cystic-metastasis-from-tonsillar-cancer—a-case-report

INTRODUCTION Brachial cleft cyst is the most common cause of cystic lesion in the neck in younger population. But in patients above 40 years of age, about 80% of the cystic neck lesions were reported to be malignant. The incidence of such type of metastasis from Waldeyer's ring accounts for 33-62%. A 60 year old male presented with aCASE REPORT painless swelling in the left side of the neck for 8 months. Clinical features, imaging and FNAC favoured infected brachial cyst. Excision biopsy showed metastatic carcinomatous deposits with high mitotic index. Panendoscopy with tonsillectomy done. Biopsy of left tonsil showed moderately differentiated squamous cell carcinoma. Then adjuvant Radiotherapy was given to the patient and on 6th month follow up, patient had no features of recurrence.CONCLUSION For any cystic neck lesion in an adult, metastatic disease must be considered as a differential diagnosis. And for proven malignant cystic cervical lymph node, a primary malignancy involving Waldeyer's ring should be suspected. Initially imaging and FNAC may be taken. If FNAC is inconclusive, excision biopsy may be done. Then depending upon the biopsy finding, pan endoscopy with guided biopsies and tonsillectomy may be done

Lamina Terminalis Fenestration in Ruptured Anterior Circulation Aneurysm for Hydrocephalus - The Limitations

Aim: The aim of the study is to analyze the usefulness of lamina terminalis fenestration (LTF) in hydrocephalus secondary tosubarachnoid hemorrhage while performing surgical interventions for anterior circulation aneurysm and to know the limitationsof this procedure in patients who undergo clipping of these aneurysms.Materials and Methods: A total of 81 aneurysms in 78 patients were included in this study from the year 2001 to 2018. Patientsin the age range of 12–80 years were included. Male-female ratio was 1:1.1. Until February 2011, LTF was done for 9 patientswho had any degree of hydrocephalus as an adjuvant to clipping of the anterior circulation aneurysms. After March 2011, insteadof LTF, intraoperative ventricular tapping was done in patients with hydrocephalus.Results: Among the 9 cases who had undergone LTF, two patients developed frontoparietal subdural hygromas with masseffect. From March 2011 till date after stopping LTF, only 2 of 47 patients required ventriculoperitoneal shunt who ultimatelydeveloped chronic hydrocephalus.Conclusion: LTF can lead to potential complications such as subdural hygromas due to poor absorption in blood cloggedsubarachnoid spaces. This procedure must be adopted with caution as it has its own limitations.