Background: Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity. Materials and Methods: Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh. Results: In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up. Conclusion: Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encephaloceles managed surgically over a period of only 6 years which is one of the largest series reported from Asia.
Aim?The aim of this study is to present our experience in management of complex, communited fractures of the frontal skull base. Patients and Methods?This was a retrospective study performed between January 2000 to January 2013. Data of 1,935 patients with head trauma operated in our department during this period were analyzed. Overall, 210 patients with compound anterior skull base fractures were reviewed. Patients were classified based on radiological features in three groups. Standard neurosurgical protocol was followed for all patients after trauma; reconstruction using titanium mesh, miniplates, and silastic graft was done 6 months to 1?year later. Conclusion?Frontal depressed fractures involving the anterior cranial base are complex and require a definitive plan of approach. Reconstruction of bony and dural defects reduces cerebrospinal fluid leak, brain herniation, and infection. Cosmetic reconstruction of the frontal deformity is necessary at a later stage.
Introduction:Parinaud's Syndrome is an inability to move the eyes upwards which is caused by damage to the tectal plate of midbrain. Commonest causes implicated are the Pineal tumors in children, Multiple Sclerosis in adults and stroke in elderly patients. We present a rare case of Tectal plate tuberculoma leading to Parinaud's Syndrome.Discussion:Parinaud's syndrome is caused by damage to the tectal plate or posterior commissure of midbrain. Our patient presented with upward gaze paresis and was diagnosed to have tuberculoma involving the midbrain region. He was managed conservatively and responded to the treatment.Conclusion:Tectal plate tuberculoma though a rare possibility, warrants proper diagnostic workup in order to prevent unnecessary brainstem surgery.
Introduction?Growing skull fractures are a rare but significant complication of pediatric head trauma, occurring mostly in children. Growing skull fractures are associated with a breach in the dura underlying the fracture line and may exceed the line of fracture making the management difficult. A delay in diagnosis exacerbates this disease increasing morbidity. Materials and Methods?A retrospective analysis of 36 patients who were operated for growing skull fracture between August 2005 and August 2015 in our institute was done. Results?Most common age group at presentation was 1 to 6 months and fall from height was the most common etiology. All patients underwent surgical repair; 23 required only duraplasty whereas cranioplasty with dural repair was done at the same time in 13 patients. Osteomesh, titanium mesh, and autologous bone chips were used for cranioplasty. All patients who presented to us with scalp swelling had complete resolution of swelling, whereas of the 7 patient who had neurologic deficit, 5 improved postoperatively (71%). Good clinical outcome was obtained in all patients. Conclusion?Herniation of the brain matter and underlying dural tear, which can extend beyond the bony defect makes management challenging in growing skull fracture.
Lateral meningocele is rare disorder of unknown etiology that represents herniation of leptomeninges through enlarged neural foramina. Most patients are asymptomatic and do not need treatment. A symptomatic case with neurologic deficit requires well-planned surgical approach. We report a case of 9-year-old boy who presented with mid backache and progressive asymmetric paraparesis with urinary incontinence. The patient did not appear to have any neurologic disorder. Magnetic resonance imaging (MRI) of spine revealed bilateral multiple thoracic and lumbar paraspinal cerebrospinal fluid (CSF) intensity cystic lesions projecting from the neural foramen and extending laterally suggesting multiple bilateral meningoceles. He was surgically treated, meningocele repair was done, and thecoperitoneal shunt was inserted. Postoperatively he improved symptomatically. Bilateral multiple lateral meningoceles are very rare entity and those who are surgically treated are few. We emphasize our innovative surgical approach to this case.
Introduction?Intracranial cavernomas are rare vascular malformations accounting for 0.4 to 0.8% of all intracranial lesions. They usually present with seizures and neurological deficits following hemorrhagic episode. Surgical excision can provide lifetime cure from these lesions. Aims and Objectives?The aims and objectives of this study were to study the clinicopathological profile and discuss management strategies affecting the outcome of patients with intracranial cavernomas. Materials and Methods?We have studied patients of intracranial cavernomas operated in our department in the past 5 years. Magnetic resonance imaging of the brain was used as diagnostic modality of choice. Patients' clinical status upon admission and accessibility of the lesion were taken into account for surgical planning. Observation and Results?Most of the patients were young. Twenty-two patients had single and 6 patients had multiple lesions. Patients with supratentorial lesions mainly presented with seizures (75%) wherein infratentorial lesions had cranial nerve palsies and long tract signs (25%). Total surgical excision was achieved in all the patients. No significant postoperative complications were encountered. None of the patient showed recurrence during follow-up period. Conclusion?Patients benefit from modern neurosurgical techniques in contrast to conservative approach in this disease of rather prolonged and unpredictable natural course.
Three-percent solution of hydrogen peroxide is commonly used as a wound antiseptic agent to irrigate the operative field in Neurosurgical cases. We report a case of 45 year male who had undergone lumbar laminectomy under general anaesthesia in prone position and irrigation of surgical wound with hydrogen peroxide led to massive gas embolism during the surgery.
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