Lumbo-peritoneal shunt as treatment modality for visual symptoms in idiopathic intracranial hypertension: A single institution experience / Derivación lumboperitoneal como modalidad terapéutica para los síntomas visuales de la hipertensión intracraneal idiopática: experiencia de una única institución

Objectives To evaluate the efficacy of lumbo-peritoneal shunt (LPS) in patients of idiopathic intracranial hypertension presenting with visual symptoms. Methods Between Apr. 2014 and Mar. 2018, 70 patients of Idiopathic Intracranial Hypertension (IIH) underwent treatment at our institution. Patients were evaluated for neurological and ophthalmological status and were subjected to LPS depending on their symptoms. Results Mean opening pressure was 29.97 ± 5.33 cm of water and mean Body-Mass Index (BMI) was 26.51 ± 3 and the two were significantly correlated (p-value 0.006). All patients with visual symptoms (23) underwent LPS and others (47) were managed medically. All patients with LPS and 25 of medically managed patients improved, while 22 medically-managed patients required LPS due to deterioration in visual symptomatology. The proportion of patients showing complete resolution of features of IIH was significantly different between the three groups. Of the 7 patients with shunt extrusion/migration, only 2 required revision. Conclusion LPS is an equally effective and more technically familiar modality for treatment of IIH for neurosurgeons and should be offered to asymptomatic patients with objective visual signs. Shunt extrusion/migration may not always warrant revision due to “mini-shunt” that drains Cerebro-Spinal Fluid (CSF) through shunt tract even after extrusion (AU)

Evaluar la eficacia de la derivación lumboperitoneal (DLP) en pacientes con hipertensión intracraneal idiopática con síntomas visuales. Métodos Entre abril de 2014 y marzo de 2018, 70 pacientes con hipertensión intracraneal idiopática (HII) se sometieron a tratamiento en nuestra institución. Los pacientes se evaluaron para determinar el estado neurológico y oftalmológico y se sometieron a DLP en función de sus síntomas. Resultados La presión de apertura media fue de 29,97 ± 5,33 cm de agua y el índice de masa corporal (IMC) medio fue de 26,51 ± 3, y los 2 presentaron una correlación significativa (valor de p = 0,006). Todos los pacientes con síntomas visuales (23) se sometieron a DLP y otros (47) recibieron tratamiento farmacológico. Todos los pacientes con DLP y 23 de los pacientes que recibieron tratamiento farmacológico mejoraron, mientras que 22 pacientes con tratamiento farmacológico precisaron DLP debido al deterioro en la sintomatología visual. La proporción de los pacientes que mostró resolución completa de las características de la HII fue significativamente diferente entre los 3 grupos. De los 7 pacientes con extrusión/migración de la derivación, solo 2 precisaron revisión. Conclusión La DLP es una modalidad igual de eficaz y más familiar desde un punto de vista técnico para los neurocirujanos para el tratamiento de la HII y debe ofrecerse a los pacientes asintomáticos con signos visuales objetivos. La extrusión/migración de la derivación puede no justificar siempre una revisión debido a la «miniderivación» que drena el líquido cefalorraquídeo (LCR) a través del conducto de derivación incluso después de la extrusión (AU)

Isolated skull base primary Ewing's sarcoma: an extremely rare location.

A 16-year-old boy presented with history of headache and blurring of distant vision. He had UMN facial paresis and papilledema. Imaging revealed a heterogenous space occupying lesion in the middle cranial fossa base with mass effect and midline shift and non homogenous contrast enhancement with erosion of the petrous bone. He underwent gross total excision of the lesion. Histopathology and immunohistochemistry were suggestive of skull base Ewing's sarcoma. Bone scan was done to rule out primary involvement of other extracranial location. We have discussed the epidemiology, presentation, management and prognosis of such cases.

Pediatric multifocal glioblastoma multiforme with fulminant course.

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in children is less common than in adults and has a better prognosis. Pediatric GBM is a rare entity, and a multifocal development in a pediatric GBM is much rarer. We report to you one such rare case of pediatric multifocal GBM in a 5-year-old child who developed rapidly increasing multiple lesions after radiotherapy. More studies are required to study the genetic analysis, tumor behavior, management and outcome of these rare tumors.

Invasive rhino-cerebral fungal granuloma.

BACKGROUND: Increased incidence of fungal infection has been reported globally in the recent years. Fungal infection of the central nervous system remains one of the most difficult diseases to treat and requires multi-modality intensive therapeutic strategies. MATERIALS AND METHODS: Retrospective analysis of case records of patients with confirmed skull base fungal granuloma treated at a tertiary hospital between 1988-2008. An attempt was made to stage the extent of skull base fungal granuloma based on neuroimaging, operative findings and course of the disease on serial follow-up. RESULTS: Thirty-three patients with skull base fungal granuloma were treated surgically during the study period. The mean age at presentation was 33.2 years and diabetes was a major predisposing factor. Eight patients expired in the first two months following surgical intervention due to flare-up of the disease. Eighteen patients who underwent grossly total excision had a mean progression-free survival (PFS) of 43 months and seven patients with subtotal excision had a mean PFS of 23 months. Better survival probability was noted in those patients who underwent total excision at surgery and received complete course of amphotericin. CONCLUSION: Total surgical excision with complete course of antimycotic drug therapy increases PFS. A better antimycotic drug with less toxicity and high efficacy with fungicidal property can make a difference in the outcomes of the disease.

Intracranial epithelioid hemangioendothelioma.

INTRODUCTION: Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a well-defined entity outside the neuraxis, its intracranial occurrence is rare. Literature review revealed 35 reported cases till date. CASE REPORT: The authors report a case of intracranial EHE in a 15-year-old girl, who presented with a short history and unusual radiology. Following radical removal, the lesion recurred within 1 month and progressed to terminal stages. This tumor is thought to have an indolent intermediate malignancy potential and such rapid progression has not been reported so far.