Multiple Intracranial Meningiomas in Absence of Neurofibromatosis Type 2: A Case Report and Literature Review.

Meningiomas are one of the most common primary intracranial tumors known to exist since pre-historic times. Most of these tumors are benign, sporadic, and solitary. Multiple meningiomas are rare and have mostly been described in patients with neurofibromatosis type 2 (NF2). The presence of multiple lesions poses a unique challenge in strategizing the treatment. We present a rare case of multiple intracranial meningiomas in the absence of NF2, which we treated at Tata Main Hospital, Jamshedpur. The relevant literature has also been discussed.

Clinicopathological Study of Intradural Extramedullary Spinal Tumors and Its Correlation With Functional Outcome.

Introduction Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of largely benign intraspinal neoplasms. These are amenable to gross total excision and usually carry a good functional outcome. Methods In this study, we reviewed the surgical outcomes of 35 patients who underwent excision of intradural extramedullary tumors. Patient demographics, severity and duration of symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were collected. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel and Nurick grading. The back pain was assessed with help of the Denis pain scale (DPS). Results The histopathological outcomes of the study were as follows: six patients of neurofibroma, 12 cases of schwannoma, nine cases of meningiomas, three cases of ependymoma, one case of dorsal neurenteric cyst, two cases of epidermoid cyst, one case of cauda equina paraganglioma, and one case of filum terminale dermoid cyst. Paresthesia/numbness were the commonest symptoms (88.6%), weakness of limbs in (80%), sphincter dysfunction in 15 patients (42.9%), and paraplegia was seen in three patients (8.57%). The complications encountered were - one case each of cerebrospinal fluid (CSF) leak, surgical site infection, and pseudomeningocele. The percentage of spinal canal occupied ranged from 71-94%. The mean percentage of the spinal canal occupied by the tumor was 81.8%. In our series, 77.14% of patients (p<0.0001) had good functional outcomes as per improvement in Frankel score. The DPS and Nurick score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significant functional improvement was noted at the one-week, one-month, and one-year follow-up, with a p-value of <0.0001. Conclusions The IDEM tumors are usually benign and are readily detected by contrast-enhanced MRI scans. These have excellent surgical outcomes with some exceptions. Greater canal occupancy and a longer duration of symptoms are usually seen to correspond with suboptimal functional outcomes.

Spinal myxopapillary ependymoma with interval drop metastasis presenting as cauda equina syndrome: case report and review of literature.

Myxopapillary ependymoma is a benign slow-growing tumour, arising predominantly in the region of the filum terminale. It has been designated histologically as grade I neoplasm according to the 2007 WHO classification. Despite this benign character dissemination and metastasis along the cerebrospinal axis and metastasis to distant sites have occasionally been reported. There have been previously reported cases of drop metastasis from MPE, however in three of these cases the drop metastasis was diagnosed with concurrent primary spinal MPE. There has been only one previously published case of interval drop metastasis in a case of operated spinal MPE in literature. We hereby present the second case of interval drop metastasis in a case of conus MPE, with history of having undergone a subtotal resection and post operative adjuvant radiotherapy prior to second surgery. The patient presented months after the primary surgery with symptoms of cauda equina syndrome attributable to the drop metastasis.

Primary intraspinal extradural primitive neuroectodermal tumor: A rare case.

Primitive neuroectodermal tumors (PNETs) are aggressive childhood malignancies and are difficult to treat. Primary intraspinal PNETs are rare. These patients have poor prognosis with short survival time even after surgery and chemoradiation. As there are no standard guidelines exist for the management of these tumors, a multidisciplinary approach has been employed with varying success. According to the review of literature, only few cases of primary intraspinal extradural PNETs have been reported. Herein, author has described a case of intraspinal, extradural PNET.

Sublaminar wiring for odontoid synchondrotic fracture stabilization in a 4-year-old: a case report.

BACKGROUND: The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury. METHODS: In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra. RESULTS: There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children. CONCLUSIONS: However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.