Vikas Vazhayil

Surgical treatment of Langerhans cell histiocytosis of cervical spine: case report and review of literature

IntroductionLangerhans cell histiocytosis (LCH) is a rare condition, and even rare is cervical spine involvement.Case reportA 9-year-old girl had neck pain, neck tilt and left upper limb weakness, occasional fever and positive family history of tuberculosis. Imaging showed C5 vertebral body collapse with epidural and prevertebral soft tissue collection causing cord and nerve root compression. The patient underwent C5 corpectomy and fusion. Histopathological was suggestive of LCH. She underwent radiotherapy and was asymptomatic at 1-year follow-up.ConclusionDespite the rarity of the condition, the possibility of LCH should be considered in such cases. When neurologic deficits are present, operative treatment should be considered.

Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke.

Background Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion. Case report We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence. Discussion Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event.

Map-Reduce based framework for instrument detection in large-scale surgical videos

Modern digital world produces massive amount of data generally refereed as Big Data, which play important roles in dictating the quality of our lives. Relationships among such data have high value, but extremely complex task to establish. Medical Field is one of the major big data sources which produces big volume of data. Modern surgical tools have the capability to record High Definition(HD) videos during the surgical procedure which enables post surgical reviews. Such tools produces giga bytes(GB) of video footage after every surgery which needs mass storage and complex processing. A major solution for this problem is parallel distributed processing using Hadoop based Map Reduce Framework. This paper proposes a Surgical Video Analysis Framework using Hadoop to analyze large surgical videos, for identifying surgical instruments used. Framework first converts videos into large number of frames and using Hadoop Image Process Interface (HIPI) it is converted to HIB image bundles. Parallel processing of images in the bundle is done by mappers and identified instrument frame informations are logged. Three different feature extraction methods: Scale-Invariant Feature Transform(SIFT), Speeded Up Robust Features(SURF) with Support Vector Machines(SVM) and Haralick Texture Descriptor with Support Vector Machines(SVM) is used in mappers for local image processing.

Abscess within a Glioblastoma: Mimicking a Matryoshka Doll

BACKGROUND Abscess coexisting within a brain tumor is rare. Case reports in the literature primarily consist of sellar pathology and parenchymal lesions, including meningioma, glioma, and metastases. We report a case of glioblastoma with an intratumoral abscess in a middle-aged patient with no prior invasive procedure or systemic focus of infection. CASE DESCRIPTION A 45-year-old woman presented with new-onset generalized seizures and rapidly progressive left hemiparesis. Imaging showed a right frontal necrotic lesion with a peripherally enhancing wall and solid component posteriorly. There was no diffusion restriction within the lesion. She was afebrile, and there was no systemic focus of infection. With provisional diagnosis of malignant glioma, she underwent surgical resection of the lesion. A differential diagnosis of abscess was considered preoperatively because of the rapid increase in size of the lesion. At surgery, there was a pus-filled cavity with a few areas of grayish, soft, flimsy wall and thrombosed veins. This raised a strong suspicion of a coexisting abscess within a malignant glioma, which was confirmed by histopathologic and microbiologic examination. CONCLUSIONS It is important for neurosurgeons to be aware of this rare entity. The treatment protocol remains controversial and is primarily guided by expert opinion. It is important to aggressively treat the patient with antibiotics followed by adjuvant therapy for malignancy. The timing and administration of adjuvant therapy are unclear. We suggest a delay of chemotherapy until at least 4 weeks of therapy with sensitive antibiotics.

Supratentorial pure cortical ependymoma: An unusual lesion causing focal motor aware seizure

Ependymomas usually arise from the ependymal lining cells of the ventricular system and central canal of the spinal cord. Supratentorial ependymoma is a rare entity with the variable clinical course. In a small number of cases, ependymoma arises from supratentorial parenchyma. Only a few cases are reported in the literature. We report a case of 3-year-old girl with left frontal mass. Total removal of the mass lesion was performed without any neurological deficit. Pathological examination of the excised tumor was consistent with anaplastic ependymoma. We have discussed management strategy of this rare entity.

Occipital Intraosseous Hemangioma over Torcula: Unusual Presentation with Raised Intracranial Pressure

BACKGROUND Hemangiomas of the bone are benign, uncommon, slow-growing lesions accounting for <1.0% of all bony neoplasms. Intraosseous occipital hemangiomas are rare, and occipital hemangiomas presenting with features of raised intracranial tension are, with only 2 cases reported to date. CASE DESCRIPTION In this case report, we describe the unique case of a 30-year-old male patient presenting with raised intracranial pressure due to venous obstruction at the torcula. The patient underwent excision of the lesion and became symptom free. CONCLUSIONS Although these are benign lesions, they can have a varied clinical presentation. An understanding of the different clinical presentations and surgical nuances in excising such tumors can lead to early diagnosis and good patient outcome.

Eosinophilic Granuloma of Skull with Fluid Level and Epidural Hematoma: A Case Report and Review of the Literature

Intracranial Langerhans cell histiocytosis commonly presents as skull lesions in children. An intratumoral cyst with fluid level and epidural hematoma occurring with eosinophilic granuloma is very rare. We report a 15-year-old boy who presented with a spontaneous epidural hematoma which was the result of a temporal eosinophilic granuloma. Multiple explanations for epidural hematoma in such cases have been discussed. Intratumoral hemorrhage followed by cyst formation and rupture may explain the pathophysiology of epidural hemorrhage formation.