Agenesis of internal carotid artery (ICA) is rare. Association of agenesis with abnormal arterial communication between the cavernous segment of the carotid arteries is extremely rare. We present a case of a middle-aged woman who presented with sudden onset severe holocranial headache. She was investigated and diagnosed to have sub-arachnoid hemorrhage on CT scan. Digital Subtraction Angiogram revealed absent right internal carotid artery. The right middle cerebral artery received blood supply from an incidentally detected intercavernous anastomosis from the left internal carotid artery. No aneurysm, arteriovenous malformation or any other vascular abnormality was detected. The patient was managed conservatively. She has been asymptomatic for five years on follow up. KeywoRds: Agenesis, Internal carotid artery, Cavernous sinus, Subarachnoid hemorrhage ÖZİnternal karotid arter (İKA) agenezi nadirdir. Agenezin karotid arterlerin kavernöz segmentleri arasında anormal arteriyel iletişim ile ilişkili olması çok nadirdir. Ani başlangıçlı şiddetli holokraniyal başağrısı ile gelen orta yaşlı bir kadın sunuyoruz. İncelemeler sonucunda BT tarama ile subaraknoid kanama tanısı konmuştur. Dijital Subtraksiyon Anjiyogramı sağ internal karotid arterin bulunmadığını göstermiştir. Sağ orta serebral arterin sol internal karotid arterden tesadüfi olarak saptanan bir intrakavernöz anastomoz yoluyla kan aldığı görülmüştür. Herhangi bir anevrizma, arteriyovenöz malformasyon veya başka vasküler anomali saptanmamıştır. Hasta konservatif olarak takip edilmiştir. Beş yıllık takipte asemptomatiktir.

Spinal schwannomas are benign intradural extramedullary tumors arising from spinal nerve root sheath. They are usually solid or heterogeneously solid. Totally cystic schwannomas are rare entities. Herein, we report a 60-year-old male presenting with backache radiating along the chest wall and weakness of both lower limbs. He had spastic paraparesis. Magnetic resonance imaging revealed a cystic mass in the thoracic region. At operation, the cystic mass was seen to be attached to D4 dorsal rootlets. It was excised in toto and histopathology confirmed it to be a schwannoma. The relevant literature is reviewed.

Adequate experience in TLE can help minimally invasive surgeons in easy adoption of RAMIE with satisfactory outcome.

Background: Myelomeningocele is the most common and complex congenital malformation of the central nervous system with an incidence of approximately 1 in 1000 live births. The lumbosacral area is the commonest site for defect. Early closure of a myelomeningocele defect is advocated because it reduces infection rates even though it is not associated with an improved neurological outcome. Aims & objectives: The aim of this study was to evaluate the effectiveness and outcome of direct repair and a Limberg ap repair for skin defects that occur in myelomeningocele. Settings and Design: This was a prospective, randomized controlled study. Material and methods: A tertiary care centre based, non-randomized, prospective, comparative study was conducted in the Department of Neurosurgery, GSVM Medical College, Kanpur, from January 2018 to October 2019, in 22 patients with lumbar myelomeningocele. 7 patients who underwent Limberg ap repair constituted Group A and 15 patients who underwent direct repair constituted Group B. Post operatively the outcomes were compared at 6 months, on the basis of cosmetic appearance and complications such as wound dehiscence, CSF leak, neurological decit, hydrocephalus, necrosis and wound infection. Results : Lesser complications and a better cosmetic outcome were seen post operatively at 6 months with Limberg ap technique compared to direct repair. Our study show better result with Limberg ap over direct repair of myelomeningocele defect closure up to the follow up period of 6 months. Conclusion: Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of myelomeningocele defects. Most lumbar myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local aps may be used to cover the defect. Overall, Limberg ap is a better technique for closure in these patients.

No abstract