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.

Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome.

BACKGROUND: Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood. METHODS: We studied 16 patients who underwent CP after decompressive craniectomy (DC) for traumatic brain injury. These patients were divided in 2 groups, early and late CP, depending on the interval between DC and CP. Three months was the cutoff time for early CP. Neurocognitive status was assessed by Glasgow Coma Scale, Glasgow Outcome Scale, and Mini-Mental State Examination scores prior to and after CP. Computed tomography (CT) perfusion was done to correlate the improvement in neurologic status and CT perfusion parameters. RESULTS: We observed that there was a positive influence of CP on neurologic and psychologic function in all of the patients. The neurocognitive improvement after CP was more remarkable in the early CP group. More complications were noted in patients in the late CP group. Brain perfusion after CP showed improvement in all parameters in both of the groups, both on the operated and contralateral side. CONCLUSIONS: Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.

Management of dual intracranial germinoma by radiotherapy alone.

Synchronous intracranial germ cell tumor in the pineal and suprasellar region is rare. They represent only 5-10% of all intracranial germinomas. They are also known by the entity "double midline atypical teratoma" and are common in the second decade of life. We report a case of an 11-year-old girl having dual midline intracranial lesions with obstructive hydrocephalus treated by ventriculo-peritoneal shunt. Diagnosis of germinoma was made on the basis of imaging and elevated beta-human chorionic gonadotropin in cerebrospinal fluid. Radiotherapy was instituted, which resulted in the total disappearance of both the lesions. Clinical expression, diagnosis and management strategies are discussed.

Elevated Skull Fractures: an Under-Recognized Entity.

Elevated skull fractures form a rare subset of compound skull fractures. Owing to the paucity of cases studied and reported, these fractures still remain an under-recognized entity. We attempt to highlight the incidence of these relatively rare presentations of head injury. We had prospectively studied eight cases of elevated skull fractures in a mixed population of adults (five patients) and pediatric age group (three patients). Patients were evaluated in terms of clinical presentation, mode and mechanism of injury, treatment options, and final outcome, highlighting the appropriate management strategies taken in each case. The injury in these patients was due to tangential impact of a heavy object or assault weapon. Compounding of the fracture externally and dural tears was an inconstant feature. Associated intracranial injuries were cerebral contusions and extradural hematomas. An initial conservative therapy was given to all pediatric patients while adult patients underwent explorative craniectomy and evacuation of hematoma. Although an unusual presentation of skull fractures, elevated skull fractures warrant an early diagnosis, careful clinical evaluation, and prompt surgical therapy (whenever needed) for a successful outcome.