A Middle Path in the Surgical Management of Glomus Jugulare: Lessons Learnt from a Short Series.

INTRODUCTION: Glomus jugulare are rare vascular tumors arising from the jugular bulb with intra- and extra-cranial extensions. Although considered benign, these tumors are locally invasive with involvement of critical neurovascular structures causing significant morbidity. Due to their highly vascular nature, they pose a challenge for surgeons. SETTINGS AND DESIGN: This is a retrospective analysis of a short series of glomus jugulare managed in a tertiary state-run referral center. SUBJECTS AND METHODS: Three patients (two females, one male) of ages ranging from 32 to 55 years were evaluated for glomus jugulare and surgically managed. In the first case, total petrosectomy after transposing the facial nerve, cerebellopontine angle exploration, neck dissection and infratemporal fossa approach including removal of the internal jugular vein were done. Case 2 and Case 3 were managed with subtotal resection. Radiotherapy (RT) for residual tumor was given in Case 2. RESULTS: Case 1 had secondary hemorrhage on 8th postoperative day to which she succumbed on postoperative day 18. Case 2 and Case 3 have been comfortable with no fresh deficits after 36- and 6-month follow-up, respectively. Apart from this, the authors also enumerate the various "lessons" learnt from this series. CONCLUSION: Planned subtotal resection followed by RT or stereotactic radiosurgery for the residual tumor yields a better outcome with lower morbidity and mortality.

Giant Encephalocoele: A Rare Case Report and Review of Literature.

Giant encephalocoeles are rare entities with only one case series and few case reports reported in medical literature. Encephalocoeles, which reach a size larger than the head size, are be called Giant encephalocoeles. We report a case of a 6 month old child who had giant encephalocoele with delayed motor milestones in the form of inability to hold neck. Anesthetic implications include difficulty in securing air way due without undue pressure on the sac. She underwent VP shunt followed by excision of the encephalocele sac. Patient is doing well at 1 year of follow up. Preoperative neurological status and amount of brain tissue herniating into the sac are the most important factors determining the long term prognosis.