Epidermoid cyst inside anterior sacral meningocele in an adult patient of Currarino syndrome manifesting with meningitis.

The Currarino triad, also known as the "Currarino Syndrome", is a rare complex of congenital caudal anomalies including three main features; a sacral bony deformity, anorectal malformations, and a presacral mass. We present an extremely uncommon case of Currarino syndrome in adulthood presenting with repeated episodes of meningitis. Magnetic resonance imaging of spine was suggestive of caudal regression. Cord was low lying, conus ending at L3 level with evidence of tethering at that level. A large cyst was noted in the sacral canal extending forwards in the pelvis through the widened sacral foramina on right side. She was operated through a posterior approach, via sacral laminectomy. Dura was opened in the midline, large silvery white epidermoid tumor was found completely occupying the anterior sacral meningocele. The case and relevant literature is discussed.

Giant intramedullary epidermoid extending from the brain stem to the upper thoracic spinal cord.

Epidermoid cysts are benign tumors originating from ectoderm remnants. Most epidermoid cyst cases are intracranial. Spinal epidermoid cysts are uncommon and most of the reported cases are in the thoracic and lumbar spine. Occurrence of intramedullary epidermoid cysts in the cervical spine is extremely rare. An 18-year-old male with a giant intramedullary tumor extending from the brain stem to the upper thoracic spinal cord presented at our outpatient department. The patient underwent total excision of a silvery white lesion through a midline myelotomy. Histopathological examination was suggestive of an epidermoid cyst. We present a brief report of the case and discuss the relevant literature.

Fat graft migration causing recurrent cervical cord compression.

AIM: Fat graft migration following spinal cord surgery is an uncommon problem. Only few cases of fat graft migration causing cauda equine syndrome, recurrent sciatica, and root compression following lumbar spine surgery have been reported. We report a case of fat graft migration causing symptomatic cervical cord compression. MATERIAL AND METHODS: A 45-years-old male with cervical spondylosis underwent anterior C4-5 discectomy and excision of hypertrophied ligament. A dural tear that occurred during the procedure was repaired with fat graft harvested from thigh. Significant improvement in stiffness was noted postoperatively. After 15 days, the patient presented again with worsening lower limbs stiffness. Magnetic resonance imaging of spine was done which revealed displacement of the fat graft causing cervical cord compression. RESULTS: Re-exploration was done and the migrated fat graft was removed. Post operatively patient noticed significant improvement in stiffness in both lower limbs. CONCLUSION: Autologous fat graft is one of the best materials used in sealing the dural cerebrospinal fluid leak during spinal surgery. However sometimes it may migrate and cause compression of cord and roots with relative symptoms. This complication should be kept in mind as removal of migrated fat graft will relieve these symptoms.

An anterior high cervical retropharyngeal approach for C1-C2 intrafacetal fusion and transarticular screw insertion.

Craniovertebral instability is a significant challenge to neurosurgeons. We describe an alternative anterior high cervical retropharyngeal approach for C1-C2 intrafacetal fusion and transarticular screw insertion. We dissected 10 cadaveric specimens and fixed the atlantoaxial joint with C1-C2 intrafacetal fusion and transarticular screw insertion. We achieved good surgical exposure and fixation in all cadavers with this technique. The anterior high cervical retropharyngeal approach for C1-C2 intrafacetal fusion and transarticular screw insertion may provide an alternative fusion technique for craniovertebral fusion.

Polytetrafluoroethylene sponge syringosubarachnoid shunt.

Syringomyelia is condition in which a cyst or cavity forms inside the spinal cavity. Its management always remains a difficult. A variety of surgical techniques have been used in management of syringomyelia. Syringosubarachnoid shunt remains an effective method in management of syringomyelia. Shunt tube obstruction remains an important complication of shunt procedure. We describe a novel technique of use of polytetrafluoroethylene sponge shunt for syringosubarachnoid shunt in patient with large syrinx and Chiari 1 malformation. Polytetrafluoroethylene sponge is a non irritant material with multiple porosities that is less susceptible to blockages or kinking. It could provide a good alternative technique in syringosubarachnoid shunting.

Cervical intradural disc herniation and cerebrospinal fluid leak.

Cervical intradural disc herniation (IDH) is a rare condition and only 25 cases of cervical have been reported. We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. The patient underwent C5/6 discectomy through anterior cervical approach. Postoperatively, the patient improved in stiffness but developed cerebrospinal fluid leak and the leak resolved with multiple lumbar punctures.

Dolichoectasia of vertebrobasilar arteries as a cause of hydrocephalus.

Dolichoectasia of vertebrobasilar artery is a condition in which the vertebral/basilar artery is elongated, distended and tortuous. It is usually asymptomatic. It may present with compressive or ischemic symptoms. Hydrocephalus as a complication of vertebrobasilar dolichoectasia is rare. We present a case of a 60-year-old male with dolichoectasia of the basilar artery causing compression of the third ventricular outflow and, thus, presenting with noncommunicating hydrocephalus.

Jarcho-Levin syndrome with diastematomyelia: A case report and review of literature.

Jarcho-Levin syndrome (JLS) is a type of segmental costovertebral malformation. It is a congenital disorder characterized by a variety of vertebral and costal anomalies. Only four cases of Jarcho-Levin syndrome with diastematomyelia have been reported in the literature. We report the fifth case of Jarcho-Levin syndrome with diastematomyelia and review the literature. A one-and-half-year-old male child born of full-term normal delivery was brought with complaints of progressively increasing weakness in lower limbs with inability to stand since 1 month. Radiological examination revealed irregular fusion of ribs, spina bifida, and diastematomyelia at L2-L3 vertebral level. The patient underwent L1 to L3 laminectomy. A large bony spur was identified and excised with microrongeurs. Spondylocostal dysplasia may be associated with diastematomyelia or other surgically correctable occult intraspinal anomalies which may be diagnosed in early asymptomatic stage by magnetic resonance image screening of spine.

Craniopagus parasiticus: A rare case.

Conjoined twins or Siamese twins are identical twins whose bodies are joined in the uterus. Craniopagus is a condition in which the heads of the two twins are joined. Craniopagus parasiticus is a rare condition in which one of the twins is rudimentary in form and parasitic on the other. Few cases of craniopagus parasiticus are reported in literature; here, we present one such rare occurrence.

Cemento-ossifying fibroma presenting as a posterior fossa mass lesion.

Cemento-ossifying fibromas are benign lesions of the jaw, which arise from the periodontal membrane. Histopathologically these are composed of fibrous tissues with calcified structures resembling bone and cementum. Surgical resection is the treatment of choice. They have rarely been reported in the ethmoid sinus, maxillary sinus and sphenoid sinus Mastoid bone is an extremely rare site of such tumors. Only one case of cemento-ossifying fibroma of petromastoid bone has been reported before. We present a case of cementoossifying fibroma involving the petromastoid bone, with the large intracranial component causing compression on the cerebellum. This unique case may provide insight into the etiopathogenesis of these tumors.

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases.

A spectrum of surgical techniques has been used in the management of chronic subdural hematomas. Single burr hole and double burr hole drainage are among the commonest techniques. A retrospective analysis of 267 patients with chronic subdural hematomas treated surgically by either single or double burr holes was performed. Recurrence rates of subdural hematomas treated either with single or double burr holes were not significantly different (chi 2; p > 0.05). Thus, the number of burr holes does not affect the post-operative recurrence rate of chronic subdural hematomas. Both techniques are equally effective treatments.

Complete recovery of visual loss following surgical treatment of mucopyocele of the anterior clinoid process.

A mucocele is a collection of mucus, which is lined by the mucus-secreting epithelium of a paranasal sinus. Paranasal sinus mucoceles occur as a result of inflammation, tumor, trauma or surgical manipulation. The anterior clinoid process may be pneumatized by an extension of the sphenoid paranasal sinus air space during normal development. Mucocele of the anterior clinoid process is rare. We report a patient with mucopyocele of the anterior clinoid process that resulted in rapid monocular visual loss. The left optic canal was exposed extradurally via a supraorbital craniotomy and the mucopyocele was totally excised. The optic canal was decompressed by drilling the superior, lateral and medial rims, to achieve circumferential decompression of the optic nerve. The patient's vision improved postoperatively.

Cerebrospinal fluid rhinorrhea after ventriculoperitoneal shunt in a patient with tectal plate glioma.

Cerebrospinal fluid (CSF) rhinorrhea due to a remote tumor is a rare but increasingly reported condition, where it is usually a presenting complaint. CSF rhinorrhea occurring after tumor decompression has also been reported. We report a patient with tectal plate glioma that caused CSF rhinorrhea following insertion of ventriculoperitoneal shunt. The pathophysiology of CSF rhinorrhea is also discussed.

An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus.

Spinal infections are commonly reported to be located in the extradural or intramedullary spaces. Infection involving the intradural-extramedullary space are uncommon. We report a patient with uncontrolled diabetes mellitus and an infected foot ulcer who presented with a cervical cord abscess and intradural gas. Early diagnosis and aggressive treatment are necessary for a favourable outcome in gas-forming intradural spinal abscesses. To our knowledge, a gas-forming intradural spinal abscess has not been reported previously and we discuss the relevant literature.

Brain herniation through the anterior cranial floor in a long-standing frontal falcine meningioma.

Brain herniation through the incisural cisterns in raised intracranial tension is well known, but brain herniation through the cribriform plate is rare. We report a patient with an anterior falcine meningioma who suffered brain tissue herniation through the cribriform plate with extension into the paranasal air sinuses.