International Journal of Neurology and Neurosurgery

Background: Delayed Cerebral vasospasm can occur following surgical resection of Craniopharyngioma in sellar and suprasellar subarachnoid cisterns. Early cerebral vasospasm following Craniopharyngioma surgery without subarachnoid hemorrhage is very rare; the pathophysiology is poorly understood and can cause significant post operative morbidity and mortality. Case description: A 3 years old female presented with recurrent suprasellar, underwent re-exploration and excision of the tumor. She had Diabetes Insipidus post operatively, managed with Tab Minirin and subsequently had neurological deterioration with dense left sided hemiplegia. CT brain showed hypodensity in Right fronto temporo parietal region with mass effect and midline shift, suggestive of cerebral infarction, underwent Right fronto temporo parietal decompressive cranicetomy. She improved clinically and neurologically. On two months followup her muscle power improved to 4/5 in both left upper and lower limb, underwent cranioplasty. Another case, a 37 years old male presented with blurring of vision, MRI brain showed sellar suprasellar Craniopharyngioma compressing the optic chiasma. Patient underwent near-total excision, post operatively he had diabetes insipidus, generalized tonic-clonic seizure and dense hemiplegia on right side, MRI brain showed infarct in Left Ganglio capsular region and in the left middle cerebral artery territory and subsequent MRI showed increase in the size of infarct with mass effect and midline shift, an emergency decompressive Crainectomy was performed. During intra-op after durotomy brain was bulging and non-pulsatile. Neurological status did not improved inspite of the surgery and developed severe brain stem dysfunction. Conclusion: Early cerebral vasospasm and cerebral infarct following Craniopharyngioma surgery is very rare. Early diagnosis, aggressive management of Diabetes Insipidus and vasospasm, avoiding spillage of the cystic components of Craniopharyngioma and minimal handling of tumor part close to the hypothalamus as well as leaving behind the capsule close to the hypothalamus during Craniopharyngioma surgery plays an important role in reducing morbidity and mortality.

Keywords: Craniopharyngioma; Early vasospasm; Cerebral infarct; Diabetes Insipidus.

Orbitosphenoid meningioma/Meningioma-en-plaque is a rare type of meningioma comprise 2-9% of all meningiomas, characterized by sheet likegrowth and bone hyperostosis. Total surgical resection is difficult and hence tumors have a high recurrence rates. We report here a case of orbitosphenoid meningiomaWHO classification Grade-IwithMicrocystic variant. The patient was a 65-year-old female presented to us with right eye severe proptosis, no perception of light, Relative Afferent Pupillary Defect and optic atrophy. Histology showed Meningioma, Imaging modalities revealed mass on either side of greater wing of sphenoid, which is extending intraorbitally on right side occupying the extraconal and intraconal compartments, another component of the lesion is seen extraaxially along right temporal convexity with a enhancing dural tail suggestive of right sphenoid wing meningioma. The tumour was removed by Right frontotemporal craniotomy, lateral orbitotomy and near total decompression of the mass. Operative findings showed advanced disease almost encroaching upon the cavernous sinus but not infiltrated.

Keywords: Proptosis; Orbitosphenoid meningioma; Craniotomy and orbitotomy

Chemical meningitis is a syndrome characterized by fever and signs of meningism with cerebrospinal fluid (CSF) pleocytosis, increased protein and blood & CSF culture negative. It is a common complication after posterior fossa surgery than the fronto, temporo and parietal craniotomy procedures. It is often self limiting course requiring repeated CSF examination to exclude infection. We report a case of recurrent thalamic pilocytic astrocytoma underwent fronto temporal craniotomy, post operatively developed pseudo meningocele with features of chemical meningitis. As all conservative measures failed, patient underwent Lumboperitoneal shunt, found to be resolution of symptoms.

Keywords: Chemical meningitis, Pseudomeningocele;Lumboperitoneal shunt.

Background and objective: Microsurgical treatment using unilateral approach and bilateral decompression is a minimally invasive procedure for Degenerative Lumbar canal stenosis. Hence the present study was undertaken to assess the unilateral approach and bilateral decompression for lumbar canal stenosis. Methodology: This was a observational clinical study carried among participant who underwent unilateral laminotomy and bilateral decompression during 2008-10. Patients with lower backpain, Neurogenic claudication, radicular pain with single canal stenosis were included in the study. Diagnosis was based on clinical profile, MRI scan X ray and SF 36. The patients were followed for 1 year post surgery to assess the improvement in quality of life. Results: 45 patients were assessed in our study, the mean age of the patient were 61 years and male were more affected than females. The microsurgical treatment showed significant improvement in quality of life within 3 months post operation wereas 47% within 1 years of life. Conclusion: The microsurgical procedure for patients with DLSS is the most recommended surgical procedure. Since. It is less invasive and showed a statistically significant improvementin the quality of life.

Keywords: Spinal stenosis; Radicular pain, Unilateral laminotomy, Bilateral decompression.

Background and Aim: Extra Dural hematomas are one of the common neurosurgical emergencies especially affecting young male in their 2nd and 3rd decade. Trauma to the head is the leading cause and occasionally non traumatic etiology like dural arterio venous fistula, sickle cell disease and patients on hemodialysis do develop spontaneous EDH. Usually presents with altered sensorium often preceded by headache with one third of patients shows classical lucid interval. Very often it presents with uncal herniation with anisocoria and rarely with end stage tonsillar herniation. CT scan is gold standard investigation for early diagnosis. Craniotomy and evacuation of hematoma is the most popular and worldwide procedure of choice and it successfully address the problem in majority of cases. Here we evaluated the important prognostic factors and outcome of 85 consecutive patients with extradural hematoma managed surgically. Material and method: Data of 85 consecutive patients of extradural hematoma who were admitted and undergone surgical management in our neurosurgical unit between the period sepember2018 to September 2020 were analyzed. The analysis was mostly made with respect to etiology, and different prognostic factors affecting the surgical outcome. Results: Standard craniotomy was done in 29 patients, trephination was carried out in 44 patients. extended burr hole was performed in 4 patients and 8 patients were subjected to craniectomy. Overall clinical outcome was good with total 5 deaths in the series. Conclusion: Extra Dural hemorrhage is a problem of mainly the younger age group. Trauma is the leading cause and CT accurately detects it. Mostly presents with features of raised ICP and focal neurological deficits .Though it carries a mortality of 10%, patients who undergo early neurosurgical intervention typically have better outcomes than patients who have delayed interventions.

Keywords: Head injury; Extradural hematoma; Glasgow coma scale; Outcome.

Aims and Objective: Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyse the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment. Materials and Methods: To prospectively assess and compare the pre- and post-operative clinical and functional status of patients with CSM using the modified Japanese Orthopaedic Association (mJOA) scores and the modified Myelopathy Disability Index (mMDI) scores at baseline, 3, 6- and 12-monthspost-surgery. The following factors were evaluated: age at presentation; gender; cigarette smoking; duration of symptoms; presence of T2WI cord signal cord abnormality on MRI. We also assessed recovery / progression of individual aspects of the mJOA: upper limb; lower limb; sensation and sphincters in both groups. Severity of CSM was assessed as mild if baseline mJOA scorewas≥12andmoderate-severeifbaselinemJOAscorewas<12. Results: Surgery was associated with significant improvement in clinical recovery as assessed by mJOA scores at 3, 6 and 12 months post-operatively. Upper limb function improved after surgery as assessed by the upper limb component of the mJOA score at 3, 6 and 12 months. Lower limb function also improved significantly as assessed by the lower limb recovery scores at 3, 6 and 12 months. Sensation and sphincter function did not improve after surgery. There was significant functional recovery as assessed by mMDI scores at 3, 6 and 12 months after surgery. Conclusions: Patients with CSM benefit from surgical decompression regardless of baseline severity, with significant clinical and functional improvement noted at least 12 months post-operatively. Upper and lower limb function improves significantly, but sensation and sphincter function do not recover. The occurrence of intraoperative complications results in a worse outcome and this negative effect is still seen 12 months post-operatively. Patients who are managed non-operatively do not show significant improvement and 42% have some clinical deterioration at 12 months. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.

Keywords: Cervical spondylotic myelopathy; Modified Japanese Orthopaedic Association; Modified Myelopathy Disability Index.