Sanjeev Chopra

Low velocity penetrating head injury with impacted foreign bodies in situ

Penetrating head injury is a potentially life-threatening condition. Penetrating head injuries with impacted object (weapon) are rare. The mechanism of low velocity injury is different from high velocity missile injury. Impacted object (weapon) in situ poses some technical difficulties in the investigation and management of the victims, and if the anticipated problems are not managed properly, they may give rise to serious consequences. The management practice of eight patients with impacted object in situ in context of earlier reported similar cases in literature is presented.

Urinary bladder perforation, intra-corporeal knotting, and per-urethral extrusion of ventriculoperitoneal shunt in a single patient: case report and review of literature

BackgroundVentriculoperitoneal shunt (VPS) surgery is the most common procedure performed for the treatment of hydrocephalus. Erosive bladder perforation by a peritoneal catheter is an extremely rare complication of VPS. Only ten cases involving the normal (non-augmented) urinary bladder have been reported so far.CaseWe report a case of erosive bladder perforation, intra-corporeal knot formation, and perurethral extrusion of the distal end of VPS. This is the second only case report so far in the world literature showing triad of uncommon VPS complications in a single patient.ConclusionPrompt management could avoid further complications. Patient’s parents should be aware about this rare complication, so that they can seek timely medical help.

Geriatric head injuries — Experience and expectations

Abstract It is widely known that global citizenry is continuing to age. The elderly head trauma patients, comprising 4.83% in our series are important from neurosurgical aspects. We conducted a study of elderly head injury patients admitted to our unit in last 11 years. Out of 620 patients, 423 males and 197 female, constituting a ratio of 2.1∶1. Fall constitutes the principle mode of injury (56.29%) followed by RTA (44.1%). We analyzed all the cases for surgical intervention after careful assessment of neurological condition. Amongst all cases operated for acute trauma, good recovery was seen in 51.8% and mortality in 41.7%, whereas in chronic subdural haematoma 84.2% cases showed good recovery as against mortality in 10.5%. In our society, due to very close family ties and desperation of family members to try active intervention even in patients with expected bleak outcome, we operated a fairly large number of cases and concluded that outcome was better after operative intervention.

Mucocele of the sphenoid sinus: A rare cause of reversible 3 rd nerve palsy

Ophthalmoplegia due to 3rd nerve palsy is a common occurrence, and is usually a sign of diabetes mellitus or a serious intracranial disease. We report a rare case of pupil sparing 3rd nerve palsy caused by mucocele of the sphenoid sinus. The patient regained 3rd nerve functions after successful decompression of the mucocele. Early and correct diagnosis of this relatively benign condition is important to prevent permanent neurological deficits, including visual loss by optic nerve atrophy. Etiology, clinical manifestations and treatment of the sphenoid mucoceles is discussed and available literature is reviewed.

CSF Hygroma in the Neck: Rare Complication of Ventriculoperitoneal Shunt

and transparent with prominent vessels. The coiled distal end of the right shunt tube was visible within the swelling ( fig. 1 ). The left-sided VP shunt was functioning well and in normal position. X-ray of the chest and abdomen showed a normal bilateral lung field, bony thoracic cage, abdomen and a normal position of the left-sided shunt tube. There was a soft-tissue shadow with the coiled distal end of the right shunt tube present in the right cervicothoracic region ( fig. 2 ). The child’s head circumference was 55 cm with lax anterior fontanels. Removal of the right-sided VP shunt was done under intravenous antibiotic cover. The postoperative period was uneventful, and the swelling gradually disappeared. Since 1905, VP shunting is the most frequently performed operation in the management of hydrocephalus [1] . Although the risk in performing a shunt operation is low, the complications related to VP shunts are many with a reported incidence of 24–47%, of which abdominal complications are reported to occur in 25% [1] . Other rare complications include migration of the peritoneal catheter into the stomach, gall bladder, urinary bladder, vagina, bowel, liver, spontaneous umbilical CSF fistula and cervical myelopathy [2–4] . The complications related to shunt use are commonly classified as infectious (5–10%), mechanical or functional, and they may be neurological or nonneurological [1, 2, 5] . These complicaIn the modern era, ventriculoperitoneal (VP) shunting is a widely accepted operative technique for the management of hydrocephalus. Various complications of VP shunting due to migration of the ventricular and peritoneal ends are reported in the literature. We describe a 1-year-old male child with an extremely unusual complication in whom the peritoneal catheter migrated in the neck and coiled under the skin, leading to the formation of a CSF-filled cystic cavity ( fig. 1 ). The child, weighing 8 kg, was admitted to our institute as a follow-up case of congenital hydrocephalus with a bilateral VP shunt in situ, with the complaint of a painless swelling, which had been progressively increasing over the right side of the lower neck for the last 15 days. There were no symptoms of raised intracranial pressure or any complaints other than swelling over the neck. The child had been operated for congenital hydrocephalus at 10 days of age. Because of poor function of the right VP shunt, a left-sided VP shunt was inserted at 2 months of age. At that time, the right-sided VP shunt was left in situ. The child had been asymptomatic for the last 10 months and now presented with a swelling over the neck. On examination, there was a soft, cystic, translucent, fluctuating, nontender, oval-shaped swelling with well-defined margins of about 6 ! 4 cm in size over the right side of the lower neck. The overlying skin was stretched, thin Received: May 19, 2008 Accepted after revision: July 29, 2008 Published online: March 4, 2009

Teeth in the brain: An unusual presentation of penetrating head injury

Abstract Penetrating injuries other than gunshot wounds or low-velocity wounds to the head are extremely rare. We report the case of a 19 year old male who sustained a penetrating craniocerebral trauma following a road traffic accident. Mechanism of injury seems to share characteristics of low velocity projectiles. We discuss the management of this unusual case reviewing the current literature on craniocerebral injuries caused by similar objects.

Intracranial metastasis of spinal intramedullary anaplastic astrocytoma

Meningeal spread of spinal intramedullary astrocytoma into the cranium is rare. Only few case reports are available so far in the literature. We report a case of intramedullary high grade astrocytoma of the conus, developing intracranial metastasis after three months of partial excision of the spinal mass. The need for radical surgery, entire neuroaxis radiation, and adjuvant chemotherapy is suggested in the management of malignant spinal cord astrocytoma to prevent dissemination.

Anal extrusion of ventriculoperitoneal shunt: A report of two cases and review of literature

We report two cases of gastrointestinal perforation by ventriculoperitoneal (VP) shunts and review the literature on the topic. The time interval between shunt surgery and detection of bowel perforation is minimum in infants and increases with age. Sigmoid and transverse colon followed by stomach are the most frequent sites of gastrointestinal perforations by VP shunts.

Use of 3D printer model to study vertebral artery anatomy and variations in developmental craniovertebral junction anomalies and as a preoperative tool—an institutional experience

Background Spinal instrumentation using rods and screws have become procedure of choice for posterior fixation. Vertebral artery anatomy is highly variable in this region posing challenges during surgery. Our study used 3D printer model to understand the anatomy and variations in vertebral artery in live patients thereby providing an accurate idea about vertebral artery injury risk in these patients preoperatively and to rehearse the whole procedure. Methods Ten patients of developmental craniovertebral junction (CVJ) anomalies who were planned for operative intervention in the Department of Neurosurgery at SMS Hospital from February 2016 to December 2016 were analysed using a 3D printer model. Results Out of twenty vertebral arteries studied in ten patients, two were hypoplastic and out of these one could not be appreciated on 3D printer model. Out of remaining nineteen, thirteen arteries were found to lie outside the joint, three were in lateral third, one traversed the middle third of joint and one lied in medial third. In one patient, the vertebral artery was stretched and it traversed horizontally over the joint. Out of ten patients studied, nine were having occipitalised atlas and so entry of these vertebral arteries into cranium were classified as given by Wang et al. into four types. Conclusions By our study, 3D printer model was extremely helpful in analyzing joints and vertebral artery preoperatively and making the surgeon acquainted about the placement and trajectory of the screws accordingly. In our opinion, these models should be included as a basic investigation tool in these patients.

Post traumatic vertebro basilar dissection: case report and review of literature

Abstract Posterior circulation territory stroke following mild head injury is a known entity although rarely seen. Numerous case reports appear in literature from time to time highlighting this complication. Blunt trauma to the head and neck possibly causes injury to the vertebrobasilar system in the form of angiorrhexis, subintimal, intramural and perivascular hemorrhage which causes secondary narrowing of the injured vessel. These processes can be complicated by progressive thrombosis & vascular occlusion. Here we are reporting a case of post traumatic vertebra-basilar dissection causing bilateral cerebellar and brainstem infarct.