Intra Fourth Ventricular Tumor

HISTORY:-

25 YR old gentleman r/o Iraq, presented with c/c of:-

• Vomitings-6 months
• Headache-4 monhts
• Gait ataxia-1 month
  
  On steroids since last one month, imorvement in sympotomatology

EXAMINATION:-

• Nystagmus
• Impaired tandem walking

INVESTIGATIONS:-

• MRI Brain

TREATMENT:-

Suboccipital craniectomy with tumor decompression done

INTRA-OPERATIVE FINDINGS:-

• Soft, suckable, intra fourth ventricular tumor attached to dorsal brainstem

HISTOPATHOLOGY:-

• Anaplastic Ependymoma

POST-OPERATIVE PERIOD:-

• Having lower cranial nerve paresis post-operatively along with diplopia, gradually improving.

A.com Aneurysm

History:-

38 yr old gentleman admitted with c/c of

· Sudden onset of severe occipital headache 1 day back, associated with stiffness of neck

· No significant past history

Examination:-

· WFNS grade-1

· Neck rigidity

Investigations:-

· NCCT head showed diffuse SAH, Fisher grade-3

· CT angiography-A.Com. aneursm with right A1 hypoplasia

Treatment:-

· Left fronto-temporal trephine craniotomy with aneurysmal clipping done under GA

Post-operative period:-

· Uneventful

INTRAVENTRICULAR TUMOR

20 yr old boy admitted with c/c of:-

· Headache-7 days

EXAMINATION-

· Pappilodema

· No neurological deficits

INVESTIGATIONS-

TREATMENT-

· Left parieto-temporal trephine craniotomy with tumor decompression done

HISTOPATHOLOGY-

· Glioblastoma Multiformae

Awake Craniotomy

History:-

26 yr old gentleman admitted with c/c of:-

• Right focal seizures-14 months

Examination:-

• No neurological deficits

Investigations:-

• MRI brain showed left frontal hypointense lesion with mild enhancement with perifocal edema in premotor cortex

Treatment:-

• Awake craniotomt with gross total excision done under local anasthesia and sedation

Post-operative period:-

• No neurological deficits

Post-operative CT scan head

Recurrent Chondrosarcoma

HISTORY :

• 53 yr old gentleman operated earlier for low grade chonrosarcoma in 2005
• Received post-operative radiation therapy in same year
• Asymptomatic till Aug. 2011
• Pain right C5 distribution since 2 months

EXAMINATION:

• Grossly intact neurological status
• MRI Cervical Spine:
• C4-C6 extradural lesion with cord compression

CT angiography neck vessels:

• Left vertebral artery block

TREATMENT:

• Tumor decompression with C4-C6 corpectomies with C3-C7 fusion with expandable cage done

Histopathology:

• Well diffrentiated chondrosarcoma

Postoperative X-Ray:

Hypothalamic hamartoma

HISTORY :

• 11 yr old boy admitted with c/c of :-

• Gelastic seizures-6 years, frequency-1/day, no relief inspite of trial of multiple antiepileptics
• Intellectual impairment-6 years

EXAMINATION :

• Impaired intellectual performance

• No neurological deficits

INVESTIGATIONS:

TREATMENT:

• Tumor excised thorough transcranial route

POST-OPERATIVE PERIOD:

• No further episodes of seizures

4th Ventricular Tumor

5 yr old girl child admitted with c/c

• Walking difficulty-2 years
• Speech difficulty-1 year
• Incoordination in the hands-6 months

EXAMINATION:-

• Conscious, awake
• Dysarthric speech
• B/l cerebellar signs with gait ataxia

INVESTIGATIONS:-

• MRI brain

TREATMENT:-

• Suboocipital craniectomy with gross total excision done

HISTOPATHOLOGY:-

• Pilocytic Astrocytoma