Posterior Epidural Migration of Lumbar Intervertebral Disc Fragment Mimicking an Epidural Mass.

Acute and chronic lower back pain can be commonly caused by intervertebral disc prolapse. This prolapse usually occurs in the dorsal direction and towards the anterior epidural space. In extremely rare cases, this migration/herniation can be seen approaching the posterior epidural space. One such rare instance has been recorded and described in our patient, a 53-year-old with a history of hypertension who presented with persistent lower back pain, radicular in nature, and recent acute aggravation, leading to mobility impairment. The patient experienced numbness in the lower limbs, urinary incontinence, and irregular bowel movements. Sensory deficits were noted along the L3 dermatome. The patient underwent an L3 laminectomy, revealing extruded disk fragments causing the compression. After surgery, the patient's power in the lower limbs began to improve, with significant recovery by discharge and complete resolution of bowel and bladder incontinence. This case highlights the diagnostic and therapeutic challenges of posterior epidural mass-like lesions in the lumbar spine, emphasizing the importance of prompt surgical intervention in restoring neurological function. The successful outcome underscores the significance of early diagnosis and intervention in such cases, ultimately improving the patient's quality of life.

Emerging Recombinant Oncolytic Poliovirus Therapies Against Malignant Glioma: A Review.

Glioblastoma multiforme (GBM) is a fourth-grade malignant glioma that continues to be the main contributor to primary malignant brain tumour-related death in humans. The most prevalent primary brain tumours are gliomas. The most dangerous of these neoplasms, GBM, has been shown to be one of the most lethal and refractory tumours. For those who have been diagnosed with GBM, the median time to progression, as determined by magnetic resonance imaging, is roughly six months, and the median survival is approximately one year. GBM is challenging to manage with old treatments like chemotherapy, tumour debulking, and radiation therapy. Treatment outcomes are poor, and due to this effect, the treatment is not up to the mark. GBM also shows diagnostic complexity due to limitations in the use of specific targeted therapies. The treatment protocol followed currently has an entire focus on safe resection and radiotherapy. Protein synthesis is not tightly regulated physiologically in malignant cells, which promotes unchecked growth and proliferation. An innovative, experimental technique for treating cancer uses polioviruses that have been genetically altered to target a fascinating aberration of translation regulation in cancer. This approach enables precise and effective cancer cell targeting based on the convergence of numerous variables. Oncolytic viruses have revolutionised cancer treatment. However, their effectiveness in glioblastoma remains restricted, necessitating more improvement. Oncolytic poliovirus has shown great potential in the treatment of GBM. Factors like the blood-brain barrier, immunosuppressive tumour microenvironment (TME), and tumour heterogeneity make treatment for malignant gliomas ineffective. In this review, we have focused on oncolytic viruses, specifically oncolytic poliovirus, and we explore malignant glioma treatments. We have also discussed currently available conventional treatment options for malignant glioma and other brain tumours.

Decompressive Craniectomy in the Management of Low Glasgow Coma Score Patients With Extradural Hematoma: A Review of Literature and Guidelines.

An extradural hematoma (EDH), also known as an epidural hematoma, is a collection of blood between the inner skull table and the dura mater. It is restricted by the coronal, lambdoid, and sagittal sutures, as these are dural insertions. EDH most frequently occurs in 10- to 40-year-old patients. EDH is uncommon after age 60, as dura matter adheres firmly to the inner skull table. EDH is more common among men as compared to women. EDH most commonly occurs in the temporo-frontal regions and can also be seen in the parieto-occipital, parasagittal regions, and middle and posterior fossae. An EDH contributes approximately 2% of total head injuries and 15% of total fatal head injuries. In EDH, patients typically have a persistent, severe headache, and also, following a few hours of injury, they gradually lose consciousness. The primary bleeding vessels for EDH are the middle meningeal artery, middle meningeal vein, and torn dural venous sinuses. EDH is one of the many consequences of severe traumatic brain injuries that might lead to death. EDH is potentially a lethal condition that requires immediate intervention as, if left untreated, it can lead to growing transtentorial herniation, diminished consciousness, dilated pupils, and other neurological problems. Non-contrast computed tomography (NCCT) imaging is the gold standard of investigation for diagnosing EDH. For patients with surgical indications, early craniotomy and evacuation of acute extradural hematoma (AEDH) is the gold standard procedure and is predicted to have significant clinical results. Nevertheless, there is an ongoing debate regarding the best surgical operations for AEDH. Neurosurgeons must choose between a decompressive craniectomy (DC) or a craniotomy to manage EDH, especially in patients with low Glasgow coma scores, to have a better prognosis and clinical results. This is a consultant-based review article in which we have tried to contemplate various pieces of available literature. Here, the objective is to hypothesize DC as the primary surgical management for massive hematoma, which usually presents as a low Glasgow coma score. This is because DC was found to be beneficial in clinical practice.

Primary solitary hydatid disease of brain in a 16-year-old girl: a case report.

Isolated involvement of brain with hydatid disease is a rare manifestation and occurs in only 1-2% of all Echinococcus granulosus infections. Here we present a young female of 16 years with primary intra cranial hydatid cyst without any extracranial involvement in the liver or lung. The patient was managed surgically and anti-helemthic medications were given, and the patient was discharged. The objective is to report a rare case of primary solitary hydatid cyst of brain. The incidence of isolated hydatidosis of brain is rare and should be considered as a differential diagnosis in endemic areas. Isolated Hydatidosis of brain is managed surgically and has to be removed carefully without spillage with postoperative medication to reduce the risk of recurrence.

Intradural extramedullary tuberculoma of the spinal cord mimicking meningioma.

Intradural extramedullary tuberculoma of the spinal cord is an extremely rare central nervous system tuberculosis manifestation. It is even rarer in patients who have no history of primary tuberculosis. A total of five cases, including the present case of intradural extramedullary tuberculoma without a history of primary tuberculosis, have been reported in the literature. We report a case of a male patient in his 20s who came with progressive weakness in his lower limbs, urinary incontinence and MRI features suggestive of meningioma. The patient underwent a D9-11 laminectomy with total debulking of the tumour. The histopathological examination revealed Langhans-type giant cells, confirming the diagnosis of a tuberculoma. The patient was advised an antitubercular therapy for 18 months. On a follow-up after 1 month, the patient could walk without support and had no urinary incontinence, indicating the importance of prompt surgical resection and adequate antitubercular therapy for a better outcome.

Atypical Symptomatic Bilateral Spontaneous Cavernous Carotid Aneurysm with Systemic Vessel Wall Pathology in Young Female: A Rare Case Report.

Bilateral cavernous carotid aneurysm (CCA) is a rare entity. Its association with connective tissue disorder makes the diagnosis and treatment of symptomatic patient an enigma. We present a case report of a 25-year-old female medical student presented to us with bilateral spontaneous atypically symptomatic CCA with incidentally diagnosed case of Ehlers-Danlos syndrome. Both surgical and endovascular options of treatment were weighed and were ultimately treated satisfactorily by high-flow bypass with carotid artery ligation with an insurance bypass.

Outcome of Ventriculosubgaleal Shunt in the Management of Infectious and Non-infectious Hydrocephalus in Pre-term Infants.

BACKGROUND: Hydrocephalus in premature infants is an onerous disease. In such situations, choosing the best option for cerebrospinal fluid (CSF) diversion is difficult. Ventriculosubgaleal shunt is an effective method of temporary CSF diversion in such situations. In this retrospective study, we compare the outcome of ventriculosubgaleal shunt in premature infants with hydrocephalus of infectious and noninfectious etiology. MATERIALS AND METHODS: All premature children with hydrocephalus secondary to various etiologies who underwent ventriculosubgaleal shunt were studied. The participants were grouped into two depending upon the etiology of hydrocephalus: Group 1 (infectious) and Group 2 (non-infectious). The primary outcome was a successful conversion to ventriculoperitoneal shunt (VPS) and the secondary outcome was mortality. Data were entered into statistical software SPSS version 16 and appropriate statistical analysis was performed to conclude any statistical significance between groups. RESULTS: The study included 16 infants among whom 9 were in the infectious group and 7 in the non-infectious group. Primary end point of conversion to VPS was achieved in 55.5% of patients in group 1 and 85.7% in group 2. The secondary end point, i.e., mortality was observed in 44.4% of patients in group 1 and 14.2% in group 2. The average duration during which this was achieved was 40 days (range 20-60 days) in group 1 and 25 days (range 20-30 days) in group 2. CONCLUSION: Ventriculosubgaleal shunt is a safe and effective procedure in infants awaiting definitive VPS for hydrocephalus of infectious as well as noninfectious origin. There was no statistical difference in the rate of successful conversion to a permanent VPS from ventriculosubgaleal shunt in hydrocephalus of either etiologies. Complications and time for successful conversion were more in postmeningitic hydrocephalus.

Ewing Sarcoma of the Cervical Epidural Space Presenting with Tetraplegia: Case Report and Review of Literature.

BACKGROUND: Ewing sarcoma (ES) is among the most frequented extremity osseous tumor in childhood. It was first described by James Ewing as diffuse endotheliomas in 1921. The name Ewing sarcoma was coined by Oberling in 1928 as a tribute to the legend who described this disease. ES exists in osseous and extraosseous forms. It shares much of its molecular typing with primitive neuroectodermal tumor (PNET); hence, they are regarded as different ends of the same molecular spectrum. ES, extraosseous ES, PNET, and Askins tumor are the other members of this family termed the Ewing sarcoma family of tumors. Extraosseous ES has been described in various locations of the spine, but its occurrence in the cervical epidural region is uncommon. CASE DESCRIPTION: A 12-year-old child presented to us with neck pain and progressive weakness of all 4 limbs. She was investigated and found to have a highly vascular lesion in the cervical epidural region extending from C2 to the C4 region. Embolization therapy was unsuccessful. She deteriorated and eventually had to undergo emergency surgery to decompress the spinal cord. The lesion was biopsied and diagnosed as extraosseous ES. After radiotherapy and chemotherapy, the patient regained most of the power in her limbs. CONCLUSION: Extraosseous ES is a rare tumor of the cervical cord in this age group. We report this case to highlight the difficulties encountered in the management of this variant.