Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation.

Medulloblastomas were originally classified under gliomas of the cerebellum until Bailey and Cushing in 1925 named these tumors as medulloblastoma. At present these tumors are classified under primitive neuroectodermal tumor. Surgical excision followed by craniospinal irradiation is the treatment of choice. A 13-year-old-girl operated for posterior fossa medulloblastoma 5 years ago presented with history of headache and vomiting on and off for 4 days in late August 2008. The MRI showed left frontal tumor which on excision was reported as medulloblastoma. Even after optimal treatment reports of recurrence abound in literature. The most common location is in the posterior fossa, followed by spinal, supratentorial, and uncommonly, systemic metastases. We conclude that medulloblastomas are highly aggressive tumor with high local recurrences if the initial excision is incomplete and that recurrence in the supratentorial area although uncommon is still a possibility. This mandates regular follow up of these children till adulthood to catch early recurrences and metastatic disease.

Spontaneous intracystic hemorrhage of the arachnoid cyst: a case report and review of literature.

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. We report a case of a years right handed lady, who presented to the emergency department with the complaints of headache and vomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region. On the fifth day of admission, patient had sudden onset of severe headache associated with loss of consciousness for about 3-4 minutes with neck rigidity. A CT scan of head was repeated, which showed left fronto-parietal cystic lesion with intracystic bleed and SAH. Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid with normal brain surface and there were no evidence of any vascular malformations. Marsupilization of the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst with spontaneous intracranial haemorrhage is reviewed.

Traumatic posterior fossa extradural haematoma.

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH with low GCS or the haematoma of more than 10 ml were subjected to evacuation. Since the volume of the posterior fossa is limited, patients deteriorate early with the development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases. A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury. Vomiting was the most common symptom accounting for 67% of cases followed by transient loss of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%). A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in 27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%.

Endoscopic treatment of chyluria using povidone Iodine with contrast agent : a preliminary experience

Objective: To evaluate the safety and efficacy of povidone iodine with contrast agent as a sclerosant for the endoscopic treatment of chyluria. Patients and Methods: From December 1999 to October 2003; a total of 22 patients having chyluria were treated. After their baseline evaluation they were subjected to endoscopic instillation therapy. The scleros-ing agent was prepared by using povidone iodine with contrast agent diluted with sterile water in the ratio of 1:1:3. The side with chylous efflux was identified via cysto-scopy. Using a bulb tip ureteric catheter the sclerosing solution was instilled in the pelvicalyceal system. Unilateral instillation was performed in 13 cases; eight on the left and five on the right side. In the remaining nine cases that had bilateral chylous efflux instillation was performed on both sides in the same session. Fluoroscopy was used to see the complete filling of the pelvicalyceal system. The sclerosing solution was kept in the system for five minutes and the ureteric catheter was then withdrawn. Results: All patients were cured from chyluria in the immediate post operative period. Relapse occurred in three patients; but retreatment by instillation therapy resulted in cessation of chyluria also in these cases. The longest follow up was three years; the shortest two months. Fifteen patients were lost to follow up after nine months. None of the cases but the three mentioned previously had relapse during the follow-up period. Conclusion: Povidone iodine is a very safe and efficacious agent for the endoscopic treatment of chyluria by instillation therapy. Using a contrast agent along with it helps to know; under fluoroscopic guidance; the exact amount of sclerosing agent to be instilled to completely fill the pelvicalyceal system. Thus overfilling of the system is avoided and the complications occurring due to pyelointerstitial backflow of the sclerosant are prevented