Penetrating spinal trauma due to missile/gunshot injuries has been well reported in the literature and has remained the domain of military warfare more often. Civic society's recent upsurge in gunshot injuries has created a dilemma for the treating neurosurgeon in many ways as their management has always involved certain debatable and controversial issues. Both conservative and surgical management of penetrating spinal injuries (PSI) have been practiced widely. The chief neurosurgical concern in these types of firearm injuries is the degree of damage sustained during the bullet traversing through the neural tissue and the after-effects of the same in long term. We had an interesting case of a penetrating bullet injury to cervical spine at C2 vertebral level. He was operated and the bullets were removed from posterior midline approach. Usually, the management of such cases differs from region to region depending on the preference of the surgeon but still certain common principles are followed world over. Thus, we realized the need to review the literature regarding spinal injuries with special emphasis on PSI and to study the recent guidelines for their treatment in light of our case.

We report the case of a 13-year-old girl presenting with left-sided hemiparesis, altered sensorium and episodic headache with bouts of projectile vomiting. Imaging revealed a large heterodense intraventricular mass lesion displaying focal calcification and hyperintensity on T1- and T2- weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance images suggesting the presence of intratumoral fat. Histologically, the tumour showed sheets of glial cells, focal perithelial rosettes and individual cells showing fat vacuoles. The morphological impression was of an ependymoma with lipomatous differentiation. Glial fibrillary acid protein (GFAP) immunohistochemistry revealed positivity in the cytoplasmic processes of the tumour cells as well as in the cytoplasmic rim of the cells having an adipocytic appearance. S100 and vimentin were also immunoreactive. Ultrastructural studies confirmed the ependymal differentiation of the tumour and the presence of an osmiophilic fat component confirming the diagnosis. After 1 year of follow-up, the patient presented with similar complaints and MRI evidence of recurrence of the tumour. A comprehensive literature review revealed that half of the reported cases of this pattern recurred suggesting a possibly tenacious clinical course.

Chryseobacterium indologenes is a non-glucose fermenting Gram-negative bacteria widely distributed in nature. It has been found to cause a variety of infections like nosocomial pneumonia, bacteremia and wound infections usually in immunosuppressed patients and those with indwelling devices. The organism is resistant to a significant number of the commonly prescribed broad spectrum antibiotics. We report a rare case of meningitis due to C. indologenes in a patient diagnosed with medulloblastoma and hydrocephalus with an external ventricular drain in situ. The patient was successfully treated with trimethoprim/sulfamethoxazole combination and external ventricular drain replacement as shown by subsequent sterile cultures.

Primary extradural meningiomas of the skull comprise 1% of all meningiomas, and lytic skull meningiomas are still rarer and are said to be more aggressive. We present a case of 38-year-old male with an extradural tumor which on histopathological examination showed features of inflammatory atypical meningioma (WHO Grade II). The intense inflammatory nature of osteolytic primary intraosseous meningioma has not been reported before. This entity deserves special mention because of the need for adjuvant therapy and proper follow-up.

Case RepoRtCase 1 was a 40-year-old male with history of sudden loss of consciousness. There was no history of fever or headache or focal neurological deficit. Magnetic resonance imaging (MRI) revealed a heterogeneously hyperintense mass on T2 weighted image [ The resection was halted after adequate surgical decompression and patient was immediately started on antifungal therapy. The patient responded quickly to the treatment. Histopathology was also consistent with Aspergillus granuloma and showed no evidence of a neoplastic lesion. Samples sent for microbiological culture confirmed Aspergillus fumigates as the infecting fungal species. An active search for primary foci was done but none was aBstRaCt Intracranial fungal granulomas can be misdiagnosed clinically and radiologically as neoplastic lesions. They also rarely occur without any history of immunodeficiency or diabetes. We report two such cases of fungal granulomas that were unsuspected clinically and radiologically but were detected on intraoperative squash cytology (SC) and later confirmed on histopathology. Timely intervention was hence possible and patient was saved from the hazards of unnecessary removal of eloquent areas of brain and was shifted on proper medical management. SC remains an indispensible tool for the neurosurgeon to get a provisional intraoperative diagnosis and in such surprising scenarios, change the surgical management of the patient, save the resection of eloquent brain areas and begin immediate postoperative medical management. These cases are being presented for their rarity and for highlighting the importance of SC as a regular tool for intraoperative neurosurgical consultation of intracranial mass lesions.found in paranasal sinuses, ear canal or lungs. The patient was not diabetic, with normal hemogram findings and was negative for human immunodeficiency virus (HIV) infection.Case 2 was a 25-year-old male who presented with a short term history of headache, low grade fever, sudden episodes of unconsciousness and two episodes of seizures since last two months. MRI revealed a necrotic mass in right parietal region showing heterogeneous postcontrast enhancement, suggestive of high grade glioma. MRS findings showed no specific peak. CSF examination was normal. Hence, the patient was operated and sample was sent for cytological consultation. Informed consent was taken preoperatively from the patient for intraoperative cytology consultation. The smears revealed glial tissue with minimal pleomorphism, no overcrowding and many plasma cells and few histiocytes. Few broad aseptate fungi were seen, suggestive of Zygomycetes infection [Table /Fig-3a]. The patient was immediately shifted on antifungal treatment histopathology revealed a granulomatous lesion surrounded by gliotic tissue and many broad aseptate hyphae which were characteristic of Zygomycosis and confirmed using periodic acid stain (PAS) stain [Table/ Fig-3b]. Interestingly, again no foci of entry of the fungal infection or any history of diabetes mellitus or immunocompromis...