Intradiploic meningioma of the orbit: a case report.

We report a case of a 12-year-old male child who presented with a gradual onset exopthalmos involving the left eye. The plain radiographs of the skull showed hyperostosis of the left orbital roof. The computerized tomography (CT) scan revealed an intradiploic orbital roof tumor with expansion of both the tables of the orbital roof. The tumor was completely excised by an extradural route using a basal frontal craniotomy. The histopathological diagnosis of the tumor was a psammomatous meningioma. A split calvarial frontal bone graft was used to reconstruct the orbital roof. The pathogenesis, radiological features and surgical technique involved in the management of intradiploic orbital roof meningioma are discussed and the relevant literature is reviewed.

Suprasellar arachnoid cyst presenting with bobble-head doll movements: a report of 3 cases.

We report a series of three patients with suprasellar arachnoid cysts who presented with a rare 'bobble-head doll' syndrome. The abnormal head movements improved after surgical evacuation of the cysts in all the three cases. Various pathophysiological mechanisms involved in the bobble-head doll syndrome are discussed. The literature on suprasellar arachnoid cysts is briefly reviewed.

Ischaemic complications after surgical resection of intracranial aspergilloma.

A 32-year-old male presented with a paranasal sinus Aspergillus fungal infection. The nasal infection was cleared by endoscopic sinus surgery and the patient was treated with antifungal agents. The patient was otherwise healthy with no evidence of immunosuppresion. Five months later, the patient had to undergo excision of the left frontal intracranial infection for symptoms of raised intracranial pressure and seizures. Within 48hours of surgery, the patient developed basilar artery thrombosis with infarction of the cerebellum and midbrain. The patient succumbed to this vascular catastrophe, which developed at a site distal to that from surgery. The pathophysiology of ischaemic complications after surgical resection of intracranial aspergilloma is discussed.

En-plaque ventricular ependymoma.

An extremely unusual case demonstrating rare behaviour of an ependymoma is presented. The tumour spread in an en-plaque fashion and involved the ependymal lining of the entire ventricular system. The patient, a 56-year-old male, presented with symptoms of raised intracranial pressure and truncal ataxia. The management issues are analyzed on the basis of a brief literature survey.

An unusual post-traumatic occipitocervical pseudomeningocele: case report.

BACKGROUND: A rare case of massive post-traumatic subcutaneous pseudomeningocele probably communicating with the cisterna magna, is reported. CASE DESCRIPTION: An 8-year-old boy sustained a severe injury to the nape of the neck, after which he developed a huge local subcutaneous swelling containing cerebrospinal fluid (CSF). Communication of the subcutaneous CSF collection with the cisterna magna or any other site of dural fistula could not be identified. After a lumbo-peritoneal CSF shunt, the swelling resolved completely. CONCLUSION: The clinical features of a rare case of symptomatic post-traumatic cerebrospinal fluid pseudomeningocele are elaborated.

Pontine glioma and cerebellopontine angle epidermoid tumour occurring as collision tumours.

A 36-year-old male was admitted with a 10-year history of gradually progressive left ear hearing loss, diplopia and right hemiparesis. Magnetic resonance imaging showed a left lateral pontine enhancing tumour and an additional cerebellopontine angle epidermoid tumour in close proximity forming a collision tumour. On exploration, the epidermoid tumour and the intraaxial pontine glioma were completely resected. The literature on collision tumours is reviewed.

Prognostic factors for cerebellar astrocytomas in children: a study of 102 cases.

OBJECTIVE: To evaluate the prognostic factors influencing the length of survival of pediatric patients with cerebellar astrocytomas. METHODS: The clinical data of 102 patients under the age of 12 years with cerebellar astrocytomas were retrospectively analyzed. The radiological features, surgical findings, histology and adjuvant radiotherapy were reviewed. Patients were followed up on an outpatient basis. Computerized tomography (CT) scans of the brain were performed to detect recurrence. RESULTS: The age of the patients at presentation varied from 10 months to 12 years. The mean age at presentation was 7 years and 11 months. The average duration of symptoms was 5.8 months. The clinical features were predominantly related to intracranial hypertension and the location of the tumor. Twenty-six tumors were located in the vermis and 76 in the cerebellar hemisphere. The brain stem was involved in 20 patients. All 102 patients had a preoperative contrast-enhanced CT scan. Midline vermian tumors were predominantly solid and enhancing, whilst the hemispheric tumors were cystic and nonenhancing. The tumors were graded into three subgroups based on histological characteristics: pilocytic astrocytoma, low-grade fibrillary astrocytoma and high-grade fibrillary astrocytoma. Total, radical and subtotal excision, as determined by the surgical impression, were performed in 82, 16 and 4 patients, respectively. Postoperative radiotherapy was administered to 12 patients. CSF diversion was carried out in 11 of 79 cases who had moderate to severe hydrocephalus. CONCLUSIONS: Our study has shown that the location of the tumor (p < 0.05), histological grade (p < 0.001) and the extent of tumor resection (p < 0.001) have a significant and definitive relationship to the length of survival of pediatric patients with cerebellar astrocytomas. The patient's age (p > 0.05) does not influence the outcome. We could not evaluate the effect of brain stem involvement and adjuvant radiotherapy in our study because of the small sample size.

Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases.

OBJECTIVE AND IMPORTANCE: This is a report of four cases of huge trigeminal neuromas that presented with the principle symptom of pathological laughter (PL). CLINICAL PRESENTATION: All four patients were male and were in either the third or fourth decade of life. In addition to PL, there were neurological deficits related to trigeminal nerve, brainstem, and cerebellar dysfunctions. INTERVENTION: All tumors were radically excised via a lateral basal temporal approach. The PL was cured immediately after surgery. CONCLUSION: PL sometimes precedes other neurological manifestations and may be a useful localizing sign. The clinical and radiological features in our cases suggest that PL is a result of extra-axial compression of the pons and adjoining neural structures.

Primary Ewing's sarcoma of the cranium.

OBJECTIVE: We analyzed the data for a series of 14 patients with primary Ewing's sarcomas of the cranium who were treated since 1985. Our aim was to assess the long-term outcomes and the selection of appropriate treatment methods. METHODS: The patients were reviewed with respect to their clinical presentations, treatment, and outcomes. Computed tomographic scanning of the brain was performed for all patients. Skeletal surveys with routine radiographs and technetium-99 bone scans to detect extracranial Ewing's sarcomas were performed for all patients. For all 14 patients, radical tumor excision was achieved surgically. All patients were then subjected to adjuvant multidrug chemotherapy and radiotherapy. The follow-up periods ranged from 8 months to 8 years (mean, 4.25 yr). RESULTS: The predominant presenting features were headaches, increased intracranial pressure, and scalp swelling. Excision was nearly total for nine patients and total for five patients. All patients experienced uneventful postoperative courses. One patient experienced a local recurrence, which was detected 2 years after surgery. This recurrent tumor was completely excised, and additional chemotherapy was administered. Eight of the 14 patients (57.1%) studied have survived 5 years or longer. CONCLUSION: Although primary Ewing's sarcoma of the cranium is a malignant bone tumor, it is associated with a good prognosis when treated with radical surgery, aggressive multidrug chemotherapy, and radiotherapy.

Holocord intramedullary abscess: an unusual case with review of literature.

STUDY DESIGN: A rare case of a holocord intramedullary abscess with review of literature. OBJECTIVES: Summary of clinical presentation, radiology, microbiology, etiology and management of intramedullary spinal cord abscess. Abscess involving the entire spinal cord is extremely rare and awareness of such an event could avoid delay in evacuation of the absess. METHODS: The incidence, clinical presentation, radiological investigations, treatment and etiology of intramedullary spinal cord abscess in 100 consecutive cases are discussed. RESULTS: Intramedullary spinal cord abscesses are rare. Presently, only five cases of holocord intramedullary abscess are described. In our analysis of 100 cases of intramedullary abscess, a male preponderance was found. The first and the third decades were the most common age groups. Prognosis is poor if treatment is delayed. Contrast-enhanced MRI is the ideal investigation for diagnosis. Prompt surgical drainage of the abscess with appropriate antibiotic therapy is mandatory since the natural course of the disease has a very unfavourable outcome. Staphylococcus and Streptococcus were the most common causative organisms. CONCLUSION: Intramedullary spinal cord abscess along the entire length of spinal cord is rare. A thorough history with precise clinical localisation, a high index of suspicion, contrast-enhanced MRI at appropriate level and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.

Aarskog syndrome. A case report.

A rare Aarskog syndrome is reported in a 12-year-old boy. The patient had a triad of characteristic symptoms consisting of short stature, genital anomaly, and unusual facies. Both jaws were hypoplastic with presence of crowded permanent teeth and over-retained deciduous teeth. Radiographic examination of teeth showed taurodontism, which has not been reported previously.

Orofacial manifestations of myofascial pain dysfunction syndrome amongst dental patients.

Orofacial manifestations in cases of Myofascial Pain Dysfunction Syndrome (MPD) diagnosed amongst 71 Dental patients were studied in detail. Findings of this study show that the chief complaint and associated orofacial manifestations of MPD are related to muscular hypertonicity. Stressful situations may produce muscular hypertension, which leads to muscle tenderness as a symptom of over work and fatigue. MPD may be considered a psycosomatic disease.