Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report.

Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant cell tumor of the bone. A combined posterior and anterior cervical approach was performed to resect the lesion, reconstruct the spine, and restore stability. Two years of follow-up revealed no recurrence of the lesion with stable reconstruction of the spine. Results The lesion was surgically managed for excision and spinal fusion by combining a posterior occipitocervical arthrodesis with an anterior retropharyngeal cervical approach. The final histopathology result confirmed a giant cell tumor of the bone. Conclusions Giant cell tumor involving the second cervical vertebra is uncommon; this tumor can be managed surgically by using a combined posterior and anterior cervical retropharyngeal approach. The presented case was unique in terms of the tumor location, patient age, and surgical management.

Role of intraoperative ultrasound in achieving complete resection of intra-axial solid brain tumours.

OBJECTIVES: To determine the frequency of completeness of resection for intra-axial solid brain tumours with the help of intra-operative ultrasound to detect residual brain tumour. METHODS: The cross-sectional study was conducted at the Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital Karachi, from September 2009 to June 2010 and comprised patients with intra-axial solid brain lesion. During operation following standard craniotomy, multi-plane sonographic examination was performed using intra-operative ultrasound for tumour localisation and calculation of dimension, followed by tumour resection in the standard fashion. At the end of tumour resection ultrasound was again used for the detection of any residual tumour. Results of intra-operative ultrasound were compared with post-operative contrast magnetic resonance imaging. RESULTS: Of the 39 cases in which intra-operative ultrasound was performed, 32(82.1%) were males and 7(17.9%) were females, with an overall mean age of 42.6±19.7 years. Intra-operative ultrasonography was able to localise and delineate the tumour in all 39 (100%) cases. It showed no residual tumour in 36 (92.3%) cases, but in 3(7.7%) cases residual tumour was detected. Post-operative contrast enhancing magnetic resonance imaging showed no residual tumour in 35(89.7%) cases and in 4(10.3%) cases residual tumour was detected. The frequency of completely resected intra-axial solid brain tumour was 35(89.7%), while in 4(10.3%) cases incomplete resection was observed. CONCLUSION: The study concluded that intra-operative ultrasonography has an important role in achieving increased frequency of completely resected intra-axial solid brain tumours.

Trilateral retinoblastoma with unilateral eye involvement.

Trilateral retinoblastoma (TRb) is a rare combination of unilateral or bilateral retinoblastoma with an ectopic midline intracranial neuroblastic neoplasm (primitive neuroectodermal tumour) usually in the area of pineal gland or sellar region. TRb can occur with both familial and sporadic forms of retinoblastoma. An occurrence of this rare tumour in a 12-year-old boy who had unilateral retinoblastoma in association with ectopic suprasellar primitive neuroectodermal tumour (PNET) is reported here. To the best of our knowledge, this is the first case report in Pakistan on TRb with suprasellar mass.

Primary intracranial malignant melanoma.

Primary intracranial melanoma is an extremely rare lesion of the brain. A 28 years old lady, without any co-morbid conditions, presented with headache and left side facial numbness. MRI of brain showed a mass lesion in left middle cranial fossa extending into posterior fossa, with signals characteristics of melanoma. Histology and immunohistochemistry confirmed the diagnosis after surgical excision of that lesion. Patient remained symptom-free till the last follow-up that was four years postoperatively.

Cataracta nigra (black cataract): a challenging task made easy with sutureless manual extracapsular cataract extraction.

BACKGROUND: Cataract surgery is constantly evolving and various procedures having their merits and demerits are practiced by ophthalmologists all over the world. The objective of this study was to evaluate the safety, efficacy, visual outcome and complications of sutureless manual extracapsular cataract extraction (SMECE) in the management of patients with black cataracts using envelop anterior capsulotomy and soft shell technique. METHODS: In a prospective observational study conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, from January 2008 to December 2009, a total of 125 consecutive patients with black cataract underwent cataract extraction using SMECE with an envelop or V-type anterior capsulotomy and soft shell technique. Their operative, postoperative complications, visual outcome and efficacy were analysed. RESULTS: Of 125 eyes with black cataracts SMECE was performed through a 12 O'clock sclerocorneal tunnel. The main Intraoperative complication was hyphaema in 10 (8%) patients. Postoperatively 9 (7.2%) patients had hyphaema. Fifteen (12%) eyes had some amount of striate keratitis superiorly. Twenty (16%) of patients had mild iritis. On 6th week follow-up 100 (80%) patients achieved uncorrected visual acuity of 6/6 to 6/18. CONCLUSION: SMECE with envelop or V-type anterior capsulotomy and soft shell technique is a safe and effective technique of cataract extraction in Cataracta Nigra (black cataract).