Intra-axial chondroblastoma: A bony tumor in the cerebral hemisphere - A case report and review of literature.

This case highlights a rare possibility of occurrence of chondroblastoma, a bony tumor, at an uncommon location. Extraosseous, soft tissue location of this bony tumor is rare and more so for intracranial intra-axial location. We report a case of an intra-axial frontal lobe lesion, histologically proven to be an extraosseous chondroblastoma. A 23-year-old male presented with a history of headache and vomiting of 1 month duration. Imaging was suggestive of left frontal lobe intra-axial calcified lesion suggestive of oligodendroglioma. Patient was operated upon by left frontal craniotomy with complete excision of the lesion. The patient recovered well postoperatively. Left sixth nerve paresis improved and ataxia decreased. Intra-axial chondroblastomas are extremely rare tumors. Differential diagnosis should be kept in mind, especially in cases of calcified lesions. Complete excision should be the aim to achieve cure.

Symptomatic lumbosacral perineural cysts: A report of three cases and review of literature.

Lumbosacral perineural cysts (Tarlov's cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov's cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure.

Spheno-orbital encephalocele: A rare entity - A case report and review of literature.

OBJECTIVE: To report a rare case of basal encephalocele (spheno-orbital encephalocele), managed successfully in our institute. This is one of the rarest type of encephaloceles with very little literature available. In this case, sphenoid dysplasia was not associated with type 1 Neurofibromatosis. SETTINGS: Grant Medical College and Sir J.J Group of Hospitals, Byculla, Mumbai, Maharashtra, India. METHODS: A 22 year old male presented with a history of protrusion of right eye since the age of 7 years followed by progressive diminution of vision in the same eye for 5 months. MRI scan was suggestive of sphenoid dysplasia with herniation of right fronto-temporal lobe. The patient was operated upon with right frontal craniotomy with excision of encephalocele and repair of skull base. Subsequently, the patient underwent plastic surgery for facial skin remodeling. RESULTS: Patient's encephalocele reduced completely after excision and repair with good cosmetic results and no neurological deficits. There is no evidence of recurrence till recent follow-up. CONCLUSION: Basal encephaloceles are very rare. Complete excision of encephalocele with repair of the defect should be the aim to achieve cure.

Vulvar migration of the peritoneal end through the inguinal canal in a female infant: An unusual complication of the ventriculo-peritoneal shunt: A case report and review of literature.

Migration of the peritoneal end of the ventriculo-peritoneal shunt through the patent processus vaginalis has been described in preterm male infants with 26 such cases in the literature. The occurrence of this rare complication in the female preterm infants has not yet been reported. We report a 3-month-old premature female infant who presented with a gradual increase in head size since birth. Computed tomography revealed obstructive hydrocephalous secondary to the aqueductal stenosis and ventriculo-peritoneal shunt was performed. Ten days following the procedure she presented with swelling and other signs of inflammation over the right vulvar region. X-ray abdomen confirmed the migration of the peritoneal end into the vulva. Surgical obliteration of the patent processus vaginalis and replacement of the peritoneal end was performed. The patient had no recurrence at 6 months of follow-up. This report presents the unusual complication of a common procedure in a female infant with a review of the current literature.

Ruptured conus medullaris dermoid cyst with fat droplets in the central canal [corrected].

Spinal dermoid tumors are rare, benign, slow growing tumors. These tumors may become acutely symptomatic after rupture or infection. Excision of the lesion with long term close follow-up studies is required for the management of these lesions. We present a very rare case of ruptured conus medullaris dermoid cyst in a 22-year-old male presented with urinary retention and low back pain. Magnetic resonance imaging scan with contrast reveals a lesion in the cauda equina inseparable from conus medullaris with fat droplets within the central spinal canal extending up to the medulla. Patient was operated with laminectomy and near complete excision of the lesion was done. Patient's low back pain was relieved following surgery. However patient had persistent urinary incontinence and on clean intermittent self-catheterization. Histopathology was suggestive of dermoid cyst.

Cerebral astroblastoma: A case report and review of literature.

Astroblastomas are uncommon neuroepithelial tumors of uncertain origin. These occur predominantly in the cerebral hemisphere of young adults and children. They form only 0.45-2.8% of all neuroglial tumors. They can be easily misdiagnosed as they are rarely encountered in clinical practice and share common radiological and histopathologic appearance with other glial neoplasms. A 12-year-old female presented to us with progressive headache and diplopia. Her neurological examination showed right 6(th) nerve paresis with papilledema. Brain magnetic resonance imaging (MRI) revealed well-demarcated, peripherally enhancing solid cystic mass of 6 cm in right parietal lobe with mass effect. She underwent gross total resection of the lesion through right parietal craniotomy. The histopathologic diagnosis was suggestive of low-grade astroblastoma. The patient had no evidence of recurrence of tumor without adjuvant radiotherapy during the last 14 months of follow-up. Supratentorial astroblastomas are very rare tumors. Complete excision without radiotherapy is sufficient in low-grade variants.

Posterior fossa meningioma "our experience" in 64 cases.

BACKGROUND: Posterior fossa meningiomas are 20% of all intracranial meningiomas. These are slow-growing tumors thus become large before presentation. Microsurgical resection is the treatment of choice for the majority of these lesions, but variable locations, large size at diagnosis, frequent encroachment of neural and vascular structures, and their potentially invasive behavior are some of the features of these tumors that make their resection challenging. MATERIALS AND METHODS: We studied 64 cases of posterior fossa meningioma operated in last 6 years, and analysed the technical difficulties encountered during excision of these tumors. Postoperative complications and outcomes of these patients were also analysed. RESULTS: Gross total excision was achieved in 72% cases. Partial excision or subtotal excision was more in petroclival, jugular foramen with extra cranial extension, tentorial with intrasinus extension and ventral foramen magnum. Postoperative complication in form of new or aggravation of existing neurological deficit was found in 33% cases and CSF leak in 12.5% cases. We encountered the recurrence of total 10 cases (16%) over mean follow-up of 4 years. Most of the recurrent cases were seen in petroclival and tentorial subgroups with partial or subtotal excision. CONCLUSION: Posterior fossa meningiomas are difficult to excise due to close relation to cranial nerves and vessels. Use of microscope, CUSA, intraoperative nerve monitor help in removal and preserving surrounding important anatomical structures. Although neurological deterioration is common postoperatively, recovery does occur completely after total removal thus increasing the recurrence free period and improving the outcome.

Pearl in interhemispheric fissure: A rare phenomenon.

Epidermoid cysts (Keratin pearls) are benign congenital lesions, found commonly in cerebello-pontine angle, suprasellar cistern, sylvian cistern, pineal region, but they are very rare in interhemispheric fissure. Approaching these lesions are challenging to neurosurgeons because of narrow and deep fissure with surrounding vital structures. The present study constitutes an analysis of interhemispheric epidermoid managed at our hospital in last 10 years (Jan 2001-Dec 2010). Total 187 cases of intracranial epidermoid operated in our institute; eight of them were interhemispheric epidermoid making about 4.27% of all epidermoids. The patients were presented with seizures (50%), headache (37%), and weakness (25%). On examination, the common findings were decreased Mini mental score (MMSE) in 50%, motor deficit in 25%, and decreased visual acuity in 25% of cases. All patients underwent craniotomy across the midline as per the location of the lesions. In seven patients, tumors were resected by interhemispheric approach but in one by transcortical. Lesion were excised with microscope and endoscopic assistance with measures to prevent spillage of epidermoid tissue while excision. Post excision tumor bed was irrigated with hydrocortisone diluted saline. All patients except one improved after surgery and non-developed chemical meningitis. One patient of parietal interhemispheric epidermoid with transcortical approach developed weakness in immediate post-operative period. Patients were followed for average 6.8 year without any recurrence. Interhemispheric epidermoids are rare tumors. Achieving safe complete excision without spillage is surgical goal to prevent chemical meningitis and recurrence. Endoscope assists in achieving complete excision so decrease incidence of chemical meningitis and recurrence.

Primary Lumbo-sacral Spinal Epidural Non-Hodgkin's Lymphoma: A Case Report and Review of Literature.

We present a case of 24-year-old male presented with low back pain radiating to the left lower limb, tingling numbness and weakness of 6 months duration. Magnetic resonance imaging scan with contrast reveals an extradural mass at lumbosacral region. Patient was operated with laminectomy and complete excision of the lesion was done. Patient's radicular pain relieved following the surgery and weakness also improved. Histopathology was suggestive of non-Hodgkin's lymphoma. Patient received chemotherapy which was followed by radiotherapy. Primary Non-Hodgkin's lymphoma of the lumbosacral spinal epidural tissue is an uncommon lesion. Lymphoma involves the central nervous system in 5-11% of cases either at presentation of the disease or during its course. The spinal epidural tissue is involved primarily in 0.1-3.3% of cases with spinal cord compression being the commonest presentation. Excision of the lesion followed by chemotherapy and radiotherapy is required to achieve cure.