Sanjib Mishra

Review of spinal neuroectodermal tumor

Abstract Primary spinal primitive neuroectodermal tumors (PNETs) are rare tumors. Most of these tumors occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. These tumors are highly aggressive with rapid growth. Review of the literature shows that the overall prognosis of PNETs of spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. All the cases reported to date are reviewed in terms of surgical treatment, adjuvant therapy and outcome and the experience with two of these cases are described. Both cases were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. Both cases underwent gross total removal of intraspinal and thoracic component. Post-operatively both underwent cranio-spinal radiotherapy. One patient died after a post-operative period of 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.

Intradiploic ossified giant cavernous hemangioma of skull with a dural tail sign mimicking primary calvarial meningioma.

250 Neurology India | Mar-Apr 2012 | Vol 60 | Issue 2 The case reported by Yilmazer et al.,[1] demonstrated a fusiform aneurysm of the left transverse sinus with bony erosion accompanied by internal jugular vein aneurysm. The patient was not treated and was followed up. Marco et al.,[2] described a case with a wide-necked venous aneurysm of the left transverse sigmoid sinus, and they treated it by endovascularly stent placement across the aneurysm neck and embolization of the aneurysm with Guglielmi detachable coils. Gologorsky et al.,[3] reported a widenecked venous aneurysm of the right transverse sigmoid sinus, and they treated it by surgically coagulation of aneurysmal neck and reconstruction of transverse sigmoid junction with a series of U-clips. In our patient both surgical and endovascular treatments were rather contraindicated, so palliative third ventriculostomy was done for obstructive hydrocephalus. This procedure helped the patient in attaining weight and growth. Perhaps use of fl ow diverters would also be useful in such cases. However, because we had little experience with the use of fl ow diverters in infants and as we also felt that the infant might grow out of it, we did not use this method.

A review of sub acute subdural hematoma (SASDH) with our institutional experience and its management by double barrel technique (DbT): A novel technique

Background: Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel “double barrel technique (DbT)” over the conventional burrhole drainage are also presented. Methods: This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3–24 months. Results: 46.87% of the patients belonged to the 35–54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features. Conclusion: SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that “DbT” is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.

Intramedullary spinal cord metastasis arising from papillary thyroid carcinoma: A case report and review of literature.

Background: Intramedullary spinal cord metastases (IMSCM) are typically drop lesions from intracranial metastases and are a rare manifestation of systemic malignancy (8.5% of central nervous system metastases). They arise from primaries such as the lungs, breast, kidney, melanoma, or lymphoma. On the other hand, they arise very rarely from papillary thyroid carcinoma (PTC), even though it is the most common type of primary thyroid malignancy. Case Description: A 54-year-old male presented with pain in the lower back along with tingling, numbness, and weakness in the bilateral lower limbs. This was associated with urine incontinence for 1½ months. In the previous month, he developed a left-sided solitary thyroid nodule. Fine needle aspiration cytology and ultrasonography were suggestive of metastasis. Furthermore, the thoracolumbar magnetic resonance imaging showed T1-hypo and T2-hyper-intense D11-D12 level intramedullary lesion, with intense enhancement, which was consistent with an intramedullary lesion involving the conus. At surgery, a firm, brownish yellow, friable, vascular tumour was removed en toto. Upon discharge, the patient was neurologically intact except for residual bladder incontinence. Conclusion: In an extensive literature review (pubmed), IMSCM metastasis from PTC primary is confirmed as a rarity and this may be the fourth documented case. Moreover, this may be the first report of a case of PTC metastatic neurological deterioration “even before the treatment of the primary was undertaken.” Early diagnosis and microsurgical resection can result in improvement of neurological deficits and in the quality of life of patients with IMSCM.

Spinal Epidural Inflammatory Pseudotumor: A Case Report and Review of Literature

BACKGROUND Inflammatory pseudotumor is a histologically proven benign tumor-like lesion of unknown etiopathogenesis. It is less commonly found in central nervous system, and least commonly in the spinal canal. Spinal epidural inflammatory pseudotumor is a rarely reported entity. CASE DESCRIPTION We report a patient who presented with paraplegia, in whom a spinal epidural mass was diagnosed as an inflammatory pseudotumor after surgical excision followed by histopathology. CONCLUSIONS It was a radiologic dilemma; thus, complete excision was required for diagnosis and a better outcome.

Traumatic “brain stem contusion” (BSC): Acute presentation and management in a tertiary medical centre- A case report and review of literature

Pankaj Kumar Swarnakar1 Soubhagya Ranjan Tripathy2* Manmath Kumar Dhir3 Sanjib Mishra4 Sitansu Kumar Rout1 Bikash Ranjan Behera1 1Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India 2Consultant Neurosurgeon, Shree Hospital, Lewis Road, Bhubaneswar, Odisha, India 3Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India 4Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India

Masson Hemangioma—An Unusual Cause of Thoracic Compressive Myelopathy

BACKGROUND Masson hemangioma is a rare pathologic entity characterized by intravascular papillary endothelial hyperplasia. Although benign, this hemangioma grows to form an expansile compressing mass. This lesion is mostly seen in skin and subcutaneous tissue. Occurrence in the central nervous system is rare. Still rarer is a spinal location with only 5 case reports published to date in the literature. CASE DESCRIPTION A 32-year-old man presented with paraplegia secondary to extradural compression at the T4-5 level. Histopathologic features were consistent with intravascular papillary endothelial hyperplasia, also known as Masson hemangioma. Differential diagnosis, management, and review of literature are discussed in this report. CONCLUSIONS This rare pathology should be in the differential diagnosis when spinal cord compressive myelopathy is encountered.

Evisceration of brain: An unusual case report of bear mauling from eastern India

Even if human beings are the most intelligent among all living beings, they are still not immune to attack from wild animals. Human contact with bears has become more frequent as their habitat is being endangered by frequent deforestation. The sloth bear is one of the few bear species found in India, especially in the hilly areas of Southern Odisha. Bears are highly intelligent and omnivorous animals with long claws coupled with powerful shoulder. Here, we describe the tale of a poor tribal males encounter with a sloth bear resulting in critical injuries to face, scalp, skull bone, with brain matter fungating-out of the skull. We immediately went for debridement of the, bulged-out contused brain matter and opted for delayed repair of scalp defect with antero-lateral thigh free-flap to save him from fatality along with an acceptable cosmetic repair of the defect.

An Unusual Combination of Posttraumatic Ipsilateral Basal Ganglia Infarction with Contralateral Hemorrhage: A Rare Case Report and Review of Literature

Posttraumatic ipsilateral basal ganglia infarction with contralateral hemorrhage (IBGICH) is an extremely rare neuropathologic entity. Hematomas or infarction of the basal ganglia in head injury have long been recognized but their mechanism has not been revealed clearly. It is presumed to be secondary to rupture and/or vasospasm, followed by thrombosis of the lenticulostriate and/or anterior choroidal artery. This happens by shearing stress as a result of acceleration or deceleration torques. Outcome of traumatic basal ganglia hemorrhage (TBGH) appears favorable unless it is large, associated with coagulation disorders or other intracranial injuries such as diffuse axonal injury, cerebral contusion etc. We present a rare case of a 32-year-old man with traumatic IBGICH (mirror-image). Patient was managed conservatively and discharged with residual paresis and aphasia. Mechanism of trauma, clinical features, management, and most importantly the medicolegal aspect of the TBGH is discussed.

Malignant peripheral nerve sheath tumor presenting as orbito temporal lump: Case report and review of literature

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. The most common anatomical sites include the upper and lower extremities and trunk and less commonly the head and neck. To our knowledge, few patients with a cranial or facial MPNST have been reported. We report such a lesion in a 35-year-old woman who presented with left sided rapidly progressive proptosis and visual loss due to an orbital lump extending up to the temporal lobe. Cranial imaging showed a huge mass invading the orbital wall and temporal bone. The presumptive diagnosis was a malignant orbital tumor. Preoperative fine needle aspiration cytology of the orbital mass came to be neurofibroma. Near total resection of the tumor was done. Histopathology revealed MPNST which was subsequently confirmed on the basis of immunopositivity for S-100. The patient recovered uneventfully and was discharged 8 days after surgery with an advice to attend cancer institute for possible radiotherapy.