Background: Calcified chronic subdural haematoma (CCSDH) is a rare complication of a relatively more common condition of Chronic Subdural Haematoma (CSDH). There is conflicting opinion regarding management of such type of disease.

Aim: Surgical procedure for this type of lesion has not been established due to the limited expansion of the brain after surgery. This is probably related to the presence of a thick calcified inner membrane, which is frequently adherent to the cortical surface of the parenchyma, limiting the dissection from the brain.

Case report: We report a case of CCSDH which was successfully excised in toto with good neurological outcome and post-operative Computed Tomography (CT) scan documented brain expansion.

Conclusion: From our experience with present case we conclude that such well loculated calcified thick CSDH can be safely excised in toto if following points are taken care. First, craniotomy is properly planned to expose a healthy dural margin of 1 cm beyond calcified lesion all around. Second, non-calcified vascular membrane of CSDH attached to margin of CCSDH are cauterized before incised. Third, care taken during dissection of CCSDH from parenchymal surface preserving the arachnoid. Further study regarding the pathogenesis of CCSDH may help us in preventing the development of this unique entity.

Keywords: armoured brain, calcified chronic subdural haematoma, chronic subdural hematoma

Background: For many years the same model has been applied to neurosurgical education; and unfortunately with the shift of healthcare to political and socioeconomic areas, it forced many surgical residents and fellows to limit their OR exposure only to certain cases. With limited resources given to graduate medical education facilities, now a more optimal approach to surgical education has to be adopted. There is a need for modern hands-on, yet safe approach to crucial neurosurgical procedures. A Virtual Reality/Augmented Reality technology can provide an optimal solution to any neurosurgeon who seeks to improve his/her OR skills on demand, without compromising patient safety, wasting OR time and most importantly cost efficiently for the hospital.

Methods: We performed online search of the Google Scholar and PubMed databases for the following keywords “virtual reality,” “neurosurgery,” “spine surgery,” “augmented reality,” separately as a single word and as a phrase. Our search strategy included publications from early 2000s to 2019 years respectively.
Results: A unique combination of 3D VR/AR technology allows neurosurgeons to get a precise planning before the actual procedure, additionally, visualize a roadmap for possible complications during the surgery. Some critical tasks of complex procedures could be segmented and rehearsed before the surgery for optimal outcome. One who immerses in 3D VR can easily explore the area of interest from any possible angle.

Conclusion: Integration of VR/AR technology in the preoperative and operative fields, allows neurosurgeons to maximize efficiency, technique and even provide an educational benefit for the patients undergoing neurosurgical procedure.

 Keywords: augmented reality, neurosurgery, virtual reality