Multiple intracranial aneurysms in a child with congenital cyanotic heart disease.

A 10-year-old child with transposition of the great arteries had multiple intracranial aneurysms. The child presented with pyogenic meningitis, and the investigations incidentally revealed numerous aneurysms involving both anterior and posterior circulation arteries. Angiography also revealed multiple fistulae between the internal and external carotid arteries. The child is under observation. The pathogenesis and management strategy of multiple intracranial aneurysms are discussed and the relevant literature is briefly reviewed.

Endolymphatic sac carcinoma of the right petrous bone in Von Hippel-Lindau disease.

A large endolymphatic sac papillary adenocarcinoma in a patient with Von Hippel-Lindau (vHL) disease is reported. A 31-year-old man was treated for a left eye retinal angioma 10 years previously and had been blind in that eye since. He was admitted with progressive tinnitus, lower cranial nerve paresis and ataxia. Investigations revealed a vascular and bone-eroding petrous tumour. The entirely extradural tumour involved a large part of the petrous bone and extended into the cerebellopontine angle. The vascular tumour was radically resected using a presigmoid approach after feeding vessel embolisation. The literature on this rare clinical entity is briefly discussed.

Plaster of Paris mould for stereotactic frame fixation.

Stereotactic procedures have been prevalent in neurosurgical practice for a prolonged time period. With the advent of new custom-made frames designed for morphologic and functional neurosurgical procedures, its extended use in the pediatric population is becoming increasingly popular. However, there is still a need for sophistication in design and instrumentation. We describe a novel method of a plaster of Paris mould for stereotactic frame fixation, which can be a useful adjunct during frame fixation. It primarily accounts for a remarkable variation in skull shapes and sizes seen in the pediatric population undergoing stereotaxy besides many other advantages.

Trigeminal neurinoma associated with Chiari malformation and syringomyelia.

We report a 36 year-old woman who presented with headaches and hypoesthesia of the face. MRI revealed a large dumbbell shaped trigeminal neurinoma extending into both the middle and the posterior cranial fossae. In addition, there was a Chiari I malformation and syringomyelia. Within two months of tumor resection, both the Chiari malformation and the syringomyelia resolved. The association of an intracranial space-occupying lesion with Chiari malformation and syringomyelia is reviewed.

Giant pituitary adenoma invading the clivus.

A 26-year-old man was admitted with complaints of worsening of vision for one month. Investigations revealed a large sellar and parasellar tumor mass invading into both the cavernous sinuses. The tumor invaded the clivus and both petrous apices. It was radically but partially resected through a transsphenoidal approach. Following surgery, the patient showed symptomatic improvement. The residual tumor was treated by radiation treatment. The case is discussed and the literature on the subject is briefly reviewed.

Petroclival mixed meningioma.

We present a 47-year-old lady with a large dumb-bell petroclival-cavernous sinus meningioma. The tumour was of mixed histopathology; the anterior part, in relationship to the cavernous sinus, was a syncitial meningioma and the posterior part in the petroclival region was a transitional meningioma. The two histological subtypes of meningioma within the same tumour displayed remarkable differences in their radiological features, nature of extensions, relationship with the adjoining structures and consistency. The clinical course of the two subtypes was also different. The unusual features of this case are reported and the relevant literature briefly reviewed.

C2 over C3 spondyloptosis in a case with absent posterior elements. Report of an unusual case and analysis of treatment options.

We report an extremely rare anomaly in a 31-year-old male patient, where the posterior elements of the axis were almost completely absent and the anterior elements were dislocated anterior to the body of the C3 vertebra. The body of C3 caused severe compression of the high cervical cord. A radical transoral decompression and plate and screw fixation resulted in sustained clinical improvement. The relevant literature is briefly reviewed and the treatment options in such a case are analyzed.

Postoperative cerebellar herniation in a large intrapetrous aneurysmal bone cyst.

An 18-year old boy presented with a tumour involving a large part of the petrous bone. A radical resection of a petrous bone 'aneurysmal bone cyst' was achieved. A large defect in the dura adjoining the posterior surface of the petrous bone was made during surgery. Post-operative MR imaging showed complete tumour resection but herniation of cerebellum into the operative defect, a phenomenon probably assisting to seal the site of cerebrospinal fluid fistula.

Head holder for microsurgical dissection.

A new apparatus to hold cadaveric head is described. The apparatus has a ring with the possibility of attaching multiple screws. The assembly is attached to a heavy rectangular base. The apparatus provides wide manoeuverability and firm stabilisation of the head in the desired optimal surgical position.

Acoustic schwannoma and petroclival meningioma occurring as collision tumours: a case report.

A case of a collision tumour comprising of an acoustic schwannoma and a petroclival meningioma in a 30-year old male patient is described. Both of these tumours were resected through a retrosigmoid route. The caudal portion of the mass was an acoustic schwannoma while the rostral portion was a distinct well-defined petroclival meningioma. The occurrence of an acoustic schwannoma and a petroclival meningioma in 'collision' has never been reported. The pathogenesis of such a rare entity is discussed and the relevant literature is briefly reviewed.

Lipoma in the region of the jugular foramen.

A 22-year-old girl presented with a gradually progressive loss of hearing in the left ear and ipsilateral facial paresis. Investigations revealed a lipoma in the region of the jugular foramen. Conservative resection of the tumor resulted in improvement in facial paresis. The treatment options in such cases are discussed in this report.

Giant cerebral cavernous haemangioma: a case report and review of literature.

An 18-year-old male presented with uncontrolled left focal seizures with secondary generalisation for the past 10 years. Investigations revealed a large lobulated mass in the right frontal brain. Surgical excision of a giant cavernous haemangioma was performed. The patient is seizure-free following the surgery. The case and relevant literature on the rare entity of giant intracranial cavernous haemangiomas is discussed.