Rhabdoid tumor of the thalamus.

Rhabdoid tumors of the central nervous system are uncommon tumors. About 188 cases have been reported in the literature so far. In this report, we describe a case of a rhabdoid tumor of the thalamus in a 35-year-old male patient. Light microscopic and immunohistochemical features are discussed and the relevant literature reviewed.

Liponeurocytoma of the cerebellum--a case report.

We report the characteristic neuropathological features of a rare case of cerebellar liponeurocytoma in a 62-year-old female. The tumor has a low proliferative potential and carries a favorable prognosis.

False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery.

We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.

Infrasellar craniopharyngioma mimicking a clival chordoma: a case report.

An unusual case of entirely infrasellar craniopharyngioma mimicking a clival chordoma is described. Only 22 cases of craniopharyngioma with nasopharyngeal extension have been reported in the literature. Of the reported cases, most were primarily intracranial with secondary downward extension; only two were thought to originate from an infrasellar location. The present case is another example of an entirely infrasellar craniopharyngioma, with extensive clival destruction, mimicking a clival chordoma. Relevant literature on the subject is reviewed.

Acoustic neurinomas during pregnancy: report of two cases and review of literature.

Though infrequent, acoustic neurinomas have been described during pregnancy and represent a therapeutic challenge for excision without producing any problem for the mother and the foetus. First Author experienced two cases of acoustic neurinomas presenting during pregnancy. One patient presented in the terminal stages of the third trimester of pregnancy and underwent caesarean section, followed by retromastoid craniectomy and excision of the tumour. Operative management of the pregnancy and tumour in the same sitting has not been reported in the literature. Second patient who presented during 2nd trimester of pregnancy, was operated on for the tumour and had a successful continuance of pregnancy. Details of the management are discussed and the relevant literature reviewed. In addition to causing aggravation of symptoms, the larger size and increased vascularity of these tumours during pregnancy, makes them more vulnerable to acute bleeding, which in turn may initiate new or exacerbate pre-existing symptoms, as noted in one of the cases presented in this report.

Solitary metastasis from occult follicular carcinoma of the thyroid mimicking trigeminal neurinoma--case report.

A 50-year-old woman presented with an extremely uncommon case of solitary metastasis from follicular carcinoma of the thyroid, which presented clinically as trigeminal neurinoma. Neuroimaging detected a tumor in the right petrous apex, which was removed surgically. Histological examination showed metastatic follicular carcinoma of the thyroid. However, no primary tumor was detected by various investigations. The tumor recurred twice, and was treated surgically both times. The patient finally agreed to adjuvant therapy for the suspected primary. Radiotherapy was performed followed by complete thyroidectomy. Examination of the gross specimen found the tumor nodule. Clinically significant metastasis can arise from histologically benign and silent follicular thyroid neoplasms.

Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy.

A rare case of non-functioning pituitary adenoma, which completely resolved following an apoplectic event without producing hypopituitarism, is described.

Fibrous dysplasia of the orbit in an infant.

Fibrous dysplasia is an idiopathic fibro-osseous lesion of the skeletal bones. These uncommon osseous lesions usually manifest within the first two decades of life. Its occurrence during infancy is extremely uncommon, and we describe here a case of fibrous dysplasia involving the orbit in a 9-month-old male child.

Medial trigonal arteriovenous malformations.

A retrospective analysis of 48 patients of medial paratrigonal arteriovenous malformations (AVMs) which constituted 18% of the total 258. AVMs surgically managed in our institute for 16 years was carried out to study their clinical presentation, radiological features, operative approaches and functional outcome. While hemorrhage was the initial presenting symptom in 35, it was longstanding headache in 10, focal seizures in two and progressive weakness in one. However, 41 of these presented with bleed at the time of admission to our hospital and in 15 there was history of multiple bleeds. Twelve and eleven patients had field cut and hemiparesis respectively. Arterial supply to the malformation was quite uniform with posterior (43 patients) and anterior cerebral (25 patients) being the most frequent source. Venous drainage was predominantly into the galenic system (70%). Preoperative embolization was carried out in six patients. While the AVM was excised through a parasagittal interhemispheric approach in 34 patients, the nidus was approached through a direct transcortical (superior parietal lobule) approach in fourteen patients. There was only one operative mortality. Twelve patients whose preoperative fields were normal developed field cut postoperatively. An improvement of the preoperative field deficit was noted only in one patient. While eight of the ten patients with preoperative weakness improved and remained independent the remaining two were moderately disabled. Only two of the 10 patients who developed postoperative weakness remained severely disabled. Our operative results suggest that these AVMs which are prone to recurrent bleeds can be resected with acceptable morbidity. Hemianopia resulting from bleed or surgery is unlikely to improve.

Epidermoid cyst involving the brain stem.

Brain stem epidermoid cysts are extremely rare. We describe an unusual case of prepontine epidermoid cyst with a large part of the tumour insinuating itself into the pons. Microsurgical total excision of tumour was done without producing any new neurological deficits. Cases reported in the literature either had high mortality/morbidity or were only subtotally removed. Relevant literature is reviewed.

Large dumbbell neurinoma of hypoglossal nerve: case report.

Hypoglossal neurinomas are rare. Only 46 cases have been reported. We report a case of dump-bell neurinoma with a large multilobulated intracranial component. The relevant literature is reviewed.

Primary osteogenic sarcoma involving sella-sphenoid sinus--case report.

A 38-year-old male presented with an extremely rare primary osteogenic sarcoma, unassociated with Paget's disease or late effects of radiation, involving the sella and sphenoid sinus region. Complete excision of the tumor was achieved through an extended frontobasal approach. Postoperatively, six cycles of combination chemotherapy (adriamycin, ifosphamide, and cisplatin) followed by a total of 55 Gy local radiotherapy in 33 fractions was given. Primary osteogenic sarcoma should be considered in the differential diagnosis of the central skull base tumors. Osteogenic sarcoma, in general, has a bad prognosis, and should be managed aggressively with multimodality treatment including gross total surgical resection, combination chemotherapy, and radiotherapy.

Changing characteristics of a colloid cyst of the third ventricle.

We describe extremely unusual radiological characteristics in a colloid cyst of the third ventricle, where the cyst became dense and its size decreased following a cerebrospinal fluid diversion procedure. Such a course of events has been reported in colloid cysts only twice in the literature.

Sellar-sphenoid sinus hemangioblastoma: case report.

A very unusual case of sellar-sphenoid sinus hemangioblastoma without stigmata of von Hippel-Lindau disease is presented. Subtotal excision of tumor was done via an extended frontobasal approach. Diagnostic controversies between hemangioblastoma and angioblastic meningioma are discussed and the relevant literature reviewed.

Oculomotor nerve neurinoma: report of two cases.

Being motor nerves neurinomas originating from ocular nerves are very rare, unless associated with neurofibromatosis. Authors describe two cases of oculomotor nerve i.e. third nerve, Schwann cell tumours. One of them presented as a cavernous sinus mass in a middle aged lady while the other was a middle aged man with a large cisterno-cavernous tumour. Surgical approach is discussed and the relevant literature reviewed.

Fenestration of the proximal anterior cerebral artery (A1) with aneurysm manifesting as subarachnoid hemorrhage--case report.

A 50-year-old female presented with rare fenestration of the proximal anterior cerebral artery (A1 segment). This rare congenital anomaly was associated with an aneurysm at the proximal end of A1 fenestration causing subarachnoid hemorrhage, and aplasia of the contralateral A1 segment. Surgical treatment to clip the aneurysm resolved her symptoms. Hemodynamic stress at the arterial fenestration probably caused the aneurysm, possible induced by aplasia of the contralateral A1 segment.