Laminectomy with Rib Shears: A Technical Note.

Introduction: Laminectomy/laminoplasty either free or vascularized pedicle flap is currently performed with a variety of expensive instruments. Use of Tudor Edwards rib shears to perform above procedure is described. Materials and Methods: Tudor Edwards rib shear was used to cut lamina in 18 cases for a variety of spinal lesions. Depending upon the size of lesion, laminectomy/laminoplasty was required for 2 to 8 levels. Vascularized pedicle laminoplasty or free flap laminoplasty was done with Tudor Edwards rib shears. Ligamentum flavum and interspinous and supraspinous ligaments were preserved in cases of vascularized pedicled laminoplasty, which was carried out in 12 cases. Free flap laminoplasty was carried out in 6 cases. Results: In all our cases, laminectomy was successfully achieved with rib shears without any injury to the dura or its underlying structures. It was possible to perform vascularized pedicle laminoplasty or free flap laminoplasty in all cases. Laminectomy was easier to perform in the cervical region and dorsal region, while it was difficult in the lumbar region due to the wider, thick lamina and its angulation, especially in adults. Conclusion: Laminectomy/laminoplasty with Tudor Edwards rib shears is quick, safe, and easy. Beveled cut edges with minimal bony loss prevents sinking of laminoplasty, thereby facilitates lamina fixation. This is an alternative method of performing laminectomy/laminoplasty, especially for those not having accessibility to expensive equipment.

Prospective Study of Sinonasal Outcome Following Endoscopic Skull Base Surgery.

Background: Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia. Aim: To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES. Materials and Method: Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery. Results: Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96. Conclusion: Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.

Giant Cavernomas: Gigantic Propositions for a Lilliputian Problem?

AIM: The aim of this case series is to report two cases of giant cavernomas treated at a tertiary level centre along with a literature review on the differences between giant cavernomas and normal sized cavernomas. METHOD: The first case was that of a 13-year-old male with habitual seizures since one year of age with normal examination findings. His imaging revealed a large parieto-occipital lesion which was excised microsurgically after a parieto-occipital craniotomy and a transcortical approach. The second case was a 26-year-old male who presented with generalised seizures and bilateral visual loss. Imaging was suggestive of a large left lateral ventricular lesion. A left fronto-temporo-parietal craniotomy was done followed by transventricular microsurgical excision. Histopathology of both cases were reported to be cavernomas. The first patient had transient hemiparesis post-operatively which improved within 24 hours. Eventually, both patients had an uneventful follow-up. CONCLUSION: Microsurgical excision remains the treatment of choice for giant cavernomas. In toto excision may be advocated depending upon the location of the cavernoma especially with respect to eloquence and venous anatomy.