A review of sub acute subdural hematoma (SASDH) with our institutional experience and its management by double barrel technique (DbT): A novel technique.

BACKGROUND: Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel "double barrel technique (DbT)" over the conventional burrhole drainage are also presented. METHODS: This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3-24 months. RESULTS: 46.87% of the patients belonged to the 35-54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features. CONCLUSION: SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that "DbT" is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.

Primary hydatid cyst of brain: Two cases report.

Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Isolated cerebral hydatid disease is a rare manifestation of it. In this report, we analyze two cases of isolated cerebral hydatid cysts and discuss their mode of presentation, radiological features, operative procedure and outcome. In our two cases, radiological features and surgical approaches were different from one another. The literature concerning isolated cerebral hydatid disease is reviewed.

Cranio cervical tuberculous hypertrophic pachymeningitis.

BACKGROUND: Hypertrophic pachymeningitis is a unique clinical entity characterized by fibrosis and thickening of dura mater resulting in neurological dysfunction. It could be idiopathic or due to variety of inflammatory and infectious conditions. Tuberculous hypertrophic pachymeningitis involving cranio cervical region is rarely reported. CASE DESCRIPTION: A 50-year-old female presented with history of progressive quadriparesis and stiffness of neck for 2 years, dysphagia to liquid for past 3 months. Her condition rapidly deteriorated when another physician prescribed her corticosteroid. Physical examination revealed high cervical compressive myelo-radiculopathy with lower cranial nerve palsy and neck rigidity. Series of serum analysis, cerebrospinal fluid (CSF) study and contrast magnetic resonance imaging (MRI) clinched the diagnosis. She improved on antitubercular treatment. CONCLUSION: In case of multilevel cervical compressive myelo-radiculopathy with lower cranial involvement, possibility of hypertrophic pachymeningitis should be kept in mind. Before diagnosing it as idiopathic, infectious causes should be excluded otherwise prescription of corticosteroid will flare up the disease process.

Tethered cord syndrome in adolescents: Report of two cases and review of literature.

The symptoms of tethered cord syndrome (TCS) cases mostly appear during infancy and childhood. Though the adolescent presentation of TCS is well-recognized, it continues to pose significant diagnostic and management controversies. In this report, we describe two cases of adolescent onset TCS associated with two different etiologies. Our first case, an 18-year-old girl who presented due to overflow incontinence in association with TCS was diagnosed to have lumbar meningocele. The second case, a 19-year-girl presenting with perianal anesthesia and bowel and bladder incontinence had lipomyelomeningocele as the cause of TCS. Both of them underwent untethering surgery. The clinical charts and follow-up data were studied in respect to the clinical manifestation, surgical intervention and outcome with a brief review of pertinent literature.

Intracerebral pial arteriovenous fistula with large venous varix: A rare case report.

BACKGROUND: Intracerebral pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions are composed of one or more direct arterial connection to a single venous channel without true intervening nidus and usually have associated venous varix or giant venous aneurysms. Intracerebral varices are occasionally associated with high-flow AVF, and usually treated by interrupting the feeding arteries leaving the varices intact. CASE DESCRIPTION: We report a rare case of a 24-year-old male with a single-channel pial AVF of the left cerebral hemisphere, which was fed by the left anterior cerebral artery (ACA) and was associated with large venous varix and continuous varicose venous dilatation. This superficially located varix was over 6 cm in diameter posing significant mass effect and had calcified walls. Direct surgical flow disconnection followed by removal of large varix resulted in complete disappearance of pial AVF without complication. CONCLUSION: Though endovascular occlusion of feeding arteries offers a simple and safe option, direct surgical removal should be considered in rare cases of intracerebral superficially located large AVF with calcified wall and mass effect.

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Young biotech companies may not need extensive patent portfolios to survive or grow.