Background:Pediatric brain tumors are unique in terms of distribution, clinical presentation, pathologic types, management, and prognosis. There are not many studies from India which have looked into the epidemiology of pediatric brain tumors.Aims:This study aimed to analyze the epidemiology of pediatric brain tumors in North Kerala and compare it with data from the rest of India and other countries.Materials and Methods:This is a retrospective study of 5-year data of pediatric brain tumors which were operated in a tertiary referral center in North Kerala, India, from 2009 to 2013. The data were procured from the departments of neurosurgery and pathology of the institution. The data were tabulated and analyzed using SPSS software.Results:A total of 71 children had histologically proven brain tumors during the 5-year period. There were 34 boys and 37 girls. Distribution in different age groups was as follows: infancy –5 (7%), 1–5 years –22 (31%), 6–10 years – 21 (29.6%), and 11–18 years – 23 (32.4%). The most common tumors were primitive neuroectodermal tumors (PNETs). In infancy, the number of high-grade tumors was more, whereas in the 11–18 years’ age group, there were a significantly higher number of low-grade tumors (P = 0.04).Discussion:Pediatric brain tumors were distributed almost equally in both sexes. PNET was the most common. We could not get statistical significance in many of our values due to small sample size.Conclusion:This study highlights the need for diligent collection of data and maintenance of a registry for brain tumors to study the disease in the Indian population.

Calvarial intradiploeic epidermal cyst are very rare neoplasms which can have intracranial extension. These cysts can attain a large size and can cause lytic destruction of the calvarium resembling malignancy. Since these lesions are benign complete excision is curative. We report the case of a 77-year-old male patient who presented with a large swelling on the forehead. Computed tomography and magnetic resonance imaging showed an expansile lytic lesion with intracranial extension. Complete excision of the lesion with cranioplasty was done. Histopathology was consistent with the epidermal cyst. These cysts attaining gigantic proportions are very few in literature.

Background: Granular cell tumors (GCTs) of the pituitary are rare tumors of posterior pituitary that can present as giant pituitary macroadenoma due to the slow indolent growth of the tumor. We are reporting this case due to the rarity of GCT and usually these tumors are confined to the suprasellar region since they are arising from the pituitary stalk. GCTs that attain such giant size with cavernous sinus invasion are still rarer. Case Description: A 38-year-old female who presented with progressive deterioration of vision and on evaluation by magnetic resonance imaging showed a giant pituitary macroadenoma with bilateral cavernous sinus invasion. The patient underwent pterional craniotomy and near-total excision of the lesion was done due to high vascularity and firmness of the tumor. Histopathology examination of the lesion showed spindle to globular cells with granular cytoplasm and was reported as GCT of the pituitary. Conclusion: GCTs are WHO grade1 non-neuroendocrine tumors arising from neurohypophysis and infundibulum. Complete excision is usually difficult due to the high vascularity, firm consistency, and local invasion of the tumor to the cavernous sinus and optic apparatus.

Background. Spontaneous spinal hematoma (SSH) is a rare condition that can result in severe functional disability and even death. But early detection and prompt intervention can substantially reduce the morbidity. We present a series of seven operated cases of SSH. Methods. All operated cases of SSH between 2017 and 2019 were studied. The demographic and clinical features, risk factors and imaging features were analyzed. The functional outcome at discharge and 6 months were assessed. Results. Seven operated cases of SSH with mean age 35(SD-20.9) were studied. Six cases were spontaneous spinal extradural hematomas (SSEDH) and one case was spontaneous spinal subdural hematoma (SSSDH). The most common site was cervicothoracic. Risk factors associated with SSH were thrombocytopenia, pregnancy, and necrotising pancreatitis. Two patients had preoperative Frankel’s grade A-B, three had grade C and two had D. The mean interval between the onset of symptoms and surgery was 4.7days. The functional outcome was dependent on the pre-operative functional status of the patient. Patients with SSEDH and thrombocytopenia had a poor outcome. Conclusion. SSH even though spontaneous may be associated with risk factors. The presence of thrombocytopenia and preoperative functional status predicted outcome. This is the only single institution case series to report thrombocytopenia as a factor predicting poor outcome.

Background and Aim: In the management of aneurysmal subarachnoid hemorrhage (aSAH), endocrine dysfunction is infrequently considered. Pituitary (neuroendocrine) dysfunction is highly prevalent after aSAH, leading to residual symptoms such as decreased cognition and quality of life. Although hypopituitarism following SAH may present with non-specific subtle symptoms, it can lead to potentially serious consequences if left undiagnosed. Methods and Materials/Patients: This study was performed to observe the incidence and pattern of neuroendocrine alterations in cases of acute aSAH. A total of 25 patients with acute SAH within 7 days of ictus were included in this prospective study, and an endocrine assessment was performed. The pituitary axes were evaluated for possible dysfunctions, including somatotropic, gonadotropic, corticotropic, and thyrotropic axes. Results: A total of 25 SAH cases (10 males and 15 females; mean age 55.24 years) were included in the study. Aneurysms were more commonly found in the anterior circulation (n=22) than in the posterior circulation (n=3). Most of the patients presented with the Hunt-Hess grade of 1, followed by grades 3, 2, and 4, respectively. Growth hormone deficiency (48%) was the most common pituitary dysfunction, followed by adrenocorticotrophic hormone (24%), gonadotropins (FSH/LH) (24%), and thyroid stimulating hormone (16%) deficiencies, respectively. Single pituitary axis neuroendocrine dysfunction was noted in 9 patients (36%) and multiple pituitary axes dysfunction was observed in 8 patients (32%). Overall, 17 patients (68%) had neuroendocrine dysfunction in single or multiple pituitary hormone axes. Conclusion: Neuroendocrine dysfunction in acute aSAH is 68%. Accordingly, 32% of the participants had single-axis pituitary dysfunction and 36% had multiple axes pituitary dysfunction. The most common endocrine dysfunction is growth hormone deficiency (48%), followed by adrenocorticotrophic hormone, gonadotropins (LH & FSH), and thyroid stimulating hormone. Therefore, it is suggested to include hormonal evaluation in the management of acute SAH for better clinical outcomes.