Bangladesh Journal of Neurosurgery

Effect of Anterior Cervical Decompression and Fusion for Cervical Myelopathy Treatment

2024-03-21T17:36:16+00:00

Background: Cervical myelopathy is a common cause for neurosurgical outpatient department visit, and a substantial proportion of patient suffering from myelopathy due to cervical spondylosis has to go through surgical management, commonly anterior cervical decompression and fusion in the form of Cloward’s procedure, Smith Robinson procedure, PEEK and Titanium cage implant and fusion. A total of 23 cases were selected according to predefined inclusion and exclusion criteria.

Method: This is a prospective study that was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Patients with cervical myelopathy undergoing anterior cervical decompression and fusion, in the form of Cloward’s procedure, Smith Robinson procedure, or Anterior Cervical Discectomy with Poly Ether Ether Ketone (PEEK) and Titanium cage implants in a single level for inclusion and exclusion criteria.

Results: This study found out that the Modified Nurick grading system is a useful tool to quantify the functional status of the patients suffering from cervical myelopathy and surgery in various forms of anterior cervical decompression and fusion has an impact on the functional status even at an early period of one month. 82.6% of the patients had functional improvement, whereas 13% remained the same. Only one out of the 23 patients deteriorated. Various methods of anterior cervical decompression and fusion or the levels of involvement did not have any statistically significant impact on improvement among the patients.

Conclusion: Anterior cervical decompression and fusion is a time-proven treatment modality for the patients suffering from cervical myelopathy owed to external compression due to spondylotic changes and Ossified Posterior Longitudinal Ligament. The functional status of the patients that have been compromised due to the disease shows promising change even in the early period undergoing surgery.

Bang. J Neurosurgery 2023; 13(1): 3-9

The Observation at Mean Oedema Index Variations with Location and Histological subtypes in Supratentorial WHO G-I Meningiomas

2024-03-24T18:42:54+00:00

Background: The term meningioma is the noncommittal, all-encompassing name coined by Harvey Cushing for this tumor of meninges which is usually benign. The severity and variety of the peritumoral brain oedema may limit operative exposure and increase the difficulties of intraoperative procedures; however, its pathogenesis is not clearly documented. Several factors, such as tumor size, location and histology, mechanical compression of draining vein by the tumor have been proposed as mechanism of peritumoral brain oedema

Aims: The objective of this study was to determination of mean oedema index in different locations and histological subtypes in patients with supratentorial WHO GI meningiomas

Methods: The study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from September, 2016 to March, 2018. This study was a cross sectional study. Data collection sheets were used to collect necessary information. Total 75 cases were selected consistent with inclusion and exclusion criteria. Tumor volume and localization and the presence of peritumoral brain oedema (PTBOe) were determined by MRI (Magnetic Resonance Image). All patients underwent microsurgical removal of tumor. Surgically resected meningiomas were classified histopathologically based on criteria of the new World Health Organization (WHO) classification. Regarding location and histological subtypes of tumor the study population were divided into 6 groups and 8 groups respectively.Statistical analyses were done by Statistical Packages for Social Sciences (SPSS-v.25).

Results: A total 75 cases were selected consistent with inclusion and exclusion criteria from September, 2016 to March, 2018. Regarding location; the mean oedema index for each of the six groups was calculated and recorded. The F value was 5.97 and the P-value was 0.0001 which was less than 0.05. This result signifies that there was association between perilesional oedema in supratentorial meningioma to its location. So, Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location. On the other hand, regarding histopathological subtypes, meningiomaswere divided into eight groups-the mean oedema index of each of the eight groups was calculated and recorded. The F value was 1.62 and P-value was 0.145 which was more than 0.05. This result signifies that there was no association between perilesional oedema in supratentorial meningioma to its histological subtypes. So mean oedema index in intracranial supratentorial meningiomas does not vary with its histological subtypes.

Conclusion: Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location but does not vary with histological subtypes

Bang. J Neurosurgery 2023; 13(1): 10-13

Comparison of Surgical Outcomes between Endoscopeassisted Evacuation and Conventional Burr Hole Aspiration of Brain Abscess at a Tertiary Care Hospital

2024-03-25T06:14:25+00:00

Background: Brain abscess is a major health problem with a reasonable morbidity and mortality rate.

Objective: The objective of this study was to compare the efficacy between endoscope-assisted evacuations of brain abscess with burr hole aspiration method in a tertiary health care center.

Methodology: This non-randomized clinical trial was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh during the period of July 2016 to December 2017. Patients with the age group of more than or equal to 18 years of both gender presented with brain abscess were enrolled in this study. The endoscope-assisted evacuation of abscess was done on group A patients and burr hole aspiration was done on group B patients. Outcome of the patients was assessed using GCS and MRC muscle power grading and by GOS. Patients were evaluated by contrast enhanced CT scan of head at pre-operative, 1st and 30th postoperative day. Both groups received best available medical treatment along with surgery.

Results: The mean age of was 13.0 ± 6.3 years in burr hole group and is 13.1 ± 6.4 years in endoscope-assisted group. The patients presented with GCS was 66.7% in burr hole group and 93.3% in endoscope assisted group. The study showed e”75.0% evacuation of brain abscess at 1st post-operative day in 13(92.9%) patients in endoscope-assisted group and 5(33.3%) patients in burr hole group. The study showed mortality rate of 6.7% in both the groups. Mean residual volume at 30th post operative day was 0.75ml in endoscope-assisted group and 1.75ml in burr hole aspiration group.

Conclusion: In conclusion endoscope-assisted procedure has better rate of abscess evacuation, less chance of residual and repeated surgeries than conventional burr hole.

Bang. J Neurosurgery 2023; 13(1): 14-19

Retrospective Review and Analysis on Outcome of Cranioplasty: A Series of 38 Cases

2024-03-25T07:08:43+00:00

Background: Cranioplasty (CP) is a straightforward procedure, it may result in a significant number of complications. These include infections, seizures, intracranial hematomas, and others.

Objective: This was a retrospective study on outcome of Cranioplasty.

Materials and Methods: This retrospective study included patients who underwent decompressive craniectomy due to traumatic brain injury with raised ICP, acute subdural hematoma, compound comminuted skull fracture & ICH, between January January 2019 to December 2020 at Enam Medical College & Hospital, Savar, Dhaka. Data were collected in pre-designed data collection sheet and were analyzed using computerbased programme statistical package for social science (SPSS) windows version 25.

Results: This study showed maximum patients (34.2%) were between 21-30 years age. Majority were male (89.5%) and only 5.9% were female. Overall rate of complications was 10.5%. Among them new onset seizure (n = 4), indrawing of skin through bone gap (n=4), hemorrhage (n=2), infection (n = 1), HCP (n = 1), and exposed implant (n=1).

Conclusion: We have found the outcome of cranioplasty was better with titanium mesh plate and screw than conventional fixation of bone with polyglactin, polypropylene suture and titanium miniplate and screw. With polypropylene and polyglactin there is more chance of inward displacement of bone fragment and with miniplate and screw there is still chance of indrawing of bone fragment through the bone gap.

Bang. J Neurosurgery 2023; 13(1): 20-23

Simulation Based Teaching and Learning in Clinical Education

2024-03-25T07:23:58+00:00

Medical education is undergoing significant changes each day in different corners of the world. Calls from different stakeholders for a change in the instructional methods have resulted in innovative medical curriculum. The new curriculum stresses the importance of proficiency in several clinical skills by medical students rather than mere acquisition of knowledge. Teaching and training using simulation technique is very powerful. It provides valuable opportunities to learn and practice the key competencies in medical education, such as communication, problem-solving, teamwork, and leadership as well as management skills such as physical examination, diagnostic and surgical procedures. Pedagogical innovations like simulation-based teaching needs to be brought to the forefront in clinical education in our country. Simulation programs may function well from a technical point of view, but they are often difficult to fit into a curriculum, especially in low-resource settings, where money and technical-know-how are the main limitations. Medical educators have been pushed inevitably to rely on such technology-based learning looking at the future of medical education. However, they should not only embrace it but also develop and evaluate its sustainability and application in preclinical and clinical settings. If well-designed, learning how to operate a simulation program generally requires little effort for them and their students. A short introduction by the teacher is often sufficient to enable the student to work with the program.

Bang. J Neurosurgery 2023; 13(1): 24-28

Outcome of Pituitary Adenoma Surgery Through Transphenoidal Endoscopic Endonasal Approach -A Study of 96 Cases

2024-03-25T08:57:04+00:00

Background: Transphenoidal endoscopic approach is minimal invasive surgery in case of pituitary adenoma.

Objective : To see the outcome of transphenoidal endoscopic approach in case of pituitary tumour.

Results : This study showed among the 96 patients, 64 (66.7%) patients were male and 32(33.33%) were female. It was documented that in 96 patients, 88(91.66.3%) were macroadenoma and 8(8.33%) were microadenoma. Among 96 patients, 88 (91.66%) had preoperative visual disturbance and 8(8.33%) had normal vision. Tumor was totally removed in 88(91.66%) patients in endoscopic approach. Clinically 92(95.8%) patients were improved in endoscopically. Two (2.1%) patient developed pneumocephalus and meningitis, between them one died due to meningitis and other cured by conservative treatment. In 2 (2.1%) patient, carotid artery was partially torn, which was managed by nasal pack.

Conclusion: It was concluded that endoscopic endonasal approach is safe and effective procedure.

Bang. J Neurosurgery 2023; 12(2): 29-33

Vein of Galen malformation with Obstructive Hydrocephalus- Endovascular Approach of Management : A Case Report

2024-03-27T11:24:59+00:00

The vein of Galen malformation is a rare arteriovenous shunt that is estimated to represent 30% of all pediatric vascular malformations. Less than 1% of cerebral vascular malformations are aneurysmal abnormalities of the vein of Galen, making it a rare disorder. Despite being uncommon, VGM is of particular clinical importance since the large cerebral shunt volume causes a significant mortality rate when left untreated because to date, the treatment of patients with VGM remains challenging. Here we report a case of an 11-month-old baby who had VGM with obstructive hydrocephalus and was effectively treated by transarterial glue embolization of the fistula and the venous sac. Subsequently, the baby made a complete recovery.

Bang. J Neurosurgery 2023; 13(1): 34-40

Pineal Region Tumor with Ventricular Extension with Hydrocephalus Removed by Supracerebellar Infratentorial Approach in a 19-Year-Old Female: A Case Report

2024-03-27T11:38:00+00:00

Pineal region tumors are uncommon, accounting for d”1% of intracranial tumors in adults and 3–8% of pediatric brain tumors. Getting an epidermoid in pinealregion is also very rare. In 1928 Cushing was the first to report the pineal localization of the epidermoid cyst.We report a case of pineal epidermoid with ventricular extension with obstructive hydrocephalus, which was diagnosed depending on magnetic resonance imaging (MRI) findings. Knowing its benign nature, at first we planned for an Endoscopic Third Ventriculostomy and later on a gross total removal was done.

Bang. J Neurosurgery 2023; 13(1): 41-43

Diagnostic Dilemma between Atypical Meningioma and Glioblastoma-Our Observation

2024-03-28T20:08:38+00:00

Both meningioma and glioblastoma are very common intra-cranial neoplasm. Typically both have distinguishing clinical and radiological features which aid in diagnosis and thus pre-operative preparation, planning, counseling the patient etc. But dilemma may often arise in case of non-grade-I meningioma making confusion in favor of higher grade astrocytoma (glioblastoma). In that case total per-operative picture, surgical approach, post- operative managements, and disease prognosis will be altered. We faced such kind of confusion in a case so reported here.

Bang. J Neurosurgery 2023; 13(1): 44-47

Primary Intracranial Leiomyosarcoma- Report of a Rare Case with Literature Review

2024-03-28T20:30:10+00:00

A 29 years old man presented with a H/O headache and vomiting for 4 months, blurring of vision and gait ataxia for 2 months. A contrast MRI of brain indicated the lesion arose from the dura over left cerebellar hemisphere. A posterior fossa craniotomy was performed with a provisional diagnosis of meningioma. Histopathology and immunohistochemistry revealed Leiomyosarcoma. Further evaluation including Contrast CT and PET scan failed to identify any primary site. Primary intracranial leiomyosarcoma is very rare and only few cases were previously reported. The prognosis for primary intracranial leiomyosarcoma is poor with the longest reported survival being 32 months.

Bang. J Neurosurgery 2023; 13(1): 48-50

Neglected Spheno-orbital Meningioma Presenting with Unilateral Blindness

2024-03-28T21:08:22+00:00

Sphenoorbital meningiomas (SOM) constitutes 9% of all intracranial meningiomas and are originated from sphenoid wing dura. They are also called en plaque meningioma. They cause hyperostosis of involved bone and their soft tissue growth may spread the orbit, the infratemporal fossa, and the temporal fossa. Most patients with SOM are middle- aged women and most commonly presents with unilateral, nonpulsating, progressive proptosis. Recently a woman with unilateral progressive proptosis from a remote area of Bangladesh presented to us with blindness of her left eye due to diagnostic delay. After thorough evaluation and imaging studies, she was diagnosed with a large spheno-orbital meningioma with extensive bony involvement of skull base and orbit.

Objective: This report highlights the necessity of creating awareness among optometrists, undergraduate medical students as well as and ophthalmologists who are practicing in remote areas of Bangladesh about clinical presentation of sphenoorbital meningiomas which is a benign lesion but may be a cause of unilateral blindness if remain undiagnosed for long

Bang. J Neurosurgery 2023; 13(1): 51-54

Augmenting CNS Tumor Surgery: The Era of Artificial Intelligence

2024-03-16T18:54:25+00:00

Abstract not available

Bang. J Neurosurgery 2023; 12(2): 1