Subcranial Approach for Management of Secondary Frontal Bone Deformity.

Abstract: Secondary correction for aesthetic purposes can be more challenging as the fractured segments may be united in abnormal positions and would require osteotomy procedures before mobilizing the segments for reconstruction. Such maneuvers require adequate exposure and visibility. The subcranial approach is an effective alternate to classical approaches, which required frontal lobe retraction. Conclusion: Subcranial approach is a viable alternative to posttraumatic deformity of frontal bone.

Spontaneous intracerebral hemorrhage in hemophiliacs-A treatment dilemma.

BACKGROUND: Spontaneous Intracerebral hemorrhage is a rare and challenging condition to treat, especially in haemophiliacs. With their innate predilection to bleed following trivial trauma, surgical management of such cases have been individualised and no treatment protocols exist. Often they are managed with craniotomy and evacuation under cover of AHF. DISCUSSION: Here we discuss the nuances, clinical and treatment dilemma that one faces while treating a patient, diagnosed with haemophilia, with spontaneous subdural haematoma. While routine management strategy would be a craniotomy and evacuation of the haematoma, in our case, we chose to closely monitor the patient under cover of AHF, to convert the acute haematoma into a chronic subdural hematoma. We then managed it with a burr hole evacuation under cover of antihemophilic factor. CONCLUSION: Treatment protocols are hard to formulate in such rare entities, however we would like to recommend the following; conservative management of an acute subdural to convert it into a chronic subdural when there are no financial constraints, there by obviating the complication of rebleed following craniotomy.

Anomalous Posterior Arch of Atlas: A Rare Cause for Craniovertebral Junction Compression.

Congenital hypoplasia of the anterior and posterior arch of the atlas has been described in the literature. Currarino and associates classified this into various types based on the part of the arch that was hypoplastic. Gin and associates stated that posterior atlantal anomalies were more frequently encountered than anterior arch anomalies. Rarely do these anomalies present in the absence of genetic syndromes. Here, we describe our clinical experience of an anomalous posterior atlantal arch in a nonsyndromic patient.

Extradural Spinal Metastasis of Adenoid Cystic Carcinoma (ACC): A Case Report.

Adenoid cystic carcinoma (ACC) is a rare malignant tumour of the major salivary glands. It accounts for 10-15% of all salivary gland tumours and 1% of all head and neck tumours. Surgical resection followed by radiation is the choice of treatment for ACC. However, late loco-regional recurrence and metastasis is often seen emphasizing the importance of long-term follow-up. We report an unusual case of extradural metastasis of ACC in the dorsal spine. The primary submandibular gland tumour was resected 11 y back. A recurrence had been detected two years prior to the occurrence of spinal metastasis. Surgical decompression was done which was followed by palliative radiotherapy. Patient is symptomatically better, ambulant and on regular follow-up.

Endoscopic excision of a lateral ventricular epidermoid-A case report of a novel technique.

INTRODUCTION: Epidermoids of the lateral ventricle are relatively rare tumours. As these tumours are soft and relatively avascular, they appear to be ideally suited for endoscopic surgical excision. At present the instruments available are specifically designed for endoscopic intra ventricular surgeries, limitations being inability to rapidly debulk the tumour and achieve adequate haemostasis. We present a case of lateral ventricular epidermoid that was excised endoscopically using a system originally designed for endoscopic disc surgery. PRESENTATION OF CASE: We describe a female patient who presented with recurrent headache and occasional episodes of vomiting since 6 years. Preoperative diagnosis of lateral intra ventricular epidermoid was made with the help of an Magnetic resonance imaging (MRI) of the brain. Intraoperatively, an incision was made over the right Kocher's point and a 2.5cm dural opening was made following a small craniotomy and the Destaudeau endoscope was introduced. A 30° scope and gentle manipulation were used to view the ventricular cavity and ensure near total excision of the tumour. Here we record this novel technique. DISCUSSION: Lateral intra-ventricular tumours are usually approached through a trans-cortical or intra hemispheric approach, under microscope. The use of endoscopes have been largely restricted because of non-availability and relative difficulty in controlling troublesome bleeding, incase of vascular tumours. CONCLUSION: A multi portal endoscope that allows use of routine pituitary instruments would enable the surgeon to achieve haemostasis effectively and, in our opinion, should be a viable alternative to microscope for excision of intra ventricular tumours.

Intraspinal hydatidosis with retroperitoneal extension: an uncommon location.

Hydatidosis is a ubiquitous disease that is endemic in India. It most commonly involves the liver (75%) and lungs (15%) with only 10% occurring in the rest of the body. Primary hydatid cyst in the spinal canal is extremely rare. Intraspinal hydatid accounts for 0.5-1% of the cases and carries a poor prognosis. It presents as a diagnostic and therapeutic challenge. We present one such case of a 64-year-old man with associated radiculopathy and myelomalcia.

Sylvian cistern arachnoid cyst--a rare cause of precocious puberty.

Precocious puberty still remains an elusive diagnosis in the majority of patients. Infrequently, lesions of the central nervous system are associated with sexual precocity. Depending on their location, these cysts may affect many systems, however, there is little information concerning their involvement in endocrinological disorders. We report a case of a sylvian cistern arachnoid cyst presenting with precocious puberty in a 3-year-old girl. The child recovered following a cystoperitoneal shunt. The mass effect of the arachnoid cyst upon the hypothalamus was, at least in part, responsible for the development of precocious puberty. To the best of our knowledge, this is the 1st case of a sylvian cistern arachnoid cyst presenting with precocious puberty. The role of surgical decompression of the cyst is also discussed.