Bangladesh Journal of Neurosurgery 2020-12-14T14:40:57+00:00 Professor ATM Mosharef Hossain Open Journal Systems <p>Published by the Bangladesh Society of Neurosurgeons, Dhaka, Bangladesh. Full text articles available.</p> <p><img style="border-width: 0;" src="" alt="Creative Commons License"><br>Articles in the <em>Bangladesh Journal of Neurosurgery</em> are Open Access articles published under the Creative Commons CC BY-NC License <a href="" target="_blank" rel="noopener">Creative Commons Attribution-NonCommercial 4.0 International License.</a></p> Editorial vol.10(2) 2020-12-14T14:38:49+00:00 ATM Mosharef Hossain <p>Abstract Not Available</p> <p>Bang. J Neurosurgery 2020; 10(1): 1</p> 2020-10-04T10:29:34+00:00 ##submission.copyrightStatement## Image diagnosis of Trigeminal Neuralgia caused by Vascular Compression 2020-12-14T14:40:57+00:00 Moududul Haque AKM Tarikul Islam Asifur Rahman Sudipta Kumar Mukharjee ATM Mosharef Hossain <p>Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurgeons. The typical pain of TGN is lancinating in nature in one side of face along the distribution of Trigeminal nerve. Pain is sharp shooting and periodic in nature, aggravated by various factors, like eating, talking, laughing. A typical trigeminal neuralgia is caused by compression to the Root exit zone (REZ) by superior cerebellar artery (SCA), aberrant loop of Antero inferior cerebellar artery (AICA), dolichobasilar artery or a large sized vein. However facial pain mimicking TGN may occur by a tumor, plaque of Multiple sclerosis or may be idiopathic. So this is very important to know the cause of TGN/ facial pain for planning of specific treatment. Most of the patients remain pain free by medical management by using Carbamazepine, oxycarbazepine, Pregabalin, Gabapentin, Clonazepam etc. But medically refractory TGN can be treated by Microvascular decompression (MVD) with significantly satisfactory results if the cause is by vascular compression. However during MVD no significant blood vessels are seen and surgery become failed. Clinical examination and evaluation is very important, however to become confirmed about the pathogenesis needs imaging of brain. MRI of brain can differentiate any tumor or Plaque of MS. But conventional MRI images can not show us clearly the blood vessel causing TGN. Conventional MRA could show the blood vessels, which might be causing compression to REZ but does not confirm the fact. Constructive interference in steady state (CISS) MR images were evaluated in our 15 cases to find neurovascular relationship at the REZ. In 11 cases CISS images showed excellent visualization of fifth nerve and blood vessels causing compression to REZ in all case of TGN who underwent Microvascular decompression (MVD) with excellent result. In 2 patients we depended on clinical findings and T2 MR Images. In one of them we could find Offending vessels who were also improved clinically. In one case we did not find any significant offending vessel except a small vein and this patient did not show any improvement. In rest two cases, in one patient CISS showed a tiny vessel and after MVD the patient did not improve. In one patient no significant vessels were not seen in CISS images. We did not go for MVD for this case. So the pre-operative CISS MR images are more precise to show the neurovascular relationship and determine the offending blood vessel causing TGN. Thus we can avoid an unnecessary MVD.</p> <p>Bang. J Neurosurgery 2020; 10(1): 3-8</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Microsurgical Excision of Olfactory Groove Meningiomas, Comparative Studies of Different Surgical Approaches 2020-12-14T14:40:51+00:00 Shamsul Alam Abu Naim Wakil Uddin Mohammad Sujan Sharif Md Mashiur Rahman Majumder Mohammad Shahnawaz Bari <p><strong>Introduction</strong>: To review the surgical approaches, techniques, outcomes and recurrence rates in a series of 11 olfactory groove meningioma (OGM) patients operated from January 2010 to April 2019.</p> <p><strong>Methods</strong>: Eleven patients underwent craniotomy and micro-neurosurgical removal of olfactory groove meningioma. Tumor diameter varied from 5 to 8.5 cm among 11 cases, 2 cases underwent Transglabellar/ Subcranial approach, 3 cases by bifrontal approach, 1 case unifrontal approach, 2 extended endonasal and 3 cases fronto-lateral approach.</p> <p><strong>Result</strong>: Total removal was possible in all cases except 2 cases. Histopathology revealed typical meningioma (WHO grade 1). There was 1 operative mortality and no permanent focal neurological deficit except anosmia. 3 patients developed CSF leak and two cases meningitis which were resolved by lumber drain and antibiotic therapy.</p> <p><strong>Conclusion</strong>: Extended endonasal approach or transglabellar/ subcranial approach were sufficient for gross total removal of OGM which is associated with bony hyperostosis, paranasal extension and optic canal.</p> <p>Bang. J Neurosurgery 2020; 10(1): 9-19</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Asymptomatic Extradural Hematoma-Our Observation In DMCH 2020-12-14T14:40:45+00:00 Sukriti Das Dipankar Ghosh Asit Chandra Sarkar Mohammed Shamsul Islam Khan <p><strong>Background: </strong>Surgical management of extradural hematoma is evacuation of extradural hematoma until otherwise. But, a number of authors have suggested that small epidural hematoma may be managed conservatively with normal outcome in selected cases. The goal of this study was to define the clinical and radiological parameters that may help in the management of the patient with small epidural hematoma where the hematoma was asymptomatic.</p> <p><strong>Objective: </strong>This study was conducted to find out the factors influencing the decision making in the management of asymptomatic extradural hematoma though they have no evidence of raised intracranial pressure or any focal neurological deficit.</p> <p><strong>Methods: </strong>Three hundred patients were evaluated clinically and by CT scan of head to see of hematoma, location of hematoma, midline shifting and overlying skull fractures etc.</p> <p><strong>Results: </strong>All 300 patients were diagnosed within 72 hours of trauma and were tired to be managed expectantly but was not possible sometimes. All these patients were analyzed on the basis of tome since trauma, GCS score, overlying skull fracture traversing any artery, vein or any venous sinuses. Among 300 patients 225 (75%) patients underwent CT scan of head within 24 hours of trauma and 185 (61.67 %) patients had overlying skull fracture. 51 (17%) deteriorated later on and 31 (10.33%) patients among them required surgical evacuation of hematoma.</p> <p><strong>Conclusion: </strong>It can be concluded that patients with small epidural hematoma with a fracture overlying major vessels or major sinuses, diagnosed within 24 hours of trauma are at risk of subsequent deterioration and may require surgical evacuation.</p> <p>Bang. J Neurosurgery 2020; 10(1): 20-26</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Histopathological Pattern of Spinal Tumor: Experience of 57 Cases in Bangladesh 2020-12-14T14:40:39+00:00 Md Shafiul Alam Kaisar Haroon Md Abdullah Alamgir Kazi Hafiz Uddin Md Farhad Ahmed Tayseer Farzana Md Nowfel Islam <p><strong>Background: </strong>Spinal cord tumors are presented with different histopathological pattern.</p> <p><strong>Objective</strong>: The purpose of the present study was to see the different histopathological pattern of spinal tumor.</p> <p><strong>Methodology: </strong>This descriptive cross sectional study was conducted in the Department of Neurosurgery at National Institute of Neurosciences &amp; Hospital, Dhaka, Bangladesh from January 2016 to December 2019 for a period of 04 (Four) years. Patients presented with spinal tumor were selected as study population. After surgical removal the spinal tumor, tissue was sent for histopathological examination to the Department of Neuropathology of the same institute.</p> <p><strong>Result</strong>: A total number of 57 spinal tumor cases were recruited for this study. The male and female ratio was 1.34:1. Out of 57 spinal tumor mostly were located in the intradural extramedullary (IDEM) which was 39(68.4%) cases. Extradural and intramedullary were found in 7(12.3%) cases in each. Most of the spinal tumor were Schwannoma which was 28(49.1%) cases. Neurofibroma and meningioma were found in 6(10.5%) cases in each. Lipoma was found in 3(5.3%) cases. Ependymoma was found in 4(7.0%) cases.</p> <p><strong>Conclusion: </strong>In conclusion Schwannoma is the most common variant of spinal tumor detected among the study population.</p> <p>Bang. J Neurosurgery 2020; 10(1): 27-32</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Incidence of Motor Cycle Accidents in Female Traveller in the Neurosurgery Ward of Rangpur Medical College Hospital 2020-12-14T14:40:33+00:00 Rajkumar Roy Habibur Rahman Shamima Sultana Tofael Hossain Bhuiyan Pijush Kanti Mitra <p><strong>Background: </strong>Motor bike is a popular two wheeler vehicle in Bangladesh especially among young generation, newly married couple and service holders. It is also popular vehicle among female NGO workers. Female like to travel on motor bike along with life partner or with guardian hanging their both legs on one side of seat increasing the tendency to fall down from motor cycle due to imbalance body weight during turning the road or crossing the uneven road or sudden increasing the speed of the motor bike or crossing on a speed breaker.</p> <p><strong>Aims: </strong>Encourage female to travel on motor bike hanging their legs on both sides of the seat to maintain the body weight balance for reducing the mortality and morbidity of RTA.</p> <p><strong>Methods: </strong>All the female patients admitted in neurosurgery ward having motor cycle accident from January/2019- December/2019 were included in this study.</p> <p><strong>Results: </strong>There is a strong association between fall from motor cycle (RTA) and hanging two legs on one side in female motor cycle traveler.</p> <p><strong>Conclusions: </strong>female should travel on motor cycle hanging their legs on both side of seat to avoid avoidable head injury due to RTA.</p> <p>Bang. J Neurosurgery 2020; 10(1): 33-38</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Tuberculum Sellae Meningiomas: Outcome of Twenty-eight Cases after Surgery 2020-12-14T14:40:26+00:00 Md Atikur Rahman Nwoshin Jahan Mohammad Shahnawaz Bari Pijush Kanti Mitra Ahsan Mohammad Hafiz Asit Kumar Saha Ehsan Mahmud <p><strong>Objective: </strong>To present this series of surgically treated tuberculum sellae meningiomas with particular regard to visual compromises</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results: </strong>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.</p> <p><strong>Conclusions: </strong>In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications.</p> <p>Bang. J Neurosurgery 2020; 10(1): 39-44</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Glucocorticoid In Cytotoxicity Followed by Delayed Edema 2020-12-14T14:40:19+00:00 Md Amir Ali Aminul Islam RU Chowdhury Al Amin Salek Sudipta Kumer Mukherjee Rafiul Karim Khan Ahmed Mursalin Chowdhury Abdul Hye Manik Md Hasnain Faisal Pariza Ashrafee <p><strong>Background: </strong>Cytotoxicity is the toxicity to cell. Any type of brain oedema producing raised intracranial pressure (ICP) which may be a fatal pathological state. Corticosteroid is contraindicated in cytotoxic brain oedema but in vasogenic oedema, it is beneficial. Cytotoxic oedema in its consequences induces vasogenic oedema where the corticosteroid may helpful.</p> <p><strong>Objectives: </strong>To determine the effects of corticosteroid on tertiary vasogenic brain oedema from cytotoxic edema.</p> <p><strong>Methods: </strong>Total of 328 patients was diagnosed as brain oedema and they had been first time reported &amp; all were admitted in Combined Military Hospital (CMH) Dhaka, between Jan 2017 to Jun 2019. Out of 328 patients, brain oedema due to spontaneous ICHs was 219 (66.77%) and traumatic ICHs were 109(33.33%). Diagnosis was based upon history, clinical examination and non-contrast Computed Tomography (CT) scan of brain.</p> <p><strong>Results: </strong>Total 328 admitted patients in CMH Dhaka from Jan 2017-Jun 2019 were included in our study who full-fill the criteria. Males were 231 (70.43%); females were 97(29.57%) and were aged between 1 to 95 year. Intracranial haemorrhage rate among age group less than 55 years old being 76 (34.70%) and 55 years or above 143 (65.30%) of total 219 patients. Traumatic ICHs were 109 and 1 to 44 years age is most vulnerable, 69(63.30%) and 45 years and above 40 (36.70%) patients. Corticosteroid was used after vasogenic brain oedema formation following cytotoxic oedema which was diagnosed mainly radiologically. Cytotoxic oedema induced by 24 hours and vasogenic oedema in two to four days of brain insult. Vasogenic oedema developed in 24 -48 hours, 65 (19.82%) patients and 117 (35.67 %) by 48-72 hours and above 72 hours rest 146 (44.51%) patients after brain insult. After vasogenic oedema formation, out of 164 patients that is 50% patients were treated with corticosteroid and GOS was assessed- GOS 4,5 -103(62.80%), GOS 3-34 (20.73%), GOS 2- 23(14.02%) and GOS 1-4(2.44%) whereas without corticosteroid treatment of rest vasogenic oedema 164 (50%) , GOS was- GOS 4,5 -85(51.83%), GOS 3-43 (26.22%), GOS 2- 27(16.46%) and GOS 1-9(5.49%) at 30 days of incidence. There is more than two times mortality without corticosteroid therapy than with steroid therapy.</p> <p><strong>Conclusion: </strong>Cytotoxic brain oedema is contraindicated for steroid but we observed that corticosteroid gives better GOS in vasogenic oedema which develops after cytotoxic brain oedema. Outcome in cytotoxic oedema followed by vasogenic oedema is beneficial for corticosteroid.</p> <p>Bang. J Neurosurgery 2020; 10(1): 45-51</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Prevention of Intra-Operative Cerebrospinal Fluid Leaks by Lumbar Cerebrospinal Fluid Drainage during Endoscopic Endonasal Trans- Sphenoidal Surgery for Pituitary Macroadenomas 2020-12-14T14:40:13+00:00 Mohammad Shahnawaz Bari Shaireen Akhtar Md Shamsul Alam Md Atikur Rahman Asifur Rahman Rezaul Amin Ayub Ansari Haradhon Debnath Dhiman Chowdhury Mohammad Hossain Kanak Kanti Barua <p><strong>Aim and Objective</strong>: Postoperative cerebrospinal fluid leak is a recognized complication of endoscopic endonasal trans- sphenoidal surgery for pituitary macroadenomas. In this study we assess the utility of prophylactic use of lumbar drain in preventing intra-operative cerebrospinal fluid leakage during endscopic endonasal transsphenoidal surgery for pituitary macroadenoma which will ultimately reduce the rate of persistent post-operative cerebrospinal fluid leakage.</p> <p><strong>Materials and Methods</strong>: 34 patients who underwent endscopic endonasal transsphenoidal surgery for pituitary macroadenoma were dividedd into two groups by non-probability convenient sampling technique. In one group of which lumbar subarachnoid drain were given just before induction of anesthesia named LD Group and another group went through conventional method without giving lumbar drain named No LD Group. In all patients of LD Group 20-30 ml of CSF was drawn through lumbar drain before giving dural incision. Valsalva maneuver was used in each group to identify intraoperative CSF leaks at the end of definitive surgery before repairing the sellar floor.Zero degree rigid endoscope was used in all cases. Intraoperative CSF leak was categorized as ‘Yes’ or ‘No’ which was decided by surgeon.Lumbar drains were removed within 24 hours of operation in 16 patients of LD Group and in case 1,who developed intraoperative CSF leak, lumbar drain was removed later.</p> <p><strong>Results: </strong>Thirty four patients were eligible for inclusion, of which 17 were assigned to the LD Group and 17 to the no LD Group. There were no statistically significant differences in patient demographics, tumor pathology, or radiology between the two groups. In LD Group intraoperative CSF leak occurred in 1(5.9%) patient and leak did not occur in 16(94.1%) patients, in No LD Group intraoperative CSF leak occurred in 14(82.4%) patients and leak did not occur in 3(17.6%) patients. Intraoperative CSF drainage significantly reduced the incidence of intraoperative CSF leaks from 82.4% in the No LD group to 5.9% in the LD group (P &lt; 0.001). There were no catheter related complications.</p> <p><strong>Conclusion: </strong>Intraoperative CSF drainage significantly reduces the incidence of intraoperative CSF leakage in patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas.</p> <p>Bang. J Neurosurgery 2020; 10(1): 52-56</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Surgical Outcome Following Meningioma Operation: Our Experience from a Tertiary Care Hospital 2020-12-14T14:40:07+00:00 Md Ibrahim Khalil Md Mohsin Ali Farazi Md Fazlul Haque Abdus Salam Md Sayedur Rahman Sheikh <p><strong>Background: </strong>Meningiomas are the commonest predominantly non malignant brain tumour in adult. Various epidemiological and risk factors are associated with and influencing surgical outcome in the treatment of meningiomas.</p> <p><strong>Objective: </strong>The aim of the study is assess surgical oucome by using Glasgow Outcome Scale (GOS) for the cranial meningiomas.</p> <p><strong>Materials and Methods: </strong>This prospective study conducted in Neurosurgery Department of Shaheed Shiek Abu Naser Specialized Hospital and others private Medical Colleges in Khulna from Jan 2018 –July2019. Total 21 patients with meningioma underwent surgery are included in the study .The parameters analyzed included age, gender, location of tumor on imaging, histopathological type, and grade of tumor according to the 2007 WHO classification. The surgical outcome was assessed by the Glasgow Outcome Scale (GOS) at the end of the 1st week of convalescence and after 6 weeks following surgery. Favorable and unfavorable outcomes were defined as GOS 4- 5 and GOS 1–3, respectively.</p> <p><strong>Results: </strong>Meningiomas are more common in the age group of 40-49 with a female preponderance(61.90%).Headache was the most common symptom and convexity meningiomas were the most common accounting for about 42.85%. Simpson grade I aceieved 10 (47.61%). Simpson II 5(23.80%), Simpson III 2(9.52%), Simpson IV 3(14.28%) and Simpson V 1(0.5%) respectively. Regarding Histopathologcal examination most of the tumours were WHO grade 1(85.71%). Surgical outcome assess by Glasgow Outcome Scale and majority of patients of this study GOS were between 4-5 which was good( 90.47%).</p> <p><strong>Conclusion: </strong>The outcome for patients with meningioma is good and is improving. However there remains a significant mortality related to disease process.</p> <p>Bang. J Neurosurgery 2020; 10(1): 57-61</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Comparison between MRI Findings and Histopathological Diagnosis in the Evaluation of Posterior Fossa Tumors in Pediatric Patients 2020-12-14T14:40:01+00:00 Rashed Mahmud Monjurul Hoque Shamiul Alam Siddiki Ehsan Mahmood <p><strong>Background: </strong>Conventional radiography and CT scan failed to reveal the posterior fossa tumors which not accurately show tumors behind bone. MRI is currently recognized as the optimal screening technique for detection of posterior fossa tumors. We tried to compare the MRI findings with the histopathological findings of different types of posterior fossa tumors in pediatric patients. Histopathological reports were regarded as the gold standard.</p> <p><strong>Objective: </strong>To assess the diagnostic effectiveness of MRI in detection of posterior cranial fossa tumors in pediatric patients.</p> <p><strong>Methods: </strong>This cross sectional study was carried out in the department of Neurosurgery, DMCH, NINS and some private hospitals in Dhaka from March, 2012 to November, 2013. Purposive sampling technique was applied and 34 cases were included in the study. Data were collected by specially designed questionnaire and analysed by SPSS.</p> <p><strong>Results: </strong>Out of 34 cases, MRI failed to match with the histopathological diagnosis only in 2 cases. One case was diagnosed as cerebellar astrocytoma by MRI, histopathology proved it brain abscess. In another case, MRI diagnosed as ependymoma but histopathology revealed medulloblastoma.</p> <p><strong>Conclusion: </strong>It can be concluded That MRI is accepted as the most effective imaging modality in the diagnosis of paediatric posterior fossa tumors. T1WI, T2WI, FLAIR, axial, sagittal, coronal and T1WI post contrast sequences permit confident diagnosis and localization of the pediatric posterior fossa tumor.</p> <p>Bang. J Neurosurgery 2020; 10(1): 62-66</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Correlation between Magnetic Resonance Imaging (MRI) Findings with Histological Grading of Patients with Supratentorial Diffusely Infiltrating Astrocytomas 2020-12-14T14:39:54+00:00 Md Motasimul Hasan Md Lylatul Kadir Kazi Hafiz Uddin Md Sumon Rana Uzzal Kumer Sadhu Khan Muhammad Mahabub Hossain Ahsan Mohammad Hafiz Md Shafiqul Islam Sudipta Kumer Mukherjee M Afzal Hossain <p>Data regarding the impact of MRI for diagnosis and staging of brain tumors in our population is sparse. Thus, the purpose of this study is to determine the efficacy of MRI in preoperative diagnosis of primary intra-axial brain tumors and to determine its diagnostic accuracy in grading of gliomas in our population, correlated with histopathological (hematoxylin &amp; eosin stain) findings taking as gold standard. There has been extensive works in developed countries regarding the diagnostic effectiveness of MRI. But only a few works have been done in our country. To be very particular, little work has been done regarding the performance tests of MRI regarding histological correlation with gliomas in Neurosurgery Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. So, I have tried to correlate MRI findings with the histopathological (hematoxylin &amp; eosin stain) findings of supratentorial diffusely infiltrating astrocytomas. To evaluate the relationship of Magnetic Resonance Imaging (MRI) findings with histological grading of patients with gliomas, to assess MRI findings of gliomas and to assess histological grading of gliomas. The study was carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from March 2015 to August 2016. This study was descriptive type of observational study (Cross sectional study). Study Population were include all the patients with supratentorial gliomas admitted in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during the above mentioned time. All patients were admitted through out patient &amp; emergency department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, were included in the study after primary screening with inclusion and exclusion criteria. History of the patients were taken with demographic data. General examinations were carried out after admission. Neurological examinations were carried out thoroughly. Grading of gliomaswere done from MRI findings. Histopathologies were done of resected tumour tissues. After ethical clearance for the study from the Department of Neurosurgery and IRB, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, written informed consents were taken from the patients and/or the legal guardians/responsible family members after completely explaining the procedure and the purpose of the study in easy local language. Patients data were collected in data collection sheets. Every patient was enjoy every right to participate or refuse participation and had the right to withdraw from the study at any time without compromising their medical care. The privacy of the patients were strictly maintained and the patients informations were notdisclosed to any source. The study data were onlyused for the purpose of this scientific study. Data were processed and analyzed using computer software SPSS (Statistical Package for Social Sciences) version 22.Descriptive data presented on categorical scale were expressed as frequencies and corresponding percentages, while the data presented on continuous scale were measured as mean and standard deviation (SD). Correlation between categorical variables were evaluated using Spearman’s rank correlation test. For analytical tests, level of significance was set at 0.05 and p-value &lt;0.05 was considered significant. The summarized informations were then presented in form of tables and figures. For the validity test, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting the grade of intracranial gliomas were calculated after confirmation of the diagnosis by histopathology. Results: The age range of patients were 18 to 70 years. The peak age incidence were &gt;50 years age group. 75.8% patients were male and 24.2% patients were female. The male to female ratio was 3.12:1. Regarding midline crossing in MRI of brain , 24 (72.7%) patients showed no crossing of midline, 2 (6.1%) patients showed equivocal and 7 (21.2%) patients showed crossed midline. In 4 (12.1%) patients there were mild edema, 12 (36.4%) patients showed moderate edema and 17 (51.5%) patients showed marked edema. 10 (30.3%) patients had well circumscribed lesion, 15 (45.5%) patients had poorly circumscribed lesion and 8 (24.2%) patients had highly infiltrating lesion. 7 (21.2%) patients showed mild mass effect, 18 (54.5%) patients had moderate mass effect and 8 (24.2%) patients had severe mass effect. Necrosis/cystic change of tumor were present in 19 (57.6%) cases. 6 (18.2%) patients showed mild heterogeneity, 22 (66.7%) patients showed moderate heterogeneity and 5 (15.2%) patients showed severe heterogeneity. Definitive haemorrhage showed 5 (15.2%) patients. WHO grading of gliomas by MRI. 17 (51.5%) patients of the gliomas were classified as WHO Grade IV, followed by 9 (27.3%) patients were Grade II and 7 (21.2%) patients were Grade III. WHO grading of gliomas by histopathology. 16 (48.5%) patients of the gliomas were classified as WHO Grade IV, followed by 9 (27.3%) patients were Grade II and 8 (24.2%) patients were Grade III. Out of 33 patients, 09 patients were diagnosed as grade II (Low grade gliomas) by MRI, among them 08 cases were proved as grade II (Low grade glioma) and 01 case was grade III (Anaplastic Astrocytoma) by histopathology. 07 patients were diagnosed as grade III (Anaplastic Astrocytoma) by MRI, among them 05 cases were proved as grade III (Anaplastic Astrocytoma) and 01 case was grade II (Low grade glioma) and 01 case was grade IV (Glioblastoma Multiforme) by histopathology. 17 patients were diagnosed as grade IV (Glioblastoma Multiforme) by MRI, among them 15 cases were proved as grade IV (Glioblastoma Multiforme) and 02 cases were (Anaplastic Astrocytoma) by histopathology. Among 33 patients, 09 patients were diagnosed as low grade gliomas by MRI, among them true positive were in 08 cases and 01 cases were diagnosed as low grade gliomas by MRI but was diagnosed as high grade gliomas by histopathology. This 01 case was false positive. Out of 33 cases of gliomas 24 were diagnosed as high grade gliomas by MRI, among them 23 cases were true negative and 01 case was diagnosed as high grade gliomas by MRI but was proved as low grade gliomas by histopathology. This 01 case was false negative. MRI is accurate in preoperative diagnosis and assessing the characteristics of intracranial gliomas. It is very accurate in assessing the grade of gliomas. Tumor necrosis, irregular margins, mass effect of tumor and peritumoral edema are most important indicators of tumor grade. The present study revealed that there is significant correlation between the MR imaging features and histopathological grading of intracranial gliomas.</p> <p>Bang. J Neurosurgery 2020; 10(1): 67-74</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Management of Carpal Tunnel Syndrome – Surgical Vs Medical? 2020-12-14T14:39:49+00:00 Md Ruhul Kuddus Md Omar Faruk Samiul Alam KM Atiqul Islam Shamsul Alam Hadadhan Debnath <p><strong>Background: </strong>Carpal Tunnel Syndrome (CTS) is the most common form of entrapment neuropathy. Both the Medical and surgical treatments are popular in the management of CTS. The effectiveness of the surgical treatment of carpal tunnel syndrome (CTS) is well known on short term. Surgical approach has proved to be more efficient relative to the conservative methods of steroid injections and splinting. On the other hand, many studies have demonstrated both advantages and adverse effects of the surgical methods. However, limited data is available about long-term outcome after carpal tunnel release (CTR). So debate is still persists regarding Conservative vs. Surgical approach to treatment of CTS.</p> <p><strong>Methods: </strong>A retrospective analysis of 15 consecutive cases performed during 1.5 year was conducted. 8 patients were treated surgically with transpalmar approach. 7 patient were treated conservatively. The criteria for treatment efficacy were improvements in symptoms, such as pain, paresthesia and recurrences after surgery. Results: Female were predominant 80% than male 20%. Right hand was more frequently affected 80% than left 20%. most paitents were diabetic except 2. outcome in the surgical group was excellent. Patient of non-surgical group was not satisfied as surgical group.</p> <p><strong>Conclusions: </strong>CTR is a robust treatment for CTS and its effect persists after a period of years. CTR is the choice of treatment in case of moderate to severe form of CTS. Long term follow up and inclusion of more cases is needed for a definite conclusion.</p> <p>Bang. J Neurosurgery 2020; 10(1): 75-81</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Correlation between the Size of Tumour with Early Postoperative Serum Sodium Imbalance in Sellar and Suprasellar Space Occupying Lesion after Transsphenoidal surgery 2020-12-14T14:39:43+00:00 Muhammad Mahabub Hossain Md Lylatul Kadir Naznin Akter Jahan Md Motasimul Hasan Kazi Hafiz Uddin Milton Kumer Saha Ahsan Mohammed Hafiz Kanak Kanti Barua <p><strong>Background: </strong>Seller and suprasellar space occupying lesions are frequently encountered intracranial lesions now-a-days. Surgery through transsphenoidal route is the most preferable approach which is frequently performed for excision of these space occupying lesions. The lesions are located in a very critical area because they are surrounded by the hypothalamus, pituitary gland and cavernous sinus which are responsible to maintain various hormonal functions as well as regulation of plasma osmolality and plasma electrolytes. So, during and after operation various types of osmolality and electrolytes related complications are often encountered. Among them serum sodium imbalance is the most frequent one.</p> <p><strong>Objective: </strong>Tumour size is one of the very important predisposing factors which influence the serum sodium level after surgery. For investigating the correlation between the size of sellar and suprasellar space occupying lesions with the incidence of postoperative sodium imbalance after transsphenoidal surgery of the patient having these lesions.</p> <p><strong>Material and method: </strong>Thirty patients with sellar and suprasellar space occupying lesions meeting the inclusion criteria were enrolled. The largest diameter of the tumour was measured in the coronal or sagittal planes from pre-operative MRI’s. They underwent transsphenoidal surgery and were observed for first 7 postoperative days and serum electrolytes was measured every day. Patients in this study were considered to have serum sodium imbalance if the narrow range of 135-145 mmol/L was not maintained. Then according to the tumour size they were divided in to two groups. Then the two groups were compared and the frequency of development of post-operative sodium imbalance, their time of onset and types of imbalances were observed.</p> <p><strong>Result: </strong>60% of the patients in our study developed post operative serum sodium imbalance after transsphenoidal surgery. Among them 40% of the patients developed hypernatraemia, 13.3% of the patient developed hyponatraemia and only 6.7% patient developed combined imbalance. Hypernatraemia is more common than hyponatraemia after transsphenoidal surgery. Peak incidence of hyponatraemia occurred on 3rd post-operative day and hypernatraemia occurred at 1st postoperative day. In the large size tumour group (&gt;30mm) 46.66% had serum sodium imbalance and imbalance was observed in 13.33% of the small size group (d”30mm) and there is significant difference of sodium imbalance between large and small size group and p-value was 0.001. r- value 0.776 indicates that the size of the tumour strongly correlates with postoperative sodium imbalance and there is significant association between size of the tumour with sodium imbalance. The study found no significant association between age, sex or types of the lesions with postoperative sodium imbalance (p=0.43).</p> <p><strong>Conclusion: </strong>Post operative serum sodium imbalance after transsphenoidal surgery is a burning issue for the neurosurgeon now a day. Early prediction of these types of notorious complication is helpful for preoperative and post operative management of the patient. The size of the lesion is one of the most significant markers. As well as a strong association between size of the tumour with post operative sodium imbalance was found. This will help us in perioperative management of the patients, and reduces complication related mortality and morbidity after the transsphenoidal surgery.</p> <p>Bang. J Neurosurgery 2020; 10(1): 82-91</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Deep Brain Stimulation in Neurosurgical Practice and Research: Its Application and Ethical Issues 2020-12-14T14:39:37+00:00 Abu Sadat Mohammad Nurunanbi Miliva Mozaffor Md Joynul Islam Kaisar Haroon <p>Deep brain stimulation (DBS), a form of neuromodulation, is recognized as a therapeutic venture for the management of chronic pain, the evaluation and management of epilepsy, and the treatment of Parkinson’s disease and other movement disorders. Clinical investigators are conducting more trials for its further use in obsessive compulsive disorders (OCD), depression, and traumatic brain injury. It is imperative to address the ethical concerns of such innovative neurosurgical treatment and research with human experimentation in the respective arena. The term ‘neurosurgical ethics’ is a moral approach towards ethical problems emerging from our day to day neurosurgical practice and research as well as current and future innovation in the field. The review paper outlined the procedures of DBS, as currently used in therapeutic and experimental applications and to discuss the ethical concerns regarding this innovative procedure.</p> <p>Bang. J Neurosurgery 2020; 10(1): 92-96</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Unilateral Papillitis as the Initial Presentation of Hemifacial Atrophy: Case Report and Review of Literature 2020-12-14T14:39:31+00:00 Akhlaque Hossain Khan Nazmin Ahmed Vijay Kumar Raut <p>Papillitis is a vision threatening condition, characterized by inflammation of the optic disc which often mimicked the features of papilledema; hence these patients often referred to the Neurosurgeon to exclude any intracranial pathology. This entity is associated with a number of intracranial, as well as extracranial pathologies. Among them, Parry–Romberg syndrome, also known as progressive hemifacial atrophy (PHA) possesses multiple ophthalmologic and neurologic manifestations. Here we report the case of a 14-year-old girl, who presented with the feature of progressive dimness of vision involving the right eye. Thorough physical examination demonstrated features of PHA overlapping with papillitis on fundoscopic examination. The patient treated with steroids, following which there was visual improvement. After evaluation in our facility, she was referred to department of plastic and reconstructive surgery for aesthetic improvement.</p> <p>Bang. J Neurosurgery 2020; 10(1): 97-101</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Lateral Orbitotomy for Cavernous Malformation: A Case Report with Technical Consideration 2020-12-14T14:39:25+00:00 Kaisar Haroon Tania Taher Abdullah Alamgir Naila Huq Md Rakib Ul Haq Sk Sader Hossain <p>Cavernoma is benign tumour of the orbit. It results in proptosis, visual disturbance, diplopia and ptosis of the eye. It is amenable to surgery and this results in complete after surgical removal without recurrence. We report a case of right orbital cavernoma in a female, who presented with non-pulsatile painless proptosis, slight ptosis and double vision while looking at the right side. Her MRI revealed that she had a cavernoma of the right orbit. She was operated by the lateral orbitotomy. This easily removed the tumour, cosmetically acceptable and she became symptom free.</p> <p>Bang. J Neurosurgery 2020; 10(1): 102-105</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Giant Solitary Plasmacytoma of Skull: A Case Report 2020-12-14T14:39:19+00:00 KM Tarikul Islam Nowshin Jahan Razib Bhattachariya Rathin Halder Ahsan Md Hafiz Shamsul Alam Moududul Haque ATM Mosharef Hossain Kanak Kanti Barua <p>Plasmacytoma is a tumor arising from plasma cell, which mainly grows within soft tissue or within axial skeleton, when it is present as a discreet solitary mass it is called as solitary plasmacytoma &amp; it is rare, we report a 46 years male, presented to us with the complaints of painless swelling in the left frontoparietal region which is about 8.6x6.5cm in diameter, Magnetic resonance imaging revealed an extra axial mass in fronto parietal region with overlying bone destruction mimicking meningioma with bony erosion, we did frontoparietal craniectomy and complete resection of tumor with bony margin subsequently cranioplasty was also done, histopathology of which revealed plasmacytoma,after that we did urinary bence jones protein which was negative.</p> <p>Bang. J Neurosurgery 2020; 10(1): 106-110</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Dual approach for Difficult Intracranial Lesions and their Outcome in BSMMU: Experience of Two Cases 2020-12-14T14:39:13+00:00 Vijay Kumar Raut Md Samsul Arifin Md Nafaur Rahman Abu Saleh Mohammad Abu Obaida Asifur Rahman Akhlaque Hossain Khan <p>Some lesions in the brain are difficult to approach through a single common route / trajectory. For those, dual approach combined together may ensure easier safe removal with better outcome as we had lesions like left petroclival meningioma &amp; large craniopharyngioma. Methods Two patients, one left petroclival meningioma and one suprasellar craniopharyngioma with intraventricular extension underwent surgery with dual approach at the Neurosurgery department, BSMMU. After detailed clinical and radiological evaluation, the left petroclival meningioma patient was planned for a combined pre and post sigmoid petrosectomy and retromastoid retrosigmoid route. These were accomplished in two stages, three months apart. The craniopharyngioma patient with intraventricular extension underwent surgery through pterional transsylvian and frontal anterior trans-callosal approach in a single sitting.</p> <p>Bang. J Neurosurgery 2020; 10(1): 111-118</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Endoscopic Removal of Third Ventricular Colloid Cyst: A Case Report 2020-12-14T14:39:07+00:00 Haradhan Deb Nath Kanak Kanti Barua Md Monirul Islam Sudip Barua Sudipta Mukherjee Rajib Bhattacherjee <p>Third ventricular colloid cyst is slow-growing benign tumor comprising &lt;1% of intracranial tumors. Previously it was removed by interhemispheric transcallosal or transcortical approach. Now a days, endoscopic removal of colloid cyst is a popular option because it is less invasive, panoramic view helps in total removal of tumor. Here we are reporting a 8 years old boy presented with occasional headache, vomiting, seizure and loss of consciousness for 3 months. Neuro-imaging revealed anterior third ventricular colloid cyst. We removed the tumor completely with rigid neuroendoscope which was confirmed by histopathology. After three months follow up patient was quiet healthy.</p> <p>Bang. J Neurosurgery 2020; 10(1): 119-122</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Refractory Trigeminal Neuralgia: Successful Treatment with LINAC Based Stereotactic Radiosurgery (SRS): First Case in Bangladesh 2020-12-14T14:39:01+00:00 Taohida Yasmin Narendra Kumar Sandip K das Murugan Appasamy KM Masud Rana Porama Zafreen R Arun Kumar Sania Ahsan <p><strong>Purpose: </strong>To present first case of refractory trigeminal Neuralgia treated with SRS in Bangladesh, procedural technique, and outcomes in terms of pain relief.</p> <p><strong>Background: </strong>Trigeminal neuralgia (TN), classically known as tic doloureaux is a chronic and recurrent disabling pain syndrome, which described as episodes of lancinating pain over the face along the sensory distribution of trigeminal nerve. First line management of TN is medical with different permutation &amp; combination to control the pain. After the failure of medical management, non-invasive SRS is an established modality to achieve long term pain control. Here, we are reporting a case of TN treated with LINAC based SRS.</p> <p><strong>Case Presentation: </strong>A 61 years old, gentleman who developed piercing pain inside his left eye for a duration 1-1.5 sec, precipitated while shaving, brushing teeth in year 2015, occurred 4-5 time a day. He was diagnosed as left TN of V1, started on Carbamazepine, Pregabalin. In 3 years, pain progressed to involve all 3 branches. Even combination Carbamazepine, Gabapentin, Tramadol, Amitriptyline, Clonazepam, &amp; Morphine could not control the pain. Pain was persisting all over the day and he also developed suicidal tendency. Later he has been referred to us for SRS. SRS was done in April-2019, a dose of 90Gy was delivered to the Distal Retrogasserian (RG) also called Marseille point of trigeminal nerve root. Eight months after the SRS patient is almost free of pain without any Medicine.</p> <p><strong>Conclusions: </strong>LINAC based SRS is a non-invasive, frameless, and safe procedure with excellent pain control for refractory Trigeminal neuralgia.</p> <p>Bang. J Neurosurgery 2020; 10(1): 123-129</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## Assessment of Quality of Life after Surgery in a Patient with Brainstem Cavernoma 2020-12-14T14:38:55+00:00 Md Moshiur Rahman SIM Khairun Nabi Khan Robert Ahmed Khan Md Rokibul Islam Mainul Haque Sarker <p>Abstract Not Available</p> <p>Bang. J Neurosurgery 2020; 10(1): 130-134</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement##