ABSTRACT
Chiari malformation is the commonest anomaly of the craniovertebral junction involving both the skeletal as well as the neural structures. It is congenital anomaly of the hindbrain characterised by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Most common presenting symptoms was pain in the nape of neck with sub-occipital headache and weakness. If not intervened early in these cases they may progress to quadriparesis and respiratory failure. This study includes authors experience of 30 surgical corrections of Chiari malformation performed at civil hospital Ahmedabad from 2017 to 2019. The age and sex of the patient, the presence of syrinx, the type of surgical procedure and the clinical outcome were determined post-operatively and on follow up. Cerebro spinal fluid leak and collection were observed in patient who undergone duroplasty only with no leakage in patient undergone syringo-subarachnoid shunt. Overall, tingling/numbness had best improvement showed improvement in 13 out of 16 patients. Power showed improvement in 20 out of 27 patients and pain showed improvement in 18 patients. Wasting, clawing and cerebellar signs and bony deformity showed no improvement in any of the above procedures. Authors can conclude for Chiari malformation decompression with or without duroplasty with additional procedure with post-operative physiotherapy and analgesia is the suitable treatment.
ABSTRACT
Background: Although meningiomas represent only ~20% ofintracranial tumors, they have been referred to as “the soul ofneurosurgery.” Meningiomas are the most common nonglialprimary tumors of the central nervous system, representing 15to 20% of primary brain tumors. Peak incidence occursbetween the fourth and sixth decades. The female/male ratio isreported variously as 2:1 to 4:1. Management of meningiomacan be done either by surgery, by radiotherapy or by medicaltreatment or combination of any of three approaches.Aims & objectives: The aims & objectives of this study wereto identify the incidence and pathological nature of intracranialmeningiomas. Also to study surgical outcomes of patientsundergoing intracranial meningioma surgery.Methods & Materials: This study was done at neurosurgerydepartment at a tertiary care centre. Retrospective analysis ofdata collected through hospital information system of patientsoperated for intracranial meningiomas between September2014 & March 2017.Results: In present study of 100 cases of intracranialmeningioma, majority were occurring at convexity 34 (34%)followed by falcine 14 (14%), sphenoid wing 10 (10%) etc. Outof 100 cases around 70% cases occurred in 4th, 5th and 6thdecade. There was a female preponderance in our series witha male:female ratio of 1:1.63. The most commonhistopathological type of tumor was meningothelialmeningioma (38%) followed by others. The commonestcomplication noted in present series was post-operative limbweakness either hemiparesis or monoparesis. Overall outcomeafter surgery was seen as 66% neurologically intact patientsand mortality was only 6%.Conclusion: Present study reported that maximum incidenceof meningiomas is in 3rd, 4th & 5th decade and Females weremore affected than male with ratio of 1.63:1. In our study themost common histopathological type of tumor wasmeningothelial meningioma. The most common complicationswere limb weakness, followed by decreased vision and lowercranial nerve palsy which improved with time.