Reverse Foster Kennedy Syndrome Caused by an Intra-axial Tumor.

We present a case of a 23-year-old male complaining of painless loss of vision in right eye for 1 year and rapidly progressing vision loss in left eye with bilateral lateral rectus palsy. His fundoscopy revealed optic atrophy on the right side and papilledema on the left. Magnetic resonance imaging (MRI) showed intra-axial contrast-enhancing left frontal tumor. We discuss this first case of reverse Foster-Kennedy syndrome in the English literature with emphasis on the clinico-radiological and clinico-histopathological correlation.

Explosion of dermoid cyst into five intracranial spaces- a rare event.

Rupture of a dermoid cyst is a rare but well known phenomenon. We present a case of forceful rupture of dermoid cyst into five intracranial spaces which is never been reported before. Timely detection, early intervention and watchful follow-ups can lead to full recovery from such a devastating complication.

Intraconal optic sheath schwannoma: report of two cases.

Optic sheath schwannoma is extremely rare. We discuss two cases of intraorbital intraconal optic sheath schwannoma. Vision significantly improved in both patients following the surgery. We have briefly described the surgical technique & discussed the relevant literature.

Deep brain stimulation of anteromedial globus pallidus internus for severe Tourette syndrome.

Tourette syndrome (TS) is a complex disorder characterized by tics and is associated with behavioral problems. Although its intensity decreases in adolescence and adult life, in some cases it continues to remain severe and refractory to medical treatment. Deep brain stimulation has been offered as a treatment option in such cases. We report two cases of TS treated with of anteromedial globus pallidum internus. Both the cases had good postoperative control of tics and associated obsessive-compulsive behavior.

Surgical Interventions for Task-specific Dystonia (Writer's Dystonia).

OBJECTIVES: Writer's cramp is a focal dystonia producing abnormal postures during selective motor activities. Thalamotomy or globus pallidus internus deep brain stimulation (GPi DBS) has been used as a surgical treatment in patients not responding to medical treatment. MATERIALS AND METHODS: Eight patients (all men, age 16-47 years) with refractory focal hand dystonia underwent either ventrooralis (Vo) thalamotomy (seven patients) or GPi DBS (one patient) using stereotactic techniques. Preoperative video recordings, Writing movment score for dystonic posture and latency of dystonia (WMS), and symptom severity scores (SSSs) were evaluated at baseline and latest follow-up ranging from 1 to 4 years. RESULTS: All patients had difficulty in performing their most common tasks. The duration of symptoms ranged from 6 months to 12 years. All patients obtained immediate postoperative relief from the dystonic symptoms, and the effect was sustained during the follow-up period. The WMS (range 0-28) improved from a mean of 14.5 before surgery to 2, whereas the SSS (maximum 43 and minimum 10) improved from a mean of 15.3 before surgery to 2 at the last follow-up. There were no surgical complications, morbidity, or mortality. CONCLUSION: Vo thalamotomy or GPi DBS offers successful symptom relief in patients with task-specific dystonia.

Progression in size of an arterio-venous malformation.

We report a case of a young girl who was admitted with history of sudden onset left hemiplegia, when she was 5 years old. Investigations revealed no vascular malformation or abnormality. On conservative treatment, she progressively improved and had residual hemiparesis. She continued to have intermittent episodes of generalized and focal convulsions. For persistent convulsions, she was investigated again with MRI and angiography after 5 years of first presentation. Investigations at this time revealed a large arteriovenous malformation in the left posterior frontal region. The arteriovenous malformation was resected by surgery. Following surgery, the episodes of convulsions reduced. Arteriovenous malformations are generally considered to be congenital lesions and their size and physical architecture generally remains constant. The presented case clearly demonstrated de novo appearance or growth of the size of the arteriovenous malformation. Such a pattern of development and growth of a arteriovenous malformation is rare and only infrequently reported.

Immediate Postoperative Reversal of Disc Herniation Following Facetal Distraction-Fixation Surgery: Report of 4 Cases.

BACKGROUND: We report cases of 4 patients where Goel facet distraction surgery resulted in restoration of herniated disc back into the intervertebral disc space in the immediate postoperative period. Such a fate of herniated disc has not been recorded earlier. METHODS: During the period 2010 to 2011, 4 patients with single level 'contained' herniated disc that extended to the posterior surface of adjoining vertebral bodies and resulted in severe cord and root compression were surgically treated. The posterior longitudinal ligament was essentially intact in all 4 cases. Surgery involved facetal distraction technique using Goel facet spacers as a standalone method of treatment. RESULTS: Immediate postoperative imaging showed nearly complete disappearance of the disc bulge, restoration of the cervical cord girth and distraction-fixation arthrodesis of the spinal segment. All patients had remarkable and sustained clinical improvement. At a 5-year follow-up, all 4 patients were well and showed no evidence of recurrent symptoms or recurrence of herniated disc-related imaging findings. CONCLUSIONS: The indications for facetal distraction surgery, its mechanisms of action and its suitability in the presented cases are discussed.

Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report.

INTRODUCTION: Though acoustic schwannoma is the most common primary tumour in the cerebello-pontine angle, its occurrence with tuberculoma has never been reported. PRESENTATION OF CASE: A case of a vestibular schwannoma and tuberculoma occurring as collision tumors in the posterior fossa in a 46 years old female is reported. She presented with chronic raised intracranial pressure manifesting as headache, occasional diplopia, speech disturbance, and unsteady gait. Magnetic resonance imaging of the brain demonstrated a vestibular schwannoma and tuberculoma in the right cerebello-pontine angle. The lesions were resected through retro sigmoid route. The caudal mass was vestibular schwannoma while the rostral and medial portion was tuberculoma. DISCUSSION: The occurrence of a vestibular schwannoma and tuberculoma in collision has hitherto never been reported. The pathogenesis, surgical challenges and management of such a rare entity is discussed and the relevant literature is briefly reviewed. CONCLUSION: The association of vestibular schwannoma and tuberculoma is rare. Surgical excision of lesions occurring in collision can be formidable. They require careful planning and strategy.

Multicentric intradural extramedullary ependymoma: Report of a rare case.

Spinal ependymoma commonly presents as an intramedullary tumor. We present a rare case of multicentric intradural extramedullary spinal ependymoma. A 59 years old female presented to us with spastic quadriparesis for 10 months. Magnetic resonance imaging of the spinal cord showed discretely located enhancing tumor masses from at C1-C2, C6-C7, and D4 to L3 level. Subtotal resection of the symptomatic tumor at C6-C7 and D7-D9 was done. The patient underwent radiotherapy with 50.4 Gy. At follow-up of 11 months, patient is doing well. The relevant literature is reviewed.

Migrated Disc at Cervicothoracic Junction Presenting as Acute Paraplegia.

Herein, we report on an inferior migration of an intervertebral disc C6-7 to the cervicothoracic junction manifesting as acute paraplegia. The patient showed a remarkable recovery after the surgery. The diagnostic dilemma and management difficulties of such an entity are briefly discussed.

An unusual variant of anlage tumor of pineal region in an infant.

A 9-month-old male child was brought with complaints of increasing head size for 2 months, increasing lethargy and vomiting for the last 2 days. Radiology revealed a heterogeneously enhancing, globular lesion in the pineal region with hydrocephalus. Near total excision of the tumor was carried out. The histopathological examination of the lesion showed heterogenous elements in the form of mature neuroepithelial and ectomesenchymal tissue. The pathology and radiology of this unusual lesion is discussed with relevant review of literature.

Bamboo in the Brain-an Unusual Mode of Injury.

A 22-year-old male presented with a history of penetration of bamboo over the head which had fallen from the height of 40 ft. The position of the object was confirmed by computed tomography and patient underwent surgery immediately with removal of the object. The patient did well after surgery. Different modes of penetrating injury to the brain by bamboo and wooden objects, complications and management issues are discussed with a brief review of literature.

Malignant fibrous histiocytoma of the skull base: A neurosurgical nuance.

A 69-year-old male, treated for colonic carcinoma 15 years back, presented to our services with status epilepticus. He had complaints of headache and vomiting for 7 days prior to presentation. Computed tomography and magnetic resonance imaging of the brain revealed heterogeneous, lobulated and osteolytic tumor involving middle and posterior cranial fossa. Excision of the tumor was planned in two stages. Middle fossa component was removed through right temporobasal approach. Histopathology was suggestive of malignant fibrous histiocytoma. Patient succumbed to pneumonia and septicemia in the postoperative period. Pathology, clinical features and therapeutic challenges of this clinical entity have been briefly reviewed.

Bifid Anterior and Posterior Arches of Atlas: Surgical Implication and Analysis of 70 Cases.

BACKGROUND: On reviewing the database of patients with craniovertebral junction anomalies, the authors identified 70 patients with a bifid posterior arch of atlas. OBJECTIVE: To speculate on the pathogenesis of spondyloschisis of both the anterior and posterior arches of atlas, particularly as it relates to atlantoaxial instability. METHODS: Seventy patients with bifid anterior and posterior arches were identified by a retrospective review of the database from 2007 to 2013. RESULTS: The ages of the patients ranged from 14 months to 50 years. The patients were divided into 3 groups. Group 1 (3 patients) had multiple additional spinal bony and neural abnormalities. Group 2 (34 patients) had mobile and partially (5) or completely (29) reducible atlantoaxial dislocation. Group 3 (33 patients) had atlantoaxial instability and related basilar invagination. The os odontoideum was identified in 21 patients, and C2-3 fusion was seen in 24 patients. Two of 3 patients in group 1 were treated conservatively and without any surgery. All patients in groups 2 and 3 were surgically treated. Surgery was done using lateral mass plate/rod and screw fixation techniques. The general observation during surgery included identification of discrete movements of both halves of the atlas, lateral positioning of the facets of atlas in relation to the facets of the axis and occipital condyle and closer approximation of the occipital bone, atlas, and axis resulting in "crumpling" of bone and neural elements. CONCLUSION: Understanding of the pathogenesis and mechanical alterations in cases with a bifid arch of atlas can assist in evaluating the clinical implications and in conduct of surgery.

Lower motor neuron facial palsy after ventriculoperitoneal shunt surgery.

A 40-year-old woman underwent marsupialisation of a symptomatic retrocerebellar cyst. She developed pseudomeningocoele after the procedure. CT of the brain showed hydrocephalus. Therefore, a right-sided ventriculoperitoneal shunt procedure was performed. Unfortunately, the patient developed lower motor neuron-type facial paralysis immediately after the surgery. We localised the site of injury in the distal fallopian canal probably during tunnelling of the subcutaneous tract for passage of the shunt. We discuss the steps to be followed to avoid such mishaps with a brief review of the literature.

Cavernoma of the septum pellucidum in the region of foramen of Monro.

A rare case of cavernoma in the region of the septum pellucidum is reported. A 35-year-old female patient presented with chronic headaches. Her neurological exam was normal. Her magnetic resonance (MR) imaging showed a lesion within the inferior aspect of the septum pellucidum extending into the anterior third ventricular region, blocking the foramen of Monro, resulting in moderate supratentorial asymmetrical hydrocephalus. A central neurocytoma or subependymoma was suspected on imaging. Complete excision of the septum pellucidum cavernoma was performed using microneurosurgical techniques through an interhemispheric transcallosal route. The patient had an excellent outcome and is cured. Although rare, septum pellucidum cavernomas should be considered in the differential diagnosis of anterior third ventricular lesions in the region of foramen of Monro. The unusual location, atypical radiological features, differential diagnosis as well as surgical nuances in the management of a cavernoma in the septum pellucidum and anterior third ventricular region are discussed in the light of current literature.