A solitary cryptococcal granuloma in an immunocompetent host.
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Adult↗
Biomedical subjects
T D Nadkarni
Publications and source records attributed to T D Nadkarni.
Intradiploic meningioma of the orbit: a case report.
We report a case of a 12-year-old male child who presented with a gradual onset exopthalmos involving the left eye. The plain radiographs of the skull showed hyperostosis of the left orbital roof. The computerized tomography (CT) scan revealed an intradiploic orbital roof tumor with expansion of both the tables of the orbital roof. The tumor was completely excised by an extradural route using a basal frontal craniotomy. The histopathological diagnosis of the tumor was a psammomatous meningioma. A split calvarial frontal bone graft was used to reconstruct the orbital roof. The pathogenesis, radiological features and surgical technique involved in the management of intradiploic orbital roof meningioma are discussed and the relevant literature is reviewed.
Child↗
En-plaque ventricular ependymoma.
An extremely unusual case demonstrating rare behaviour of an ependymoma is presented. The tumour spread in an en-plaque fashion and involved the ependymal lining of the entire ventricular system. The patient, a 56-year-old male, presented with symptoms of raised intracranial pressure and truncal ataxia. The management issues are analyzed on the basis of a brief literature survey.
Brain Neoplasms↗
Ischaemic complications after surgical resection of intracranial aspergilloma.
A 32-year-old male presented with a paranasal sinus Aspergillus fungal infection. The nasal infection was cleared by endoscopic sinus surgery and the patient was treated with antifungal agents. The patient was otherwise healthy with no evidence of immunosuppresion. Five months later, the patient had to undergo excision of the left frontal intracranial infection for symptoms of raised intracranial pressure and seizures. Within 48hours of surgery, the patient developed basilar artery thrombosis with infarction of the cerebellum and midbrain. The patient succumbed to this vascular catastrophe, which developed at a site distal to that from surgery. The pathophysiology of ischaemic complications after surgical resection of intracranial aspergilloma is discussed.
Adult↗
Suprasellar arachnoid cyst presenting with bobble-head doll movements: a report of 3 cases.
We report a series of three patients with suprasellar arachnoid cysts who presented with a rare 'bobble-head doll' syndrome. The abnormal head movements improved after surgical evacuation of the cysts in all the three cases. Various pathophysiological mechanisms involved in the bobble-head doll syndrome are discussed. The literature on suprasellar arachnoid cysts is briefly reviewed.
Arachnoid Cysts↗
Cavernous sinus thrombosis and air embolism following surgery for acoustic neurinoma: a case report.
A 55 year old male patient was operated on for a massive and vascular acoustic neurinoma in a sitting position. The tumor was completely excised. Post-operatively, the patient developed irritability and clinical features suggestive of contralateral cavernous sinus thrombosis. CT scan showed air within the dural walls of the cavernous sinus on the side of surgery. However, there was no radiological evidence of cavernous sinus thrombosis on the contralateral side. Cavernous sinus thrombosis as a post-surgery complication has not been reported. Air within the dural confines of the cavernous sinus has also not been observed or radiologically recorded in the literature.
Cavernous Sinus↗
An unusual post-traumatic occipitocervical pseudomeningocele: case report.
BACKGROUND: A rare case of massive post-traumatic subcutaneous pseudomeningocele probably communicating with the cisterna magna, is reported. CASE DESCRIPTION: An 8-year-old boy sustained a severe injury to the nape of the neck, after which he developed a huge local subcutaneous swelling containing cerebrospinal fluid (CSF). Communication of the subcutaneous CSF collection with the cisterna magna or any other site of dural fistula could not be identified. After a lumbo-peritoneal CSF shunt, the swelling resolved completely. CONCLUSION: The clinical features of a rare case of symptomatic post-traumatic cerebrospinal fluid pseudomeningocele are elaborated.
Calcinosis↗
Prognostic factors for cerebellar astrocytomas in children: a study of 102 cases.
OBJECTIVE: To evaluate the prognostic factors influencing the length of survival of pediatric patients with cerebellar astrocytomas. METHODS: The clinical data of 102 patients under the age of 12 years with cerebellar astrocytomas were retrospectively analyzed. The radiological features, surgical findings, histology and adjuvant radiotherapy were reviewed. Patients were followed up on an outpatient basis. Computerized tomography (CT) scans of the brain were performed to detect recurrence. RESULTS: The age of the patients at presentation varied from 10 months to 12 years. The mean age at presentation was 7 years and 11 months. The average duration of symptoms was 5.8 months. The clinical features were predominantly related to intracranial hypertension and the location of the tumor. Twenty-six tumors were located in the vermis and 76 in the cerebellar hemisphere. The brain stem was involved in 20 patients. All 102 patients had a preoperative contrast-enhanced CT scan. Midline vermian tumors were predominantly solid and enhancing, whilst the hemispheric tumors were cystic and nonenhancing. The tumors were graded into three subgroups based on histological characteristics: pilocytic astrocytoma, low-grade fibrillary astrocytoma and high-grade fibrillary astrocytoma. Total, radical and subtotal excision, as determined by the surgical impression, were performed in 82, 16 and 4 patients, respectively. Postoperative radiotherapy was administered to 12 patients. CSF diversion was carried out in 11 of 79 cases who had moderate to severe hydrocephalus. CONCLUSIONS: Our study has shown that the location of the tumor (p < 0.05), histological grade (p < 0.001) and the extent of tumor resection (p < 0.001) have a significant and definitive relationship to the length of survival of pediatric patients with cerebellar astrocytomas. The patient's age (p > 0.05) does not influence the outcome. We could not evaluate the effect of brain stem involvement and adjuvant radiotherapy in our study because of the small sample size.
Astrocytoma↗
Primary petrous bone Ewing's sarcoma.
A case of primary Ewing's sarcoma involving a large portion of the petrous temporal bone in an eighteen month old child is reported. The lesion was treated by radical surgery and adjuvant chemotherapy and radiotherapy. An extremely rare age of presentation, an unusual location and an excellent response to treatment are the highlights of this case.
Antineoplastic Combined Chemotherapy Protocols↗
Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases.
OBJECTIVE AND IMPORTANCE: This is a report of four cases of huge trigeminal neuromas that presented with the principle symptom of pathological laughter (PL). CLINICAL PRESENTATION: All four patients were male and were in either the third or fourth decade of life. In addition to PL, there were neurological deficits related to trigeminal nerve, brainstem, and cerebellar dysfunctions. INTERVENTION: All tumors were radically excised via a lateral basal temporal approach. The PL was cured immediately after surgery. CONCLUSION: PL sometimes precedes other neurological manifestations and may be a useful localizing sign. The clinical and radiological features in our cases suggest that PL is a result of extra-axial compression of the pons and adjoining neural structures.
Adult↗
Primary Ewing's sarcoma of the cranium.
OBJECTIVE: We analyzed the data for a series of 14 patients with primary Ewing's sarcomas of the cranium who were treated since 1985. Our aim was to assess the long-term outcomes and the selection of appropriate treatment methods. METHODS: The patients were reviewed with respect to their clinical presentations, treatment, and outcomes. Computed tomographic scanning of the brain was performed for all patients. Skeletal surveys with routine radiographs and technetium-99 bone scans to detect extracranial Ewing's sarcomas were performed for all patients. For all 14 patients, radical tumor excision was achieved surgically. All patients were then subjected to adjuvant multidrug chemotherapy and radiotherapy. The follow-up periods ranged from 8 months to 8 years (mean, 4.25 yr). RESULTS: The predominant presenting features were headaches, increased intracranial pressure, and scalp swelling. Excision was nearly total for nine patients and total for five patients. All patients experienced uneventful postoperative courses. One patient experienced a local recurrence, which was detected 2 years after surgery. This recurrent tumor was completely excised, and additional chemotherapy was administered. Eight of the 14 patients (57.1%) studied have survived 5 years or longer. CONCLUSION: Although primary Ewing's sarcoma of the cranium is a malignant bone tumor, it is associated with a good prognosis when treated with radical surgery, aggressive multidrug chemotherapy, and radiotherapy.
Adolescent↗
Pediatric intramedullary spinal cord tumors. Critical review of the literature.
The objective of this review was to analyze the literature on the management of intramedullary spinal cord tumors to determine whether enough information was available for treatment guidelines to be established. Using standard computerized search techniques, databases containing medical literature were queried for keywords related to intramedullary spinal cord tumors, beginning in 1966. Of the 445 articles published in English and with potential relevance, only 75 articles were included in the final analyses. Based on the strength of their recommendations for the treatment of this controversial condition, articles were divided into class I, class II and class III data. There were no class I studies related to any aspect of the treatment of intramedullary spinal cord tumors. Based on this critical review of literature, gross total removal of an ependymoma confirmed by immediate postoperative magnetic resonance imaging and adjunctive treatment for high-grade tumors using radiotherapy, with or without chemotherapy, can be recommended as standards of therapy. With the strength of a guideline, radiotherapy should be withheld after gross total removal of intramedullary ependymomas and radical resection of low-grade intramedullary astrocytomas. The use of intraoperative ultrasonography and evoked potentials, important surgical adjuncts, can also be considered guidelines. The radical resection of intramedullary low-grade astrocytomas is an option.
Astrocytoma↗
Trochlear nerve neurinoma presenting as pathological laughter.
A case of trochlear nerve neurinoma in a 48-year-old women is reported. She presented with pathological laughter as her principal symptom which was cured by tumour resection. A brief review of the available literature on the subject is reported.
Affective Symptoms↗
Brainstem dysfunction in chiari malformation presenting as profound hypoglycemia: presentation of four cases, review of the literature, and conjecture as to mechanism.
OBJECTIVE: We report four patients whose cases resulted in our observation that profound hypoglycemia resulting from intermittent hyperinsulinism plays a significant role in patients with brainstem dysfunction from Chiari I or II malformations who have intermittent autonomic dysfunction ("blue spells"). METHODS: The records of four children with severe brainstem dysfunction associated with hindbrain herniation (Chiari I or II malformation) were reviewed retrospectively. Each patient had severe lower cranial nerve dysfunction that required tracheotomy and feeding tube placement. After we found that profound hypoglycemia had occurred during a spell of autonomic dysfunction in one patient, the charts of the other three patients were reviewed for evidence of hypoglycemia. Now, whenever one of them has evidence of autonomic dysfunction, prospective studies of glucose and insulin levels are performed. Three of the patients had Chiari II malformation in association with myelomeningocele, and one patient had a Chiari I malformation resulting from Pfeiffer's syndrome. RESULTS: Hypoglycemia occurred in these patients episodically, and usually when their shunts were functioning. The hypoglycemia was associated with hyperinsulinemia in each patient. The brainstem structures of these children (presumably the dorsal motor nuclei of the vagus) were extremely sensitive to changes in local or regional intracranial pressure. These changes were triggered by intermittent shunt failure, agitation from pain, abdominal distention from constipation, and retention of CO2. In patients with Chiari malformations, even mild increases in intracranial pressure lead to brainstem dysfunction. One possible explanation is that pressure on the deformed Xth cranial nerve nuclei may lead to insulin release and life-threatening hypoglycemia. Continuous-drip feeds are necessary to prevent this complication. CONCLUSION: Patients with severe intermittent brainstem dysfunction after decompression of Chiari I or Chiari II malformations should have laboratory studies of glucose levels performed at the time of the episodes to rule out hypoglycemia.
Adolescent↗
Plexiform neurofibroma of the cauda equina. Case report.
Plexiform neurofibroma of the cauda equina has been reported only twice previously. The authors report the first pediatric patient in whom such a tumor has been found. A 4-year-old boy presented with low-back pain that radiated bilaterally into the L-4 and L-5 dermatomes. A dermal sinus noted at the midthoracic level was surrounded by a hemangiomatous lesion. Magnetic resonance imaging confirmed the presence of the dermal sinus and revealed a well-defined lumbosacral mass that showed heterogeneous intensity with irregular enhancement. Intraoperatively, a solid mass, which engulfed the entire cauda equina, could not be dissected from the roots. The dermal sinus tract, however, was excised from the thoracic spine. The patient underwent radiotherapy to control the tumor and relieve his pain. Plexiform neurofibromas of the cauda equina are characterized by an insidious and progressive clinical course. The tumor mass may engulf all the roots of the cauda equina. No plexiform neurofibroma of the cauda equina has been reported to be associated with neurofibromatosis Type 1. The authors assume that the thoracic-level dermal sinus observed in this child was an incidental finding.
Cauda Equina↗
Cavernous haemangioma in the cavernous sinus.
A case of intracavernous sinus cavernous hemangioma is reported. The tumor was totally resected en masse. The management of the lesion and technical issues concerning the surgery are discussed.
Adult↗
Neurosurgery in India.
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History, 20th Century↗
Bilateral otogenic cerebellar abscesses.
An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.
Adolescent↗