In this study 61% patients with STBI had good recovery in functional outcome and 45.4% in psychosocial outcome at 1 year follow-up. However, improvement in cognitive outcome was not so optimistic with the ability to learn new things being most affected.
A 24-year-old female presented with weakness of left upper limb and an episode of generalised seizure. She had a history of right parieto-occipital Arteriovenous Malformation (AVM) which was embolised in four settings with different embolic agents (glue, polyvinyl alcohol). She had received Gamma Knife Surgery (GKS) for residual AVM. Post radiosurgical procedure, there was complete obliteration of AVM which was confirmed on angiography. However, she had developed an intracranial Space Occupying Lesion (SOL) at the site of AVM with atypical imaging features [Table/ Fig-1]. Surgical excision of this lesion was carried out and histological examination of the specimen showed a foreign body reaction.She then came to our institute with weakness of left upper limb and an episode of generalised seizure. Gadolinium contrast MRI showed multiple conglomerate ring enhancing lesion at right parieto-occipital region with mass effect [Table/ Fig-2]. Computed Tomography (CT) scan showed artefacts due to the presence of onyx . We proceeded to do a re-exploration of the previous craniotomy and microsurgical excision of the contrast enhancing lesion. It was a firm mass which was excised completely in piecemeal fashion. Histopathological examination showed an AVM nidus with necrotising granulomatous inflammation with predominant foreign body giant cell reaction. The patient made a good postoperative recovery and has had an uneventful follow-up for the last one year. ABSTRACTOnyx is a liquid embolic agent presently gaining wide acceptance for embolisation of multiple vascular cranial pathologies like Arteriovenous Malformation (AVM) and Arteriovenous Fistula (AVF). Onyx stays in the nidus of vascular pathology and initiates inflammatory response leading to thrombosis and subsequently resulting in occlusion of vascular nidus. However, if onyx spills into the surrounding brain tissue, reaction occurs in the form of foreign body inflammatory reaction. This is one of the very few cases in literature whereby embolisation of AVM with onyx lead to granuloma formation which needed surgical excision. It presented with limb weakness and seizure episodes.[
A 20-year-old male was referred to Department of Neurosurgery for evaluation of 3 episodes of seizure over 10 months. His neurological examination, fundus examination, higher mental functions, sensory and motor examination of limbs were normal. He was started on Levetiracetam drug therapy (500 mg twice a day) as a symptomatic measure prior to investigations. MRI brain revealed T1 hypo and T2 hyper intense cystic lesion in middle cranial fossa with no enhancement on contrast administration [Table/ Fig-1,2]. CT scan showed a cystic lesion involving greater wing and pterygoid plate of sphenoid on left side [Table/ Fig-3]. CT cisternographic evaluation had shown CSF outpouching in the sphenoid air sinus. We were unable to determine nature of lesion based on preoperative scans. Provisionally, diagnosis was suspected to be fibrous dysplasia eroding the bone and presenting as meningo encephalocele. Excision of the cystic lesion was carried out through endoscopic trans-maxillary trans-pterygoid approach. Intra operatively a cystic lesion involving pterygoid and greater wing of sphenoid was demonstrated. Small encephalocele was seen in the widened Foramen Rotundum. Repair of encephalocele was done using fat, free fascia and vascularized naso-septal flap. Histopathological examination was suggestive of a simple bone cyst . Patient had made good post-operative recovery and had no seizure episodes during the follow up period of 12 months. He was asked to continue Levetiracetam in the post-operative period for 6 months. DISCUSSIoNSimple bone cyst (Unicameral bone cyst) was first described by Jaffe and Lichtenstein in 1943 [1]. Simple bone cysts are typically benign, fluid filled cystic lesion which can virtually affect any bone. Typical location for simple bony cyst is proximal humerus and proximal femur [2]. Though literature states that simple bone cyst can occur in the ends of long bones, rarely, if at all, do they occur at skull base [2]. Mode of presentation of simple bone cyst varies like an incidental finding, pain and swelling at involved site, seizure episodes or pathological fracture of involved site [3]. Radiologically it appears as a radiolucent lesion at the end of long bone. Magnetic Resonance Imaging (MRI) could be used to diagnose simple bone cyst at unusual location like skull base. On MRI it may appear as a fluid filled lesion isointense on T1 and hyperintense on T2 weighted images. ABStRACtSeizure is a classical feature of intra axial brain parenchymal lesion. Simple bone cyst is an unusual bony pathology at skull base presenting with unexpected symptoms of complex partial seizures. Skull base neuro-endoscopy has managed such lesions more effectively with reduced post-operative morbidity as compared to transcranial approach. This case report discusses a 20-year-old male who presented with 3 episodes of seizure over a time period of 10 months. MRI brain revealed T1 hypo and T2 hyper intense cystic lesion in middle cranial fossa with no enhancement on contrast administration. CT scan showed cystic lesion in...
Encephalocele means if meninges and brain tissue protrude out of the cranium. There are different types of encephalocele. The occipital encephaloceles are the most common type. Craniocervical junction and upper cervical spine abnormalities can rarely be associated with occipital encephalocele. We discuss this case because there is rare association between torcular encephalocele and proatlas anomalies.
<p class="abstract"><span lang="EN-US">Petrous apex lesions are highly challenging for surgical access as they lie in the most medial portion of the temporal bone, surrounded by vital structures. These lesions are traditionally tackled by labyrinthine approaches. Endoscopic endonasal approach has been described to drain cystic lesions like cholesterol granulomas. Intraosseous schwannomas of the petrous apex are a rare occurrence with only 3 cases being reported so far. We are the first to describe a transphenoidal route to completely excise a solid petrous apex lesion like a schwannoma</span>.</p>
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.