Background:Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years.Subjects and Methods:We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component.Results:Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%).Conclusions:Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.

Melanotic schwannomas (MS) are rare variants of schwannomas the occurrence of which is described in case reports only. They usually arise from posterior spinal nerve roots and less commonly from other cells of neural crest origin. Although they are relatively benign tumors in young, aggressive behavior is reported. They occur as isolated tumors or as part of a syndrome named Carney complex. We try to describe the pathology, diagnosis, management, and prognosis of MSs in two different cases: one cervical intramedullary with no recurrence on 5-year follow-up and the other one extramedullary in lumbar region with early recurrence and aggressive course. A brief review of literature is done.

Intramedullary spinal cord abscess is a rare infection of the spinal cord with less than 120 cases reported since its first description by Hart in 1830. It is usually associated with abnormalities of the spinal cord or documented source of infection or immunodeficiency, requiring clinical radiological suspicion for accurate diagnosis. The first case is a middle-aged healthy woman without any underlying risk factors, presented with progressive paraparesis, in whom prompt, accurate diagnosis with contrast magnetic resonance imaging, diffusion-weighted imaging, and apparent diffusion coefficient mapping followed by early surgery was possible, which resulted in the favorable neurological outcome. The second case is a 10-year-old boy with paraparesis whose definite treatment and surgery was delayed due to a delay in accurate clinical and radiological diagnosis which resulted in poor outcomes. Hence, we try to establish that prompt diagnosis and surgical treatment can result in a favorable neurological outcome, though the prognosis, in general, is poor in this clinical condition. A review of literature in support of our cases is given.

Epithelioid hemangioendothelioma is an uncommon vascular neoplasm. It is rare in the intracranial location. Its occurrence in the region of cavernous sinus is reported only once. Here, we report a case of 49-year-old man who presented with a headache, pain in the right eye, diplopia, and ptosis due to third and sixth cranial nerve involvement. Imaging showed an enhancing lesion in the region of cavernous sinus on the right side. Pterional craniotomy, combined extradural and intradural approach, and subtotal excision of the tumor was done. Histopathology and immunohistochemistry were suggestive of epithelioid hemangioendothelioma which is a rare tumor in this location. We report this case because of its rarity and uncommon location.

118revealed a normal higher mental function with a gaze-evoked nystagmus to the right and profound sensori-neural hearing loss on the same side. He had right-sided cerebellar signs, House-Brackmann (HB) grade 2 facial palsy and no neurocutaneous markers or enlarged lymph nodes.Magnetic resonance imaging (MRI) brain showed a T2 heterogeneously hyperintense extra-axial lesion, measuring 4.5 × 3.5 × 3 cm in the right CP angle with solid and cystic areas. The lesion showed intense enhancement on contrast administration and pressure effect on pons, with no extension to internal auditory canal [ Figure 1]. There was evidence of obstructive hydrocephalus. A preoperative diagnosis of CP angle meningioma was made, and preoperative embolization was planned. Digital subtraction angiography revealed dense tumor blush with predominant arterial feeders from vertebro-basilar system and small branches from right external carotid artery (ECA) [ Figure 2]. Embolization was not carried out as the predominant supply was from intracranial arteries, and the ECA feeders were too small to cannulate.Right suboccipital retrosigmoid craniectomy was done. The tumor was reddish in color and highly vascular. It was soft in consistency, with no definite plane with surrounding normal parenchyma; and was adherent to the petrous ridge and to the tentorium cerebelli. Facial nerve was found antero-superior to the tumor.