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