Post-traumatic cervical spondyloptosis: A rare entity with multiple management options.

Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient.

Large occipito-cervical encephalocele with Chiari III malformation.

Chiari type III is the rarest of the Chiari malformations and is usually associated with high morbidity and mortality. Treatment consists of primary closure of the encephalocele with or without cerebro-spinal fluid (CSF) shunting. In our case, the patient was treated with ventriculoperitoneal shunt followed by excision of the encephalocele. We propose that large encephaloceles should be treated with CSF shunting prior to repair of the sac so as to achieve optimal result.

Nondysraphic cervical and thoracic intraspinal lipomas: a review.

BACKGROUND: Intraspinal lipomas are commonly seen in the lumbosacral area. A cervical and thoracic location is very rarely encountered. Management of these lesions is still controversial. METHOD: We report a series of 8 such patients, who were surgically managed at our institute. FINDINGS: All the patients were adults (mean age-34 years). Subcutaneous lipomas were seen in two patients. None of the 8 patients were obese. Mean duration of symptoms was 484 days. The Nurick's grade at the time of presentation ranged from 3 to 5. All 8 patients underwent partial decompression. Only 1 patient required repeat surgery after 11 years. All the patients reported improvement or stabilization of symptoms at follow-up (mean 56.3 months). The Nurick's grading at the time of follow-up ranged from 1 to 4. CONCLUSION: A cervical or thoracic location is extremely rare among intraspinal lipomas. Patients usually present with a long duration of symptoms. Complete excision is extremely difficult and likely to be detrimental. Partial decompression usually leads to good improvement.

Calcified epidermoid cyst of the anterior interhemispheric fissure.

Epidermoid tumours are rare intracranial tumours. They are commonly found in the cerebellopontine angle and the suprasellar region. However, they are also known to occur in other locations. Anterior interhemispheric fissure epidermoid cysts are rarer still, and calcification among epidermoids is considered unusual and dystrophic in nature. We present here an unusual case of an anterior interhemispheric epidermoid with near-complete calcification, which presented with long-standing seizures and was amenable to total surgical excision.

Abscess-a rare fourth ventricular mass.

Midline posterior fossa mass lesions in young adults are usually medulloblastomas, pilocytic astrocytomas, haemangioblastomas or ependymomas. We present clinical, imaging and intraoperative findings of an abscess occurring within the fourth ventricle which was associated with right chronic suppurative otitis media and right transverse sinus thrombosis. The possible pathogenesis is discussed.

Multi-slice computed tomography appearance of abscess of cavum septum pellucidum: a case report and review of the literature.

Abscesses involving the cavum septum pellucidum are rare and, owing to their location, detection may be difficult with routine conventional computed tomography (CT). Only a few isolated cases have been reported and mostly in children. We report a case of abscess involving the cavum septum pellucidum in an adult and its appearance on multi-slice spiral CT.

Hypothalamic tumour with haemorrhage.

Haemorrhage in low-grade glioma is rare. A 4-year-old boy presented with sudden loss of consciousness. CT scan of his head revealed anterior third ventricular tumour with bleeding, intraventricular haemorrhage and hydrocephalus. The boy expired within 26 h of the onset of his illness, and an autopsy revealed a haemorrhagic juvenile pilocytic astrocytoma arising from the lateral hypothalamus with intraventricular haemorrhage. Intracranial tumour as the cause of sudden death and tumour with bleeding are discussed.

Intramedullary spinal epidermoid cyst.

Intramedullary epidermoid cysts of the spinal cord are rare tumours, especially those not associated with spinal dysraphism. Around 50 cases have been reported in the literature. Of these, only seven cases have had magnetic resonance imaging studies. We report two cases of spinal intramedullary epidermoid cysts with MR imaging. Both were not associated with spina bifida. In one patient the tumour was located at D4 vertebral level, while in other within the conus medullaris. The clinical features, MR imaging characteristics and surgical treatment of such rare intramedullary benign tumours are discussed, and the relevant literature reviewed.

Facial nerve neurinoma presenting as middle cranial fossa and cerebellopontine angle mass: a case report.

Facial nerve neurinomas are rare. The tumours arising from the geniculate ganglion may grow anteriorly and superiorly and present as a mass in the middle cranial fossa. Only a few cases of facial nerve neurinomas presenting as middle cranial fossa mass have so far been reported. These tumours present with either long standing or intermittent facial palsy along with cerebellopontine angle syndrome.

CSF rhinorrhoea from unusual site : report of two cases.

CSF rhinorrhoea is associated with high morbidity and mortality. Bone and dural defects may result from trauma or enlarging 'pitholes' or breach in lateral recess of sphenoid sinus. Unless surgically corrected, they tend to cause meningitis and rhinorrhoea. Unusually delayed rhinorrhoea is a diagnostic problem.

Intraventricular tuberculous abscess: a case report.

Ventricles can be involved in different ways in neurotuberculosis, however, the occurrence of intraventricular abscess has been rarely reported. We report a young woman who had intraventricular tubercular abscess. Cranial computed tomographic scan showed hypodense ring enhancing lesion in the right lateral ventricle with unilateral hydrocephalus. She underwent parasagittal craniotomy with total excision of the lesion. The pus obtained from the lesion was teeming with acid fast bacilli.

Cystic cavernous malformation of the cerebellopontine angle.

A 46 year old male presented with a cerebellopontine angle syndrome. CT scan and MRI revealed a cystic mass with a solid nodule in the cerebellopontine angle. At surgery, a vascular lesion was encountered which was totally excised in two stages. The histopathology was consistent with that of a cavernous malformation. Only four such cases have been reported so far in the English literature. The clinical and radiological features and the surgical management are discussed.

Syringomyelia presenting soon after cranial and possible spinal trauma : a case report.

A 30 year old man, who had a fall from the top of a vehicle, was operated for frontal extradural haematoma. In the post-operative period he was noted to have features of central cord syndrome. MRI of the cervical spine revealed a multiseptate cervicothoracic syringomyelia, suggesting a long standing but asymptomatic syrinx. A syrinx-subarachnoid shunt was placed through a C6 and C7 hemilaminectomy. Patient improved in neurological status postoperatively. The possible mechanism of conversion of an asymptomatic syrinx to symptomatic syrinx following cranial and possible spinal trauma shall be discussed.

Intracranial plasma cell granuloma : a report of four cases.

Intracranial plasma cell granulomas are a rare group of idiopathic inflammatory pseudotumours often mistaken for lymphoreticular malignancies and myeloproliferative disorders. The clinial and pathological findings in respect of four cases of intracranial plasma cell granuloma clinically diagnosed as meningioma and glioma are presented in this report. The range of microscopic features seen included a mixed cell population with predominance of plasma cells, absence of cellular atypia and mitosis, multinucleate giant cells, perivascular cuffing by inflammatory cells and emperipolesis. The major considerations in differential diagnosis of this lesion are discussed.

Anomaly of arch of atlas--a rare cause of symptomatic canal stenosis in children.

Symptomatic canal stenosis at the level of atlas (C1) without atlantoaxial dislocation is thought to be very rare in children. Though common, anomalies of the arch of atlas are generally incidental findings in X-rays. High cord compression due to a narrow canal from a bifid posterior arch, or an absent posterior arch, is a very rare condition. We report 5 children with high cord compression from stenosis of C1 arch.

Spinal extradural cavernous haemangioma.

A case of spinal extradural cavernous haemangioma without a vertebral lesion is reported. Clinical and radiological features of the lesion are discussed. Relevant literature is reviewed.