Abstract Background Epilepsy is a neurological disorder affecting approximately 70 million people worldwide, characterized by seizures. Around one-third of patients do not respond to medical treatment. Resective surgery is an established treatment for drug-resistant epilepsy, with success depending on a comprehensive presurgical evaluation. This evaluation ensures the appropriate selection of candidates and accurate identification of the epileptogenic zone for safe resection. The assessment includes clinical history, interictal EEG, high-resolution MRI, neuropsychological evaluation, and additional techniques like functional imaging and intracranial monitoring. The alignment of these methods is crucial for a successful outcome; this study aims to assess the outcome of resective surgery in patients with drug-resistant focal epilepsy. It was conducted between October 2021 and October 2023; 35 patients with drug-resistant focal epilepsy underwent resective surgical intervention, including lesionectomy, anterior temporal lobectomy, and selective amygdalohippocampectomy. Preoperative evaluations involved seizure semiology, interictal EEG, and MRI. Postoperative outcome was evaluated using the ENGEL classification (Class I: Free of disabling seizures, Class II: Rare disabling seizures (almost seizure-free), Class III: Worthwhile improvement, Class IV: No worthwhile improvement) and changes in anti-seizure medications (ASMs). Results The study included 35 patients for whom resective surgery was done as follows: 24 underwent lesionectomy, 4 had anterior temporal lobectomy, and 7 had selective amygdalohippocampectomy. According to the ENGEL classification, 25 patients achieved Class I, and 10 achieved Class II. A significant reduction in the number of anti-seizure medications was observed in the follow-up period following surgery compared to preoperative use. Conclusion Resective surgery in drug-resistant focal epilepsy is effective and results in improved outcomes as regards epileptic seizure freedom.

Abstract Objective To investigate if papaverine improves anastomotic stenosis, promotes microcirculation, and enhances the prognosis of patients with moyamoya disease (MMD). Methods This study enrolled 120 patients with MMD, 60 individuals in the experimental group receiving intraoperative and postoperative treatment with papaverine, and the control group who did not receive papaverine, respectively. We performed transcranial Doppler (TCD), computed tomography perfusion (CTP), and digital subtraction angiography (DSA) before and within 3 days postoperatively to assess the effectiveness of papaverine. TCD measurements included the internal diameter and blood flow velocity of all patients’ superficial temporal, internal carotid, and vertebral arteries. CTP was used to evaluate perfusion in various brain regions, including the frontal, temporal, parietal, and occipital lobes. DSA was used to assess the collateral vessel proliferation in patients diagnosed with MMD. Patient prognosis was evaluated using the Modified Rankin Scale (mRS) score, Random Forest analysis, and monitoring for potential complications. Results Postoperative examination of the parietal and temporal lobes using CTP revealed that the experimental group exhibited shorter time-to-peak, shorter mean transit time, and a higher cerebral blood volume than the control group. Postoperatively, we observed a more significant increase in collateral circulation in the experimental group due to postoperative collateral grading. mRS scores in both groups were statistically different. However, no statistical difference was observed between both groups regarding complications. Conclusions These findings suggest that adding papaverine to revascularisation procedures in patients with MMD promotes anastomotic patency and enhances collateral circulation proliferation, ultimately leading to improved prognosis.

Abstract Background Diffuse low grade gliomas (LGGs) are a heterogeneous population of intrinsic brain tumors accounting for about 15% of all glial brain neoplasms in which the natural history is characterized by initially indolent growth with significant tendency for recurrence and malignant transformation. However, early and maximal safe resection is currently the first-line treatment for LGGs, the ideal resection technique has not been clearly defined. Objective The study aimed to evaluate safety and efficacy of circumferential sulcus guided resection (SGR) of LGGs. Patients and methods This study was prospectively conducted on 20 patients subjected to microsurgical circumferential sulcus guided resection of LGGs between May 2023 and May 2025 in the department of Neurosurgery, Tanta university hospitals. Results Twenty patients (12 males and 8 females) with a mean age of 31.65 years, ranging from 14 to 53 years. All (100%) patients suffered from generalized seizures as the main complain. The mean preoperative tumor size was 31.43 cm 3 ranging from 15.21 to 55.84 cm 3 with mean extent of tumor resection was 96.83% ranging from 45.05 to 100%. Only 3 (15%) patients have short-term postoperative neurological complications and no patients at all (0%) developed permanent postoperative neurological complications. 15 (75%) patients had diffuse astrocytoma IDH-mutant, grade 2 and 5 (25%) had oligodendroglioma IDH1-mutant & 1p/19q codeleted, grade 2. All (100%) patients were Engel 1 seizure-free with no recurrence all through the research time. Conclusion LGGs typically exhibit limited infiltration across sulcal boundaries, allowing sulci to serve as natural anatomical landmarks for tumor delineation. The SGR approach exploits this characteristic growth pattern to facilitate surgical precision. According to our findings, SGR is both safe and practical technique for LGG removal, including in eloquent brain areas, and is independently correlated with an increased likelihood of achieving complete tumor resection without worsening neurological morbidity.

Abstract Background Prolactinomas in men frequently present with erectile dysfunction, infertility, and hypogonadism. Dopamine agonists offer a non-surgical alternative capable of reversing hyperprolactinemia and associated symptoms. This study evaluated the effects of medical therapy on sexual function, hormonal profile, and tumor size in male patients with prolactinomas. Methods In this retrospective cohort, 50 men treated with dopamine agonists between August 2015 and August 2022 were analyzed. Baseline and post-treatment data included sexual function (IIEF-5 scores), semen parameters, hormone levels, and tumor measurements on MRI. Statistical analysis involved paired t-tests (α = 0.05) to assess treatment efficacy. Results Mean age was 35.2 ± 5.7 years. Erectile dysfunction was the most common presenting complaint (96%). Post-treatment, significant improvements were observed: IIEF-5 scores increased from 11.7 to 21.3, sperm count from 7.59 to 17.68 million/ml, and testosterone levels from 175.2 to 364.6 ng/dl (all p < 0.001). Prolactin dropped from 197.9 to 28.2 ng/ml, and tumor diameter reduced markedly from 25.0 to 3.8 mm ( p < 0.001). Conclusion Dopamine agonist therapy achieves rapid and significant restoration of sexual and reproductive function, hormonal normalization, and tumor shrinkage in men with prolactinomas. It remains an effective, first-line treatment option with robust clinical outcomes.

Abstract Background Traumatic brain injury (TBI) remains a major health concern in Indonesia, where the burden is strongly associated with motorcycle-related traffic accidents, limited neurocritical care facilities, and unequal access to rehabilitation. This study aimed to analyze clinical patterns, disability risk factors, and long-term quality of life outcomes in Indonesian TBI patients, with a focus on the role of Glasgow Coma Scale (GCS) scores, clinical predictors, and socioeconomic disparities. Methods A prospective cohort study was conducted at Hasan Sadikin Hospital, Bandung, from March 2021 to March 2025, involving 128 patients with moderate-to-severe TBI (GCS ≤ 12). Diagnosis was confirmed through cranial CT scans and clinical assessments. Data collection included baseline neurological evaluations (GCS, GOSE, MoCA), neuroimaging (CT/MRI), and biannual SF-36 quality-of-life surveys. Statistical analyses were performed using chi-square tests and effect size calculations with SPSS version 29. Results Low admission GCS scores (3–8) were the strongest predictor of long-term disability (74.2% of cases; p < 0.001), followed by diffuse axonal injury (DAI) ( p = 0.02) and comorbidities ( p = 0.03). Surgical intervention (70.3% of cases) did not significantly reduce disability risk compared to conservative management ( p = 0.16). At the five-year follow-up, patients with mild injuries (GCS 13–15) reported higher quality-of-life outcomes, particularly in the physical (mean = 79.1) and mental (mean = 80.4) domains. Socioeconomic disadvantages, limited neurocritical resources, and cultural stigma toward disability further contributed to poor recovery in severe TBI patients. Conclusions In Indonesia, initial injury severity (GCS 3–8), DAI, and comorbidities are major predictors of long-term disability. Higher GCS scores correlate with improved quality of life, highlighting the urgent need for road safety programs targeting motorcycle users, standardized time-sensitive clinical protocols, and integrated rehabilitation systems. Larger multicenter studies are warranted to provide broader national insights.

Abstract Background Globally, motorbike riders and pillion riders are frequently involved in road traffic accidents (RTAs), and head injuries are the major cause of morbidity and fatality. Objective To perform a comparative analysis of head injury severity between riders and pillion riders in motorbike RTAs and assess the factors associated with head injury severity. Materials and methods This hospital-based, prospective observational study involved 1000 adult motorbike riders and pillion riders who sustained head injuries following RTA. The study was performed in the Department of Neurosurgery of a tertiary care institute from February 2023 to January 2024. Modified Glasgow Coma Scale was used to determine the head injury severity. Univariate and multivariate logistic regression analysis was done to evaluate the association of head injury severity with various factors. Results Of 1000 patients, 38.4% were riders and 61.6% were pillion riders. Compared to pillion riders, a significantly greater proportion of riders had severe head injuries (p = 0.027); however, this was not significant on multivariate analysis (p = 0.9031). Severe head injuries were associated with not using a helmet (OR 8.51; 95% CI 5.24–14.59; p < 0.001), side saddle sitting posture (OR 1.76; 95% CI 1.21–2.56; p = 0.003), and need for neurosurgery (OR 2.49; 95% CI 1.86–3.32; p < 0.001), while mild–moderate head injuries were associated with higher survival (OR 0.17; 95% CI 0.148–0.196; p < 0.001). Conclusion Among motorbikers, severe head injuries are linked to lack of helmets use, sitting in side saddle posture, and need for surgical management, while mild–moderate head injuries are linked to lower mortality risk.

Abstract Background Ventriculoperitoneal shunting is a standard tool in treating patients with hydrocephalus. With advanced shunting systems and easy-to-reach imaging techniques, straightforward surgery usually alleviates the symptoms of carefully selected patients. Nonetheless, its follow-up and common complications create an encumbrance for surgeons. Case presentation A 64-year-old woman presented with a headache, cognitive decline, and urinary incontinence. She was diagnosed with idiopathic normal pressure hydrocephalus. She underwent six revision surgeries for shunt-related and unrelated complications throughout 2 years. Notably, shunt dysfunction was observed even after the placement of an MRI-compatible valve. She continues to follow up on her controls with no significant symptoms. Conclusions In this case, we report our experience with a hydrocephalic patient who underwent multiple shunting surgeries with numerous complications. Selecting the proper valve and managing a vast entity of complications is a complex process. Most notably, the interaction of valves with electromagnetic fields should be cautiously monitored.

BackgroundChronic subdural haematoma (cSDH) is a significant neurological condition predominantly affecting the elderly, characterised by the accumulation of fluid, blood, and breakdown products in the subdural space. Given a global prevalence of roughly eight cases per 100,000 individuals, the incidence is anticipated to increase as a result of an ageing population and heightened use of anticoagulants. cSDH, however, is classically associated with minor head trauma, but the exact reason is still complex and remains unknown. The clinical presentation progresses unnoticed, therefore presenting a challenge in getting a cSDH diagnosis, but most patients suffering from cSDH can develop some sort of cognitive dysfunction and even unconsciousness.Case presentationThis case study highlights a rare case of a 61-year-old female patient who presented with impaired sensorium and no history of trauma or anticoagulant use. She was diagnosed with bilateral infratentorial cSDH with obstructive hydrocephalus. After a bilateral suboccipital burr-hole craniostomy, the patient’s neurological condition significantly improved, and by the fifth postoperative day, the hydrocephalus had resolved.ConclusionThe difficulty of related disorders like hydrocephalus, the rarity of infratentorial cSDH, and the necessity of prompt surgical intervention, especially in the absence of structured treatment protocols, are all highlighted in this instance. Further research is warranted to establish standardised treatment protocols for this uncommon neurosurgical challenge.

BackgroundBrain tumors pose a significant health challenge globally, with limited comprehensive data on their surgical outcomes in Africa. This review explores the surgical landscape, challenges, and future directions for brain tumor management on the continent. Main bodyThe prevalence of brain tumors in Sub-Saharan Africa, notably in Nigeria, Egypt, and Uganda, underscores the need for improved strategies. Despite challenges such as limited resources, studies demonstrate the feasibility and safety of neurosurgical interventions, emphasizing the adaptability of practices in resource-constrained environments. The review addresses risk factors, genetic considerations, and highlights the urgent need for expanded genomic studies in Africa. Challenges, including limited healthcare access, lack of specialized services, and socioeconomic factors, hinder optimal outcomes. Policymakers are urged to prioritize neurosurgical infrastructure, implement training programs, and foster international collaborations. Telemedicine, public awareness campaigns, and research initiatives are crucial components for enhancing surgical outcomes. ConclusionThe proposed comprehensive policy approach aims to overcome barriers, improve access, and ultimately contribute to global efforts in combating brain tumors in Africa.