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   2012| July-September  | Volume 7 | Issue 3  
    Online since November 22, 2012

 
 
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ORIGINAL ARTICLES
Posterior fossa meningioma "our experience" in 64 cases
Vernon Velho, Vivek Agarwal, Rahul Mally, DA Palande
July-September 2012, 7(3):116-124
DOI:10.4103/1793-5482.103710  PMID:23293666
Background: Posterior fossa meningiomas are 20% of all intracranial meningiomas. These are slow-growing tumors thus become large before presentation. Microsurgical resection is the treatment of choice for the majority of these lesions, but variable locations, large size at diagnosis, frequent encroachment of neural and vascular structures, and their potentially invasive behavior are some of the features of these tumors that make their resection challenging. Materials and Methods: We studied 64 cases of posterior fossa meningioma operated in last 6 years, and analysed the technical difficulties encountered during excision of these tumors. Postoperative complications and outcomes of these patients were also analysed. Results : Gross total excision was achieved in 72% cases. Partial excision or subtotal excision was more in petroclival, jugular foramen with extra cranial extension, tentorial with intrasinus extension and ventral foramen magnum. Postoperative complication in form of new or aggravation of existing neurological deficit was found in 33% cases and CSF leak in 12.5% cases. We encountered the recurrence of total 10 cases (16%) over mean follow-up of 4 years. Most of the recurrent cases were seen in petroclival and tentorial subgroups with partial or subtotal excision. Conclusion : Posterior fossa meningiomas are difficult to excise due to close relation to cranial nerves and vessels. Use of microscope, CUSA, intraoperative nerve monitor help in removal and preserving surrounding important anatomical structures. Although neurological deterioration is common postoperatively, recovery does occur completely after total removal thus increasing the recurrence free period and improving the outcome.
  11 3,737 646
CASES ILLUSTRATION WITH REVIEW
Frontal sinus mucocele with orbital complications: Management by varied surgical approaches
Sushil Kumar Aggarwal, Kranti Bhavana, Amit Keshri, Raj Kumar, Arun Srivastava
July-September 2012, 7(3):135-140
DOI:10.4103/1793-5482.103718  PMID:23293669
A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua­mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.
  9 5,785 863
EDITORS CHOICE
Computational fluid dynamic analysis following recurrence of cerebral aneurysm after coil embolization
Keiko Irie, Hitomi Anzai, Masahiko Kojima, Naomi Honjo, Makoto Ohta, Yuichi Hirose, Makoto Negoro
July-September 2012, 7(3):109-115
DOI:10.4103/1793-5482.103706  PMID:23293665
Hemodynamic factors are thought to play important role in the initiation, growth, and rupture of cerebral aneurysms. However, hemodynamic features in the residual neck of incompletely occluded aneurysms and their influences on recanalization are rarely reported. This study characterized the hemodynamics of incompletely occluded aneurysms that had been confirmed to undergo recanalization during long-term follow-up using computational fluid dynamic analysis. A ruptured left basilar-SCA aneurysm was incompletely occluded and showed recanalization during 11 years follow-up period. We retrospectively characterized on three-dimensional MR angiography. After subtotal occlusion, the flow pattern, wall shear stress (WSS), and velocity at the remnant neck changed during long-term follow-up period. Specifically, high WSS region and high blood flow velocity were found near the neck. Interestingly, these area of the remnant neck coincided with the location of aneurysm recanalization. High WSS and blood flow velocity were consistently observed near the remnant neck of incompletely occluded aneurysm, prone to future recanalization. It will suggest that hemodynamic factors may play important roles in aneurismal recurrence after endovascular treatment.
  8 2,932 397
ORIGINAL ARTICLES
Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: A five-year prospective study
Palaniappan Manickam Jagannath, Neelam Krishnan Venkataramana, Abhilash Bansal, Madineni Ravichandra
July-September 2012, 7(3):125-130
DOI:10.4103/1793-5482.103713  PMID:23293667
Introduction : Trigeminal Neuralgia (TGN) is a syndrome characterized by Paroxysmal, shock like hemifacial pain. Among the various treatment options micro vascular decompression (MVD) has gained popularity in the recent years. Materials and Methods : 182 patients underwent MVD, between 1995-2007 out of 530 patients treated for Trigeminal Neuralgia at our service. All were operated by retro auricular sub occipital craniectomy by a single surgeon using autologous muscle graft. They were assessed for pain relief, complications and the data was analysed. Results : Males were 84 (61.3%) females 53 (38%) with a ratio of 1.5=1. Age ranged from 25-75 years. Duration of symptoms ranging from 6 months to 25 years (average 4-6 years). Seventy seven (56.2% were affected on the right side whereas 60 (43.8%) had pain on the left side. Imaging demonstrated vascular compression in 84 (61%). At surgery superior cerebellar artery was the commonest cause of compression in 71.5%. More than one artery was found in relation to the nerve in 15.3%. There was no mortality, CSF leak 2.9% and transient facial palsy in 2.2% were the notable complications. Conclusion : MVD is the procedure of choice for TGN if there is no contraindication for surgery. Adequate tissue respect, meticulous surgical steps and experience will reduce complications. Autologus muscle graft can give comparable and durable results possibly with lesser complications.
  8 3,048 565
CASE REPORTS
Schwannoma originating in lateral recess of the fourth ventricle
Rajneesh Kachhara, Prakash Raje, Apoorva Pauranik
July-September 2012, 7(3):151-153
DOI:10.4103/1793-5482.103728  PMID:23293673
Intracranial schwannomas most commonly occur in relation to vestibular nerves followed by trigeminal nerves. Authors describe a very unusual case of schwannomas originating in lateral recess of the fourth ventricle. Tumor was completely excised micro-surgically via midline suboccipital craniectomy and C1 laminectomy. Dissection of the surgical specimen revealed that the tumor was completely free from surrounding structures and just hanging in the fourth ventricle. It was not attached to any cranial nerves, brain parenchyma, and blood vessel or to the dura mater. Histopathological examination confirmed the diagnosis of schwannoma. To our knowledge, no such case has been reported so far from this extremely rare location. Relevant literature is reviewed and hypothesis for ectopic location of these tumors has been highlighted.
  5 1,446 210
CASES ILLUSTRATION WITH REVIEW
Penetrating skull fracture by a wooden object: Management dilemmas and literature review
Muhammad Zafrullah Arifin, Arwinder Singh Gill, Ahmad Faried
July-September 2012, 7(3):131-134
DOI:10.4103/1793-5482.103716  PMID:23293668
Most penetrating skull injuries are caused by gun shot wounds or missiles. The compound depressed skull fracture represents an acute neurosurgical emergency. Management and diagnosis of such cases have been described, but its occurence following a fall onto a piece of wood is quite unusual. A 75-year-old female fell onto a piece of wood that penetrated her skull on the left frontal region and was treated in our department. The patient had no neurological deficits during presentation. She was managed surgically and removal of the wooden object was performed to prevent early or late infection complications. Wooden foreign bodies often pose a different set of challenges as far as penetrating injuries to the brain are concerned. Radiological difficulties and increased rates of infection due to its porous nature make these types of injuries particularly interesting. Their early diagnosis and appropriate treatment can minimize the risk of complications.
  4 2,553 414
CASE REPORTS
Giant cell glioblastoma in a child: A rare case report
SK Jain, I Vijay Sundar, VD Sinha, Vinod Sharma, Vishal Bhasme, Ravishankar S Goel
July-September 2012, 7(3):144-146
DOI:10.4103/1793-5482.103723  PMID:23293671
Giant cell glioblastoma (GCG) is a subtype of Glioblastoma multiforme that is rare in incidence and distinct in features and histopathological examination. It is reported to have better prognosis than common glioblastomas. The incidence of GCG in children is even more rare. We report a case of GCG in a 10-year-old boy along with a review of the relevant literature focusing on the differentiating points from common glioblastoma.
  3 2,676 319
Traumatic bilateral basal ganglia hematoma: A report of two cases
Pranshu Bhargava, Sarvpreet Singh Grewal, Bharat Gupta, Vikas Jain, Harman Sobti
July-September 2012, 7(3):147-150
DOI:10.4103/1793-5482.103725  PMID:23293672
Traumatic Basal ganglia hemorrhage is relatively uncommon. Bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We report two cases of traumatic bilateral basal ganglia hemorrhage, and review the literature in brief. Both cases were managed conservatively.
  2 1,839 334
EDITORIAL
Role of the Asian Congress of Neurological Surgeons in neurosurgery development of Kazakhstan
Serik Akshulakov
July-September 2012, 7(3):107-108
DOI:10.4103/1793-5482.103702  PMID:23293664
  - 1,095 228
YNS CORNER
Cerebellar metastasis from serous adenocarcinoma of the ovary mimicking pilocytic astrocytoma
Vivek Tandon, Kanwaljeet Garg, AK Mahapatra
July-September 2012, 7(3):141-143
DOI:10.4103/1793-5482.103720  PMID:23293670
Serous adenocarcinoma of the ovary rarely can present with solitary solid -cystic cerebellar metastasis, mimicking pilocytic astrocytoma. A middle aged women, who underwent total abdominal hysterectomy with bilateral salpingoopherectomy and adjuvant chemotherapy for ovarian adenocarcinoma, presented to us with the history of headache, vomiting, and imbalance. Contrast enhanced magnetic resonance imaging (MRI) showed solitary cerebellar, solid cystic lesion with cyst lining and solid portion enhancing on contrast which was mimicking pilocytic astrocytoma and there was no perilesional edema. Gross total excision of the cerebellar lesion was done followed by resolution of her symptoms. Histopathology showed metastatic adenocarcinoma consistent with the primary ovarian carcinoma. In patients of ovarian carcinoma, presenting with features of raised intracranial pressureICP] thorough investigations must be done to rule out metastasis. Solitary metastasis of the cerebellum because of ovarian carcinoma may mimic pilocytic astrocytoma.
  - 1,312 226
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