D.P Muzumdar

Endodermal cyst anterior and anterolateral to the brainstem. A report of an experience with seven cases

We report our experience with seven cases of endodermal cysts located anterior and anterolateral to the brainstem. The ages of the patients ranged from 10 to 35 years. There were three males and four females. The cysts had characteristic imaging features, and contained fluid having a ‘greenish-yellow pus-like’ hue and consistency varied from thin watery fluid to colloid gel like material. The capsule of the tumour was relatively thin. A radical resection of the cyst contents was done in all cases. Because of the thin nature of capsule, wide extensions and intimate relationship with critical nerves and vessels, complete resection of the cyst wall was possible only in one case, whilst in others the wall was partially resected. All patients showed a rapid symptomatic and neurological recovery. During the average follow-up period of 53 months, there has been no recurrence in the cyst and all patients are leading normal lives. In this presentation, the clinical and radiological features and surgical management of endodermal cysts are discussed and the relevant literature is briefly reviewed. It appears that evacuation of the cyst contents and partial resection of the cyst wall could be a safe treatment option in these cases.

C2 over C3 spondyloptosis in a case with absent posterior elements. Report of an unusual case and analysis of treatment options

We report an extremely rare anomaly in a 31-year-old male patient, where the posterior elements of the axis were almost completely absent and the anterior elements were dislocated anterior to the body of the C3 vertebra. The body of C3 caused severe compression of the high cervical cord. A radical transoral decompression and plate and screw fixation resulted in sustained clinical improvement. The relevant literature is briefly reviewed and the treatment options in such a case are analyzed.

Pontine glioma and cerebellopontine angle epidermoid tumour occurring as collision tumours

A 36-year-old male was admitted with a 10-year history of gradually progressive left ear hearing loss, diplopia and right hemiparesis. Magnetic resonance imaging showed a left lateral pontine enhancing tumour and an additional cerebellopontine angle epidermoid tumour in close proximity forming a collision tumour. On exploration, the epidermoid tumour and the intraaxial pontine glioma were completely resected. The literature on collision tumours is reviewed.A 36-year-old male was admitted with a 10-year history of gradually progressive left ear hearing loss, diplopia and right hemiparesis. Magnetic resonance imaging showed a left lateral pontine enhancing tumour and an additional cerebellopontine angle epidermoid tumour in close proximity forming a collision tumour. On exploration, the epidermoid tumour and the intraaxial pontine glioma were completely resected. The literature on collision tumours is reviewed.

Transnasal intracranial entry of a flying wire fragment

A 7-year-old boy was playfully revolving a partly insulated electric wire which accidentally struck a bamboo pole in its path. He soon found that his left nostril was hit and blood trickled from the site. Unsuspected on investigation, a small fragment of the wire was found within the brain. The sequence of events is reported.

Giant pituitary adenoma invading the clivus

A 26-year-old man was admitted with complaints of worsening of vision for one month. Investigations revealed a large sellar and parasellar tumor mass invading into both the cavernous sinuses. The tumor invaded the clivus and both petrous apices. It was radically but partially resected through a transsphenoidal approach. Following surgery, the patient showed symptomatic improvement. The residual tumor was treated by radiation treatment. The case is discussed and the literature on the subject is briefly reviewed.

Pathological laughter as a presenting symptom of acoustic schwannoma: report of two cases.

Two cases of acoustic schwannoma in a 48-year-old woman and 18-year-old male are reported. Both patients presented with an extremely unusual symptom of pathological laughter as a principal presenting symptom. Complete resection of the tumour via a retrosigmoid route resulted in an immediate resolution of pathological laughter.

Ischaemic complications after surgical resection of intracranial aspergilloma

A 32-year-old male presented with a paranasal sinus Aspergillus fungal infection. The nasal infection was cleared by endoscopic sinus surgery and the patient was treated with antifungal agents. The patient was otherwise healthy with no evidence of immunosuppresion. Five months later, the patient had to undergo excision of the left frontal intracranial infection for symptoms of raised intracranial pressure and seizures. Within 48hours of surgery, the patient developed basilar artery thrombosis with infarction of the cerebellum and midbrain. The patient succumbed to this vascular catastrophe, which developed at a site distal to that from surgery. The pathophysiology of ischaemic complications after surgical resection of intracranial aspergilloma is discussed.

Acoustic schwannoma and petroclival meningioma occurring as collision tumours: A case report

A case of a collision tumour comprising of an acoustic schwannoma and a petroclival meningioma in a 30-year old male patient is described. Both of these tumours were resected through a retrosigmoid route. The caudal portion of the mass was an acoustic schwannoma while the rostral portion was a distinct well-defined petroclival meningioma. The occurrence of an acoustic schwannoma and a petroclival meningioma in collision has never been reported. The pathogenesis of such a rare entity is discussed and the relevant literature is briefly reviewed.

Spinal tuberculoma in a patient with spinal myxopapillary ependymoma

Intramedullary spinal tuberculosis is a clinical curiosity. A 19-year-old female was diagnosed and treated for lumbosacral myxopapllary ependy moma (MPE). Three years later, she presented with back pain and hypoesthesia of the left upper limb. Besides revealing local recurrence, the MRI demonstrated a fresh lesion in the cervicomedullary area. The latter was operated and the histopathology revealed a tuberculoma.

Cholesterol granuloma in the middle fossa presenting 30 years after surgery for chronic otitis media: a case report

A massive left subtemporal extradural cholesterol granuloma in a 45 year old male patient is reported. The lesion communicated with the petrous temporal bone and was diagnosed after it became symptomatic 30 years following surgery for left chronic otitis media. The case is analysed and the literature on the subject is reviewed.