Amit Mahore

Arachnoid cyst associated with painful tic convulsif

Combined clinical presentation of hemifacial spasm and ipsilateral trigeminal neuralgia is known as painful tic convulsif (PTC). It is a rare condition and the most common cause is vascular compression. We report an arachnoid cyst of the posterior fossa that caused PTC in a 50-year-old woman. Her radiological evaluation revealed a median, well-circumscribed, cystic lesion of the posterior fossa suggestive of arachnoid cyst, pushing the cerebellum and brainstem anteriorly. Midline suboccipital craniotomy and marsupialization of cyst was performed with complete recovery of symptoms. To our knowledge, this is the first report of a retrocerebellar arachnoid cyst causing PTC.

Chronic intradiploic hematoma in patients with coagulopathy

Intradiploic hematomas occur rarely. They have been reported in patients with and without coagulation disorders. The presentation of intradiploic hematomas varies depending on their location and the severity of the coagulopathy. We describe a patient with a huge hemicranial chronic intradiploic hematoma. Surgery involved opening the thinned outer table and evacuation of a jelly-like material and an organized clot, leaving behind the inner table. The rarity of this disease, possible pathogenesis and related surgical aspects are discussed.

Malignant fibrous histiocytoma of the skull base: A neurosurgical nuance

A 69-year-old male, treated for colonic carcinoma 15 years back, presented to our services with status epilepticus. He had complaints of headache and vomiting for 7 days prior to presentation. Computed tomography and magnetic resonance imaging of the brain revealed heterogeneous, lobulated and osteolytic tumor involving middle and posterior cranial fossa. Excision of the tumor was planned in two stages. Middle fossa component was removed through right temporobasal approach. Histopathology was suggestive of malignant fibrous histiocytoma. Patient succumbed to pneumonia and septicemia in the postoperative period. Pathology, clinical features and therapeutic challenges of this clinical entity have been briefly reviewed.

Migrated Disc at Cervicothoracic Junction Presenting as Acute Paraplegia.

Herein, we report on an inferior migration of an intervertebral disc C6-7 to the cervicothoracic junction manifesting as acute paraplegia. The patient showed a remarkable recovery after the surgery. The diagnostic dilemma and management difficulties of such an entity are briefly discussed.

Cerebral shading sign in a giant intraparenchymal white epidermoid

10.4103/0028-3886.96439 A 50-year-old female presented with bifrontal headache of two months’ duration. Computed tomography (CT) of brain showed a well-defi ned hyperdense mass (7.3 × 6.2 × 5.6 cm) in the left basifrontal region with density ranging from 90–94 Hounsfi eld units [Figure 1a]. Magnetic resonance imaging (MRI) of brain revealed an intra-axial lesion with marked hypointensity on T2-weighted image (T2WI) and hyperintensity on T1-weighted images (T1WI) with minimal perifocal edema [Figures 1b and 1c]. A small solid component located antero-medially was hypointense on T2WI and isointense on T1WI with heterogeneous post-contrast enhancement. The lesion did not show any restriction of diffusion on diffusion-weighted imaging (DWI) [Figure 1d]. The cyst was non-enhancing [Figures 1e and 1f]. Based on these imaging features, a diagnosis of a high-protein-containing lesion like craniopharyngioma or neurenteric cyst was postulated. During surgery, a thin-walled intra-axial cyst containing xanthochromic pultaceous material and viscous fluid along with a solid nodule in the antero-medial location were excised. There was no evidence of calcifi cation during surgery. Patient was relieved of her symptoms after the surgery. She has no neurological defi cit at 14-month follow-up. On histopathology, the cyst wall consisted of lamellated keratinizing squamous epithelium [Figure 2a]. Foamy histiocytes, foreign-body giant-cells and cholesterol clefts were also seen, suggestive of an epidermoid cyst with focal granulomatous infl ammation [Figure 2b]. There was no calcifi cation.

Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report

Highlights • We report a case of a 46 years female found to have vestibular schwannoma and tuberculoma in collision.• Such association of vestibular schwannoma and tuberculomas never been reported.• It must be kept in mind if two different tumors are detected radiologically in patients residing in endemic regions of tuberculosis.

An unusual variant of anlage tumor of pineal region in an infant.

A 9-month-old male child was brought with complaints of increasing head size for 2 months, increasing lethargy and vomiting for the last 2 days. Radiology revealed a heterogeneously enhancing, globular lesion in the pineal region with hydrocephalus. Near total excision of the tumor was carried out. The histopathological examination of the lesion showed heterogenous elements in the form of mature neuroepithelial and ectomesenchymal tissue. The pathology and radiology of this unusual lesion is discussed with relevant review of literature.

Infratorcular Meningoencephalocele with Dermoid Cyst

Encephalocele represents one end of the spectrum of open neural tube defects. We report an infant with Chiari type 3 malformation manifesting as infratorcular occipital meningoencephalocele with dermoid cyst. To our knowledge, this is the first time that this association is described. The pathogenesis, surgical treatment, prognosis and management difficulties are also being discussed.

Intradiploic cavernous hemangioma presenting as multiple craters on skull.

Dear Sir, A 16-year-old boy presented with complaints of progressive development of multiple depressions on the right side of the skull associated with local headaches over the period of 4 years with skin being intact. His neurological examination was normal. Local examination revealed multiple small defects on vault and convexity of the right fronto-parietal region with intact skin and no bone palpable at their depth. Computed tomography (CT) suggested the presence of multiple osteolytic lesions in the skull bone without marginal sclerosis (Fig. 1a, b and c). Magnetic resonance imaging (MRI) confirmed the presence of the above-mentioned bone defects with normal underlying brain (Fig. 1d, e and f). We had a provisional diagnosis of eosinophilic granuloma. The patient was subjected to surgery. At operation, the scalp flap was raised covering all the defects. A burr hole was made on normal skull and craniotomy including the lesions with surrounding healthy bone was made. The lesions showed a thin layer of avascular fibrous tissue over the dura. The dura was not infiltrated by lesions (Fig. 1g and h). The resultant bone defect was covered with appropriately tailored polymethyl methacrylate (PMMA) bone cement. The histopathology revealed variably sized, blood-filled, vascular spaces lined by endothelial cells consistent with cavernous hemangioma (Fig. 1i). The patient has no recurrence at follow-up of 36 months. In 1845, Toynbee first reported a case of cavernous hemangioma of the skull, and this condition was defined histologically by Rowbotham in 1924 [6]. Hemangiomas are benign tumors of blood vessels. Intraosseous hemangioma account for only 0.7 % of these tumors and are mostly found in the vertebral column. Hemangiomas are rarely seen in the calvarium, constituting 0.2 % of all bone neoplasms. These are usually solitary lesions, mostly involving the frontal or parietal bone [4]. Only 11 cases of multiple calvarial cavernoma including the present case have been described. All of them presented with swelling or pain, or both, but to the best of our knowledge, this is the first case of multiple cavernomas presenting as craterlike depressions of the scalp due to punched-out lesions of skull bone [1, 4–6]. Hong et al., in their series of 38 patients with osteolytic skull lesions, described one patient with solitary calvarial cavernous hemangioma presenting as a painful impression of the scalp. He described another four such lesions associated with eosinophilic granuloma [2]. Hemangiomas are histologically classified as cavernous and capillary. Most of the calvarial hemangiomas are of the cavernous type as in our case whereas vertebral hemangiomas are of the capillary type [4]. The hemangioma erodes the surrounding bone with growth in size; however, the inner table is usually intact. The osteoclastic activity of the tumor and secondary reactive osteoblastic remodeling with trabecular bone form spicules that are arranged perpendicular to the calvarium, giving rise to the typical Bsunburst^ appearance on radiographs [1, 4]. Our case was unique because it had not only eroded both inner and * Raghvendra Ramdasi drraghavr@gmail.com

Infected cervico-dorsal dermoid cyst with fluid - fluid level

We report a case of a 22-year-old female who was operated at the age of 3 months for cervico-dorsal swelling. She presented with gradual onset, progressively worsening dull aching pain in the cervico-dorsal region, 21 years following previous surgery. Magnetic resonance imaging showed intradural dermoid cyst with the fluid level. She underwent excision of the dermoid cyst with excision of the wall. The clinical profile, etiopathogenesis, radiological features, and management of intraspinal dermoid cysts are discussed in the light of current literature.