Giant frontal encephalocele

Giant encephaloceles are described in the occipital location. However, giant frontal encephaloceles are extremely rare. We came across an unusual case of giant encephalocele in the frontal region, in a 7-month-old child. Complete excision of the lesion and repair of the defect was done with good outcome. This constitutes a rare anomaly of cranium bifidum

Giant pituitary adenomas: surgical outcome in a series of 127 cases

To analyze the surgical and visual outcome of giant pituitary adenomas. One-hundred-twenty-seven patients surgically treated over a 9-year period were studied. Fifty-four-point-three percent had non-functioning adenomas. Among the functioning adenomas, prolactinomas were the most common. A total of 90 transsphenoidal and 52 transcranial procedures were performed in 127 patients. The complications and deaths were significantly higher in the transcranial group. There were a total of 15 deaths [11.8%], Thirty-two-point-two percent had single/multiple postoperative complications. Vision improved in 49 patients [41.9%] at the time of discharge. Thirteen-point-eight percent of the pituitary adenomas are giant. Transsphenoidal surgery was the procedure of choice for most of the patients. These tumours represent a difficult group to treat. Prolactin estimation and preferably immunohistochemical analysis should be done in all patients in order to clinically diagnose indistinct prolactinomas

Asymptomatic posterior fossa subdural effusion

Though subdural effusion is very common supratentorially; a similar occurrence in the posterior fossa is rather unusual with all the cases of posterior fossa subdural collection reported in the literature being symptomatic, mandating some form of intervention. An asymptomatic posterior fossa collection is not reported before as per the authors' review of the literature. The authors report a 5-year-old child was found to have a posterior fossa subdural collection postoperatively after a posterior fossa surgery. As the child was asymptomatic, the parents were reassured and the child was managed conservatively. Posterior fossa subdural effusion is very rare condition mandating some form of surgical intervention. It can occasionally be asymptomatic, in which case a conservative approach can be followed. A regular follow-up is recommended to detect any neurological deterioration, however

Acute epidural haematoma following ventriculoperitoneal shunt in an adult

The authors report a 50-year-old patient of pituitary macroadenoma with hydrocephalus, who developed a large left parieto-occipital epidural haematoma following placement of a ventriculoperitoneal shunt. This is the first case report describing this complication in an adult patient, and it is hypothesised that coagulation of the dura along with rapid lowering of intracranial pressure, may lead to its stripping from the bone with attendant tear in the emissary vein [s] resulting in the possibility of epidural haematoma formation in adults. Judicious dural coagulation should therefore avoid this uncommon and potentially life-threatening condition

Unusual case of cystic cerebellar metastasis from breast cancer

Cerebellar metastasis in a 70-year-old female is reported. She was admitted with a 1-month history of vertigo and unsteadiness of gait. There was no history suggestive of raised intracranial pressure. Except for cerebellar signs on right side, she had no other neurological deficit. Systemic examination revealed no abnormality except for a 3cm mobile lump under the nipple that was present for last 10 years without increasing in size. Computed tomography and magnetic resonance imaging of the head revealed a cystic tumour 3 x 3 cm diameter in right cerebellar hemisphere with a possible diagnosis of haemangioblastoma. The lesion was excised and she had an uneventful recovery. Histopathology revealed a metastatic carcinoma of the breast. After two months she underwent modified radical mastectomy. She received deep x-ray therapy for the brain and the breast. Follow-up 6 months later showed no neurological deficits or local recurrence

Petroclival tumour surgery: a personal experience of 20 cases

petroclival lesions are amongst the most difficult lesions in Neurousrgery and carry a significant mortality and morbidity. However, over the last decade, publications from specialized centers have reported on the outcome of surgery for these lesions. we have analysed 20 patients, who had undergone surgery for petroclival tumour in general neurosurgical center over a 3-year-period [January 1997- December 1999]. there were 10 meningiomas, 5 chordomas, 3 trigeminal neurofibromas and 2 giant cell tumours. Seventeen patients had primary surgery while 3 had surgery for recurrent lesions. Investigations included CT scan, MRI and DSA or MRA in all patients. Ten patients were operated through retromastoid post-sigmoid approach, 7 through subtemporal combined with orbito-zygomatic approach and 3 were operated through combined retromastoid and subtemporal approach. There were two deaths. One was primarily related to surgery and the other due to respiratory complications. Six patients developed postoperative chest infection and 3 postoperative haematoma, of whom only 1 required surgical evacuation. Postoperative meningitis was recorded in 2 patients. Follow-up ranged from 9 months to 36 months with a mean of 21 months. None of the patients have, so far, developed recurrence or re-growth significant enough to merit a re-operation. tumour could not be removed totally in a significant number of cases inspite of all advances. Radiosurgery is an important adjuvant in the management of residual and recurrent lesions. Outcome was not different when compared to a specialized Neurousurgery unit

Multiple central nervous system tumors and combined treatment modalities - an illustrative case

Multiple space occupying lesions in the craniospinal axis pose special type of challenges in their management. Surgeries for decompression or total excision of the symptomatic tumors at various sites and at different times are needed. Radiosurgery and administration of chemotherapeutic agents are other modalities for the treatment of such lesions caused by benign or malignant conditions and acute or chronic infections. We report a case of a young woman with central neurofibromatosis harbouring bilateral acoustic neurinomas multiple meningiomas and other cranial and spinal neurofibromas. she underwent radiosurgery for the right vestibular schwannoma [VS] and surgery for the left sphenoidal wing meningioma and a large right C5 nerve root neurofibroma. There was no evidence of tumor necrosis or shrinkage 4 years after the radiosurgery. Brain stem compression increased over 4 years period. she is likely to need futher intervention for symptomatic lesions