V.K. Kak

Gliosarcoma With Cartilage Formation

A case of gliosarcoma with cartilaginous component is described. Immunohistochemical and electron microscopic studies confirmed the presence of glial and fibroblastic elements. A major part of the sarcomatous tissue was undifferentiated and not labeled by any of the markers used including those for endothelial cells. The cartilage cells also were not labeled either by antiglial fibrillary acidic protein or any other marker. The occurrence and histogenesis of cartilage in gliomas and gliosarcomas have been reviewed.

Intramedullary spinal cysticercosis. Case report and review of literature.

Intramedullary spinal cysticercosis is extremely uncommon; only 29 cases have been reported previously. A case of solitary intramedullary spinal cysticercosis is described. Factors accounting for the rarity of intramedullary cysticerci are reviewed and the probability of reaching a preoperative diagnosis is discussed. This is the fifth such case reported from India.

Spontaneous spinal extradural hematoma in children

Three young children who presented with acute backache and rapidly progressive neurological deterioration were investigated and found to have spontaneous spinal extradural hematoma (SSEDH). They were operated on soon after the diagnosis had been confirmed. The present report highlights the fact that in children progressive weakness of nontraumatic origin should be investigated thoroughly and as early as possible. Patients with SSEDH should be operated on immediately, as this is a curable condition. The pertinent literature has been reviewed.

Tension pneumocephalus following evacuation of chronic subdural haematoma.

Five cases of a rare complication of tension pneumocephalus following evacuation of chronic subdural haematoma are described. This occurred in 8% of all cases of chronic subdural haematoma treated following installation of a CT scanner. The chronically compressed brain contributes to the ingress of this intracranial air. The increase in the brain bulk and gradual re-expansion of the brain, in the early postoperative period, competes with the trapped subdural air resulting in a rise in intracranial pressure leading to neurological deterioration. Twist drill craniostomy and aspiration, using a brain cannula with a three-way connector, has produced excellent results.

Value of precraniotomy shunts in children with posterior fossa tumours

Seventy children with posterior fossa tumours treated over a period of 6 1/2 years were studied. Most patients presented in the late stage of disease. Sixty-four required insertion of a precraniotomy shunt for one or more of the following: persistent vomiting, severe headache, dehydration, poor general condition, failing vision, altered sensorium, marked periventricular lucency, and brain stem involvement deferring total removal of the tumour. Insertion of precraniotomy shunt improved the general condition and signs and symptoms of increased intracranial pressure. It also provided a lax brain during definitive surgery and a smooth postoperative course. Shunt-related complications, consisting of block and/or infection, were observed in 21 patients. It was concluded that precraniotomy shunt is important in the management of children with posterior fossa tumours in developing countries where these patients present in the late stage of disease.

Actinomycotic brain abscess

A histologically confirmed actinomycotic brain abscess, in a previously healthy female, is reported. CT scan findings of a thick walled multiloculated ring enhancement with smooth inner margin and irregular nodular enhancement of outer margin, along with contiguous patchy enhancing lesion with circular low attenuation areas were suggestive of a chronic granulomatous abscess. Surgical excision and prolonged antibiotic therapy produced a good resolution.

Cranial chordoma in the first decade

Cranial chordomas are extremely rare in childhood with only 25 cases having been reported in the first decade of life. A 6-year-old female child with cranial chordoma is reported. Literature on the subject is reviewed, with special reference to the management, histopathological features and prognosis in childhood chordomas as compared to the adult variety.

Supratentorial tumours in infants

Three hundred and ninetysix paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours were located supratentorially. These 82 patients included 14 infants (below 1 year of age), who made up 3.5% of all paediatric patients with brain tumours and 17% of those with brain tumours in a supratentorial location. There was a male preponderance, and two-thirds of the 14 patients were within their first 6 months of life. Increasing head size, vomiting and failure to thrive were the common presenting features. One infant presented with asymmetric skull growth. The tumours tended to be large, occupying almost the entire affected cerebral hemisphere; histological types included astrocytomas, malignant astrocytomas, glioblastoma multiforme, primitive neuroectodermal tumours, malignant choroid plexus papillomas and malignant teratomas. Two children had congenital tumours and another two tumours, in children with associated lobar agenesis, were thought to be congenital in origin. Associated hydrocephalus was present in seven patients, but precraniotomy shunt was required in only two patients. The perioperative (within 1 month) mortality was 57%. Only 30% of the patients survived for more than 1 year after surgery and chemotherapy. The longest survival was 20 months. Delay in diagnosis, poor general condition prior to surgery, and the high vascularity and malignant nature of these tumours accounted for the poor results.

Histopathological and biochemical changes in the sutural region in craniosynostosis

Abstract Object: Histopathological observations and biochemical analysis of sutural bones in nine patients with craniosynostosis were compared with control subjects of the same age range. Methods: Microscopic examination in craniosynostosis showed formation of an active osseous front, with higher osteoblastic activity than in controls. Biochemical analysis revealed higher calcium, phosphorus, alkaline phosphatase, phospholipids and chon-droitin sulphate-A contents in sutural bones of the same patients. Conclusions: The present study systematically establishes a pre- mature increase in osteogenesis in the sutures of craniosynostosis patients.

Brain abscess following insertion of skull traction

A case of brain abscess developing 2 weeks after insertion of skull tongs is reported. The abscess was treated with aspiration and appropriate antibiotic therapy and its complete resolution was confirmed by CT scan. The pathogenesis, through retrograde spread of superficial infection to durocortical veins, is discussed in the light of serial CT scans at different stages of formation and treatment of the abscess.