Dhananjaya I. Bhat

Cerebral sparganosis: a diagnostic challenge.

Cerebral sparganosis is a rare cestode larval parasitic infestation of the nervous system. We report a 28-year-old female from South India with a temporo-occipital mass lesion, which mimicked a tuberculoma on imaging. She received antituberculous therapy for 7 months. Surgical excision of the mass revealed a parasitic abscess containing larval form of Sparganum mansoni. Cerebral sparganosis can closely mimic tuberculoma or neoplastic lesions. Hence, in areas endemic for tuberculosis, such as India, it is appropriate to suggest that histological diagnosis be sought in tuberculoma mimicking lesions, especially when the lesion is not responding to treatment.

Papillary glioneuronal tumor—evidence of stem cell origin with biphenotypic differentiation

Papillary glioneuronal tumors are newly recognized seizure producing tumors. We report two such cases with immunohistochemical characterization of glial and neuronal components and briefly review literature. Co-localization of glial and neuronal markers was demonstrable on confocal microscopy with expression of stem cell markers (Nestin and CD133) suggesting possible origin from neuroepithelial stem cell with biphenotypic differentiation.

Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study.

BACKGROUND Following successful intercostal-musculocutaneous nerve (ICN-MCN) neurotization for brachial plexus injuries (BPIs), patients initially show a synkinetic movement of elbow flexion during inspiration. Later they are able to flex the elbow, independent of respiratory activity. OBJECTIVE To demonstrate cortical reorganization following ICN-MCN coaptation in BPI through functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). METHODS Thirty adult patients underwent ICN-MCN coaptation for BPI. The controls were age and sex matched. All patients had Sunderland 3 or 4 degree of injury. Patients underwent fMRI and DTI (pre- and postoperatively) with electromyography of the biceps. Maps of neural activity within the motor cortex were generated in the paralyzed and control arms and center of maximum activity was calculated. Fractional anisotropy and apparent diffusion coefficient were generated from fMRI and DTI over the motor cortex and comparison was made between the paralyzed and control arms. RESULTS Median deinnervation interval was 6 months. Seventeen patients improved from grade 0 to grade 3 or more. There was no significant difference between the coordinates for maximum activity, when the cortical activity following elbow flexion of the patients who improved was compared with the control arm activity. There was reduction in FA and ADC values in patients who have improved following surgery when compared to controls. Fractional anisotropy and apparent diffusion coefficient values of the postoperative patients revealed no significant difference from the controls or preoperative patients. CONCLUSION Cortical plasticity following ICN-MCN transfer in BPI does occur. There was no correlation between the degree of improvement either with the transposition of activity on the motor cortex from the chest to the elbow area, or the amount of activity on the motor cortex representing the elbow area.

Intradural clival chordoma: a rare pathological entity

Chordomas constitute about 1% of intracranial tumors. They are generally extradural destroying the bone. Intradural chordomas are very rare. We present one such case of a clival intradural chordoma who presented with a left trigeminal nerve sensory neuropathy. The lesion was totally excised uneventfully via a retromastoid suboccipital approach. There was no recurrence of the lesion at 1-year follow-up. Characteristics of intradural chordoma and its close differential ecchordosis physaliphora are reviewed in this article.

Cerebellar abscesses in children: excision or aspiration?

OBJECT Cerebellar abscesses are common neurosurgical emergencies in developing countries, and have a distressingly high mortality rate of 10 to 15% even today. There is still no consensus on the standard approach to these lesions, and controversy persists over whether these lesions should be treated with primary excision or aspiration. METHODS The authors retrospectively analyzed 82 cases of cerebellar pyogenic abscesses in children treated at their institution over a period of 10 years. This represents the largest such series being described in literature. All lesions except 1 were otogenic in origin. The clinical and radiological features are discussed. RESULTS Primary excision was undertaken in 66 patients (80%) and aspiration in 16 patients (20%). Five patients in whom the abscesses were initially treated with aspiration subsequently underwent elective excision. Nine (12.6%) of 71 patients in whom the abscesses were excised had residual abscesses on postoperative imaging; in those who had undergone aspiration as the primary treatment, 6 (54.5%) of 11 patients had recurrent abscesses. There were no deaths among the patients who underwent excision of the abscess. Also, excision of posterior fossa abscesses required fewer repeated procedures with lower recurrence rates, and statistically lower rate of complications. CONCLUSIONS Compared to primary aspiration, the authors found that primary excision is the preferred method for treating cerebellar abscesses.

Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells

Astroblastomas are extremely rare neuroepithelial tumors of uncertain histogenesis, affecting children and young adults, and constitute a new addition to the WHO 2000 classification of CNS tumors. We report the largest series of nine cases diagnosed in a single institute over the last 13 years and review published literature. Mean age at presentation was 12.8 years (range: 22 months to 27years). Seven out of nine cases were supratentorial (frontal/frontoparietal – three, parieto‐occipital – three, parafalcine – one), one was intraventricular and another was optochaismatic/suprasellar. Five cases were high grade (anaplastic) astroblastomas with Ki‐67 labeling index of 8–10%. Immunohistochemical and ultrastructural evidence suggesting origin from cells intermediate between ependymocytes and astrocytes is presented. The histogenetic origin of these tumors remains speculative. But the lack of Isocitrate dehydrogenase 1 (IDH1) mutation as detected by immunohistochemistry in this study, which is similar to ependymomas supports putative origin from ependymoglial cells. Out of the nine cases, recurrence was noted in one case, 12 months after gross total resection with progression to high grade in the recurrent tumor. There is no recommended treatment protocol due to the rarity of this entity and prognostic factors are yet to be established.

Injection nerve palsy.

Objective: To study the clinical profile and outcome of surgery for injection nerve palsies. Materials and Methods: This is a retrospective study of patients with INP who were treated at our institute during May 2000 to May 2009. Clinical, electroneuromyography (ENMG), and operative findings were noted. Intraoperative nerve action potential monitoring was not used in any case. Outcome of patients who were followed was reviewed. Results: INP comprised 92 (11%) of 837 nerve injury patients. Seventy one patients were children less than 16 years. The nerves involved were sciatic in 80 patients, radial in 8, and others in four. Fifty seven patients had power, grade 0/5. ENMG studies revealed absent compound muscle action potential in 64 and absent sensory nerve action potential in 67 patients. Thirty nine (42.3%) of 92 patients underwent surgery. The mean duration since injury in these patients was 5.2 months (3 months to 11 months). All underwent neurolysis. Only 18 patients who underwent surgery had a follow up of more than 3 months. Ten (55.5%) patients had good or fair outcome after surgery. Except for grade of motor deficit prior to surgery, none of the variables were found to significantly affect the outcome. Conclusion: The outcome of INP is generally good and many patients recover spontaneously. The outcome of surgery is dependent on preoperative motor power.

Anterior communicating artery aneurysm presenting with vision loss.

Anterior communicating artery aneurysm rarely presents with symptoms of compression of anterior visual pathways. We report a case of 65 years old man, who had complete loss of vision in right eye and temporal hemianopsia in left eye due to giant anterior communicating artery aneurysm.

Intraventricular ganglioglioma with bleed: a rare case report.

Gangliogliomas are benign lesions that are predominantly temporal in location and present with chronic epilepsy. Intraventricular gangliogliomas are extremely rare and still rarer is intratumoral hemorrhage. Till date only 9 cases of lateral ventricular gangliogliomas have been reported. To the best of our knowledge only 1 case of intratumoral hemorrhage has been reported. We report a rare case of lateral ventricular ganglioglioma with intratumoral hemorrhage in a 27-year-old man.

Unusual complications of a benign tumour – our experience with midline posterior fossa epidermoids

Abstract Epidermoids of the brain are uncommon benign tumours. Their midline posterior fossa location is exceedingly rare. Fifteen patients with this condition were operated during a 14-year period. Majority of the patients presented in their middle age with mean duration of symptoms of 10 months. Gait imbalance was the commonest symptom observed. Seven patients had features suggestive of raised intracranial tension. Computed tomography scanning showed typical hypodense lesions. On MRI, tumours were hypo-intense on T1 weighted images and hyper-intense on T2 weighted images. All patients underwent microsurgical excision. We encountered certain complications in the post-operative period. This prompted us for a review of our case material and literature and is the basis of the present article. Implications of these findings are discussed.