Clival dysgenesis associated with Chiari Type 1 malformation and syringomyelia.

We report an 11-year-old boy with dysgenesis of the clivus. The boy presented complaining of progressive difficulty in walking. The clival anomaly was associated with severe basilar invagination, Chiari Type 1 malformation and syringomyelia.

Brain herniation through the anterior cranial floor in a long-standing frontal falcine meningioma.

Brain herniation through the incisural cisterns in raised intracranial tension is well known, but brain herniation through the cribriform plate is rare. We report a patient with an anterior falcine meningioma who suffered brain tissue herniation through the cribriform plate with extension into the paranasal air sinuses.

Reversal of longstanding musculoskeletal changes in basilar invagination after surgical decompression and stabilization.

Object: The authors investigated the changes in the bone architecture and the characteristics of the neck and craniovertebral region in selected cases of basilar invagination. The reversal in these changes that occurred after decompression and fixation are analyzed. The implications of such an analysis in understanding the pathogenesis of a number of features that are characteristically associated with basilar invagination are evaluated.

Two patients with intracavernous haemangiopericytoma.

Haemangiopericytomas are relatively uncommon intracranial lesions making up less than 2.5% of all intracranial meningiomas. Their location in the cavernous sinus is extremely rare.

Unilateral atlantal mass hypertrophy in acromegaly. Case report.

The authors report an extremely rare case of a patient with acromegaly who had unilateral enlargement of an atlas facet resulting in cord compression and progressive quadriparesis. Although unilateral atlas facet enlargement has been identified in the literature in cases of spondylosis and as a component of congenital malformation, its association with acromegaly has not previously been reported. Resection of the offending facetal bone and atlantoaxial fixation resulted in rapid neurological recovery.

Fiber dissection of the visual pathways: analysis of the relationship of optic radiations to lateral ventricle: a cadaveric study.

Objective: Using a fiber-dissection technique, our aim is to study the fiber bundles of the optic radiation. We focused on the course, the length, anatomical relations with lateral ventricle and the relevance of these finding during surgery in the region.

Materials And Methods: Five previously frozen and formalin-fixed cadaveric human brains were used.

Colloid cyst of the velum interpositum: a common lesion at an uncommon site.

Background: Colloid cysts are typically located in the region of the anterior third ventricle in the proximity of foramen of Monro. Although 'endodermal cyst' has been identified in several regions of the brain, location of characteristic colloid cyst entirely within the confines of velum interpositum and outside the ventricles has not been reported earlier.

Case Description: We report a unique case of colloid cyst located in the region of velum interpositum in a 33-year-old patient with headache and seizures.

High cervical C3-4 'disc' compression associated with basilar invagination.

A 20-year-old male had torticollis and short neck since birth. He presented with symptom of progressive quadriparesis over a two-year period. Investigations revealed basilar invagination with marked rotation in the craniovertebral region and relatively large C3-4 region osteophytes.

Takayasu's arteritis with ostial and left main coronary artery stenosis.

Takayasu's arteritis with coronary artery involvement is rare, and there is little published information on the subject. Coronary angiographic and histopathologic studies have revealed coronary artery lesions in 9% to 11% of cases. Coronary artery involvement consists mostly of stenosis or occlusion of the coronary ostia.

Noma neonatorum.

Noma Neonatorum is characterized by a gangrenous process involving mucocutaneous junctions of oral, nasal and anal area and occasionally, the eyelids and scrotum. It is seen during the first few weeks of neonatal life in premature and low birth weight babies. Noma Neonatorum is commonly described with pseudomonas aeruginosa septicemia.

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation.

Object: The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation.

Methods: Twenty-two patients with basilar invagination-in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines-were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented.

Atlantoaxial fixation using plate and screw method: a report of 160 treated patients.

Objective: We review our experience with the use of the plate and screw method of fixation in the treatment of 160 patients with atlantoaxial instability during a 14-year period at our center. We previously described this method of fixation in 1994.

Methods: Between 1988 and 2001, 160 patients with atlantoaxial instability were treated with the use of a plate and screw method of fixation at the Department of Neurosurgery at King Edward Memorial Hospital in Bombay, India.

Plate and screw technique for advancement of the supraorbital bar in surgery for craniosynostosis: a preliminary technical report.

An alternative plate and screw method of advancement of the supraorbital osteotomy bar in cranial remodelling surgery for craniosynostosis is described. The lateral orbital rim is transversely cut and using miniplates, screws are implanted into its advanced cut ends. Appropriate screws and miniplates are used to suit the size of the orbital rim in patients of different age groups.

Preoperative shunts in thalamic tumours.

Thirty one patients with thalamic glioma underwent a pre-tumour resection shunt surgery. The procedure was uneventful in 23 patients with relief from symptoms of increased intracranial pressure. Eight patients worsened after the procedure.

Reconstruction of the skull base: a review of personal techniques.

With increasing technological and surgical sophistication in cranial base and craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalisation. Some improvised methods of basal reconstruction with vascularised pedicle flap are described in this presentation. The dependable blood supply, long length, ease of harvesting and the ability to alter the arc of rotation of the described flaps make them versatile for lining skull base.

Hyperdense intracranial epidermoid: an uncommon presentation.

A thirty year old female presented with sudden onset of severe headache, papilloedema and altered sensorium. Computerised tomography (CT) scan showed a hyperdense vermian mass in the posterior fossa. Operative findings and histological examination revealed spontaneous bleed into the epidermoid cyst.

Quantitative anatomy of the lateral masses of the atlas and axis vertebrae.

The study was carried out to determine the safe site of entry and the appropriate trajectory of the screw implantation in the lateral masses of atlas (Cl) and axis (C2) during their fixation using the plate and screw technique. Fifty dried specimens of atlas and axis vertebrae were studied. Various dimensions of the lateral masses were quantitatively measured, laying stress on their relationship with the vertebral artery foramen.

Unusual mode of spread and presentation of meningioma: a case report.

Although rare, extracranial extension of a meningioma has been well documented. An interesting natural history of neglected meningioma with skull vault hyperostosis and predominantly extracranial extension is described. Following surgical resection of the highly vascular meningioma, the patient developed fatal coagulopathy.