A neurosurgical perspective to approaches to the orbit: A cadaveric study.

Neurosurgeons are getting increasingly involved in surgery for orbital tumours. The various approaches to the orbit can be challenging. The authors have demonstrated on cadavers the various approaches to the orbit which are required to be mastered by the neurosurgeon. The superior approaches which include the transcranial, supraorbital and the hybrid approaches are the most commonly utilized surgical approaches by the neurosurgeon for excision of orbital pathologies. The lateral orbitotomy is an elegant approach for excision of the tumours lateral to the optic Nerve and lacrimal gland tumours. The authors also demonstrate the medial approach through a medial orbitotomy which is a relatively unfamiliar approach to neurosurgeons. The importance of the various landmarks in each approach is emphasised along with the methods to minimize complications. It is imperative that neurosurgeons are intimately familiar with the microsurgical anatomy of the orbit and the various approaches to it.

Management of cervical monoradiculopathy due to prolapsed intervertebral disc, an institutional experience.

BACKGROUND: Cervical radiculopathy is the common clinical entity, often caused by "wear and tear" changes that occur in the spine. In the younger population, cervical radiculopathy is a result of a disc herniation or an acute injury causing foraminal impingement of an exiting nerve, whereas in the older individuals, it is due to foraminal narrowing from osteophyte formation, decreased disc height, and degenerative changes of the uncovertebral joints anteriorly and of the facet joints posteriorly. In most (75%-90%), cervical radiculopathy responds well to conservative treatment, whereas the remaining patients, who fail to achieve acceptable recovery with conservative modalities, alone need surgical decompression of the nerve root. Surgical interventions can be categorized into anterior and posterior approaches to the spine. Our study is focused on the surgical outcome of anterior discectomy with fusion versus posterior cervical discectomy with foraminotomy for cervical monoradiculopathy. MATERIALS AND METHODS: Ours is a retrospective study including patients of one level unilateral posterolateral cervical disc prolapse with radiculopathy operated in Department of Neurosurgery, Bangalore Medical College and Research Institute between 2012 and June 2016. The hospital records, imagings, operation notes, and follow-up records were reviewed and analyzed. One hundred and fourteen patients of cervical monoradiculopathy were investigated and operated, 76 operated by anterior cervical discectomy with fusion (ACDF), and 38 operated by posterior cervical laminoforaminotomy (PCL). RESULTS: The average operation time in 76 patients of ACDF group was 178 min and in 38 patients of PCL group was 72 min. Sixty-nine (91%) patients of ACDF and 38 (100%) patients of PCL had symptomatic relief but statistically (P > 0.5) was not significant. Three patients in ACDF group had hoarseness of voice due to recurrent laryngeal nerve palsy and there were no fresh permanent neurological deficits in any patients of PCL group over a follow-up period of 36 months. The average postoperative hospital stay was 5 days in ACDF group and 3 days in PCL group. The average intraoperative blood loss was <50 ml in ACDF group and 650 ml in PCL group. The need of analgesic for pain arising from bone graft site in ACDF group was comparable with operative site pain in PCL group. CONCLUSIONS: PCL is a simple approach, yields gratifying results, and is a promising alternative in selected cases of cervical monoradiculopathy due to disc prolapse.

Apoplectic presentation of a cauda equina paraganglioma.

BACKGROUND: Cauda equina paragangliomas (CEPs) are rare spinal tumors that are mostly misdiagnosed preoperatively as ependymomas or schwannomas on magnetic resonance imaging (MRI). Clinically, they usually present with the gradual onset of back pain and radiculopathy rather than an acute cauda equina syndrome. CASE DESCRIPTION: A 36-year-old female presented with an acute flaccid paraparesis/cauda equina syndrome. Based upon MRI studies, the predominant differential diagnoses included ependymoma or schwannoma. The intraoperative findings revealed an acute intralesional hemorrhage or apoplexy, responsible for the acute clinical deterioration. Histopathology and immunohistochemistry (IHC) revealed that the tumor was a paraganglioma. CONCLUSION: CEPs commonly present with mild symptoms and signs rather than the acute-onset of a flaccid paraparesis/cauda equina syndrome as seen in this case. Here, the authors review the radiological and histopathological characteristics of CEP and emphasize the role of IHC in differentiating "CEP" from the more common ependymomas.