Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Background: The surgical management of symptomatic adult Chiari malformation type 1 (CM1) with or without syringomyelia (SM) continues to be a dilemma considering the outcomes. Objectives: The study aimed to compare the clinical outcomes between stealth cranioplasty (SC) and one of the most commonly practiced standard procedures, posterior fossa decompression with duraplasty (PFDD). Clinical outcomes between SC and another procedure posterior fossa decompression (PFD) were also compared. Methods: This comparative cross-sectional study was carried out on 37 males and 16 females symptomatic adult CM1 patients, ranging from 18 to 47 years of age from June 2019 to May 2021. Clinical outcomes were assessed, compared, and analyzed in terms of changes in clinical symptoms and signs, chicago chiari outcome scale (CCOS) score, and occurrence of complications.  Results: Of the 53 patients, 23, 19 and 11 underwent SC, PFDD, and PFD, respectively. There were no significant post-operative changes in symptoms and signs among groups except changes in limb weakness between SC and PFDD (P=0.004). Considering average CCOS score, SC performed better only than PFDD (P=0.003), while category-wise SC was better than both PFDD (P=0.004) and PFD (P=0.010). Considering complications, the PFDD group had a significantly higher rate of complications than the SC group (P=0.001), while there was no significant difference in the rate of complications between the PFD and SC groups. Conclusion: SC was found to have better clinical outcomes than the PFDD and PFD groups as a technique. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 08-1

Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Background: The surgical management of symptomatic adult Chiari malformation type 1 (CM1) with or without syringomyelia (SM) continues to be a dilemma considering the outcomes. Objectives: The study aimed to compare the clinical outcomes between stealth cranioplasty (SC) and one of the most commonly practiced standard procedures, posterior fossa decompression with duraplasty (PFDD). Clinical outcomes between SC and another procedure posterior fossa decompression (PFD) were also compared. Methods: This comparative cross-sectional study was carried out on 37 males and 16 females symptomatic adult CM1 patients, ranging from 18 to 47 years of age from June 2019 to May 2021. Clinical outcomes were assessed, compared, and analyzed in terms of changes in clinical symptoms and signs, chicago chiari outcome scale (CCOS) score, and occurrence of complications.  Results: Of the 53 patients, 23, 19 and 11 underwent SC, PFDD, and PFD, respectively. There were no significant post-operative changes in symptoms and signs among groups except changes in limb weakness between SC and PFDD (P=0.004). Considering average CCOS score, SC performed better only than PFDD (P=0.003), while category-wise SC was better than both PFDD (P=0.004) and PFD (P=0.010). Considering complications, the PFDD group had a significantly higher rate of complications than the SC group (P=0.001), while there was no significant difference in the rate of complications between the PFD and SC groups. Conclusion: SC was found to have better clinical outcomes than the PFDD and PFD groups as a technique. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 08-1

Hand-Schuller-Christian disease

Hand-Schuller-Christian disease (HSC) is a rare disease of unknown cause. We report a case of Hand-Schuller-Christian disease with a solitary swelling over left parieto-occipital region of scalp, and increased thirst with polyuria. Prompt diagnosis and treatment of the disease will improve the life expectancy

Hand-Schuller-Christian disease

Hand-Schuller-Christian disease (HSC) is a rare disease of unknown cause. We report a case of Hand-Schuller-Christian disease with a solitary swelling over left parieto-occipital region of scalp, and increased thirst with polyuria. Prompt diagnosis and treatment of the disease will improve the life expectancy

Post-irradiation bilateral basal ganglia calcification in a patient with cerebral metastasis

Background:  Basal Ganglia calcification is now being diagnosed with increasing frequency with the widespread application of computed tomography (CT) scan in clinical practice. One of the rare causes of bilateral basal ganglia calcification is post-irradiation sequelae. So far, there are a total of 11 reported cases of post-radiotherapy basal ganglia calcification. Case report: Here, we report another case of bilateral basal ganglia calcification following radiotherapy for cerebral metastasis from Ca- ovary along with a review of the other reported cases. The exact pathogenesis of this condition is not clear. It appears, however, to be related to radiation vasculitis of the small vessels of the brain with resultant hyalinization and calcification. Conclusions: A long-term follow-up study would be necessary to evaluate the significance and implication of post-irradiation calcification of the grey matter

Post-irradiation bilateral basal ganglia calcification in a patient with cerebral metastasis: A case report and review of literature

Background:  Basal Ganglia calcification is now being diagnosed with increasing frequency with the widespread application of computed tomography (CT) scan in clinical practice. One of the rare causes of bilateral basal ganglia calcification is post-irradiation sequelae. So far, there are a total of 11 reported cases of post-radiotherapy basal ganglia calcification. Case report: Here, we report another case of bilateral basal ganglia calcification following radiotherapy for cerebral metastasis from Ca- ovary along with a review of the other reported cases. The exact pathogenesis of this condition is not clear. It appears, however, to be related to radiation vasculitis of the small vessels of the brain with resultant hyalinization and calcification. Conclusions: A long-term follow-up study would be necessary to evaluate the significance and implication of post-irradiation calcification of the grey matter

Posterior lumber interbody fusion with pedicle screw fixation for the management of spondylolisthesis: An analysis of 40 cases

Spondylolisthesis is forward slipping of upper vertebra in relations to its lower one, commonest is L4-L5. The ideal surgical treatment of spondylolisthesis is still controversial. Posterior lumber interbody fusion with pedicle fixation is one of treatment choices for the lumber spondylolisthesis. Forty patients who operated through posterior lumber interbody fusion and pedicle screw fixation by single surgeon was included from January 2012 to March 2015. Periodical follow-up was done both clinically and radiologically up to 6 months. Patient outcome was completed based on pain relief graphic rating scale and Oswestry disability index. In our series, the excellent outcome were 25 patients (62.5%), good were 12 patients (30%), and fair were 3 patients (7.5%). There were no poor outcome and no new neurological deficit. This study concludes that posterior lumber inter-body fusion with pedicle is an effective treatment for the lumber spondylolisthesis. It helps to maintain the biomechanics, associated with less complication and improve the quality of life of patient

Posterior lumber interbody fusion with pedicle screw fixation for the management of spondylolisthesis: An analysis of 40 cases

Spondylolisthesis is forward slipping of upper vertebra in relations to its lower one, commonest is L4-L5. The ideal surgical treatment of spondylolisthesis is still controversial. Posterior lumber interbody fusion with pedicle fixation is one of treatment choices for the lumber spondylolisthesis. Forty patients who operated through posterior lumber interbody fusion and pedicle screw fixation by single surgeon was included from January 2012 to March 2015. Periodical follow-up was done both clinically and radiologically up to 6 months. Patient outcome was completed based on pain relief graphic rating scale and Oswestry disability index. In our series, the excellent outcome were 25 patients (62.5%), good were 12 patients (30%), and fair were 3 patients (7.5%). There were no poor outcome and no new neurological deficit. This study concludes that posterior lumber inter-body fusion with pedicle is an effective treatment for the lumber spondylolisthesis. It helps to maintain the biomechanics, associated with less complication and improve the quality of life of patient

Resolution of Papilledema Following Ventriculoperitoneal Shunt or Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus: A Pilot Study

Background and Objectives: Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema. This comparative study was carried out at the Department of Neurosurgery of Dhaka Medical College and Hospital to compare the efficacy of VPS and ETV in the resolution of papilledema in 18 patients with obstructive hydrocephalus. Materials and Methods: The success of CSF diversion was evaluated by a decrease in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) and modified Frisen grading of papilledema at the same time. The statistical analyses were carried out by using paired sample t test and the Spearman’s correlation coefficient test. The level of significance (p value) was set at Results: After 7 days, both VPS and ETV were able to reduce RNFL thickness of both eyes with a p value = 0.016 (right eye) and 0.003 (left eye) in group A (VPS) and with a p value p value > 0.05. Further, the inter-group comparison between VPS and ETV showed no difference in decreasing RNFL thickness and modified Frisen grading (p value = 0.56). Conclusion: VPS and ETV procedures both appear very efficient in treating obstructive hydrocephalus, which in turn reduces papilledema in these patients. This paper is preliminary and requires further work

Surgical management of clinoidal meningiomas: 10 cases analysis

Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique’s advantages that aid in achieving an improved extent of tumor resection and enhancing the patients’ overall outcome, specially their visual outcome.Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months.Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients; 70.0%).Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients’ visual and overall outcomes