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Sphenoid-orbital meningiomas (SOMs) are difficult to completely resect because they involve the sphenoid wing, orbit, and cavernous sinus. As the tumor invades the optic canal, SOMs frequently appear with visual deficits. The authors of this case report dealt with the case of a 65-year-old male patient who had right-sided proptosis. We diagnosed the patient, and his MRI revealed of having SOMs. The surgical approach was determined by the tumor’s placement in the orbit and cranial cavity and its connections to the optic canal and optic nerve axis. Surgical excision was used to successfully remove the SOM. The patient maintained a proptosis of less than 4 mm during the follow-up period. The visual acuity, visual field, and ocular fundus were examined during the optical follow-up. SOMs are notoriously difficult to treat surgically. The primary goal of surgery in symptomatic individuals with SOMs is to slow down the tumor’s progression. Longer periods of post-operative observation and follow-up are recommended to observe long-term advantages. Bang. J Neurosurgery 2022; 11(2): 145-149

The primary concern for symptomatic back pain in elderly patients is to treat them according to guidelines. Surgical decompression for lumbar spinal stenosis may be laminotomy, laminectomy, or unilateral approach. Endoscopic or microscopic approaches are also promising though bony decompression is still the gold standard. Functional evaluation for instability, endplate changes, facet hypertrophy, and diagnostic tools like electrophysiological studies have been proposed. ODI, Swiss Score, and other back pain questionnaires assess the need for surgery. Here in this article, the authors have done a literature review with PRISMA analysis for surgical decompression in lumbar spinal stenosis with a ten-year database from Google Scholar, PubMed and Medline. Bang. J Neurosurgery 2021; 11(1): 36-40

not available Bang. J Neurosurgery 2021; 10(2): 216-222

Background Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors. Methods Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients’ age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study. Results The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years’ success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt. Conclusions Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.

Arteriovenous malformations (AVMs) are tangled lesions that may digress the blood flow particularly the high flow ones and microsurgical resection is challenging. The natural history of AVM is not completely understood and its management is controversial. Microsurgical resection of cerebral arteriovenous malformation is a challenging procedure, particularly for high-flow type. Embolization, microsurgery, or radiotherapy are treatment options. Preoperative planning to control the feeders, arachnoid dissection around the AVM for identification and control of all arterial feeders around the AVM surfaces, lastly control of draining vein is the principal of microsurgery. The goal of surgery is to remove the AVM completely to eliminate the risk of bleeding avoiding neurological deterioration. In this paper, we reviewed a case of high-flow cerebral AVM in recurrent bleeding with successful microsurgical resection.The patient in this case report significantly improved his neurological condition and demonstrated a good quality of life during long-term follow-up. The results of this study showed that the microsurgical removal of AVMs represents an efficient treatment with good clinical outcomes. In the future, more investigations of the factors that lead to AVM rupture are required for the advancement of effective medical procedures.

Not Available Bang. J Neurosurgery 2020; 10(1): 130-134

Atlanto-occipital non-segmentation failure of segmentation between the fourth occipital sclerotome and the first cervical sclerotome results in atlanto-occipital non-segmentation/ assimilation, also known as occipitalization of the atlas.1The incidence of occipitalisation has been reported to be between 0.08% to 3% of the general population, affecting males and females equally.2 A cartilaginous cleft and an open synchondrosis between the osseous posterior arches of the atlas is a normal finding in children up to four years of age; therefore, a true defect in the posterior arch was diagnosed only in patients who were more than four years old.3 Atlanto-occipital fusion reduces the foramen magnum dimension leading to neurological complications due to compression of spinal cord.4 The slow development of the fibrosis was the source of gradual spinal-cord compression with increasing symptoms.5 Fusion of atlanto-occipital joints can also result in restricted neck movement.6 Basilar invagination is an abnormality at the craniocervical junction (CVJ) either congenital or degenerative, where the odontoid tip is inside the foramen magnum with or without neurological symptoms.7

Objective: The objective of the study was to compare the surgical outcome between Bilateral Laminotomy, Laminectomy and Unilateral approach in Lumber Spinal Stenosis. Methods: One hundred forty four (144) patients were going to underwent three prospective surgery such as Bilateral Laminotomy (48 patients), Laminectomy (48 patient) and Unilateral approach (48 patients). This study conducted between 2009 to 2014 at private medical hospitals in Dhaka. All the patients ages are e” 40. All the patients were observed prospectively. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and Swiss score. Results: Satisfactory decompression was accomplished in all patients. The complications were less in patients who had experienced Unilateral Laminotomy rather than Bilateral Laminotomy and Laminectomy. Mean age of patients were 52.16+/ - 6.87 years with the range of 40-68 years. Among them 101 patients are male (70.11%) and 43 patients are female (29.99%). The rates of improvements are 79.17% in Laminectomy, 85.1% in Bilateral Laminotomy and 91.9% in Unilateral Laminotomy. From here unilateral Laminotomy have quite better results than others. Minimum follow up period was 2 years. Conclusion: Unilateral Laminotomy has a satisfactory outcome in Lumber Spinal Stenosis surgery in comparison to rest of two approaches. Postoperative complications were minimum in respect to blood loss, hospital stay and revision surgery. Bang. J Neurosurgery 2020; 9(2): 105-110

Spondylolisthesis is a condition of the spine that causes lower back pain. It is a vertebra slippage that occurs at the base of the spine, in most instances. We report a case of occult spondylolisthesis of a patient with grade 1 spondylolisthesis (L4 over L5). We presented the radiologic finding, diagnosis, and treatment here. A 45-year-old female was presented with the complaints of low back pain with sciatica for 4 years. The radiologic finding showed that she had dysaesthesia on both L5 dermatome and MRI of LS Spine revealed prolapsed disc at L4/5. The patient underwent decompression, stabilization via pedicle screw at L4 and L5 with fusion at L4/5 and after constant follow-ups, she was symptom-free with a full range of motion of the spine. Posterior fusion with instrumentation of the pedicle screw is commonly considered the gold standard method of lumbar spinal fusion. Non-surgical treatment is effective in relieving low back pain of the patient in most cases however, symptomatic patients need to be treated with the surgical method.

Background: Disc herniation of the thoracic spine is a rare lesion that is believed to occur in 1 in 1000 to 1 in 1,000,000 patients each year. Endoscopic-assisted thoracic disc microdiscectomy is a safe and effective surgical removal technique for intervertebral herniated thoracic discs. Case Presentation: A 48-year-old female was presented with progressive weakness in both lower limbs for three months, incapacity to void urine for 2 weeks. She had back pain and neck pain for 5 years. Clinically, she was diagnosed with paraplegia at stage D6/7 as a case of dorsal disc prolapse. After doing unilateral transpedicular microscopic discectomy she recovered over 4 weeks and her muscle strength was 4/5 in the lower limbs, and she was able to walk. Conclusion: Thoracic disc herniations are relatively uncommon compared with lumbar and cervical disc pathologies. Although it has posed significant problems for spinal surgeons, the adoption of minimally invasive thoracic disc resection procedures may result in decreased operating time, reduced blood loss, and faster patient recovery.

We report a case of a patient with pituitary tumor with psychiatric disorder, which posed a significant diagnostic dilemma and management challenge for the treating teams of neurosurgery, endocrinology and psychiatry. A more comprehensive endocrine work-up of atypical presentations can be considered in some cases. The criteria for determining when endocrine work should be considered should be investigated further. Bang. J Neurosurgery 2019; 9(1): 75-77

Mobile intraspinal tumours have rarely been reported. In most cases, mobile tumours such as schwannomas or ependymomas were located in the cauda equina. Perusal of the literature revealed only two reports of mobile schwannomas in the cervical and thoracic regions. We report a case of thoracic schwannoma which migrated twice in successive operations resulting in negative exploration in the expected area. The aim of this report is to remind the surgeons about the possibility of migration of intradural-extramedullary tumour.