Sandeep Vaishya

In vivo and in vitro MR spectroscopic profile of central neurocytomas

This study reports in vivo and in vitro magnetic resonance spectroscopic findings in two cases of central neurocytomas (CNC) confirmed by immunohistochemistry. Volume localized in vivo proton magnetic resonance spectroscopy (MRS) was carried out before surgery using a point resolved spectroscopy (PRESS) sequence with a repetition time of six seconds and an echo time of 135 msec. Normal spectrum was obtained from gray matter from a volunteer for comparison. 1H and 31P in vitro MRS studies were carried out at 9.4 T on the extracts prepared from the surgically excised tumors. The in vivo spectra showed prominent glycine (Gly) and choline (Cho) and low N‐acetyl aspartate compared to the normal. The Gly peak was assigned using the in vitro studies. These studies showed that the major contribution to the Cho peak observed in vivo is from phosphocholine. A combination of the presence of NAA and an increased Gly in the proton MR spectrum could be a characteristic feature of CNCs, which are rare intraventricular tumors of neuronal origin. J. Magn. Reson. Imaging 2003;17:256–260.

Chordoid glioma: report of two rare examples with unusual features

SummaryBackground. Chordoid glioma, a rare tumour of the third ventricle, represents a distinct clinico-pathologic entity. Thirty nine examples have been described in the literature, mostly in females and in the third ventricle. The clinical presentation is variable but they tend to occur mostly in adults. There is only one report of a chordoid glioma in a 12 year old child.Finding. This paper describes two examples of chordoid glioma in a seven year old female child and a 70 year old male respectively. Radiologically, the paediatric chordoid glioma was located in the juxtaventricular region in the occipital horn of the lateral ventricle and was of mixed density whereas the adult patient had a typical third ventricle location with homogenous contrast enhancement. Gross total surgical removal was achieved in both but the adult patient died post-operatively due to intra ventricular bleeding and bacterial meningitis. The younger patient is doing well at the last follow up two years post-operatively. Microscopically, both showed the classic morphology of chordoid glioma. Ultrastructural examination was suggestive of ependymal differentiation.Conclusion. The younger age and unusual location are some of the rare features which need documentation and have not been described earlier. We propose that chordoid glioma is a variant of an ependymoma (WHO grade II) which arises from tanycytes and should be included in the WHO classification of brain tumors.

Arachnoid cyst presenting as subdural hygroma

Arachnoid cysts are developmental lesions which are usually asymptomatic or may present with a variety of clinical features. Subdural hygroma is an extremely unusual complication associated with arachnoid cysts. A case of subdural hygroma that developed after the rupture of an asymptomatic middle cranial fossa cyst, following minor head injury is reported.

Split cord malformation: three unusual cases of composite split cord malformation

Abstract. Background: All split cord malformations (SCMs) arise from one basic fault, i.e. the formation of an accessory neurenteric canal between yolk sac and amnion through the midline embryonic disc that splits the notochord and neural plate. Multiple accessory neurenteric canals may lead to two or more noncontiguous SCMs, also known as composite SCM. Case histories: We present here three cases of composite SCM. First, a 2 1/2-year-old boy had type II SCMs at two different levels with normal cord between them. In case 2, a 16-month-old girl revealed a type I SCM at levels L2–3 and a type II SCM at level L5. The third case had a combination of both these types of SCMs at levels L1–3. Only very few cases of composite SCM have been reported in the literature. Conclusions: These three cases also support the unified theory proposed by Pang et al.

Unusual spinal teratoma with an accessory penis on the back

IntroductionSpinal teratomas are extremely rare tumours, and their association with split cord malformation is even rarer.Case reportThis is a case report of an infant with a large teratoma with a lipomyelomeningocele along with a split cord malformation and with an unusual accessory penis and scrotum on the back over the swelling. This, to our knowledge, is the first such case reported in the English literature.

Umbilical CSF fistula: a rare complication of ventriculoperitoneal shunt

SummaryAn umbilical CSF fistula following a ventriculoperitoneal shunt is an extremely rare complication. We report a 28-year-old man who presented with leak of clear fluid from the umbilicus, one month after a ventriculo-peritoneal shunt revision. Shuntogram revealed communication between umbilicus and abdominal end of the catheter. He was managed successfully with shunt exteriorization, antimeningitic treatment, and later shunt re-insertion.

Economics of head injuries.

Head injuries account for significant proportion of neurosurgical admissions and bed occupancy. Patients with head injuries also consume significant proportions of neurosurgical resources. A prospective 6-month study has been carried out to evaluate the expenditure incurred on head injury patients in a modern neurosurgical center equipped with state of the art infrastructure. Costing areas included wages / salaries of health care personnel, cost of medicines / surgical items / crystalloids, general store items, stationary, all investigation charges, equipment cost, overhead building cost, maintenance cost, electricity and water charges and cost of medical gases, air conditioning and operation theatre expenses. Expenditure in each area was calculated and apportioned to each bed. The statistical analysis was done using X2 test. The cost of stay in ward was found to be Rs. 1062 / bed / day and in neurosurgical ICU Rs. 3082 / bed / day. The operation theatre cost for each surgery was Rs. 11948. The cost of hospital stay per day for minor, moderate and severe head injury group was found to be Rs. 1921, Rs. 2569 and Rs. 2713 respectively. The patients who developed complications, the cost of stay per day in the hospital were Rs. 2867. In the operative group, the cost of hospital stay per day was Rs. 3804. The total expenditure in minor head injury was Rs. 7800 per patient, in moderate head injury was Rs. 22172 per patient, whereas in severe head injury, it was found to be Rs. 32852 per patient. Patients who underwent surgery, the total cost incurred was Rs. 33100 per operated patient.

Ganglioglioma of the spinal cord: Report of two cases and review of literature

Ganglioglioma can involve any part of the central nervous system. Mostly ganglioglioma occur in temporal lobe. Spinal cord ganglioglioma is a very rare entity. We report two cases of cervico-dorsal region ganglioglioma, who underwent complete surgical excision. In the postoperative period they had transient deterioration of their neurological status that gradually recovered with follow-up.

Frontal intraparenchymal schwannoma: an unusual presentation.

Case reportA 13-year-old male with an 11-year history of a seizure disorder presented with recent onset raised intracranial pressure symptoms and no obvious phakomatosis. CT revealed a heterogeneous, frontal, intra-axial, densely enhancing, solid lesion with intense perilesional oedema and mass effect. Total microsurgical excision resulted in cure. Histopathological examination showed characteristic Antoni A and B areas and occasional Verocay bodies consistent with the diagnosis of an intraparenchymal schwannoma.DiscussionThe authors present a very rare, entirely solid manifestation of this highly uncommon lesion seen mostly in young adults and children with symptoms suggestive of raised intracranial pressure and associated seizure disorders. The possible developmental origins are discussed.

Spontaneous thoracic spinal cord herniation presenting as tethered cord syndrome

The spinal cord may be injured directly by the weapon or by indriven bony fragments. The damage to the cord may be either direct or indirect due to impaired arterial supply or venous drainage with resulting hemorrhage or edema.[1,5] The indriven fragment of the weapon may cause a foreign body granulomatous reaction[3] or may act as a micro-traumatizing agent[6] and cause delayed neurological damage. CSF leaks occur in 4 to 6% of the cases and in most instances it is transient. Approximately one-third of the patients present with a complete transaction of the cord and the remaining patients present with partial cord injury with varying forms of Brown-Sequard syndrome. [6] Our patient had a pure motor deÞ cit.