BackgroundPosterior fossa EDH (PFEDH) is one entity which is quite uncommon and spontaneous /Drug induced PFEDH is one of most rare radiological finding.

Background: Rosai Dorfman disease (RDD) is a benign lymphohistiocytosis that often involves lymph nodes and present as massive painless lymphadenopathy with sinus histiocytosis. Usually systemic involvement and with rare intracranial and extremely rarely intracranial involvement without the involvement of lymphadenopathy. Case Presentation: We presented a case of 60 years old female with seizures and left side weakness and no lymphadenopathy. The magnetic resonance imaging (MRI) revealed contrasting right frontal homogenously enhancing convexity mass. Management & Results: The patient was kept on antiepileptic medications but soon presented with fits and slight expansion in frontal mass. Surgery was performed (right frontal craniotomy), the mass was surgically resected and biopsy indicated RDD. Conclusion: By now only seven of such cases are reported and prognosis of the disease is not poor if surgically treated however other measures including radiotherapy, chemotherapy, steroids are not very effective for treating the disease. And due to the rarity of disease suspicion of such disease should always be kept as a key differential in homogenously enhancing lesions with dural involvement with or without lymphadenopathy.

Background: Extradural hematoma (EDH), and acute subdural hematoma (ASDH) are common pathologies encountered in neurosurgical emergencies following traumatic injuries usually secondary to road traffic accident, assault and fall. Both extradural hematoma and acute subdural hematoma have dreadful effects on patient's health if not managed properly and timely and even lead to death. The standard treatment for such problems is conventional large craniotomy under general anesthesia to prevent fatal outcomes. Method: We have presented a case of ASDH with EDH in a patient having history of large ventricular septal defect and due to large ventricular septal defect patient had delay in getting fitness and alongside patient had fallen Glasgow Coma Scale (GCS) which encouraged surgeon to perform the surgery under local anesthesia by following Peer Regimen. Results: The outcome of case turned fruitful and providing possibility of Local anesthesia (Peer Regimen) as an alternate in case of critical emergency to save life of patient. Conclusion: Acute Subdural hematoma with either concomitant ventricular septal defect or alone can evacuated safely under local anesthesia using Peer regimen. Further studies should be carried to know the more benefits of procedure and potential hazards of procedure and to improve outcome from this lethal type of brain injury.

Objective:  To evaluate success rate of the endoscopic third Ventriculostomy (ETV) in non-communicating type of hydrocephalus in pediatric age group. Material and Methods:  This study was carried in the department of neurosurgery at Liaquat university hospital, Jamshoro in which an endoscopic third Ventriculostomy procedure was performed in patients (n = 55) with non-communicating hydrocephalus from October 2016 to April 2017. Post-operative follow-up was done on the 15th day post-operative to assess clinical and radiological improvement. Results:  55 patients were included in this study, 26 (47.27%) males and 29 (52.73%) females. The mean age was 3.96 years. The most common etiology was aqueductal stenosis 28 (50.90%) patients followed by posterior fossa tumors in 18 (32.72%) patients. The operative technique was successful in 41 (74.55%) patients. Out of 41 successful patients, 34 (82.92%) patients had clinical as well as radiological improvement whereas 7 (17.07%) patients had clinical improvement only. Conclusion:  The success rate of ETV was 74.55% in the non-communicating hydrocephalus in the pediatric age group in our study. Endoscopic third Ventriculostomy is an effective treatment for non-Communicating hydrocephalus in pediatric age groups by diversion of CSF intracranially. This procedure provides shunt freedom and can be used alternative to shunts in pediatric age groups with non-communicating hydrocephalus.

Extradural hematoma as a result of traumatic injury is a serious neurological emergency that required immediate intervention. The standard protocol is to identify the condition at earliest and provide quick surgical evacuation of the hematoma. The situation tends to be fatally deteriorating and marks a high mortality rate and worse health outcomes. We have presented a case of extradural hematoma in this study where the surgery had a delay due to the unavailability of general anesthesia. However, the falling Glasgow Coma Scale scores encouraged the surgeons to induce the surgical procedure with the employment of local anesthesia. The intervention turned out to be successful and produced the possibility of using local anesthesia as an alternative in case of critical emergency situations in order to save a life.