meningioma when they are mostly sellar and directing towards third ventricle. The major limitation of this approach is a narrow surgical corridor. The gross total removal was better achieved with minibifrontal basal and minipterional craniotomy. Bang. J Neurosurgery 2022; 11(2): 80-88

Objective: To present this series of surgically treated tuberculum sellae meningiomas with particular regard to visual compromises Methods: A retrospective analysis was done on 28 patients (21 females) with meningiomas originating from the tuberculum sellae who underwent surgery between 2010 and 2019. The standard surgical approach of pterional craniotomy. Twelve meningiomas extended posteriorly onto the diaphragma sellae, 13 anteriorly to the planum sphenoidale, and 3 to the anterior clinoid process. 21 tumours involved the optic canal, one bilaterally. Follow up ranged from 6 to 12 months. Results: Total microscopic resection was achieved in 28 patients. Median tumour size was 3.2 cm. Postoperatively, visual acuity improved in 19 patients and deteriorated 3. Preoperative and postoperative visual acuity worsened with increasing duration of preoperative symptoms and with increasing age. Extension into the intraconal space was a negative predictor. Recurrence occurred in one cases. One patients died from causes unrelated to the tumour. Conclusions: In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications. Bang. J Neurosurgery 2020; 10(1): 39-44

Background: Invasive sinu-naso-orbital aspergilloma is a rare disease with variable clinical features, but in an immunocompetent patient, it is rarely considered and often resulted in a poor prognosis due to its diagnostic and therapeutic challenges. In this article, we report a rare case of invasive sinu-naso-orbital aspergillosis with intracranial extension following dacryocystorhinostomy. To the best of our knowledge, this is the only reported case in the past 109 years. Case Description: A 61-year-old normotensive nondiabetic male was referred to us from an ophthalmologist with complaints of retro-orbital pain followed by progressive dimness of vision and later blindness on right eye after dacryocystorhinostomy. Diagnosis and Intervention: His MRI reveals an isointense lesion in the T1W and T2W images in the right maxillary, ethmoidal sinus with orbital and retro-orbital, and intracranial extension with heterogeneous contrast enhancement. A radiologist suggested a case of inflammatory pseudotumor, and initially he was treated with steroids due to a lack of clinical response; later, antifungal was given, but the patient still was nonresponsive. A right pterional craniotomy was performed on the patient to access the optic nerve and perform the biopsy. Aspergillus infection was seen by histopathology. Postoperatively, he was treated with voriconazole. Lessons: In immunocompetent individuals, invasive sino-orbital aspergillosis is uncommon. For effective care, early diagnosis is essential. Our advice is that a patient with vague symptoms or retro-orbital discomfort should encourage the doctor to investigate this diagnosis due to the diagnostic difficulties and greater mortality and morbidity rates. Abbreviations: DCR: dacryocystorhinostomy, PL: Perception of light, PR: Projection of rays

Sciatica is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice. However rare patholo­gies such as epidural varices may mimic them by causing radicular symptoms. In this case report, we present a 20-years-old man with the complaint of low back pain and bilateral sciatica (Lt>Rt) & neurogenic claudication who was operated for right L5–S1 disc herniation. The lesion interpreted as an extruded disc herniation pre­operatively on MRI but was found to be an epidural varix compressing the nerve roots intraoperatively. The varicosity of veins was found in epidural space causing canal stenosis.