No abstract

Giant encephalocoeles are rare entities with only one case series and few case reports reported in medical literature. Encephalocoeles, which reach a size larger than the head size, are be called Giant encephalocoeles. We report a case of a 6 month old child who had giant encephalocoele with delayed motor milestones in the form of inability to hold neck. Anesthetic implications include difficulty in securing air way due without undue pressure on the sac. She underwent VP shunt followed by excision of the encephalocele sac. Patient is doing well at 1 year of follow up. Preoperative neurological status and amount of brain tissue herniating into the sac are the most important factors determining the long term prognosis.

Introduction:Glomus jugulare are rare vascular tumors arising from the jugular bulb with intra- and extra-cranial extensions. Although considered benign, these tumors are locally invasive with involvement of critical neurovascular structures causing significant morbidity. Due to their highly vascular nature, they pose a challenge for surgeons.Settings and Design:This is a retrospective analysis of a short series of glomus jugulare managed in a tertiary state-run referral center.Subjects and Methods:Three patients (two females, one male) of ages ranging from 32 to 55 years were evaluated for glomus jugulare and surgically managed. In the first case, total petrosectomy after transposing the facial nerve, cerebellopontine angle exploration, neck dissection and infratemporal fossa approach including removal of the internal jugular vein were done. Case 2 and Case 3 were managed with subtotal resection. Radiotherapy (RT) for residual tumor was given in Case 2.Results:Case 1 had secondary hemorrhage on 8th postoperative day to which she succumbed on postoperative day 18. Case 2 and Case 3 have been comfortable with no fresh deficits after 36- and 6-month follow-up, respectively. Apart from this, the authors also enumerate the various “lessons” learnt from this series.Conclusion:Planned subtotal resection followed by RT or stereotactic radiosurgery for the residual tumor yields a better outcome with lower morbidity and mortality.

Diffuse cerebritis is a devastating disease presenting with features of raised intracranial tension, deficits, and features of meningeal and neural irritation. The most common feature is seizures which may persist despite normal antiepileptic medication. We present a patient with diffuse cerebritis who presented as a subacute middle cerebral artery (MCA) territory infarct without any symptoms of meningeal irritation or infection. The patient once admitted deteriorated with pupillary asymmetry and loss of consciousness. A computerized tomography scan revealed a massive increase in cerebral edema of the infarcted brain with midline shift and mass effect. In view of the serious threat to life, a decompressive craniectomy was done. Once the dura was opened, pus was seen subpially oozing into the subdural space. This was sampled for analysis and the scalp flap was closed with a drain. The patient improved well post surgically and was gradually extubated. His pus was found to grow Klebsiella pneumoniae sensitive to amikacin and gentamicin. A prolonged course of antibiotics was started. An angiogram done to determine the cause of the infarct showed only distal MCA branches (M4) occluded. The patient later deteriorated with venous thrombosis and succumbed to his illness later. We present a discussion on the etiology of the patient's condition and possible treatment options when faced with such situations.

Paediatric spinal dermoids are a subtype of cutaneous inclusion tumours of the spine consisting of ectodermal derivatives. They are relatively rare conditions with associated with the stigmata of spinal dysraphism with possible devastating consequences. We present a case series, in which we study the clinical, radiological and surgical aspects and follow up of the tumour in the last one year. All patients presented with either para or tetraplegia with or without sensory involvement. Contrast MRI was done in all cases, of which 3 were intradural extramedullary lesions and one was intramedullary lesion. The age ranged from 1 year to 4 years. 2 cases were associated with tethering of cord, 2 cases with dermal sinus and another with dandy walker malformation. One case had infected discharging sinus with dermoid. Gross total excision of tumour was done in all cases with Neuro monitoring. All had good post operative outcome without worsening of deficits. All patients received rehabilitation. Follow up study ranged from 3 months to 11 months. No residual tumour noted in follow up MRI.