An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplas... more An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplastic osseous lesions in children and young adults. Seventy-five percent of ABCs occur before the age of 20 years. They comprise 1.4% of all primary bone tumors, and commonly occur in the long bones. Spinal ABCs are much rarer. We present to you one such rare case of ABC involving the lumbar spine which was successfully treated with surgery. The clinical pathological and radiological features are described. The treatment options available are discussed.
Deformity in the cervical spine is ascribed to congenital, degen erative, traumatic, infective, n... more Deformity in the cervical spine is ascribed to congenital, degen erative, traumatic, infective, neoplastic, iatrogenic causes. The deformity can be in the sagittal and coronal plane and is an important factor in the generation of symptoms in cervical spondylotic myelopathy (CSM). Better understanding of the etiopathogenesis, imaging and improving instrumentation allows for the tackling of these deformities. Correction requires to be tailored to each patient and may require anterior, posterior or combined approaches.
Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervo... more Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervous system. Typically spinal NCC involvement has a concomitant cranial involvement. Spinal involvement by NCC, either intramedullary or extramedullary is very uncommon. The authors report a case of D12-L1 intradural extramedullary lesion in a 38-year-old female patient who presented with complaints of back pain and weakness of lower limbs. She underwent laminectomy and excision of the lesion. Histopathology revealed extramedullary cysticercal abscess. Post-operatively she was treated with albendazole. She had a successful recovery post-operatively and at 8 months follow up had no neurological deficits. This current case presents a very rare case of cysticercal abscess of dorsolumbar spine, without any evidence of cranial involvement. This report is to reemphasize the importance of including NCC as a differential diagnosis in intradural extramedullary lesion at the conus level in endemic a...
Background: The authors describe their surgical experience of a hydatid cyst in the brainstem, wh... more Background: The authors describe their surgical experience of a hydatid cyst in the brainstem, which is an unusual site. The cyst was internally decompressed and totally excised. Although the Dowling technique has been described to be the ideal method for removal of hydatid cysts, it may not be possible when the cyst is in a deep-seated, vital, and eloquent location. We report the use of internal decompression by aspiration followed by total excision as an alternative method when the cyst is located in vital areas of the brain. Case Description: A 40-year-old female presented with headache, progressive right-sided weakness, double vision, and unsteadiness of gait of 1-month duration. On examination, she had left one-and-ahalf syndrome, right hemiparesis of 3/5, and left cerebellar signs. Computed tomographic and MRI scans of the brain revealed a solitary, stenciled-out cystic lesion in the brainstem more toward the left side with features suggestive of hydatid cyst. A left retromastoid craniectomy followed by left middle cerebellar peduncle approach, aspiration of the cyst, and total excision of the cyst was performed. Postoperatively, the patient improved progressively and was asymptomatic with minimal left cerebellar signs at 1-year follow-up. Conclusion: Hydatid cyst is a benign lesion. Appropriate management is mandatory for reducing the morbidity. Although the Dowling technique with its modifications is appropriate for cerebral parenchymal surfacing or superficial hydatid cysts, in deep-seated cysts located in eloquent and vital areas such as the brainstem, management by internal decompression by aspiration followed by extirpation of the cyst wall, protecting the surrounding cisterns and CSF spaces, is an alternative option.
Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiolo... more Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated. Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment. Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died 4 hours after the admission. On follow-up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances. Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared with the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
ABSTRACTGlioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in ch... more ABSTRACTGlioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in children is less common than in adults and has a better prognosis. Pediatric GBM is a rare entity, and a multifocal development in a pediatric GBM is much rarer. We report to you one such rare case of pediatric multifocal GBM in a 5-year-old child who developed rapidly increasing multiple lesions after radiotherapy. More studies are required to study the genetic analysis, tumor behavior, management and outcome of these rare tumors.
Journal of Craniovertebral Junction and Spine, 2012
We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented w... more We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented with cauda equina syndrome and acute bladder disturbance. He underwent emergency surgical resection of the lesion, which was proved to be a lymphoma by histopathology and immunohistochemistry. He has improved neurologically and after 1 year, he is leading a normal life with near normal neurological functions. This is the second case of primary spinal intradural extramedullary lymphoma. This is the fi rst such case in the pediatric age group and causing cauda equina syndrome. We describe the characteristics of such tumors along with pathogenesis and management.
Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a w... more Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a well-defined entity outside the neuraxis, its intracranial occurrence is rare. Literature review revealed 35 reported cases till date. The authors report a case of intracranial EHE in a 15-year-old girl, who presented with a short history and unusual radiology. Following radical removal, the lesion recurred within 1 month and progressed to terminal stages. This tumor is thought to have an indolent intermediate malignancy potential and such rapid progression has not been reported so far.
A 17-year-old man presented a month after suffering a penetrating injury to the right side of the... more A 17-year-old man presented a month after suffering a penetrating injury to the right side of the neck with a broken sharp-ended casuarina stick. The stick had been pulled out and a course of antibiotics was given. A week later there was a purulent discharge from the wound and 2 weeks later he developed progressive weakness and numbness of the right-sided limbs. Plain radiographs of the cervical spine showed loss of lordosis. MRI showed a foreign body with a sinus tract extending from the skin into the epidural space of the C5 vertebra on the right side through the right C5 foramen (Fig. 1). There was an epidural collection with compression of the cord opposite the C5 vertebra with signal intensity changes in the cord.
Cutaneous melanoma can metastasize to any organ, including brain and spinal cord. A 27-year-old l... more Cutaneous melanoma can metastasize to any organ, including brain and spinal cord. A 27-year-old lady, four months after conception presented with generalized seizures and was diagnosed to have subarachnoid hemorrhage. Further investigation did not reveal aneurysm. She underwent right ventriculo-peritoneal shunt for hydrocephalus and MTP for unprotected radiation from CT scan. Six weeks later she came to our institution with symptoms of dorsal compression. Imaging showed multiple intradural extramedullary spinal lesions at D3-D4, D8 and D10-D11. Surgical excision of the lesions was done and histopathology was consistent with metastatic deposits from malignant melanoma which was confi rmed by immunohistochemistry studies also. Her conscious level deteriorated on the second postoperative day and CT scan showed multiple small tumor emboli with evidence of right temporal bleed and diffuse cerebral edema. In spite of aggressive treatment she could not be saved. This reported case concludes that pregnancy aggravates the clinical course of metastatic melanoma.
Spinal drop metastasis of Glioblastoma-Two Case Reports, Clinicopathological features, Current Mo... more Spinal drop metastasis of Glioblastoma-Two Case Reports, Clinicopathological features, Current Modalities of Evaluation and Treatment with a Review of literature.
An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplas... more An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplastic osseous lesions in children and young adults. Seventy-five percent of ABCs occur before the age of 20 years. They comprise 1.4% of all primary bone tumors, and commonly occur in the long bones. Spinal ABCs are much rarer. We present to you one such rare case of ABC involving the lumbar spine which was successfully treated with surgery. The clinical pathological and radiological features are described. The treatment options available are discussed.
Deformity in the cervical spine is ascribed to congenital, degen erative, traumatic, infective, n... more Deformity in the cervical spine is ascribed to congenital, degen erative, traumatic, infective, neoplastic, iatrogenic causes. The deformity can be in the sagittal and coronal plane and is an important factor in the generation of symptoms in cervical spondylotic myelopathy (CSM). Better understanding of the etiopathogenesis, imaging and improving instrumentation allows for the tackling of these deformities. Correction requires to be tailored to each patient and may require anterior, posterior or combined approaches.
Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervo... more Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervous system. Typically spinal NCC involvement has a concomitant cranial involvement. Spinal involvement by NCC, either intramedullary or extramedullary is very uncommon. The authors report a case of D12-L1 intradural extramedullary lesion in a 38-year-old female patient who presented with complaints of back pain and weakness of lower limbs. She underwent laminectomy and excision of the lesion. Histopathology revealed extramedullary cysticercal abscess. Post-operatively she was treated with albendazole. She had a successful recovery post-operatively and at 8 months follow up had no neurological deficits. This current case presents a very rare case of cysticercal abscess of dorsolumbar spine, without any evidence of cranial involvement. This report is to reemphasize the importance of including NCC as a differential diagnosis in intradural extramedullary lesion at the conus level in endemic a...
Background: The authors describe their surgical experience of a hydatid cyst in the brainstem, wh... more Background: The authors describe their surgical experience of a hydatid cyst in the brainstem, which is an unusual site. The cyst was internally decompressed and totally excised. Although the Dowling technique has been described to be the ideal method for removal of hydatid cysts, it may not be possible when the cyst is in a deep-seated, vital, and eloquent location. We report the use of internal decompression by aspiration followed by total excision as an alternative method when the cyst is located in vital areas of the brain. Case Description: A 40-year-old female presented with headache, progressive right-sided weakness, double vision, and unsteadiness of gait of 1-month duration. On examination, she had left one-and-ahalf syndrome, right hemiparesis of 3/5, and left cerebellar signs. Computed tomographic and MRI scans of the brain revealed a solitary, stenciled-out cystic lesion in the brainstem more toward the left side with features suggestive of hydatid cyst. A left retromastoid craniectomy followed by left middle cerebellar peduncle approach, aspiration of the cyst, and total excision of the cyst was performed. Postoperatively, the patient improved progressively and was asymptomatic with minimal left cerebellar signs at 1-year follow-up. Conclusion: Hydatid cyst is a benign lesion. Appropriate management is mandatory for reducing the morbidity. Although the Dowling technique with its modifications is appropriate for cerebral parenchymal surfacing or superficial hydatid cysts, in deep-seated cysts located in eloquent and vital areas such as the brainstem, management by internal decompression by aspiration followed by extirpation of the cyst wall, protecting the surrounding cisterns and CSF spaces, is an alternative option.
Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiolo... more Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated. Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment. Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died 4 hours after the admission. On follow-up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances. Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared with the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
ABSTRACTGlioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in ch... more ABSTRACTGlioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in children is less common than in adults and has a better prognosis. Pediatric GBM is a rare entity, and a multifocal development in a pediatric GBM is much rarer. We report to you one such rare case of pediatric multifocal GBM in a 5-year-old child who developed rapidly increasing multiple lesions after radiotherapy. More studies are required to study the genetic analysis, tumor behavior, management and outcome of these rare tumors.
Journal of Craniovertebral Junction and Spine, 2012
We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented w... more We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented with cauda equina syndrome and acute bladder disturbance. He underwent emergency surgical resection of the lesion, which was proved to be a lymphoma by histopathology and immunohistochemistry. He has improved neurologically and after 1 year, he is leading a normal life with near normal neurological functions. This is the second case of primary spinal intradural extramedullary lymphoma. This is the fi rst such case in the pediatric age group and causing cauda equina syndrome. We describe the characteristics of such tumors along with pathogenesis and management.
Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a w... more Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a well-defined entity outside the neuraxis, its intracranial occurrence is rare. Literature review revealed 35 reported cases till date. The authors report a case of intracranial EHE in a 15-year-old girl, who presented with a short history and unusual radiology. Following radical removal, the lesion recurred within 1 month and progressed to terminal stages. This tumor is thought to have an indolent intermediate malignancy potential and such rapid progression has not been reported so far.
A 17-year-old man presented a month after suffering a penetrating injury to the right side of the... more A 17-year-old man presented a month after suffering a penetrating injury to the right side of the neck with a broken sharp-ended casuarina stick. The stick had been pulled out and a course of antibiotics was given. A week later there was a purulent discharge from the wound and 2 weeks later he developed progressive weakness and numbness of the right-sided limbs. Plain radiographs of the cervical spine showed loss of lordosis. MRI showed a foreign body with a sinus tract extending from the skin into the epidural space of the C5 vertebra on the right side through the right C5 foramen (Fig. 1). There was an epidural collection with compression of the cord opposite the C5 vertebra with signal intensity changes in the cord.
Cutaneous melanoma can metastasize to any organ, including brain and spinal cord. A 27-year-old l... more Cutaneous melanoma can metastasize to any organ, including brain and spinal cord. A 27-year-old lady, four months after conception presented with generalized seizures and was diagnosed to have subarachnoid hemorrhage. Further investigation did not reveal aneurysm. She underwent right ventriculo-peritoneal shunt for hydrocephalus and MTP for unprotected radiation from CT scan. Six weeks later she came to our institution with symptoms of dorsal compression. Imaging showed multiple intradural extramedullary spinal lesions at D3-D4, D8 and D10-D11. Surgical excision of the lesions was done and histopathology was consistent with metastatic deposits from malignant melanoma which was confi rmed by immunohistochemistry studies also. Her conscious level deteriorated on the second postoperative day and CT scan showed multiple small tumor emboli with evidence of right temporal bleed and diffuse cerebral edema. In spite of aggressive treatment she could not be saved. This reported case concludes that pregnancy aggravates the clinical course of metastatic melanoma.
Spinal drop metastasis of Glioblastoma-Two Case Reports, Clinicopathological features, Current Mo... more Spinal drop metastasis of Glioblastoma-Two Case Reports, Clinicopathological features, Current Modalities of Evaluation and Treatment with a Review of literature.
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