HighlightsSpontaneous intracerebral hemorrhage poses a risk in all patients and a treatment dilemma in patients with bleeding and clotting disorders. The haemophiliac patient is a rare and challenging vignette to the average neurosurgeon.Routine treatment would surmise with a craniotomy and evacuation of the haematoma, however this form of intervention is associated withsignificant morbidity and rebleed rates.Our management involved close monitoring of the patient while we converted the acute hematoma into a chronic subdural hematoma and successfully managed it with burr hole evacuation under cover of antihemophilic factor.Dosage and monitoring of AHF is described in detail.

Precocious puberty still remains an elusive diagnosis in the majority of patients. Infrequently, lesions of the central nervous system are associated with sexual precocity. Depending on their location, these cysts may affect many systems, however, there is little information concerning their involvement in endocrinological disorders. We report a case of a sylvian cistern arachnoid cyst presenting with precocious puberty in a 3-year-old girl. The child recovered following a cystoperitoneal shunt. The mass effect of the arachnoid cyst upon the hypothalamus was, at least in part, responsible for the development of precocious puberty. To the best of our knowledge, this is the 1st case of a sylvian cistern arachnoid cyst presenting with precocious puberty. The role of surgical decompression of the cyst is also discussed.

SUMMARYHydatidosis is a ubiquitous disease that is endemic in India. It most commonly involves the liver (75%) and lungs (15%) with only 10% occuring in the rest of the body. Primary hydatid cyst in the spinal canal is extremely rare. Intraspinal hydatid accounts for 0.5-1% of the cases and carries a poor prognosis. It presents as a diagnostic and therapeutic challenge. We present one such case of a 64-year-old man with associated radiculopathy and myelomalcia. BACKGROUND

Background:C1 lateral mass–C2 transpedicular fixation is an accepted surgical procedure of choice in a large number of cases with traumatic atlanto-axial instability. However, bony and vascular anomalies can predispose to unacceptably high risk with this procedure, And hence are the contraindications for this procedure. The purpose of this study is to analyze the clinical and radiological results in such cases for which only unilateral fixation has been performed in cases where bilateral fixation could not be performed due to various reasons.Materials and Methods:Eight patients (7 males, 1 female) with a mean age of 41.12 years (range 12-68 years), who presented with traumatic atlanto-axial instability and in whom bilateral fixation could not be performed, were treated with unilateral C1 lateral mass–C2 transpedicular fixation. Of these cases, preoperative vertebral artery occlusion was noted in one case, iatrogenic vertebral artery injury in two cases and bony anomalies or fractures in the remaining of five cases. All patients were evaluated clinically with the American Spinal Injury Association (ASIA) scale and radiologically with computed tomography scans and serial X-ray using criteria to evaluate stability.Results:All cases were evaluated at 6 months followup with mean followup of 2 years and one month (range 6 months to 4 years). All eight patients showed adequate stability and fusion at 6 months; clinically there was no significant restriction of neck movement in any of the patient. There was no neurological deterioration in any of the patient at their last follow-up.Conclusion:Unilateral C1 lateral mass–C2 transpedicular fixation could be considered a viable option in cases of traumatic atlanto-axial instability where vascular and osseous anomalies contradict a bilateral fixation.

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