Intracranial rosai-dorfman syndrome

Rosai-Dortman disease [KDD] is a rare and idiopathic histoproliferative disorder characterized by painless cervical lymphadenopathy. Intracranial involvement is extremely rare. Three cases 6 years, 36 years and 32 years of age with RDD are reported here. The 6-year-old female child presented with bilateral submandibular lymphadenopathy and generalized seizures. She had an extensive mass in skull base with periventricular extension on MRI. Incisional biopsy of submandibular gland proved the diagnosis of RDD and the patient was referred for radiotherapy. Thirty-six-year-old male presented with generalized seizures and minimal focal neurological deficit. Magnetic resonance imaging of head revealed an enhancing right frontal parasagittal mass simulating with meningioma. A total excision proved the diagnosis of RDD. Third case was a 32-year-old female presenting with generalized seizures and no neurological deficit. Magnetic resonance imaging revealed left frontal parafalcine mass enhancing on contrast with perilesional oedema. Excision was done and on histopathology it turned out to be RDD. The clinical presentation, differential diagnosis and issues of treatment of RDD are discussed here

Neurenteric cyst in the region of conus medullaris

The authors present a case of 35-year-old male who presented with weakness and numbness of both lower limbs and urinary disturbance. Magnetic resonance imaging dorsolumbar spine was suggestive of neurenteric cyst in the region of conus medullaris. Complete surgical excision was performed. The relevant literature is discussed briefly

Outcome predicting factors in intracranial aneurysms: defining the complex aneurysms

The development of neurosciences has made the understanding and management of intracranial aneurysms better. It has been realized over the years that there may be a subgroup of patients who fare differently from the rest. The identification of factors which make the aneurysm different or complex may help in prognosticating patients. The aim of the current study was to identify such factors to assess how well they correlated with the outcome. Three-hundred-fourteen consecutive cases of spontaneous subarachnoid haemorrhage with intracranial aneurysms were retrospectively analyzed. Sixteen independent factors broadly categorized into three categories viz., patient related, radiological factors and surgery related factors were analyzed and their correlation with outcome studied. Univariate and multivariate analysis was done using logistic regression analysis and P values, and predictive values were determined. Five factors viz, WFNS grade 4-5, clinical vasospasm, smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to have highly significant association with poor outcome both using univariate and multivariate analysis. The clinical factors predominate and have more significant association with the outcome. The presence of factors viz, WFNS grade 4- 5, clinical vasospasm [DIND], smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to correlate with poor outcome and any of these factors could lead to poor outcome and are sufficient to label the patient as having a complex aneurysm

Arachnoiditis mimicking recurrent spinal ependymoma

Spinal arachnoiditis is a cause of persistent symptoms or recurrence of symptoms in 6-16% of postoperative patient. Spinal arachnoiditis mimicking ependymoma tumour recurrence in a young child is reported here. A 9-year-old child was operated 3 years back for extensive lumbar and sacral ependymoma. He presented with short history of rapidly progressive paraparesis and radiology was stongly suggestive of recurrent tumour in lumbar spinal canal. However, surgery revealed only CSF loculation in the spinal canal. No tumour was seen. The patient improved after adhesiolysis. Postoperative spinal arachnoiditis can mimic tumour recurrence in ependymomas. This is an interesting case observed by us and we advise that the possibility of spinal arachnoiditis should be kept in mind in the differential diagnosis of causes of neurological deterioration in previously operated cases of ependymoma

Surgery in adult spinal dysraphism: a series of 51 patients

To study the various clinical presentation of spinal dysraphism in adults and analyse the risks and benefits of surgical treatment for spinal dysraphism in adults. Patients of spinal dysraphism who were operated after 16 years of age were included in this study and the clinical-radiological details, operative finding and histopathological findings of these patients were analysed. Age of the patients ranged from 16 - 58 years, with the mean age at surgery being 24.5 years. Lipomatous malformation was the commonest associated anomaly [53%] followed by split cord malformations [23.6%]. Sensory [62.7%], motor [60%] and bladder disturbances [49%] were the most common presentations. Detethering led to resolution of pain in 68%, healing of trophic ulcers in 100% and improvement in motor and sensory symptoms in 29% and 37.5% of the patients respectively. The results for sphincter dysfunction were particularly disappointing and none of these patients had improved during the follow-up period. There was no deaths or major postoperative complication in this study. This study clearly shows that a substantial number of patients benefit by surgery with the surgical outcome being excellent for healing of trophic ulcers and relieving pain. However, as none of the patients with established sphincter disturbances improved following surgery, prophylactic surgery early in childhood may be required in this group of patients to prevent the development of autonomic disturbances