Satyawati Mohindra

Rhinocerebral mucormycosis: the disease spectrum in 27 patients

The variable forms of clinical complaints, findings and time interval of presentation in 27 cases of mucormycosis have been described, which were encountered over a span of 8 years. The previous concept about this fungal infection attacking chronic, debilitated, immunocompromised patients does not appear to hold true. Seven of the 27 patients (22.2%) did not reveal any predisposing factors and their outcome of 42.9% survival seems to be poorer than the total outcome (66.7%). ‘Chronic form’ of disease presentation, the definition of which is still not delineated, was encountered in four patients (14.8%). Again, the outcome was not significantly different from the total survival. Burr‐hole tap of an intracranial abscess revealing mucor in a 2‐month‐old infant has been described. Even in the present era, extranasal exenteration of sinuses along with disfiguring orbital exenteration is required to ensure satisfactory surgical debridement. Control of the underlying predisposing illness, along with the aggressive surgical debridement and the parenteral administration of amphotericin B, remains the treatment essentials even today.

Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature.

Development of a contralateral epidural haematoma during or immediately after cranial surgery is a well-described entity. However, in a case of acute subdural haematoma where the brain is usually tense, postoperative development of contralateral extradural haematoma is uncommon. We report two cases of contralateral extradural haematoma after decompressive surgery for acute subdural haematoma. We recommend routine postoperative CT immediately after cranial surgery for head trauma. This would help in timely detection and treatment of such a complication.

Ear surgery without microscope; is it possible.

Our experience of endoscope usage in otological surgery is presented. We included 17 patients with secretory otitis media for grommet insertion, 49 cases of myringoplasties and 6 cases of ossiculoplasties operated between May 2005 and 2008. All the procedures were performed through transcanal route. The success rate regarding perforation closure was 91.5% and average air-bone gap improved from 22.24–12.28 db in myringoplasty group and from 27.5–13 db in ossiculoplasty group. Secretory changes subsided in 16 out of 17 patients in secretory otitis media group. Endoscopic surgery offers many advantages over microscopic surgery which have been discussed.

Fine needle aspiration cytology in lesions of the nose, nasal cavity and paranasal sinuses.

Objective: To assess the spectrum of lesions in the sinonasal region diagnosed on FNAC. Study Design: This is a retrospective audit of sinonasal lesions diagnosed on FNAC over a period of 12 years (1998–2009). Results: Out of a total of 79,851 FNACs, 158 (0.2%) were from the sinonasal region. FNAC was non-diagnostic in 20 (12.6%) cases. Infective/inflammatory lesions comprised of 30 (19%) cases including non-specific inflammation (19), fungal infection (7), tuberculosis (2), actinomycosis (1) and filariasis (1). Benign cysts (24; 15.2%) included epidermal inclusion cysts, mucocele and aneurysmal bone cyst. Benign bone tumors (4) comprised of giant cell tumor, fibrous dysplasia, chondroma, and osteoblastoma. Other benign tumors included lipoma (6), hemangioma (5), schwannoma (2), meningioma (1), pleomorphic adenoma (1), sebaceous adenoma (1) and other skin adnexal tumors (3). Malignant epithelial tumors (24; 15.2%) included squamous cell carcinoma (10), basal cell carcinoma (5), poorly differentiated carcinoma (4) and metastatic carcinoma (5). Two cases of chordoma and one case each of dermatofibrosarcoma pertuberance and hemangiopericytoma were seen. Sarcomas included sarcoma, not otherwise specified (4), rhabdomyosarcoma (3), osteosarcoma (2), chondrosarcoma (2), leiomyosarcoma (1), malignant fibrous histiocytoma (1), fibrosarcoma (1) and malignant peripheral nerve sheath tumor (1). There were cases of malignant small round cell tumor (11), non-Hodgkin lymphoma (3), plasmacytoma (2) and malignant melanoma (2). Conclusion: A variety of non-neoplastic and neoplastic conditions can involve the sinonasal region. FNAC is a reliable diagnostic procedure in a good number of cases, especially in the light of clinico-radiological data.

Giant cell tumour of the clivus

Primary giant cell tumours of the craniospinal axes are rare lesions. These are benign, localized and lytic bony lesions with occasional malignant behaviour. Their clinical behaviour is unpredictable and, hence, management remains controversial. Radical excision of bony lesion, with adjuvant therapy helps in achieving the desired outcome. In the present communication, we present malignant giant cell tumour of clivus, managed successfully with surgical decompression and adjuvant therapy. Patient remains symptom-free at 2 years of follow-up.

Orbital roof growing fractures: a report of four cases and literature review.

Trivial injuries among paediatric patients are usually underestimated. Such injuries may account for delayed problems such as growing fractures of skull vault. Growing fracture of the orbital roof is rarely reported. Four cases of paediatric cranial trauma with growing orbital roof fractures are presented. Three cases required only dural repair, while the fourth patient underwent both duraplasty and cranioplasty, due to a large orbital roof defect. At follow-up, all had satisfactory outcome. Trivial injuries among children should be evaluated with caution. The development of orbital symptomatology should ask for a complete radiological survey. The orbital roof growing fractures are potentially important cause of orbital problems. The dural repair alone, usually provides satisfactory outcome, while calvarial bone graft may be of help in cases with large bony defects. Early diagnosis and management of such cases may prevent permanent neurological deficits.

Cortical mastoidectomy in surgery of tubotympanic disease. Are we overdoing it

BACKGROUND AND PURPOSE OF THE STUDY the role of cortical mastoidectomy in the surgical treatment of tubotympanic type of otitis media has remained controversial especially when there is no evidence of active infection. Though literature is replete with studies for and against the requirement of mastoidectomy, there is a paucity of prospective studies in this regard. A randomized controlled trial was conducted to assess the impact of mastoidectomy in the management of mucosal chronic otitis media. METHODS 62 patients with uncomplicated mucosal chronic otitis media were randomly allotted to two groups of 31 each. Patients in group A underwent tympanoplasty with mastoidectomy and group B underwent tympanoplasty without mastoidectomy. All the patients were followed up for a minimum of three months and results were assessed in terms of graft uptake, hearing improvement and need for repeat procedure. RESULTS no significant difference in outcome was observed between the two groups in all parameters compared. The residual air-bone gap was 12.55 ± 12.98 in group A and 12.71 ± 11.54 in group B. Graft uptake rate was 93.55% in group A and 96.775% in group B. 2 patients in group A and one patient in group B underwent repeat procedures. CONCLUSIONS there is little evidence in favour of cortical mastoidectomy in surgery of tubotympanic disease.

Posterior-fossa intra-tumoural abscess: a report of three patients and literature review.

Intraparenchymal posterior fossa neoplasms containing intratumoural abscesses are rare. Intrasellar or parasellar tumours are among the common neoplasms developing such a complication, as the result of direct extension of the microbial flora from the contiguous infected sinuses. All meningiomas reported with such a complication have been located parasagittally. A short series of three posterior fossa tumours, containing intra-tumoural abscesses, are described, of which only one was diagnosed pre-operatively. A haematogenous pathway was considered as the mode of spread in all three patients. Magnetic resonance imaging was performed in all patients and the features are discussed.

Primary osteosarcoma of clivus: A short report

Abstract Next to multiple myeloma, osteosarcoma is the commonest primary malignant neoplasm of skeletal system. These are aggressive tumours, composed of spindle cells producing osteoid and rarely occur in calvaria. The authors report a 55-year-male harbouring clival osteosarcoma, his clinical presentation, radiological findings, management and outcome.

Cerebellar Aspergillosis in an Infant: Case Report

OBJECTIVE AND IMPORTANCE: Intracranial aspergillosis is occasionally seen among immunocompromised patients, the incidence increasing in consequence to large-scale use of chemotherapy against malignancies and immunosuppression after organ transplantation. Immunocompetent patients harboring invasive intracranial fungal infections still remain an elusive diagnosis. CLINICAL PRESENTATION: A 7-month-old immunocompetent infant who developed and harbored cerebellar aspergillosis until 3 years of age is reported. INTERVENTION: Radical surgical resection of posterior fossa mass (aspergilloma) and parenteral administration of Amphotericin B led to a successful outcome. CONCLUSION: The differential diagnosis at both stages of presentation and the possible mode of infection are discussed according to the radiological images. Preoperative diagnosis on the basis of imaging is difficult. The pathogenesis of such an infection remains uncertain. Parenteral Amphotericin B, followed by prolonged itraconazole therapy, remains the “gold standard” modality for central nervous system fungal infections in adjunct to aggressive surgical debridement.