Congenital orbital teratoma up to posterior fossa.

Congenital orbital teratoma is a rare condition which presents as marked proptosis of eyeball in a newborn. It is rapidly progressive with secondary damage to eyeball due to pressure effect. This case presented by us is of interest due to radiological features and rarity of this tumor extending into posterior fossa.

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.

Utility of in vitro proton magnetic resonance spectroscopy in aetiological characterisation of brain abscesses.

PURPOSE: Brain abscesses often present an aetiological dilemma. Microscopy is insensitive and culture techniques are time consuming. Hence, a new rapid technique in vitro Proton Magnetic Resonance Spectroscopy (1HMRS) was evaluated for its usefulness in the identification of aetiology of brain abscesses. MATERIALS AND METHODS: A total of 39 pus specimens from brain abscesses were subjected to in vitro 1HMRS. These pus specimens were also processed by conventional culture methods. The spectral patterns generated by in vitro 1HMRS were further correlated with culture results. RESULTS: Pus specimens which showed the presence of anaerobes on culture revealed the presence of multiplet at 0.9 ppm (100%), lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (100%) and succinate at 2.4 ppm (75%). Pus specimens that revealed the presence of facultative anaerobes on culture showed a pattern B, i.e., the presence of lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (88.88%) along with the multiplet at 0.9 ppm (100%). Pattern C was seen in aerobic infection which showed the presence of lactate-lipid at 1.3 ppm (100%) along with the multiplet at 0.9 ppm. Pus from two tuberculous abscesses showed the complete absence of multiplet at 0.9 ppm. CONCLUSIONS: We observed in this study that it was possible to differentiate bacterial and tuberculous brain abscesses using in vitro 1HMRS. Further, it was also possible to distinguish between aerobic and anaerobic brain abscesses on the basis of spectral patterns. In vitro 1HMRS of fungal and actinomycotic brain abscess are also presented for its unusual spectra.

Current epidemiology of intracranial abscesses: a prospective 5 year study.

Intracranial abscesses remain a significant health-care problem in developing countries. In view of this, we undertook a comprehensive study to determine the demographics and bacteriological spectrum of brain abscesses in our hospital. Bacteriological profiles and antibiograms were studied by conventional microbiological methods. Seventy-five patients were admitted with brain abscesses over a 5 year period (2001-2005). There was 9.5% mortality in patients included in this study. The most important factors influencing mortality from intracranial abscess were the age and neurological condition of the patient at the time of admission. Brain abscess could develop at any age but there was a preponderance of males over females. Chronic suppurative otitis media was the most common predisposing factor for temporal lobe infections. Forty-one (54.70%) abscesses were found to be due to pyogenic organisms, 4% due to Mycobacterium tuberculosis and 1.3% were due to Cladophialophora bantiana. The majority of microbial isolates were sensitive to the therapeutic regime adopted in our neurosurgery unit (cefotaxime, gentamicin and metronidazole). Chloramphenicol is another antibiotic with in vitro activity against the isolates.

Rapid identification of non-sporing anaerobes using nuclear magnetic resonance spectroscopy and an identification strategy.

PURPOSE: The non-sporing anaerobes cause a wide spectrum of infections. They are difficult to culture and their identification is tedious and time-consuming. Rapid identification of anaerobes is highly desirable. Towards this end, the potential of nuclear magnetic resonance (NMR) spectroscopy for providing a fingerprint within the proton spectrum of six genera belonging to anaerobes reflecting their characteristic metabolites has been investigated. METHODS: NMR analysis was carried out using Mercury plus Varian 300 MHz (7.05 T) NMR spectrophotometer on six different anaerobes. These included Bacteroides fragilis, Prevotella melaninogenica, Prevotella denticola, Fusobacterium necrophorum, Peptococcus niger and Peptostreptococcus spp. After the NMR analysis (256/512 scans), the different peaks were noted. The eight pus specimens, which yielded pure culture of anaerobe, also were analysed similarly. RESULTS: The major resonances of multiplex of amino acids/lipid at 0.9 ppm along with lactate/lipid at 1.3 ppm, acetate at 1.92 ppm and multiplex of lysine at 3.0 ppm remained constant to label the organism as an anaerobe. There was a difference found in the MR spectra of different genera and species. A simple algorithm was developed for the identification of the six different anaerobes studied. The MR spectra of the pure culture of the organism matched the MR spectra of pus from which the organism was isolated. CONCLUSIONS: MR-based identification was of value in the identification of anaerobes. However, a larger database of the peaks produced by anaerobes needs to be created for identification of all genera and species. It could then have the potential of diagnosing an anaerobic infection in vivo and thus expedite management of deep-seated abscesses.

Calvarial tuberculosis.

OBJECTIVE: Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare and only a few cases have been reported. In a review of the literature, we found only six cases of calvarial tuberculosis reported with computed tomographic findings. We report a series of seven patients with calvarial tuberculosis, and we discuss their presentations and treatments. METHODS: The patients were studied with respect to age and sex prevalences, previous histories of trauma and tuberculosis, and presenting complaints. Plain cranial x-ray films and computed tomographic scans were used for diagnoses. All patients underwent surgery and antituberculous chemotherapy. RESULTS: Of the presenting patients, 71.42% were less than 20 years of age. There was a female predominance, with a male/female ratio of 1:6. Painless swelling and discharging sinuses over the scalp were the most common presenting features. One patient presented with osteomyelitis and sinus formation, with associated meningitis. All patients recovered well after surgery and antituberculous chemotherapy, except for one patient who discontinued drug treatment. CONCLUSION: Although calvarial tuberculosis is rare, the possibility of this disease should be considered when patients report previous histories of tuberculosis or are from areas in which the disease is endemic. Surgery is indicated in cases with associated neurological deficits or sinus formation. Antituberculous therapy should be continued for 18 months.

Abscess formation in invasive pituitary adenoma: case report.

OBJECTIVE AND IMPORTANCE: Pituitary abscess is rare, with few cases of secondary pituitary abscess reported. To our knowledge, only 14 cases of pituitary adenomas with abscess have been reported, and this is the first report to include a magnetic resonance image of a pituitary adenoma with abscess. CLINICAL PRESENTATION: A 22-year-old man presented with decreasing vision, headache, and vomiting. His higher functions were normal, with visual disturbance in both eyes. Computed tomographic scans and magnetic resonance images were suggestive of a sellar tumor with a cystic component. INTERVENTION: A right pterional craniotomy was performed, and the tumor was debulked, revealing an abscess in the center. Postoperatively, the patient received a regimen of antibiotics. CONCLUSION: Early surgical intervention plus follow-up antibiotic therapy are the mainstay of treatment for abscess formation in pituitary adenomas.

Video endoscopic neurosurgery (VENS) : a prospective study of 55 patients.

Neurosurgery has undergone dramatic innovations in the last few decades. It now allows the use of a microchip camera mounted on to an endoscope, introduced through a key hole in the brain. The image is projected onto a TV monitor located next to theoperating table. The minimally invasive technique is what we call Video Endoscopic Neurosurgery (VENS). Cab's universal rigid endoscope is used in all cases. VENS has a wide spectrum of diagnostic and therapeutic applications but cannot as yet replace open microscopic surgery. A prospective study of 55 patients from January, 1990 to February, 1995 is described. Hydrocephalus was a major indication, where VENS was useful for its diagnostic orientation especially when there were ambiguities on the CT/MRI.It also helped in the proper placement of the shunt, doing a III ventriculostomy and stenting of the aqueduct. VENS was utilised to diagnose, debulk and at times excise III ventricular and various other cystic lesions, visualize vascular loops in trigeminal neuralgia and hemifacial spasm. It is also useful in searching small CP angle lesions and residual tumour after intrassphenoidal excision of pituitary adenoma. Results were satisfactory in 94.5 of patients with an average follow up period of 26.4 months. Laser and CT-guided stereotactic VENS have already arrived which allows precise target localization and excellent visual control of any bleeding.

Cranioplasty using silastic implants.

Twenty five cases of post operative cranial vault defects were repaired using tailor made silastic implants in the last three years. Twenty four patients are tolerating the implant without any problems. All of them had symptomatic, relief and achieved an excellent cosmetic skull contour. Ten patients had subgaleal serous collection postoperatively, probably due to reaction to the implanted material, which usually subsided within three weeks. Only in one patient, the implant had to be removed due to infection. In conclusion, silastic is a good implant material for cranioplasty.