Outcome of Surgical Resection of Craniopharyngioma:Single Center 12 Years' Experience.

Background Craniopharyngiomas (CPs) are rare epithelial tumors arising from the Rathke's pouch remnant located along the path of the craniopharyngeal duct accounting for 1.2-4% of all primary intracranial brain tumors, the primary treatment of which is surgery. Objective Whether radical surgical resection or partial resection followed by radiotherapy is a topic of debate. We presented our 12 years single center experience on surgical resection of craniopharyngioma. Method This was a descriptive cross-sectional study conducted among forty-five patients who underwent transcranial resection of craniopharyngioma during a period of 12 years. Data were collected from medical record archives. Glassgow outcome score (GOS), electrolyte imbalance and visual complications were assessed as outcome measure. GOS > 3 was considered favorable while score ≤ 3 was considered unfavorable. Recurrence of tumors were analyzed. Result Out of 45 patients, 28 patients were male with male to female ration of 1.64. Mean age was 32.22±16.42 years. Supra-sellar craniopharyngioma were the most common location. Gross total resection was accomplished in 32 patients (71.1%) while subtotal resection among 13 patients (28.9%). Post-operative Diabetes Insipidus was developed among 35 patients (77.7%). Adamantinomatous craniopharyngioma was the most common histopathological type. Postoperative MRI with contrast was repeated to ascertain the completeness of resection. All patient with subtotal resection received radiotherapy. Follow up period ranged from 3 months to 8 years with mean of 4.2 years. Favorable outcome (GOS>3) was seen among 41 patients while unfavorable among 4 patients. Recurrence seen among 4 patients (8.9%). Overall mortality was 4 (8.8%). Conclusion Gross total excision of craniopharyngioma has a favorable outcome with acceptable morbidity.

Adamantinoma of tibial shaft.

Adamantinoma is an extremely rare primary bony neoplasm. Because of its malignant nature, accurate and early diagnosis is very important. On the other hand adamantinoma mimics many benign conditions, so it is doubly important to establish correct tissue diagnosis to avoid radical surgery with morbidities. Because of its rarity, diagnosing adamantinoma still remains difficult, even if when it occurs in classical sites. We report a case of adamantinoma of tibial shaft diaphysis in a 23 year male. In this case, because of classic clinic-radiological features, we were suspecting adamantinoma from very beginning but final diagnosis was delayed for nine months.

Computed tomography guided percutaneous transthoracic fine needle aspiration cytology in chest masses.

A retrospective, hospital based descriptive study was done to know the pathological spectrum of thoracic lesions and to correlate the radiological findings with cytological findings obtained from computed tomography guided percutaneous transthoracic fine needle aspiration of chest mass. The clinical, radiological and cytological data of 100 patients were studied who underwent CT guided FNAC from May, 2004 to May, 2007. Diagnostic accuracy of FNAC is 82%. Cytological examination showed that 51 cases were malignant and 31 cases were benign. Provisional diagnosis based on radiological findings were 50 and 32 cases of malignant and benign lesions respectively. Sensitivity and specificity, positive and negative predictive value of radiological findings in this study was 88%, 84%, 90% and 81% respectively. Post procedure complication were (a) pneumothorax in two cases and both the cases had to be hospitalized for active management (b) minimal perilesional hemorrhage and hemoptysis in three cases and (c) chest pain in six cases. CT guided FNAC is a simple and safe procedure with high diagnostic accuracy in the evaluation of focal chest lesions. Pneumothorax, perilesional hemorrhage, hemoptysis and chest pain are the usually encountered complications. Very few cases of complication require active management.