Guru Dutta Satyarthee

Giant spheno-ethmoidal osteoma in a 14-year boy presenting with visual impairment and facial deformity: Short review

Osteoma located in the paranasal sinus is a slow growing benign tumor. It commonly occurs in frontal, ethmoid and maxillary sinuses in the order of frequency. Giant osteoma is very rare in the pediatric population, and only nine cases of giant osteoma are reported till date in the form of isolated case reports. Authors report a giant spheno-ethmoidal osteoma in a 14-year-old boy, who presented with progressive visual impairment and proptosis of the left eye for last 1-year. Total excision was carried out using transcranial extradural approach. The postoperative recovery was uneventful and showed remarkable visual recovery along with cosmesis.

Giant pediatric glioblastoma multiforme causing primary calvarial erosion and sutural diastasis presenting with enlarged head.

Authors report a rare case of supratentorial glioblastoma multiforme in a 13-year-old boy, who had headache, vomiting and left sided hemiparesis for last 6 months. On evaluation by primary physician he was labeled as hydrocephalus in view of enlarged head with papilledema on fundoscopic evaluation and no imaging was carried out. On current admission, magnetic resonance imaging brain revealed a large heterogeneous mass lesion involving right frontoparietal region associated with massive perilesional edema causing significant mass effect. He underwent right fronto-temporal craniotomy and intraoperatively erosion of parietal bone was observed, unassociated with any extradural deposit of tumor. After surgery, he noticed improvement in headache along with hemiparesis. Primary calvarial erosion in glioblastoma is extremely rare, and there is paucity of literature as evident from the few case reports reported previously and all occurred in elderly, so current case is the first pediatric case having primary calvarial erosion. Management of such case and pertinent literature is briefly discussed.

Posttraumatic orbital emphysema in a 7-year-old girl associated with bilateral raccoon eyes: Revisit of rare clinical emergency, with potential for rapid visual deterioration.

Orbital emphysema is usually considered as self-limiting condition, rarely carries a risk of vision loss as catastrophic consequences due to occlusion of the central retinal artery. It can occur as a consequence of head trauma associated with fracture of the orbit, previous surgery, infection or exposure to high-pressure air jet. Authors report an interesting 7-year-old girl who presented with proptosis of left eye, associated with swelling of eyelids of both eyes. Computerized tomography scan head and orbit revealed orbital emphysema in the left eye with fracture of medial wall of left orbit and fracture of orbit roof with small pneumocephalus over left basifrontal region. Fortunately, she responded well to conservative therapy. Current article reminds uncommon condition to prevent potential visual loss, describing briefly management options.

Postdecompressive craniectomy surgery, ventriculomegaly, or hydrocephalus development: imaging, prevention, and management

reduced CSF outflow and absorption, promoting communicating variety of hydrocephalus. However, obstructive hydrocephalus may develop due to presence or extension of hemorrhage in the intraventricular cavity or subarachnoid space. Thus, the diminished CSF absorption leads to increasing accumulation, resulting in the development of chronic hydrocephalus. [2‐6] The acute variety of hydrocephalus is chiefly caused by sudden intraventricular obstruction. In few cases, ventriculomegaly may not represent raised ICP but simply represent cerebral atrophic process caused as sequelae of previous diffuse brain injury.[2]

Ways to Improve Outcomes of Traumatic Acute Spinal Cord Injury: Integrated Approaches of Improved Prehospital Care, the Adoption of Synergistic Medical and Surgical Intervention, Along with Care for Associated Systemic Injury and Rehabilitation and Social Inclusion

LETTER: We read with great interest the recent study by Catapano et al. 1 titled “Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries.” Spinal cord injury often results in significant neurologic dysfunction and disability, loss of economic productivity, huge expenditures in treatment and rehabilitation and cost to the society, in addition to the need for a caretaker to assist the patient in activities of daily living.

Management and outcome analysis of pediatric unstable thoracolumbar spine injury: Large surgical series with literature review

Pediatric thoracolumbar spine fractures are considered rare injuries with paucity of publication across the globe. Further, spine injuries in children are comparatively rarer, and pediatric spine differs from adults, both biomechanically and anatomically; so, adult spine management strategy cannot be applied to pediatric cases, and exact guidelines for management of pediatric spinal injury is lacking. The current study is undertaken to study epidemiology, surgical management, and outcome of pediatric dorsolumbar unstable spine injury. A total of 25 pediatric patients were analyzed retrospectively with thoracic, thoracolumbar junction and lumbar spine injuries, who were managed surgically at our institute since June 2008, formed the cohort of the present study. There were 19 males and six females with a mean age 14.8 years. Clinically, complete spinal cord injuries were observed in 11 (44%), and rest 14 had incomplete injury. Most common mode of injury was fall (76%) in contrast to the western countries and the thoracolumbar junction was the most common affected site. Among all patients who underwent surgical intervention, 68% cases had posterior decompression and pedicle screw fixation. Mean duration of hospital stay was 18 ± 31 days. The mean follow-up period was 13.83 ± 5.97 months. In incomplete neurological injury group, a total of 13 patients showed neurological improvement, out of which four cases improved by two Frankel grades, eight patients improved by at least 1 grade, and rest one by Grade 3 (Frankel Grade B to E). Neurological outcome was statistically significant in relation to the level of fracture (P - 0.03) and preoperative Frankel grade, however, other factors, for example, gender, mode of injury, type of fracture, various surgical approaches with instrumentation, and correction of kyphotic deformity were found to be statistically nonsignificant. Surgical management of unstable pediatric dorsolumbar spine is a safe and an effective procedure which can provide good neurological outcome. The current study is one of largest series of cases managed surgically in this part of the world.

Advanced elbow joint tuberculosis with cervicothoracic junction extramedullary tuberculoma in a school boy: Unusual association

Sir, Tuberculosis constitutes a global health concern, however, with increase in cases of HIV cases; there is also likely concurrent rise in incidence of cases suffering with tuberculosis. However, tuberculosis is endemic in developing country. The lung is the primary site of tuberculosis and skeletal system involvement is observed in approximately 1%–3% of the patients.[1‐3] Vertebral involvement is considered as the most common site of skeletal system involvement. Skeletal extraspinal tuberculosis involvement is usually noted only in hip, knee, foot, and shoulder joints.[4‐7] Tuberculosis affecting the joints of upper limb is rare and elbow joint tuberculosis is uncommon but reported.[8‐11] Tuberculous arthropathy is a type of musculoskeletal manifestation of tuberculosis and a common cause of infectious arthritis in developing countries and usually represents reactivation of primary pulmonary or lymph node tuberculosis. Tubercular arthropathy can occur at any age; however, no sex predilection is observed. The primary causative organism is Mycobacterium tuberculosis; however, atypical mycobacteria can affect in immunocompromised patients. Usually, M. tuberculosis remains dormant until recrudescence occurs.[12] Tuberculosis involvement of elbow joint is extremely uncommon and about thirty cases are reported in the literature. Charcot arthropathy may rarely be sequelae of tuberculous arthropathy, characterized by dislocations of joint, pathological joint fractures, causing profound debilitating deformities. It results due to progressive destruction of bone and joint soft tissues, preferably affecting large weight bearing joints, and in the advanced stage may cause significant disruption of the bony architecture. Author reports an interesting case of advanced elbow joint tuberculosis occurring in a 16‐year boy, who also had intradural‐extramedullary mass of tuberculosis origin at cervicothoracic junction.

Unruptured internal carotid artery aneurysm associated with functional pituitary adenoma: A true association

Detection of incidental intracranial aneurysm on neuroimaging can be associated with pituitary adenoma; however, such association is extremely rare. However, aneurysm with extension into the sella is extremely rare, and increases the risk of inadvertent intraoperative rupture, if trans-sphenoidal decompression is attempted either using endoscopic or microscopic surgical approach. Hanak et al. in a literature review of intrasellar noniatrogenic aneurysms over PubMed search in 2012 could only collect 31 studies, of which only eight cases had pituitary adenoma associated with aneurysm extending into sella. Authors report an interesting case of 52-year-old male diagnosed as case of acromegaly, was put on dopamine agonist, bromocriptine and responding well to therapy, however the magnetic resonance imaging raised suspicion of vascular pathology, and underwent digital subtraction angiography at our center revealed presence of right supracliniod internal carotid aneurysm, which was coiled using endovascular technique with resultant good outcome.