Transcranial approach as surgical treatment for giant pituitary adenoma during COVID 19 pandemic - What can we learn?: A case report.

INTRODUCTION: In the COVID 19 pandemic, pituitary surgery is one of challenging surgical treatment, especially the involving transsphenoid approach. It was reported that the aerosolisation and mucosal involvement increase the risk of viral transmission during operation. Therefore, transcranial is a safer surgical approach during COVID-19 pandemic. This study aimed to reported transcranial approach to treat giant pituitary adenoma with aggressive visual disturbance which require urgent surgical management. CASE PRESENTATION: We reported a 21-year old male, who required urgent surgery because of progressive visual disturbance due to giant pituitary adenoma. On brain MRI with contrast, it was revealed an extraaxial tumor extending anteriorly over plannum sphenoidal with the greatest diameter was 5.34 cm. Transcranial approach was chosen to resect the tumor. Near total removal of the tumor was achieved without damaging vital neurovascular structure. The visual acuity was improved and no significant postoperative complication. Pathology examination revealed pituitary adenoma. CONCLUSION: Transcranial surgery for pituitary adenoma is still an armamentarium in neurosurgical practice, especially in the COVID 19 pandemic to provide safer surgical approach.

An Intracerebral Penetration of Air Shotgun Pellet in Toddler: A Case without Neurological Sequelae.

BACKGROUND: A non-powder firearm including air shotgun remains a significant source of injury to children. It causes severe damage and can involve the brain, eyes, heart, abdomen, and other body parts. CASE REPORT: A toddler boy was accidentally shot by an air shotgun at the forehead, and there was no sign of neurological deficit, both before and after surgical removal of the pellet. Herein, we report a case of air shotgun pellet which penetrated a toddler's head from the forehead, all the way up to the occiput. Removal of the pellet was successfully performed without eliciting any neurological sequelae. CONCLUSION: Air shotgun pellet may potentially cause severe injury to the central nervous system when the head is affected, which can be safely prevented by a prompt but deliberate surgical removal. The study would also like to emphasise the importance of education to reduce gunshot incidence in the pediatric population.

Management of unusual dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) in a developing country: Case report and review of the literature.

Dysplastic cerebellar gangliocytoma or Lhermitte-Duclos disease (LDD) especially in children are extremely rare. In this report we add one further case to this rare entity. A three year old boy with a history of cerebellar and brain stem compression signs was presented in unconscious condition. Computerized tomography (CT) scan revealed a well defined lesion mixed with area of calcification in the right cerebellum and severe obstructive hydrocephalus. Ventricular shunting was performed followed by gross total tumor removal three days after shunting. In the follow up period, the patient showed almost total resolution of all neurological deficits. MRI has been an imaging tool to preoperatively diagnose this disease; otherwise it would be uncertain preoperative diagnosis. However, in this report we would like to emphasize that not all uncertain diagnosis of LDD leads to palliative treatment. Well demarcated lesion may account for the safe surgical resection of this disease.