Dural sinus malformation presenting with proptosis: report and review of a rare entity.

Dural sinus malformation (DSM) is a rare vascular malformation characterized by the dilatation of a dural venous sinus with or without an anomalous jugular bulb. Its presentation with venous-reflux-related secondary proptosis is anecdotal, with only six such cases reported so far. We report a 17-month-old boy who presented with a progressive proptosis of the right eye secondary to a DSM of the transverse sinus and torcula. Following endovascular embolization of the arterio-venous fistula, complete thrombosis of the venous lake and improvement in proptosis was noted at 6-month follow-up. Prognosis of this rare malformation is variable and dependent on specific angio-architectural features.

Endovascular Nuances in Management of Multiple Intracranial Aneurysms.

BACKGROUND: Endovascular treatment of aneurysm is the accepted standard of treatment. Multiple intracranial aneurysms are frequently detected due to advances in imaging. OBJECTIVE: The purpose of this study was to determine aneurysm properties, management strategies, and outcome of patients with multiple intracranial aneurysms managed by endovascular approach. MATERIALS AND METHODS: Data of all patients with multiple intracranial aneurysms who were managed at our institute over a period of 1 year were retrospectively studied. Data of 20 consecutive patients with single aneurysm who were endovascularly managed during the same study period were also collected. Patient demographics, intraprocedural radiation exposure, hardware used, and clinical and angiographic outcome at discharge were analyzed. RESULTS: A total of 112 patients with intracranial aneurysm were managed during the study period, of which 11 patients had multiple intracranial aneurysms, with a total of 23 aneurysms. Incidence was more among females (63.6%). Proximal of multiple aneurysms ruptured more commonly (63.6%), and internal carotid artery (ICA) bifurcation was the most common site (45.4%). Of the 23 aneurysms, 18 were coiled. Seven patients had good outcome and it was found to be influenced by preoperative Hunt and Hess scale. Based on Raymond-Roy grading, 17 of 18 aneurysms (94.4%) were completely coiled; angiographic outcome was comparable in both the groups. Patients with multiple aneurysm had statistically significant high radiation exposure (4.5 vs 3.8 m SV) as compared to patients with single aneurysm (P < 0.05), but had low stochastic effect. In patients with aneurysm involving different arterial compartment, 66.2% required change of microcatheter. CONCLUSION: Single-stage treatment of multiple aneurysm can be achieved with good outcome. Even though radiation exposure is high while treating multiple aneurysm as compared to single aneurysm cases, its stochastic risks are low.

A prospective comparative clinical study of peripheral blood counts and indices in patients with primary brain tumors.

BACKGROUND: Elevation of the neutrophil to lymphocyte ratio (NLR) has been shown to be an indicator of poor prognosis in many malignancies including recurrent glioblastoma multiforme. OBJECTIVES: This study was aimed at assessing if the NLR and other leukocyte counts and indices were deranged in treatment-naïve patients with primary brain tumors when compared with an age-matched healthy control group. MATERIALS AND METHODS: This was a prospective comparative clinical observational study by design. A healthy control population was compared with treatment-naïve patients diagnosed with intra- and extraaxial brain tumors. Leukocyte counts (neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts) as well as leukocyte ratios such as the NLR and the monocyte to lymphocyte ratio (MLR) were calculated. We also evaluated if the counts and indices were related to the tumor volume. RESULTS: In all patients with tumors, the platelet and neutrophil counts were elevated when compared to the controls. In contrast, monocyte counts and the MLR were found to be decreased in patients with tumors when compared to the controls. The subset of patients with glioblastoma showed a significant increase in NLR when compared to the controls. CONCLUSIONS: Significant changes in the neutrophil, monocyte, and platelet counts as well as NLR and MLR were observed. Prospective longitudinal studies are required to determine the prognostic and therapeutic implications of these findings.

An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression - A comparative clinical study.

OBJECTIVES: This study aimed at determining the frequency of abnormal finger flexion, Hoffman's and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients. METHODS: Patients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffman's and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed. RESULTS: The frequency of the reflexes in healthy controls were finger flexion - 1%, Hoffman's - 0.3% and Babinski sign - 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression. CONCLUSIONS: A combination of finger flexion, Hoffman's and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals.

The posterior cranial fossa: a comparative MRI-based anatomic study of linear dimensions and volumetry in a homogeneous South Indian population.

PURPOSE: The posterior fossa contains structures that are vital to life. In this study, we aimed at establishing normal linear dimensions and volume data of the posterior fossa in a homogeneous south Indian population. We also evaluated the influence of large tumors on these parameters. We evaluated the accuracy of different techniques of measuring these dimensions and compared them with literature. MATERIALS AND METHODS: Control and tumor MRIs were selected from an imaging database. Linear posterior fossa dimensions as well as volumes were measured using Image J and Fiji. The volume data were compared with similar data from literature. The effect of the presence of a tumor on posterior fossa volume was measured. RESULTS: The posterior fossa volume was higher in men than in women, irrespective of whether the volume was estimated on axial, sagittal or coronal MR images. Despite the wide variation in the techniques used, there was no significant difference between the volumes reported in literature and the volumes calculated in the current series. The presence of large tumors did not affect linear dimensions or posterior fossa volumes. Among the techniques based on linear measurements that were assessed for concordance with manual segmentation, the technique using the formula for volume of an ellipsoid had the best agreement. CONCLUSIONS: Posterior fossa volume is higher in men than in women, Posterior fossa dimensions were not affected by the presence of large tumors. Manual segmentation remains the most accurate method to measure posterior fossa volume.