Post-craniotomy leptomeningeal cyst: a new presentation of an old problem.

Leptomeningeal cyst (LMC) is a known complication of pediatric head injury but has not been described following a craniotomy other than for craniosynostosis. We present the case of a 20-month-old boy who underwent craniotomy for a traumatic epidural hematoma. There was an inadvertent tear of the dura which was repaired with a pericranial patch and dural sealant. The patient presented with a progressive surgical site swelling 5 months post-surgery and a CT scan revealed an LMC with elevation of the bone flap. He underwent re-exploration with watertight repair of the dural defect and rigid fixation of the bone flap. This iatrogenic LMC provides an opportunity to compare and confirm the pathogenesis vis a vis the more common spontaneous post-traumatic LMC. Our report highlights the importance of proper dural closure and bone fixation after craniotomy in children whose skulls are still growing.

Tension Subdural Hygroma Following Resection of Posterior Fossa Tumour in a Child: A new clinico-radio-pathological entity.

Persistent hydrocephalus is common in children after resection of posterior fossa tumours. However, occurrence of subdural hygroma is very rare. We report the case of a 14-month-old child who presented at a paediatric neurology clinic in Muscat, Oman in 2021 who developed a tense subdural hygroma with stable hydrocephalus, in the early postoperative period, following posterior fossa tumour resection. We describe the distinctive clinical, radiological and pathological features associated with the development of a tense subdural hygroma. We also discuss the management by cerebrospinal fluid diversion, which includes either a ventriculoperitoneal or subduroperitoneal shunt. This unique condition is distinguished from external hydrocephalus by features that are critical to the management strategy.

Extradural Hematoma Following Decompressive Craniectomy for Acute Subdural Hematoma: Two Case Reports Illustrating Different Mechanisms.

The occurrence of extradural hematoma (EDH) after decompressive craniectomy (DC) for traumatic brain injury is uncommon. We report two cases, one developing ipsilateral EDH and another developing contralateral simultaneous EDH and subdural hematoma after DC. The strategies to anticipate the occurrence of such concurrent hematomas (CH) are highlighted. We propose a subclassification of CH into "immediate" and "delayed," based on their difference in clinical presentation, image findings, pathogenesis, and surgical management.

Spontaneous Ventriculostomy into the Subdural Space in a Neonate with Congenital Hydrocephalus.

We report a case of spontaneous temporary resolution of congenital hydrocephalus due to drainage into the subdural space, which is not a physiological space for cerebrospinal fluid (CSF). This is the first report of spontaneous drainage of CSF into the subdural space, and we term it "ventriculosubdurostomy." We highlight the fact that spontaneous resolution of hydrocephalus due to drainage into a nonphysiological CSF space is temporary.

Complex congenital atlantoaxial dislocation in an infant: case report.

The authors report the case of congenital atlantoaxial dislocation in a 9-month-old female infant, who presented with progressive quadriparesis and respiratory failure. The problems in management due to such an early age of presentation, including atypical clinical presentation, unique radiological findings, limited management options, and variable clinical outcomes discussed. This is the youngest case of non-syndromic congenital atlantoaxial dislocation, reported to date, and is a unique combination of lateral, rotatory, and antero-posterior atlantoaxial dislocation.

Spontaneous evacuation of hyperacute extradural hematoma: two illustrative case reports.

Spontaneous drainage of extradural hematoma (EDH) through a skull fracture is rare, with only 14 cases reported to date. Five of these belong to pediatric age group. The authors report two cases of spontaneous evacuation of acute EDH, in children, with two differing types of skull fractures, one being an elevated fracture. The context, in which the terminologies of "spontaneous evacuation" and "spontaneous resolution" to be used, is clarified.

Primary Extradural Meningioma Presenting as Frontal Sinusitis with Extensive Bony Changes: Case report.

Primary extradural meningiomas are rare tumours and calvarial meningiomas with extensive bony changes and frontal sinusitis are rarer still. We report a 40-year-old female patient who presented to the otorhinolaryngologist at the Sultan Qaboos University Hospital in Muscat, Oman, in October 2013 with headaches and frontal swelling. She was diagnosed with frontal sinusitis complicated by osteomyelitis. Further clinical examination and imaging revealed a left frontal calvarial meningioma with extensive bony changes and extracalvarial extension into the frontal sinus. She underwent a left frontal craniotomy during which the tumour was removed. The postoperative period was uneventful and a follow-up computed tomography scan after three months showed only postoperative changes. This report discusses the radiological differential diagnosis and management of this type of lesion.

Post-traumatic blepharocele in an adult.

Cerebrospinal fluid (CSF) collection in the eyelid is known as blepharocele. It is rarely reported in adults. In this report, we describe one such patient who developed a non-resolving swelling of the left upper eyelid associated with mechanical ptosis following a head injury. He had fractures involving the left orbital rim and roof, and the medial and lateral walls. His left frontal sinus was hypoplastic. The diagnosis of CSF blepharocele was made based on clinical, biochemical and radiological findings. He underwent transcranial repair of the left frontobasal dural tear with a good recovery.