Somil Jaiswal

Twist drill craniostomy vs Burr hole craniostomy in chronic subdural hematoma: a randomized study

Abstract Aim: To compare two most common operative procedures used in patients with chronic subdural hematomas - Twist drill craniostomy and Burr Hole Craniostomy. Material and Methods: The study was a prospective randomized controlled trial on patients with chronic subdural hematomas. Results: Both procedures are comparable with respect to outcome but surgical duration is statistically higher in Burr Hole craniostomy than Twist Drill Craniostomy. Conclusion: Twist Drill Craniostomy is procedure of choice in emergency surgical situation.

A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage

Context: Spontaneous intracerebral haemorrhage (ICH) accounts for 4–14% of all strokes and has a high mortality rate of 30–50% during the first month. Management of large hematomas is controversial, with some advocating medical management while others favoring surgical evacuation. Aim: This study was undertaken to compare the outcome of patients with a spontaneous supratentorial intracerebral hemorrhage (SSICH) managed with or without surgical evacuation. Settings and Design: Four hundred and eighty-two SSICH patients admitted from September 2013 to August 2015 were evaluated based on the inclusion and exclusion criteria. Materials and Methods: Among a total of 61 patients with Glasgow Coma Scale (GCS) of 4–14 and hematoma volume of >30 ml, 27 were randomized to receive medical management (MM) alone and the remaining 34 were randomized to combined surgical as well as medical management (SM). Primary and secondary outcomes were mortality and dependency at 3 months, respectively. Statistical Analysis Used: Students t-test and X2 test were used for univariate analysis, and logistic regression analysis was employed for multiple variables. Results: On univariate analysis, mortality was significantly lower in the SM group (n = 21,61.8%) compared to the MM group (n = 23,85.2%) (P = 0.043); however, the groups showed no significant difference in dependency at 3 months. Further subgroup analysis showed that a hematoma volume of 30–60 ml, a deeply located hematoma, associated intraventricular hemorrhage, and a Glasgow Coma Scale (GCS) of 4–8 had a significantly lesser mortality in the SM group (P < 0.05). On multivariate analysis, a significant association was found between the mortality and the treatment arm (P = 0.006). Conclusions: In patients with SSICH, mortality was found to be significantly associated with the treatment arm and the results were in favour of SM among the patients presenting with GCS 4–8, hematoma volume 31–60 ml, midline shift of more than 5 mm, and intraventricular extension of the hematoma.

Spontaneous umbilical CSF fistula due to migration of the peritoneal end of VP shunt: A case report and review of pathogenesis

Abdominal complications after ventriculoperitoneal (VP) shunt surgery for hydrocephalus have been known to occur. The more common complications include peritoneal pseudocyst, obstruction of the lower end, and shunt infection. Perforations of the intra-abdominal hollow viscera leading to spontaneous extrusions of the peritoneal catheter via the natural orifices have also been reported. A rarer phenomenon still is the migration of the lower end of the VP shunt through the anterior abdominal wall, leading to the formation of a spontaneous umbilical fistula at a site unrelated to the surgical site. Eight cases have been described in the literature so far with various causes elucidated. We report this condition in a child 4.5 years after his shunt surgery and postulate different mechanisms for both early and late presentations of this condition.

Isolated cysticercosis involving the anterior abdominal wall: a rare case report

Isolated cysticercosis of anterior abdominal wall without parasitosis of central nervous system is very rare and may mimic a tumor leading to diagnostic and therapeutic dilemma. Histopathological examination plays an important role in making a definitive diagnosis. Here we report a case of a 13-year old Muslim girl presenting with swelling and pain in left lower abdomen which was clinically diagnosed as lipoma. On histopathological examination cysticercus with surrounding inflammation was seen. Since cysticercosis is a preventable disease, early and accurate diagnosis is necessary for the reduction of disease burden in the endemic areas.

Primary Ewing sarcoma of squamous temporal bone with intracranial extension: a case report

Abstract Primary Cranial Ewing sarcoma (ES) is rare and that of temporal bone is even rarer entity. Only a few sporadic cases have been reported and no such case has been reported from Eastern India In this report we describe a case of 18 yrs old male with primary cranial ES of squamous temporal bone involving intracranial and extracranial compartment. The patient presented with swelling in zygomatic fossa and imaging studies showed a mass originating in the right temporal bone. Gross total resection of the tumor was done and sent for histopathological study. The case was referred for radio-chemotherapy and had no recurrence up to eight months of follow up.

Extradural Spinal Meningioma: Mimicking Metastasis

Meningiomas are usually arise within the dura, sometimes extend beyond it, but completely outside the dura are very rare. Spinal meningiomas represent around 10% of all meningiomas and, commonly occur as intradural extramedullary lesions. Purely extradural spinal meningiomas are very rare and only few cases are reported in literature. We describe a case of 50yr old female who presented with upper dorsal region pain and sensory-motor spastic paraparesis. Imaging features were suggestive of D1-3 epidural lesion with significant cord compression. Patient underwent complete excision of lesion. On HPE, a diagnosis of meningothelial meningioma was made. Post-operatively patient showed a good clinical outcome without any recurrence during follow-up of 6 months.

Primary Type I cutaneous meningioma of the scalp: Cytohistological and immunohistochemical features of a rare neoplasm

Primary cutaneous meningioma of scalp is a rare lesion and often clinically misdiagnosed. As clinical features are nonspecific, the diagnosis is often perplexing in this exceptional site. We report a case of a 7-year-old girl presenting with a nodule over occipital region of scalp since birth. No bony defect was noted on X-ray. On fine needle aspiration cytology, smears were cellular consisting mostly cohesive clusters of cells having pale pink granular cytoplasm, round to oval nuclei with unassuming nucleoli along with psammomatous calcification suggestive of cutaneous meningioma. Histology and immunohistochemistry with epithelial membrane antigen (EMA) confirmed the diagnosis. Histological sections revealed a proliferation of a spindle-shaped cell in the dermis, arranged in whorls or individually amid collagen fibers and psammoma bodies. Immunohistochemical study revealed positivity for EMA. A diagnosis of Type I cutaneous meningioma was finally rendered based on characteristic clinical, intraoperative, morphological, and immunohistochemical observations.