Context:Not enough literature is available to suggest a link between the histological subtypes of intracranial meningeal brain tumors, called ‘meningiomas’ and their location of origin.Aim:The evidence of correlation between the anatomical location of the intracranial meningiomas and the histopathological grades will facilitate specific diagnosis and accurate treatment.Materials and Methods:The retrospective study was conducted in a single high-patient-inflow Neurosurgical Center, under a standard and uniform medical protocol, over a period of 30 years from December 1982 to December 2012. The records of all the operated 729 meningiomas were analyzed from the patient files in the Medical Records Department. The biodata, x-rays, angiography, computed tomography (CT) scans, imaging, histopathological reports, and mortality were evaluated and results drawn.Results:The uncommon histopathological types of meningiomas (16.88%) had common locations of origin in the sphenoid ridge, posterior parafalcine, jugular foramen, peritorcular and intraventricular regions, cerebellopontine angle, and tentorial and petroclival areas. The histopathological World Health Organization (WHO) Grade I (Benign Type) meningiomas were noted in 89.30%, WHO Grade II (Atypical Type) in 5.90%, and WHO Grade III (Malignant Type) in 4.80% of all meningiomas. Meningiomas of 64.60% were found in females, 47.32% were in the age group of 41-50 years, and 3.43% meningiomas were found in children. An overall mortality of 6.04% was noted. WHO Grade III (malignant meningiomas) carried a high mortality (25.71%) and the most common sites of meningiomas with high mortality were: The cerebellopontine angles, intraventricular region, sphenoid ridge, tuberculum sellae, and the posterior parafalcine areas.Conclusion:The correlation between the histological subtypes and the anatomical location of intracranial meningeal brain tumors, called meningiomas, is evident, but further research is required to establish the link.

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Elevated fractures of the skull, which are rarely reported in the literature, are always compound, have maximal neurological deficits at presentation and have been reported only in adults. We report two cases of elevated skull fractures in the pediatric age group, one of which was a simple elevated fracture and presented with delayed neurological deterioration. The etiologies were a fall in first case and an animal attack (bear maul) in the second case as reported for the first time. One of the cases presented with delayed onset of left focal hemispheric signs. The first case underwent debridement, duraplasty and reduction of fracture whereas in the second case the bone flap was not replaced immediately because of gross contamination. Both patients had an excellent outcome. Elevated skull fractures are not uncommon in the pediatric age group. Compound elevated skull fractures should be managed early as open depressed fractures. Reduction of a simple elevated fracture presenting with neurological deficits not explained by any other lesion can result in a good outcome.

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Intradiploic epidermoid tumors so rarely present with extradural hemorrhage that prophylactic removal cannot be recommended in all such cases. However, in view of the seriousness of the hemorrhage, prophylactic removal may be recommended, especially if the patient, such as a sportsman, child, or elderly person, is prone to injuries.

Compression at the craniovertebral junction because of tumors is not a very common entity. The commonest tumors present here are neurofibroma and meningioma. Any vertebral tumour can be present at this location. Benign bony tumors are very uncommon at this location and amongst these enchondromas are exceptionally rare. Enchondromas are rare bony tumours of chondrogenic origin. These are benign tumours with a propensity for malignant transformation. There are four histological types: osteochondromas, enchondromas, chondroblastoma and chondromyxoid fibroma. Enchondromas are often asymptomatic because of their slow growth but may have varied presentation. An enchondroma may occur as an individual tumor or as several tumors together. We here report a case of enchondroma arising from the atlas and causing myelopathy. The best treatment is complete excision which we could achieve in our case.

Apoplexy in sellar metastasis is very rare with only a few case reports in literature. A case of apoplexy in sellar metastasis from follicular thyroid carcinoma is reported and the literature is briefly reviewed. The patient presented with sudden onset headache and bi-lateral loss of vision following thyroidectomy in a case of follicular carcinoma thyroid with proven sellar metastasis. CT scan showed hyperdense blood in sellar mass suggestive of apoplexy in sellar metastasis. The patient underwent early trans-sphenoidal decompression. Apoplexy in sellar metastasis, although very rare, can be clinico-radiologically indistinguishable from pituitary apoplexy and should be especially considered in the differential diagnosis of patients with known primary neoplastic disease. In view of similar patho-physiological mechanism, sellar metastasis with apoplexy should be managed in a similar manner as pituitary apoplexy.

AIm:To describe imaging findings of cerebral hydatid cysts on computed tomography of brain. mAterIAl and methOds: We retrospectively reviewed CT scans of brain in 5 patients with pathologically confirmed hydatid cysts in cerebral hemispheres. The patients were scanned either on a spiral (single slice) CT or on multidetector-row CT before and after intravenous injection of iodinated contrast material. results: All the patients were children aged 8 to 13 years with 3 boys and 2 girls. Features of raised intracranial tension were present in all the cases at presentation. CT findings of a large intracerebral cystic lesion with significant mass effect and without any calcification or enhancement were common in all 5 cases. Perilesional edema was present in 1 case. Cerebral hydatid was seen as either a homogenous fluid attenuation unilocular cyst (3 cases) or a unilocular cyst with few peripheral daughter cysts (1 case) or cyst filled by multiple daughter cysts inside (1 case). All the cases were operated and cyst was removed completely after craniotomy. COnClusIOn: Accurate preoperative diagnosis of cerebral hydatid by CT followed by surgery with care to avoid cyst rupture can result in favorable outcome. KeywOrds: Cerebral hydatid cyst, CT, Echinococcosis ÖZ AmAÇ: Beyin bilgisayarlı tomografisinde serebral kist hidatiklerin görüntüleme bulgularının tanımlanması. yÖntem ve GereÇ: Serebral hemisferlerde hidatik kistleri olduğu patolojik olarak onaylanmış 5 hastanın BT görüntüleri retrospektif olarak incelendi. Hastalar iyotlu kontrast madde verilmesinden önce ve sonra ya bir spiral BT (single slice) ya da multidetector-row BT ile tarandı. BulGulAr: Hastalar 8 ile 13 yaş arası 3 erkek ve 2 kız çocuğu idi. Bütün vakalarda başvuru esnasında kafaiçi basınç artış bulguları vardı. 5 vakanın hepsinde belirgin kitle etkisi yapan ve kalsifikasyon veya kontrast tutulumu göstermeyen büyük bir intraserebral kistik lezyona ait BT bulguları görüldü. 1 vakada perilezyonel ödem görüldü. Serebral kist hidatik ya homojen sıvı dolu tek lobüllü kist (3 vaka), ya birkaç tane çevresel yavru kisti olan tek lobüllü bir kist (1 vaka), ya da içinde birçok yavru kist olan bir kist (1 vaka) şeklinde görüldü. Bütün vakalar ameliyat edildi ve kist kranyotomiyle tamamen çıkartıldı. sOnuÇ: Serebral kist hidatiklerin ameliyat öncesi BT ile doğru teşhisi ve kist patlamasını engellemek için dikkatli cerrahi uygulanması iyi sonuçlar alınmasını sağlayacaktır.