Primary extradural hydatid cyst associated with nephrotic syndrome in a pediatric patient.

BACKGROUND: Primary intracranial extradural hydatid cyst is a very rare entity. Overlying bony erosion and extension of an extradural hydatid cyst into the scalp has never been described in literature. Association of nephrotic syndrome is described in pulmonary and hepatic hydatid cysts, but never reported in intracranial hydatidosis. CASE REPORT: We report a 6-year-old girl with primary extradural hydatid cyst having unusual radiological features. The child initially presented with features of nephrotic syndrome. Steroid therapy failed to achieve complete remission of the nephrotic syndrome, which was later abolished by cyst removal and albendazole therapy. CONCLUSION: Because of the very slow increase in the volume of the extradural hydatid cyst, intensification of symptoms may also be very slow. Sometimes, the cyst may already be very large at the time of the diagnosis. The hydatid disease should be considered in the etiology of nephrotic syndrome especially in the endemic zones.

Proliferative index in astrocytic tumours.

The accurate grading of astrocytic tumours is of prime importance because it is critical to the patient management and survival/outcome. Although internationally accepted WHO grading system of CNS tumours is based on histological features of H&E stained sections, yet there are cases where differentiation between grade II and grade III is difficult particularly when the biopsy is small. Proliferative index derived from MIB-1 immunostaining has been found to be useful in the distinction between various grades of malignancy. Formalin-fixed paraffin-embedded surgical specimens from 90 cases of astrocytic tumours, 30 each of low-grade astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma multiforme (grade IV), were immunostained by standard indirect immunoperoxidase technique using MIB-1 monoclonal antibody. MIB-1 labeling index (MIB-1 LI) was calculated. The mean MIB-1 LI values of astrocytomas, anaplastic astrocytomas and glioblastomas were 1.75 +/- 1.5%, 8.74 +/- 6.2%, and 20.54 +/- 12.2% respectively and there was statistically significant difference between grade II and III (Unpaired "t" test, T value 5.907, p value < 0.001) and grade III and grade IV (T value 4.734, p value < 0.001). The statistical analysis also revealed that the mean MIB-1 LI increased with histological grade of malignancy (One way ANOVA test, p value < 0.001). This investigation further reinforces and corroborates the findings that MIB-1 LI is useful tool in assigning grading to the astrocytic tumours and hence in treatment modalities and should be used routinely.

Central neurocytoma: a clinico-pathological study of eight cases.

Central neurocytomas are benign neuronal tumours generally found in the lateral or third ventricles. They are rare, comprising < 1% of all brain tumours. It is frequently confused with other tumours of the central nervous system particularly oligodendroglioma. The present study was done to analyse the histopathological features including immunohistochemical profile of these rare tumours. Eight cases were taken up for the study. Seven of the cases had an intraventricular location and one was located outside the ventricles. Increased intracranial pressure was the most common presenting symptom. Microscopically all tumours were composed of small uniform cells with perinuclear halos and regular round nuclei. The tumour in extraventricular location showed atypical features. Immunohistochemistry showed positivity for neuronal markers. The present series highlights the characteristic clinical and pathological findings of this rare brain tumour. Immunostaining for neuronal markers are essential for distinguishing them from other small round cell tumours of the brain.

Intracranial actinomycoma with osteomyelitis simulating meningioma. Case report.

A rare case of actinomycotic osteomyelitis with an intracranial granuloma is presented. The computerized tomography findings are probably the first of their kind. Both the site of osteomyelitis and clinical presentation are unusual. The pertinent literature is reviewed.

Cervical spondylotic myelopathy treated by single-stage multilevel anterior decompression. A prospective study.

Fifty patients suffering from advanced cervical spondylotic myelopathy were surgically treated to eliminate compression of the cord. All disc protrusions demonstrated by positive-contrast myelography that measured larger than 1.5 mm were excised. Each patient was operated on in a single-stage procedure by anterior discectomy, without bone fusion, for protrusions between 2 and 4 mm, and by vertebral trephination and intercorporeal iliac bone-graft fusion for protrusions larger than 4 mm. There were no serious complications. Improvement by one clear disability grade (as defined by the authors) was observed in 36% of the cases, by two grades in 56%, and by three grades in 8%. No patient showed an improvement of four grades. During a follow-up period varying from 2 to 5 years, none of the patients showed clinical evidence of progression of myelopathy; however, 44% of patients showed definite radiological evidence of progression of cervical spondylosis. This indicates that myelopathy may be arrested and may regress, but the process of cervical spondylosis continues unabated in almost half of the cases.

Giant cystic cavernoma in a child. Case report.

A totally cystic giant cavernous hemangioma is described in a 3-year-old girl. The clinical presentation and computerized tomography findings were both unique. The patient was successfully treated by surgery.

Chronic spinal subdural hematomas. Report of two cases.

Two patients with chronic spinal subdural hematomas are described. Both had a fluctuating clinical course, not previously documented in the literature. Surgical evacuation resulted in almost complete recovery. The pathogenesis of spinal subdural hematoma is discussed and the pertinent literature is reviewed.

Congenital ventriculocisternostomy. Case report.

A case of congenital ventriculocisternostomy is reported. This infant presented with occipital meningocele. Conray ventriculography demonstrated a spontaneous ventriculocisternostomy and stenosis of the aqueduct. The case is discussed and pertinent literature reviewed.

Significance of gadolinium-enhanced magnetic resonance imaging in differentiating spinal cord radiation myelopathy from tumor. Case report.

A young woman with a fourth ventricular ependymoma underwent radiotherapy following tumor excision. Twenty months later she developed a progressive neurological deficit at the C-2 vertebral level. Gadolinium-enhanced magnetic resonance imaging, showed an intramedullary lesion at the C-2 level. Although radiation myelopathy was suspected, tumor recurrence could not be excluded. Re-exploration and histopathology both confirmed a diagnosis of radiation myelopathy. A retrospective review of the case indicated findings favoring radiation myelopathy. The pertinent literature is reviewed and the findings discussed.

Isolated 5th to 10th cranial nerve palsy in closed head trauma.

Isolated involvement of the 5th through 10th cranial nerves, in blunt head trauma, without any other neurological deficit, is extremely rare. Two such cases are reported and relevant literature reviewed. The mechanics of trauma involved and the poor recovery is outlined.

Solitary osteochondroma of spine causing spinal cord compression.

Three cases of spinal cord compression due to solitary osteochondroma of the spine are reported. The rarity and benign nature of the tumour is stressed. Other reported cases are reviewed.

Collet-Sicard syndrome after closed head injury.

A case is reported of basilar fracture of the occipital bone passing through the left occipital condyle, ascending the clivus anteriorly, with marked medial displacement of the bony fragment. The injury produced ipsilateral palsies of nerves IX through XII (Collet-Sicard syndrome). A CT scan accurately delineated the extent of the fracture. Partial neurological recovery ensued following surgery.

Intradural extramedullary tuberculous spinal granulomas.

Four cases of intradural extramedullary tuberculous spinal granulomas without bony involvement are presented. Both, the rarity of the disease, as well as the successful microsurgical resection with good recovery prompted this report. The pathogenesis with the controversies therein, is discussed and pertinent literature is reviewed.

Primary spinal epidural Ewing's sarcoma.

A rare case of Ewing's sarcoma, originating primarily in the spinal epidural space is reported. Only five similar case reports are available in the English literature. Full recovery from a state of complete paraplegia, due to malignant compression, local recurrence without distant metastases and the longest survival of more than three years and six months, makes a unique combination. Pathology and therapy are briefly discussed and the pertinent literature reviewed.

Cystic intracerebellar epidermoids with rim enhancement. A case report.

A case of two infected cystic epidermoids of the right cerebellar hemisphere is reported. One of the cysts showed peripheral contrast enhancement on CT. Relevant literature regarding the pathogenesis and CT diagnosis is reviewed.

Cranial chordoma in the first decade.

Cranial chordomas are extremely rare in childhood with only 25 cases having been reported in the first decade of life. A 6-year-old female child with cranial chordoma is reported. Literature on the subject is reviewed, with special reference to the management, histopathological features and prognosis in childhood chordomas as compared to the adult variety.

Brain abscess following insertion of skull traction.

A case of brain abscess developing 2 weeks after insertion of skull tongs is reported. The abscess was treated with aspiration and appropriate antibiotic therapy and its complete resolution was confirmed by CT scan. The pathogenesis, through retrograde spread of superficial infection to durocortical veins, is discussed in the light of serial CT scans at different stages of formation and treatment of the abscess.

Infected intradural hydatid cyst at foramen magnum. A case report.

A case of infected intradural extramedullary hydatid cyst at foramen magnum with recurrent spinomedullary compression is described. The diagnosis was based on operation and histopathology. So far, no case of extraparenchymatous multiple cysts with cervicomedullary compression has been described in literature. Infection within an intact cyst is extremely rare.

Measurements of the skull base for transpetrosal surgery.

To understand the anatomy and the surgical approaches to the petrous, 19 adult human skulls (38 specimens) were studied. The foramen spinosum, groove for greater petrosal nerve, superior and posterior margins of the internal auditory meatus, fissure for the endolymphatic sac, and anterior margin of the groove for sigmoid sinus were the constant, easily identifiable bony landmarks located strategically; they served as guides during the transpetrosal approach. Measurements between various points helped both to understand the local anatomy better and to decide the degree and direction of safe bony removal during transpetrosal surgery.