Bone flap resorption following cranioplasty in a cost-constrained scenario.

Bone flap resorption is an infrequently reported yet significant late complication of autologous bone cranioplasty. It requires serial imaging both to pick up and to monitor progression. Custom-made implants avoid this complication, but are expensive. In a resource-limited situation, when bone flaps placed in the abdomen undergo demineralisation and sutures are used to fix the flap as opposed to plates, where artificial cranial flap substitutes are prohibitively expensive and frequent postoperative imaging may not be feasible, prevention and management of this complication will continue to remain a problem.

Intracranial epidermoid--a 10-year study.

Twenty-eight cases of intracranial epidermoids were operated over a period of 10 years at the Bangur Institute of Neurology, Kolkata; 17 of them were male and 11 were female with an age range of 11 to 55 (mean 28.21) years. Their locations include--cerebellopontine angle region (n = 15), fourth ventricle (n = 6), lateral ventricle (n = 3), corpus callosum (n = 2), pineal region (n = 1) and basal cistern near temporal lobe (n = l). Hearing loss and vertigo were commonest features of cerebellopontine angle epidermoids. Fourth ventricular tumours presented with gait disturbances and cerebellar signs. Symptomatology of other lesions were varied. CT scan was diagnostic in 23 cases. Sixteen patients had ventriculomegaly and 10 of them required ventriculoperitoneal shunt. Total removal was achieved in 6, near total in 14 and partial in 8 cases. Five patients died. Postoperative complications included chemical meningitis in 7, worsening of cerebellar functions in 3 and aggravation of cranial nerve deficits in 2 patients. All of them except one case of cranial nerve deficit resolved with time. Nineteen patients were followed up over a mean duration of 5 years and 10 months. Reoperation was required in one. Rest had satisfactory outcome.

Bone flap preservation after decompressive craniectomy--experience with 55 cases.

We describe our experience with the previously described technique of preservation of the bone flap in a subgaleal pocket created over the intact side of the calvaria, discuss our experience of this method and review the literature to compare this method with other alternative techniques.

Peripheral nerve tumors: management strategies and molecular insights.

Because of its relative rarity and a wide variety of clinical manifestations, peripheral nerve tumors (PNTs) often present to specialists from widely different disciplines, thus often resulting in delayed diagnosis and a non-cohesive pattern of management. Critical appraisal of the history and physical examination followed by radiological investigations, by experienced medical personnel, ultimately suggests that the extremity mass is perhaps a PNT, rather than the wide variety and more common soft tissue tumors. Included in this appraisal is a search for a pre-disposition syndrome, the most common of which are neurofibromatosis-1 and -2 (NF1, NF2) and schwannomatosis, which may require life-long careful follow up. Intra-operative and post-operative management decisions in a multidisciplinary manner with knowledge of the biological, pathological and clinical behavior of the PNT, is of utmost importance. In the context of pre-disposition syndromes, where multiple tumors may exist along with other nervous system lesions, molecular biological insights and hopefully the biological therapies that stem from this knowledge are of interest. In this article the spectrum of PNTs and their management protocols, including the algorithm for treatment of malignant PNTs advocated by our institute, are presented and currently available genetic insights and probable role of experimental therapies are briefly reviewed.