Mohinish Bhatjiwale

Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases.

OBJECTIVE AND IMPORTANCE This is a report of four cases of huge trigeminal neuromas that presented with the principle symptom of pathological laughter (PL). CLINICAL PRESENTATION All four patients were male and were in either the third or fourth decade of life. In addition to PL, there were neurological deficits related to trigeminal nerve, brainstem, and cerebellar dysfunctions. INTERVENTION All tumors were radically excised via a lateral basal temporal approach. The PL was cured immediately after surgery. CONCLUSION PL sometimes precedes other neurological manifestations and may be a useful localizing sign. The clinical and radiological features in our cases suggest that PL is a result of extra-axial compression of the pons and adjoining neural structures.

Basilar invagination and Chiari malformation associated with cerebellar atrophy: report of two treated cases

We report two patients with an unusual complex of anomalies wherein the basilar invagination and Chiari malformation was associated with marked cerebellar atrophy. Both patients presented with relatively severe lower cranial nerve deficits and showed clinical improvement following a posterior foramen magnum bony decompression. The pathogenesis of the anomalies is discussed and the rationale of treatment is analysed.

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.

Spontaneous cerebrospinal fluid (CSF) rhinorrhoea in spongiform dysplasia of the cranium: an unusual presentation of neurofibromatosis

A 20-year-old woman with neurofibromatosis presented with CSF rhinorrhoea. Spongiform dysplasia of the cranium was found. The dysplastic bone contained CSF. The exact site of the CSF fistula into the calvarium and into the paranasal sinuses could not be detected on investigation but nasal packing of the ethmoid and sphenoid sinuses controlled the rhinorrhoea. The unique features of this case are presented along with a brief review of the literature.

Giant cerebral cavernous haemangioma: a case report and review of literature

An 18-year-old male presented with uncontrolled left focal seizures with secondary generalisation for the past 10 years. Investigations revealed a large lobulated mass in the right frontal brain. Surgical excision of a giant cavernous haemangioma was performed. The patient is seizure-free following the surgery. The case and relevant literature on the rare entity of giant intracranial cavernous haemangiomas is discussed.

Basilar invagination: a study based on 190 surgically treated patients

OBJECT The authors analyzed the cases of 190 patients with basilar invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure. METHODS Depending on the association with Chiari malformation, the anomaly of basilar invagination was classified into two groups. Eighty-eight patients who had basilar invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both basilar invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II. CONCLUSIONS Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.