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

Hypothalamic Tumor

37 year old gentleman admitted with c/c of

• Left hemicranial headache-3 months
• Drooping of left eyelid-2 months

EXAMINATION:-

• Left partial ptosis
• Diplopia on seeing left, down and outward

INVESTIGATIONS:-

• CT Scan head was normal

• MRI brain-T2 & FLAIR showed hyperintense lesion in the hypothalamic area

TREATMENT:-

• Fusion of CT and MRI brain done and coordinates calcucated
• Biopsy done stereotactically

Pediatric Neurosurgery - Indian Prospective

Year : 2011 |
Volume : 6 |
Issue : 3 |
Page : 1

Indian pediatric neurosurgery has come a long way! It all started with the dream of one person with a passion for pediatric neurosurgery and the zeal to develop this subspeciality in India. Over the years, his persistence and perseverance finally culminated in the International Society of Pediatric Neurosurgery (ISPN) coming to Bombay, as it was then called, for its annual meeting in 1989. The spark was ignited. This meeting, attended by several Indians, enthused them to establish the Indian Society of Pediatric Neurosurgery (IndSPN) in 1990 with this dreamer, Prof. S. N. Bhagwati, as the founder President.

Interest in pediatric neurosurgery has increased over the years with several neurosurgeons taking this up as their special interest. The demographics of the country and the shortage of neurosurgeons precludes them from doing only pediatric neurosurgery to the exclusion of the rest of neurosurgery - but often the heart is in pediatric neurosurgery. A major role in kindling this interest has been the willingness of the International Society to hold academic meetings and Continuing Medical Education meetings frequently in India. The Indian Society has been holding regular conferences and has a good academic program. Its journal, "Journal of Pediatric Neurosciences" is in its 6th year of publication and attracts contributions from both India and overseas.

Full Article, Read More

http://www.pediatricneurosciences.com/text.asp?2011/6/3/1/85701

Epilepsy surgery in India

Year : 2011 |
Volume : 6 |
Issue : 3 |
Page : 130-134

Abstract

Modern epilepsy started in India in 1995 at Sri Chitra Tirunal Institute of Medical Science and Technology, Trivandrum and at All India Institute of Medical Sciences, New Delhi. At both centres the attempt was to get the program going with patients having surgically remediable epilepsy syndromes -who could be evaluated with non invasive investigations. The mainstay of the evaluation was a good quality epilepsy specific MRI and video EEG coupled with a SPECT study and a neuropsychological evaluation. Concordance of the focus on all investigations was critical to a good outcome. There were several problems on the way - but they were managed keeping in consideration our local needs and requirements. Intraoperative electocorticography was done and good outcomes attained. The critical determinants of success were the formation of a team with various interdisciplinary specialists and a strong will to succeed.

Singh VP. Epilepsy surgery in India. J Pediatr Neurosci [serial online] 2011 [cited 2011 Oct 18];6:130-4.

Available from: http://www.pediatricneurosciences.com/text.asp?2011/6/3/130/85734

Paraganglioma

HISTORY:

• Lower bachake-10 years
• Urinary frequency-2 years
• Pain right lower limb-5 months

EXAMINATION:

• Power in both lower limbs-4+/5
• DTR’s –absent in both lower limbs
• Right ankle clonus
• B/L plantars-mute
• B/L sensory loss in S2-S4 by 20%

INVESTIGATIONS:

• MRI dorso-lumbar spine

TREATMENT:

• D12-L1 laminectomy with complete excision of the tumor done

HISTOPATHOLOGY:

• Paraganglioma

Cervical Intramedullary Tumor

History
- 31 yr old presented with c/c of-
- Neck stiffness with restriction of neck movements-5 months
- Weakness in both upper limbs-3 months
- Sensory loss in both upper limbs-3 months
- Urinary urgency-3 months

EXAMINATION:
- Lower motor type of weakness in both upper limbs more on left side with sparing of both lower limbs
- Sensory loss in both upper limbs in C5 to T1 distribution with dissociation
- B/L biceps and supinators inverted, triceps normal, B/L lower limb jerks exaggerated
- B/L plantars-extensors
- Restriction of neck movements in all directions

INVESTIGATIONS:
MRI cervical spine:



TREATMENT:
C2-C6 laminectomy with complete excision of the tumor done

Left hemispheric porencephalic cyst with raised ICP

3 yr old girl child, FTND, with normal developemental milestones presented with

History:-

1. Right focal seizures with secondary generalization associated with low grade fever-2.5 months

2. Right foot deformity since childhood-under Orthopaedic treatment since then

Examination:-

Right club foot with weakness

Investigations:-

NCCT head-left hemispheric Proencephalic Cyst

MRI brain-same findings as on NCCT head with clear features of raised pressure-midline shift, enlarged left hemisphere, diverticulum from lateral ventricle.

Treatment :

Endoscopic Fenestration of Septum Pellucidum

POSTERIOR FOSSA NHL

58 yr old lady presented with c/c

• — Vertigo -4 weeks
• — Diplopia , right sided hearing impairment and tinnitus, gait ataxia-3 weeks
• — No history s/o facial asymmetry, lower cranial neuropathy
• — No h/o headache, vomitings, seziures, motor/sensory deficits
• — Known h/o HT-on regular treatment

EXAMINATION

• — Fundii-no pappilodema
• — Right ptosis
• — Gaze evoked nystagmus
• — Right 6th, right 8th nerve paresis
• — Right cerebellar signs

INVESTIGATIONS

• — Pure tone audiometry-lower frequency moderate loss of hearing on right side
• — MRI brain-B/L cerebellopeduncular and vermian lesions
• — PET scan-increase uptake in bilateral cerebellopeduncular and vermis

TREATMENTS

• — Right retrosigmoid craniotomy with microsurgical tumor decompression of right cerebellar peduncle lesion done under GA on 19.07.2011
• — Findings-greyish, soft to firm, intraaxial, mildly vascular, infilterating lesion attached to 7th, 8th nerve root entry zone, tumor attached to brainstem and cranial nerves left, rest excised

Unusual case of Diastematomylia

HISTORY

• 4 year old male child-Tuft of hair over lumber spine since birth
• Born at full term §
• Pre and post-natal histories were not contributory
• Physical and mental development were normal

EXAMINATIONS

§

• No neurological deficits
  • §
• Tuft of hair on the back at lumber spine
  • §
• 3D CT reconstruction
  • §
• MRI lumbosacaral spine

INTRA-OPERATIVE FINDINGS

§

• Hypertrophic posterior elements §
• Two bony spurs at L1 and L3, covered by dural sleeves, extradural in location
• Type 1 SCM
• The two spurs were complete i.e. from vertebral body to lamina
• Upper spur was cephalad and the lower one was caudal in direction
• Postoperative period uneventful

TREATMENT

§D12-L4 laminectomy with excision of bony spurs L1 and L3 with detethering of cord done on 17.03.11