Objective: Spinal cord swelling with abnormal gadolinium (Gd) enhancement is a rare preoperative radiological finding in patients with cervical spondylosis. In the presence of progressive myelopathy, timely surgical decompression can be curative. Case presentation: We report 3 patients with cervical spondylotic myelopathy. Preoperative magnetic resonance imaging (MRI) revealed spondylotic changes and intramedullary lesions in the cervical spine. We noted cervical cord swelling with high intensity on T2-weighted MRI and abnormal Gd-DTPA enhancement. Laminoplasty resulted in marked improvement of their neurological condition and postoperative MRI revealed gradual regression of the intramedullary lesions during the first year. Conclusion: We posit that the intramedullary lesions in our patients were reflective of spinal cord edema with blood-brain-barrier disturbance in the cervical cord, possibly due to minor recurrent spinal cord injury and disturbed venous circulation. Spinal cord edema is a rare condition in patients with cervical spondylosis and an accurate diagnosis and timely surgery are necessary for cure. Therefore, this unusual condition must be considered in spondylosis patients manifesting as intramedullary lesions on MRI of the cervical spinal cord. Careful evaluation of the postoperative course can be used to confirm the diagnosis and help in selecting a subsequent therapeutic strategy.

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-Venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report five cases of surgically treated TLE that were due to a MTS, MTS with arachnoid cyst, low grade ganglioglioma, high grade ganglioglioma and a tuberculoma in the department of neurosurgery, Dhaka Medical College Hospital and Islami Bank Central Hospital, Dhaka, Bangladesh from August 2009 to February 2010. In all cases the only presenting symptoms was complex partial seizures (psychomotor epilepsy) for which all underwent scalp EEG (Electro Encephalogram) and MRI (Magnetic Resonance Imaging) of Brain. All patients were managed by amygdalohippocampectomy plus standard anterior lobectomy. One patient with high grade ganglioglioma recurred within two months of operation and expired within five months. The rest of the cases are seizure and disease free till the last follow up.

Background: Rosai-Dorfman Disease (RDD) is a rare idiopathic non-neoplastic histioproliferative disease characterized clinically by massive painless cervical lymphadenopathy, fever and weight loss. Extranodal involvement has also been recognized. Central nervous system (CNS) manifestations are extremely rare and patients with intracranial involvement usually present with clinical and radiological findings suggestive of a meningioma. Case description: We report our experience in the management of three patients with RDD. Two patients had dural based lesions, radiologically in favour of a meningioma, and one patient had a parenchymal lesion suggestive of a tuberculous granuloma. Treatment consisted of total excision in one case, and subtotal excision followed by conventional radiotherapy in two cases. The diagnosis was confirmed by histopathology and immunochemistry which is essential for a definite diagnosis of RDD.

Background: Dural substitutes are used to achieve a watertight closure in situations where adequate closure is not possible .This study was conducted to evaluate the efficacy and safety of use a new collagen matrix dural substitute ( Duradry, Tecnodry, Belo Horizonte MG) in repair or expansion of cranial and spinal dura-mater. Methods: 30 patients operated on between March and September 2008, were studied. Surgical logs were reviewed for sex, age, diagnosis, location of the graft, technique and presence of fistula or infection. The patients were followed-up for at least 3 months, and the presence of complications as cerebrospinal leakage, infection, aseptic meningitis, hydrocephalus, pseudomeningocele were analysed. Results: Only one patient presented with CSF fistula. No patients presented with wound infections, hydrocephalus, pseudomeningocele, meningitis, brain abscesses or signs of toxicity related to the material. Conclusions: The new dural substitute used in this study is effective and safe, and the initial results are similar to those of other dural substitutes reported in the literature.

Introduction: Surgical treatment of extramedullary craniovertebral and upper-cervical tumors differs essentially, depending on the peculiarities of their localization. Materials and methods: In the Spinal department of the Institute of Neurosurgery during the period from 2000 to 2010 years, 96 patients with ventral and ventrolateral intradural extramedullary craniovertebral tumors and tumors of upper-cervical localization were examined and operated. The patients were distributed as follows: tumors of the craniovertebral localization - neoplasms spreading in rostral direction up to the boundary of the lower third of the clivus, and in caudal direction up to the upper edge body of the axis (C0 - C1): 12patients; tumors at the C1 - C2 level: 28 patients and at 1 - C2 - C3 level: 56 patients. The tumors were also divided as: ventral - 60 patients and ventrolateral - 36 patients. Conclusion: Therefore, the adequate choice of a surgical approach firstly depends on the localization of the tumor, its size and the extent to which it has spread. Far-lateral and posterolateral approaches in most cases are the most optimum and the least traumatic in cases of extramedullary ventrolateral tumors of craniovertebral and upper cervical localization. The extreme lateral approach is advisable in cases of large sized ventral craniovertebral tumors.

Background: The objective of this study is to compare the clinical, functional, and radiological outcomes of using bone-filled Polymethylmethacrylate (PMMA) implant as an inexpensive alternative to Polyetheretherketone (PEEK) cage and Autologous bone graft (ABG) fusion after anterior cervical discectomy (ACD) for the treatment of single level cervical disc disease. Methods: 60 patients were prospectively randomized according to the material used for fusion after ACD into: 1) PMMA implant; 2) ABG; and 3) PEEK implant. The clinical outcomes were evaluated using Visual Analogue Scale (VAS), whereas the functional outcomes were evaluated using Odom's criteria. Radiological evaluations were also conducted using radiography and Computerized tomography (CT) scans and considered the following factors; bony fusion, cervical stability and disc space height (DSH) changes. The post- operative outcomes were evaluated at the following intervals; 2 weeks, 3 and 6 months. Results: The clinical outcomes demonstrated insignificant difference among the three treated groups throughout their follow up period. ABG group showed significant lower satisfactory functional outcomes (68.1%) compared to PMMA and PEEK groups (85% and 88.9%, respectively) at the 2-week post operative evaluation, but the ABG group showed closer functional outcomes to the PMMA and PEEK groups at the 3 and 6-month post operative evaluations. Despite the inferior bony fusion rates of the PMMA group (30%) compared to ABG group (86.3%) and PEEK group (77.7%) at the 6-month post operative evaluation, the clinical and functional outcomes were comparable. Conclusions: Bone-filled PMMA implant is a reliable treatment option; despite its inferior fusion rate at the 6-month postoperative evaluation, it still provides acceptable segmental stability, satisfactory clinical and functional outcomes that are comparable to ABG and PEEK grafting procedures.

Aneurysms of the middle cerebral artery represent almost a third of all the aneurysms of the circle of Willis anterior sector. Among them, those located at its so-called M1 segment (from its origin up to the bifurcation) range between 2% and 7% of all the aneurysms. It is highly important to know the anatomy of the M1 segment, as well as of the arterial branches that arise from it, since causing its damage during dissection or occlusion of an aneurysm may determine the neurological sequelae. The authors of the present work, based on a recent anatomical analysis carried out by one of them (FM), have performed a study of the aneurysms of the M1 segment in a series of 1059 aneurysms treated with surgery along 25 years. At the mentioned location 23 aneurysms were found, which represented 2.2% of the total operated aneurysms. The cases, location of the aneurysms and their relation with the early branches of the middle cerebral artery were studied, as well as the surgical difficulties that they pose. A review of the scanty bibliography referring specifically to the aneurysms in this topography has been carried out.

Introduction: Pedicle screw instrumentation provides a rigid construct to promote fusion in cases of spinal trauma and degenerative diseases. Minimally invasive percutaneous technique in lumbar spine is a safe and reliable procedure as compared to the well established Magerl technique. It is a straight forward alternative to open approaches or minimally invasive ones and the accuracy of screw placement is also similar to that reported for other techniques. Case Report: A 16 year old high school boy presented to us with accidental fall from third floor. He was suffering from common cold with resulting high fever. He developed low back ache with bilateral radiculopathy and weakness of dorsiflexors. Neuro-imaging revealed a burst fracture of L4 vertebral body (type A 3.3 according to Magerl/AO spine classification), with bone fragments compromising the spinal canal. Delayed surgery was planned in view of anticipated excessive bleeding from the wound site in addition to poor general condition. Using a bone impactor, the bony fragments were impacted back into the original vertebral body space. Sextant (Medtronic Sofamor Danek, Tennessee, USA) percutaneous pedicle screw and rod fixation device was then used as a rigid construct to stabilize the lumbar spine. Post-operative CT scan and MRI revealed accurate pedicle screw fixation with adequately decompressed spinal canal. Conclusion: Short segment fusion with minimally invasive pedicle screwing following decompression of cauda equina was considered to be a minimally invasive approach for this case.

Introduction: Temporal lobe tumors commonly present with seizures, headache, auditory and visual hallucination, memory disturbance. Isolated cranial neuropathies are rare in patients with tumors affecting temporal lobe. Methods and material: The authors report a retrospective review of two cases of glioblastoma multiforme of the temporal lobe presenting with isolated oculomotor nerve palsy as their clinical feature. Results: Oculomotor nerve palsy in the temporal lobe tumor occurs primarily as result of herniation of uncus through the tentorium cerebellli. The tumors located anteromedially in the temporal lobe are usually asymptomatic and sudden medial expansion of these tumors due to intratumoral hemorrhage causes direct compression of the adjacent third nerve, which lies in the suprolateral border of the cavernous sinus, thereby producing painful oculomotor nerve palsy as the isolated clinical feature of these temporal lobe lesions. Conclusions: The authors conclude that the differential diagnosis of painful isolated oculomotor nerve palsy should also include tumor of temporal lobe located anteromedially with intratumoral hemorrhage, in addition to the rupture of an aneurysm of posterior communicating artery.

Introduction: We present the case of a pregnant woman who underwent linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) and we discuss the fetal exposure to radiation. Clinical Presentation: A 20-year-old woman at 18 weeks of gestation presented with right cerebral hemorrhage and underwent urgent evacuation of the hematoma. She recovered well after surgery, but cerebral angiography after the surgery revealed a small deeply seated arteriovenous malformation (AVM) in the right frontal lobe extending to the right basal ganglia. Methods and Results: We examined the diffuse AVM and treated it with LINAC-based SRS at 24 weeks of gestation. Before SRS, the fetus was exposed to a radiation dose of 8.26 mGy, which was estimated by conducting an experiment using an adult RANDO phantom, and a radiophotoluminescent (RPL) glass rod dosimeter (GRD) system. The patient underwent Caesarean delivery at 36 weeks of gestation and gave birth to a healthy baby. Conclusion: The exposure of fetus to radiation during SRS was exceedingly low. SRS can be used as an alternative treatment to microsurgery for resolving small deeply seated AVMs even in pregnant patients.