European Journal of Molecular & Clinical Medicine

Meningiomas are most common tumours of human population, most cases being incidentalomas. Giant meningiomas (>50mm) demand thorough evaluation and planning for management to avoid untoward events. This study was mainly undertaken to understand technical factors and challenges faced in dealing with giant meningiomas.
Methods: The data of the 45 giant meningioma cases, diagnosed and operated on during the study period, was collected from the preoperative, intraoperative and postoperative periods. The data of neurological examination was also collected retrospectively. The data was compiled and analyzed.
Results: Majority of the patients were female and middle aged. Seizures was the most common presentation. The predominant location of the lesion was in parasagittal region and maximum size was upto 90 mm. Neuronavigation was used for precision of craniotomy. Venogram was not routinely performed even in tumors having sinus involvement. More than half of the cases had Simpson grade 1 excision, almost one third had grade two excision. Most of the higher grade excisions were seen in tumors abutting major venous sinuses. Posterior fossa lesions were found to have relatively more complications. Two patients had morbidity and one patient had mortality in this study.
Conclusions: A good pre-operative planning including temporary CSF drainage if required, is essential for good results. The size of the lesion does not necessarily seem to influence the outcome.

ISDE (intracranial subdural empyema) is a potentially fatal disorder. Patients who have
had previous intracranial surgeries are more likely to develop ISDE. ISDE might be
challenging to identify due to its non-specific clinical appearance. We provide a rare
case of ISDE that mimicked a recurrent chronic subdural hematoma, underlining the
importance of obtaining early magnetic resonance imaging of the brain for early
diagnosis and treatment in order to achieve the best possible outcome.

Cerebralaneurysmscoexist with arteriovenousmalformations. In tandem arteriovenousmalformation and aneurysm, in the case of haemorrhage, itisoftendifficult to indicatewhichis the source ofbleeding.Thiscancausediagnosticdifficulties.We present a case of a 40-year-old patient with subarachnoid hemorrhage, occipital malformation and concomitantaneurysm of the ipsilateral posterior cerebral artery. After clinical and neuroimaging analysis, anddiagnostic deliberations, the source of bleeding turned out to be an aneurysm. This case is significant because the aneurysm was treated by surgical clipping, which is rare today. Intravascularcoilingis the treatment of choice for vertebrobasilaraneurysms. Due to the development of endovasculartechniques, clipping of suchaneurysmshasbecomehistoricmethod.We present a procedure of clippingthroughanextendedpterionalcraniotomy. We detail the nuanses, limitations, and potentialcomplications.We also pay attention to maintaining the diagnostic vigilance of indicating the source of bleeding in the event of coexisting aneurysm and malformation.