There is no doubt that many synthetic materials used in cranioplasty have given good result regarding patient's calvarial shape. However, the use of these materials is costly to the patient and requires complex intraoperative process. There has been a long history regarding the use of acrylic bone cement called as polymethyl-methacrylate (PMMA) as an implant due to its desirable properties. Here, we present three cases of simple, cost effective manually sculpted calvarial defect using three-dimensional (3D) printer. Sharing the achievement and challenges, we want to focus that the 3D customized implant of PMMA can be used as bone substitute.

Though the brain metastasis from gestational trophoblastic neoplasia is rare, incidence is 3-21.4%. In this article, we report the rare case of a young female, presented with the features of raised Intracranial Pressure (ICP) with intracranial space occupying lesion, who was treated for tubercular abscess because she was clinically diagnosed as case of pulmonary TB from core biopsy of lung mass and was under Anti tubercular treatment at other center and the differential diagnosis of cavernoma bleed made from imaging modalities. However, to our surprise the histopathology came out as metastatic choriocarcinoma. There was history of incomplete abortion 1 year back which could have developed from any gestational trophoblastic tissue resulting from a hydatidiform mole, miscarriage, or ectopic pregnancy.  She gave this history after the histopathology came out as metastatic choriocarcinoma. The social tabu and going through traumatic experience, would be the region for her not to disclose the history before surgery. Although miscarriages are common and women continue to suffer in silence. The rarity of brain metastasis from gestational trophoblastic neoplasia, there are still no guidelines on treatment strategies for these patients yet.

Abstract“I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription–polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic.