Mc Vasudevan

Suboccipital segment of the vertebral artery: A cadaveric study

OBJECTIVE To study the course, relationships, branches and possible anomalies of the vertebral artery in the suboccipital region in adult Indian cadavers. MATERIALS AND METHODS Twenty-one suboccipital segment vertebral artery specimens from embalmed, Indian adult cadavers were dissected and studied. Dissection was performed using microsurgical instruments and was carried out from the skin up to the vertebral artery in layers. The course, relationships and the branches of the vertebral artery were studied and measurements were taken using Vernier calipers. The readings obtained were corroborated with the measurements derived from the digital images using a computer. OBSERVATIONS All the vertebral arteries had a tortuous course and were covered with rich venous plexuses. None of the specimens had an anomalous course. The artery was divided into a vertical segment (Vv) between C2 and C1 vertebra and a horizontal segment (Vh) from the C1 transverse foramina to its dural entry. The mean diameter of the artery was 4.8 mm. The shortest distance of Vv segment from the dural tube was 16.1 mm, and the distance from the C2 ganglion was 7.2 mm. The average length of the Vv segment was 15 mm and the average length of the Vh segment was 35.6 mm. The average of the shortest distance between the vertebral artery and the midline was 13.4 mm. CONCLUSION The vertebral artery has a tortuous course and is prone to accidental iatrogenic injury, which can result in devastating neurological sequelae depending on contralateral vertebral artery flow. A thorough anatomical knowledge of this segment is essential for the surgeon who intends to operate in this area.

Primary spinal intradural extramedullary lymphoma causing cauda equina syndrome.

We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented with cauda equina syndrome and acute bladder disturbance. He underwent emergency surgical resection of the lesion, which was proved to be a lymphoma by histopathology and immunohistochemistry. He has improved neurologically and after 1 year, he is leading a normal life with near normal neurological functions. This is the second case of primary spinal intradural extramedullary lymphoma. This is the first such case in the pediatric age group and causing cauda equina syndrome. We describe the characteristics of such tumors along with pathogenesis and management.

Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.

Suprasellar epidermoid presenting with precocious puberty

Epidermoids are inclusion tumors of the central nervous system and are rare, benign slow-growing tumors. They are estimated to constitute 0.5-1.8% of the brain tumors and have an affinity for the subarachnoid cisterns at the base of the brain, the suprasellar cistern being one of the most favoured sites. We report a case of suprasellar epidermoid in a 2-year-old male child with an unusual CT and MRI appearance, who presented to us in February 1995 with features of precocious puberty. In October 2004, at the age of 11 years, he presented with symptoms and signs of raised ICP.

Intradural extramedullary cysticercal abscess of spine.

Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervous system. Typically spinal NCC involvement has a concomitant cranial involvement. Spinal involvement by NCC, either intramedullary or extramedullary is very uncommon. The authors report a case of D12-L1 intradural extramedullary lesion in a 38-year-old female patient who presented with complaints of back pain and weakness of lower limbs. She underwent laminectomy and excision of the lesion. Histopathology revealed extramedullary cysticercal abscess. Post-operatively she was treated with albendazole. She had a successful recovery post-operatively and at 8 months follow up had no neurological deficits. This current case presents a very rare case of cysticercal abscess of dorsolumbar spine, without any evidence of cranial involvement. This report is to reemphasize the importance of including NCC as a differential diagnosis in intradural extramedullary lesion at the conus level in endemic areas like India.

Primary interhemispheric subdural empyemas: A report of three cases and review of literature

Interhemispheric subdural empyema is an uncommon condition and is considered neurosurgical emergency. These are generally seen following neglected otorhinological infection, but may be posttraumatic or iatrogenic in origin. The source of infection can be frequently found, but in few cases no source of infection can be identified, called idiopathic empyemas. These idiopathic interhemispheric subdural empyemas are even rare. They can present with a rapid progression of symptoms and can carry poor prognosis. Early intervention with craniotomy and appropriate antibiotics can improve the condition of these patients. We present three cases of idiopathic interhemispheric empyemas who underwent emergency craniotomy and evacuation followed by antibiotics for 6 weeks. All the patients had excellent recovery on mean follow-up of 10 years. Early diagnosis and treatment of interhemisheric subdural empyema can lead to excellent recovery and outcome.