Objective:Lumbar intervertebral disc herniation (LIVDH) is rare in children and adolescents when compared to adults. In literature, children generally constitute around 0.5–3% of surgically treated LIVDH. Though much rarer, they are less likely to respond to conservative treatment than adults. In this study, we analyze our experience in the management of adolescent LIVDH (ALIVDH) (age group 12–18 years) including the demographic, clinico-radiological features; surgical management strategies and outcome.Materials and Methods:This retrospective analysis constituted all patients between 12 and 18 years, who underwent surgery for LIVDH at our institute over a period of 15 years from January 1999 to June 2014. The records of these patients were retrieved, and demographic features, clinical picture, radiological features, operative findings, and postoperative events were evaluated. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire and telephone conversations. The long-term outcome was analyzed by using standardized and condition specific outcome scales in addition to routine clinical follow-up evaluation. The long-term outcome was analyzed by using the short form-36 (SF-36).Results:There were a total of 32 patients (26 males, eight females) with an average age of 15.64 years. Trauma was a significant etiological factor 57.14% (n = 16/28). Vertebral anomalies were present in 35.7% (n = 10/28) cases. Majority had a neurological deficit at presentation (n = 20/28). The most commonly involved level was the L4–L5 level (n = 18/128) in this series. Multiple level disc degeneration was present in eight patients (28.6%). Immediate postoperative relief was achieved in all but one patient. At long-term follow-up twenty patients were pain-free (71.4%). At follow-up, the physical functioning scale of SF-36 was significantly lower in patients with gross motor deficit prior to surgery.Conclusions:Early diagnosis and adequate management contribute to a good outcome. In our study, trauma and presence of preexisting vertebral anomalies were significant factors in the etiogenesis of ALIVDH.

Problems Considered?Bifrontal contusions are common and pose surgical dilemma regarding both indication as well as extent of surgery. There is no guideline available for optimal treatment of such lesions. The objective of this study was to determine the best modality of surgical treatment for such patients. Methods?This is a retrospective study of patients who were surgically treated for bifrontal contusions during the last 5 years. Clinical features, computed tomographic scan findings, surgical treatment modality, in-hospital mortality, and follow-up data were recorded. Results?A total of 98 patients (mean age 45 years) were operated for bifrontal contusions. Mean Glasgow coma score was 9 and motor response was M5. Contusions were of the same size on both sides in 22 cases and asymmetric in 76 cases. Patients underwent following surgical procedures: bifrontal decompressive craniectomy without evacuation of contusion (40 cases), bifrontal craniotomy and evacuation of bifrontal contusion (34 cases), and evacuation of unilateral contusion (24 cases). The overall mortality was 36.7%. The mortality was 55, 35.3, and 8.3%, respectively, with the above-mentioned surgical treatments. There was no difference in mortality between patients with symmetric and asymmetric contusions. The mean duration of follow-up was 23 months. Follow-up data were available for 42 (67.7%) survivors. Favorable outcome was seen in 80.9% of the survivors. Frontal lobe dysfunction was seen in 59.5% of the survivors. Conclusion?Patients who underwent bifrontal decompressive craniectomy without evacuation of contusion had worst outcome. Variable removal of contused brain tissue is required for reducing mortality.

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Cavernous sinus hemangiomas (CSHs) are benign lesions accounting for less than 2% of the cavernous sinus tumors. They provide a formidable surgical challenge because of their vascularity and their being surrounded by critical neurovascular structures. In this study, one of the largest in available literature, we analyze our experience in the management of these unusual tumors and review the available literature. This is a retrospective analysis of patients who were managed surgically (both microsurgical and Gamma knife radiosurgery [GKRS]) for CSH at our Institution from 2007 to 2015. Complete demographic, clinical-radiologic surgical records were analyzed. Follow-up data were collected from the hospital records. Total 23 patients were managed. Among these, 15 patients underwent microsurgery (group 1) whereas 8 underwent GKRS (group 2). Predominant clinical presentation in both the groups included headache and involvement of multiple cranial nerves. Five patients in group 1 had deteriorating vision. The volume of tumors ranged from 29 to 115 cm (mean = 64.57 cm ) in group 1 and from 2.1 to 11.6 cm in group 2. GKRS was performed with a mean dose of 13 Gy, an average isodose line of 50% with an average coverage of 96%. In group 1, the follow-up period ranged from 6 to 62 months (mean = 29.4 months). The extraocular movement (EOM) preservation rate in our series was not favorable, as most patients presented late with large tumors and established deficits. Recurrence/residual tumor was seen in two cases. In group 2, the follow-up was 5 to 48 months. All of them showed significant reduction in size. Both surgery and radiosurgery are highly effective in the management of CSHs. They are complementary to each other, with individual characteristics-the size and volume of the lesion-being the main factors in deciding the choice of treatment.

Objective The objective of this study was to analyze clinical, radiological and surgical results of subacute and chronic subdural hematomas (CSDH) in young patients less than 40 years. Methods This is a retrospective study of young patients who were surgically treated for subacute and chronic SDH during a 10-year period from 2002 to 2012. A total of 1642 patients were treated for these conditions, of which 136 patients (0.083%) were of 40 years or less. Complete clinical, surgical, and radiological records were available for 92 (15 female and 77 male) patients. Results 79 (86%) cases had history of prior trauma. However few cases had association with toxoplasmosis, renal failure, hypothyroidism and VP shunt. Young patients mainly presented with symptoms of raised intracranial pressure and around 19% had history of alcohol abuse.13 cases had altered blood parameters. Overall results of surgery were good. Post-operative recurrence was seen in only 13 cases. Conclusion Young adults with CSDH show less severe clinical and radiologic features as well as fewer recurrences than noted in the elderly population. In young adults with unexplained headaches, there should be low threshold for computed tomographic scan of brain. Burr hole evacuation is satisfactory and histological examination is mandatory particularly in cases where there is no history of trauma.