[Show abstract][Hide abstract]ABSTRACT: Medullomyoblastoma is a variant of medulloblastoma with an aggressive course. It is typically seen in children less than 10 years of age and usually arises from the cerebellar vermis. Authors report an unusual case of medullomyoblastoma arising from the right middle cerebellar peduncle in an adult patient and pertinent literature is reviewed regarding this uncommon entity.
[Show abstract][Hide abstract]ABSTRACT: The vertebral arteries are rarely injured in penetrating neck trauma due to their deep location in the foramen transversarium. These injuries in isolation are not associated with neurological deficits or ischemic changes on radiology as the collaterals are usually sufficient. We report a case of fatal unilateral vertebral artery stab injury leading to bilateral cerebellar and brainstem infarction. The carotid Doppler ruled out the presence of any carotid artery injury. Life-threatening injuries are possible in the presence of hypoplastic contralateral vertebral artery or inadequate flow from the anterior circulation not making up for the deficit. This emphasizes that thorough evaluation and timely management of suspected injuries to even a single vertebral artery should be undertaken.
[Show abstract][Hide abstract]ABSTRACT: Pituitary apoplexy is a rare clinical event, used to occur spontaneously. Although, some predisposing factors for pituitary apoplexy is reported ie. head injury, digital cerebral angiography, bromocriptine therapy, coughing, lumbar puncture for CSF drainage, pneumoventriculography, even during surgery, in the immediate postoperative period and raised intracranial tension. Although pituitary apoplexy occurring following radiotherapy as primary treatment modality is reported, however, apoplexy occurring in residual adenoma following surgery, receiving adjuvant radiation therapy for residual adenoma is not reported in the literature. Authors reports two-cases of pituitary apoplexy, which occurred in the residual pituitary adenoma after a varying period in the follow-up period. These patients were previously operated by transcranial approach for decompression of the pituitary adenoma. The pituitary apoplexy occurred in one case after an interval of one and half years following surgical intervention for pituitary adenoma decompression and next case developed after five years. Both the cases had also received radiotherapy in the postoperative period for residual pituitary adenoma.
Full-text Article · Jun 2016 · Romanian Neurosurgery
[Show abstract][Hide abstract]ABSTRACT: We examined the effect of early intensive care unit (ICU) adherence to 2007 Brain Trauma Foundation Guideline indicators after traumatic brain injury (TBI) on inpatient mortality at a level 1 trauma center in India (Jay Prakash Narayan Apex Trauma Center [JPNATC]) and Harborview Medical Center (HMC) in U.S. among adults older than 18 years with severe TBI. At each site, ICU Guideline adherence in first 72 hours for 17 indicators was determined and expressed as a percentage. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores at 3, 6, and 12 months after discharge. JPNATC and HMC Guideline adherence rates were 74.9% [11.0] and 71.6 % (SD ±10.4), and overall in-hospital mortality was 24% and 27%, respectively. At JPNATC, less than 65% ICU Guideline adherence was associated with higher inpatient mortality (adjusted relative risk [aRR], 1.92; 95% confidence interval [CI], 1.11-3.33) and an increase in ICU Guideline adherence rate by 1% was associated with a 3% lower in-hospital mortality (aRR, 0.97; 95% CI, 0.95-0.99). Among patients discharged with a GOS score of 2-4 at JPNATC, 67% improved at 12 months (R2 = 0.991; P < 0.01; 99% follow-up rate) compared with discharge, but 35%, 25%, and 14% of patients discharged with a GOS score of 3-5 deteriorated at 3, 6, and 12 months to a lower GOS at home. Achieving early ICU adherence to guideline indicators was feasible and associated with significantly lower in-hospital mortality at JPNATC. Although the intracranial pressure (ICP) monitoring rates varied, in-hospitals deaths were similar between the two institutions. Although long-term outcomes generally improved, patients discharged with favorable GOS score often deteriorated at home.
[Show abstract][Hide abstract]ABSTRACT: Twin nasal dermal sinus with associated intracranial dermoid located in interfalcial region is a very rare occurrence and is reported only in the occipital and temporal regions. However, multiple sinuses located in the canthus and dorsum of nose are not reported till date. Authors report an interesting first case of interfalcial dermoid cyst associated with twin discharging dermal sinuses, who underwent successful surgical repair in the world literature. The authors report the management of an unusual case and the review has been discussed briefly.
Article · Jan 2016 · Journal of Pediatric Neurosciences
[Show abstract][Hide abstract]ABSTRACT: Two-wheeler riders have a disproportionately higher incidence of traumatic brain injuries (TBI) as compared with other modes of transport. Diagnosis of posttraumatic falcotentorial subarachnoid hemorrhage can be made from CT scan. With such findings on CT scan, the authors are proposing a new sign named as “Mercedes-Benz” sign to identify such type of hemorrhage.
[Show abstract][Hide abstract]ABSTRACT: Neurenteric cysts (NEC) are uncommon, benign, congenital lesions. Ventral foramen magnum (FM) location is very rare. The difficulties in diagnosis and management aspects are detailed with a review of the pertinent literature. We report four new cases of ventral FM NEC, all managed surgically and present a literature review of ventral FM NEC. A retrospective analysis of histopathologically confirmed cases of ventral FM NEC, operated from 2010-2013 at our institute, was performed. For review, only those cases of NEC extending from the lower clivus to the C2 level constituting the foramen magnum were included. Including our four cases, a total of 47 cases were identified. The male to female ratio was 1.2:1. Mean age was 33.5 years (range 1-60 years). Neck pain and occipital headache were the most common symptoms, followed by limb weakness and cranial nerve paresis. Recurrent meningitis was noted in three cases. Hyperintensity on both T1- and T2-weighted sequences with absent enhancement was the most common finding on MRI. Surgical approaches were as follows: suboccipital (n = 21), far/extreme lateral (n = 18), retrosigmoid (n = 6), and transoral (n = 4). The extent of resection was as follows: total, 26; near total, 6; subtotal, 9; and partial, 3 cases. Cerebrospinal fluid diversion was done in four cases for intracranial hypertension. Mean follow-up duration was 26.8 months (range 1 month-9 years). Recurrence was noted in four (8.5 %) cases. One (2 %) case had malignant transformation. Mortality rate was 4 %. Foramen magnum neurenteric cysts are rare, benign tumors of the central nervous system. Accurate preoperative diagnosis can often be established with MRI. Surgical removal is the treatment of choice. Complete excision is ideal but often not possible. Near total removal would suffice with good progression-free periods. A long-term follow-up with radiological studies is necessary as delayed recurrences can occur.
[Show abstract][Hide abstract]ABSTRACT: To evaluate and correlate retinal nerve fiber layer changes on optical coherence tomography (OCT) with visual functions in pituitary adenomas in order to define OCT changes prognostic for visual recovery after neurosurgery.
[Show abstract][Hide abstract]ABSTRACT: Introduction:
Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.
The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).
Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.
[Show abstract][Hide abstract]ABSTRACT: Combined fracture involving atlas together associated with axis (CAAF) accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5), commonest mode of injury was fall (n=3), time interval since injury was within 24 hours in (n=4), however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3), neurological deficit (n=2), neck tenderness and swelling tenderness (n=3) Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5), one case had multiple site fracture of both arches, odontoid fracture (n=2), lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3), transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study.
Full-text Article · Sep 2015 · Romanian Neurosurgery