Role of Pericardial Patch in Neurosurgery: Institutional Experience.

Introduction: Dural closure is an important part of neurosurgery, failure which may lead to wound infection, pseudomeningoceles, meningitis, severe morbidity to a patient, and even mortality. In cases where primary dura closure is not possible, a bovine pericardial patch is a good alternative with the benefits of suturability and the ability to provide watertight closure, hence preventing Cerebrospinal Fluid (CSF) leak. The present study demonstrates the use of the bovine pericardial patch in both cranial and spinal disorders for dural closure as well as for transposition technique in microvascular decompression.

Extra-Axial Third Ventriculostomy Through Lamina Terminalis with Multiple Cisternostomies - Rescue Surgery for Patients with Failed Shunt Surgeries and Hydrocephalus.

Background And Aim: Contemporary management of hydrocephalus involves various modes of cerebrospinal fluid (CSF) diversion, including shunt surgery and endoscopic ventriculostomy. However, there are times when either of these procedures have either failed or are not feasible. Highly invasive procedures aimed at internal CSF have been described previously, which, with the aid of modern microsurgical techniques, can be attempted in cases with very limited options.

Intraoperative Ultrasound an Economical Tool for Neurosurgeons: A Single-Center Experience.

Background: Over the past decade, the use of intraoperative image guidance in neurosurgery has gradually gained in importance. Apart from some sophisticated and very expensive techniques, intraoperative ultrasound (IOUS) is a simple and economical technique that allows the surgeon to localize deep-seated lesions under a real-time ultrasonic image display without dissection. The purpose of this study was to present our own preliminary experiences in various (n=1250) neurosurgical procedures carried out at our tertiary care centre in a developing country.

Surgical management of cerebellopontine angle epidermoid cysts: an institutional experience of 10 years.

Background: Cerebellopontine angle (CPA) epidermoids, although of benign nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and brain stem. In this paper, we describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. The main objectives were to study various modes of surgical management of CPA epidermoids with regard to removal and preservation of the cranial nerves and also to evaluate the role of endoscopic assisted microsurgical excision thereby minimizing recurrences.

Collision Tumors: A Rare Case Report.

The presence of collision tumors without any evidence of phacomatoses, genetic syndromes, or any history of previous radiation to the brain is extremely rare. We report a case with two diverse primaries, a tentorial meningioma and a colloid cyst found in the same patient occurring in the absence of these conditions. To the best of our knowledge, a single case of a colloid cyst and meningioma found together in the same patient has been reported till date.

Management Strategies of Cranial Encephaloceles: A Neurosurgical Challenge.

Background: Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity.

Large Intradiploic Growing Skull Fracture of the Posterior Fossa with Syringomyelia.

Growing skull fracture (GSF), also known as leptomeningeal cyst, is a rare but significant complication of pediatric head injury. It is mainly seen in infancy and childhood. GSFs of the posterior fossa are uncommon, and intradiploic location in the posterior fossa is extremely rare.

Lateral Semi-sitting Position: A Novel Method of Patient's Head Positioning in Suboccipital Retrosigmoid Approaches.

Background: The most common methods of positioning patients for suboccipital approaches are the lateral, lateral oblique, sitting, semisitting, supine with the head turn, and park bench. The literature on the positioning of patients for these approaches does not mention the use of lateral semisitting position. This position allows utilization of the benefits of both semisitting and lateral position without causing any additional morbidity to the patient.

The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai.

The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60 anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country.

Unravelling Hitherto Unreported Masses Camouflaged as Pituitary Macro Adenomas.

Background: Lesions of the pituitary gland and the juxtasellar region are quite frequently encountered in daily practise of a neurologist/neurosurgeon. While the differentials of sellar masses are quite large and form an extensive list and the management protocol varies in each case, the onus of properly categorizing and diagnosing the pituitary mass often falls on the reporting radiologist. We hereby present two such unusual masses in the sellar-suprasellar region which were masquerading as pituitary macro adenomas.

Effect of Mannitol Irrigation on Brain Edema in a Live Rat Model.

Background: Mannitol has been used intravenously for decreasing cerebral edema since decades. The study was performed to evaluate the effect of its irrigation on edema in live rats. Edema was induced by artificial brain injury.

Silent Migration of Ventriculoperitoneal Shunt per Anus in a Child: Management and Review of Literature.

The aim of this paper is to report a case of ventriculoperitoneal (VP) shunt tube coming out through the anus in a 6-year-old boy, who had undergone shunt revision surgery for the malfunctioning of the peritoneal end 6 months back. Among the complications of VP shunt surgery, such unusual migration of peritoneal end of the VP shunt is very rare. The possible factors responsible for this complication, in our case, were abdominal adhesions and thin bowel wall in the children.

Tectal Tuberculoma: An Unusual Cause of Parinaud's Syndrome.

Introduction: Parinaud's Syndrome is an inability to move the eyes upwards which is caused by damage to the tectal plate of midbrain. Commonest causes implicated are the Pineal tumors in children, Multiple Sclerosis in adults and stroke in elderly patients. We present a rare case of Tectal plate tuberculoma leading to Parinaud's Syndrome.

Pediatric Isolated Cortical (Ectopic) Anaplastic Ependymoma.

Ependymomas are tumors derived from ependymal cells lining the ventricles or from the central canal of the spinal cord. It usually arises in the ventricles with extra ventricular extension. Less than 15 cases of purely cortical ependymomas are reported.

Mature Cystic Teratoma of Dorsal Spinal Cord in Adult: An Unusual Lesion.

Teratomas are a type of multipotential cell tumor that contain a mixture of multiple germinal layers formed by normal organogenesis and reproductive tissues the incidence of intracranial teratomas is low, approximately 0.5-2.2% of all intracranial tumors.

Primary pleomorphic xanthoastrocytoma of the spinal cord: A case report and review of literature.

Primary pleomorphic xanthoastrocytoma (PXA) of the spinal cord is a rare slow growing tumor. To our knowledge, only five such cases have been reported in the literature till date. We report the clinical, radiological, and histopathological features of a spinal PXA in a 23-year-old female previously operated 5 years back for a spinal tumor, presented with weakness in lower limbs, sphincter incontinence and low back pain.

Recurrent intraventricular meningioma with malignant transformation.

Benign meningioma undergoing a malignant transformation (to a chondrosarcoma) in intraventricular location is very rare and this is first case report to best of our knowledge. Herein, we report a rare case of malignant transformation of a benign intraventricular meningioma with relevant literature.

Intra-axial chondroblastoma: A bony tumor in the cerebral hemisphere - A case report and review of literature.

This case highlights a rare possibility of occurrence of chondroblastoma, a bony tumor, at an uncommon location. Extraosseous, soft tissue location of this bony tumor is rare and more so for intracranial intra-axial location. We report a case of an intra-axial frontal lobe lesion, histologically proven to be an extraosseous chondroblastoma.

Primary intracranial choriocarcinoma presenting as a ring-enhancing lesion: A case report and review of literature.

We report here a rare case of primary intracranial choriocarcinoma without evidence of tumor elsewhere, presenting as a ring-enhancing lesion managed successfully in our institute (Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India).

Unusual site of Rathke's cleft cyst: A case report and review of literature.

We report an eight years female child of symptomatic giant Rathke's cleft cyst extending from right parasellar, paraventricular region to right fronto-temporo-parietal cortical surface which is an unusual site for Rathke's cyst. MRI Brain scans of patient who presented with diminution of vision in right eye with headache and vomiting revealed a large cystic mass in right parasellar, paraventricular region with peripheral enhancement and midline shift. In this case, we performed the right fronto-temporo-parietal craniotomy with drainage and marsupilization of cyst wall.

Primary aneurysmal bone cyst of the petrous temporal bone: A case report and review of literature.

Aneurysmal bone cyst (ABC) arising in the petrous portion of the temporal bone is a rare entity with only five such reported cases in the literature. We report the case of a 28-year-old man who presented with a tender swelling in the right preauricular region with right ear discharge and conductive hearing loss of 4 years' duration. Computed tomography and Magnetic Resonance imaging showed a destructive lesion in the right petrous bone with cavitation consistent with the diagnosis of ABC.