Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.

Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

Introduction: Diseases of the Para nasal sinuses include wide spectrum ranging from inflammatory conditions to neoplasms. CT has replaced conventional radiographs as imaging modality of choice for assessment of Para-nasal sinus diseases. Material and Method: This was the prospective study carried out on 50 symptomatic sinus diseased patients who underwent CT imaging of paranasal sinuses in both coronal and axial sections in Department of Radiodiagnosis, NSCB Medical College and hospital, Jabalpur from November 2014 to October 2015. Results: Most patients were in the 3 rd and 5 th decades of their life with male : female ratio of 4:1.The common complaint with which they presented was headache followed by nasal obstruction. Sensitivity and specificity for detection of mucosal abnormality was very good. On evaluating patients with CT PNS, the most common sinus involved was maxillary sinus. Commonest pattern of inflammation was sinonasal polyposis followed by osteomeatal unit pattern. Conclusion: To conclude, this study proved good result of CT evaluation of diseases of paranasal sinuses due to high sensitivity and specificity to diagnosis and the planning of management in paranasal sinuses diseases.

Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus.

Endoscopic excision of a colloid cyst is an effective and safe alternate method. Although the follow-up time was short, residual cyst wall remained asymptomatic without any evidence of growth after subtotal excision and coagulation of wall.

A case of bifid sternum is reported, which illustrates that it is sometimes not possible to repair the sternal defect either by approximation of the sternal bars or by a large autogenous cartilage graft from the ninth, tenth and eleventh ribs. In such cases, the only alternative is to take a graft from the mother.

BACKGROUNDComputed tomography is an important procedure for detecting mediastinal masses. Computed tomography findings used to differentiate between inflammatory and neoplastic masses includes location, nature of mass (Solid, Cystic, Vascular), enhancement pattern, status of surrounding fat planes (Maintained or lost), involvement of adjacent structures, associated extramediastinal lesion, presence of calcification and fat.

BACKGROUND: Gynecological neoplasms is one of the major causes of morbidity and mortality in females especially in peri and postmenopausal women. Ultrasonography (Both TAS & TVS) is the method of choice for examining the female pelvis and it is the principle imaging modality in the evaluation of gynecological diseases. Duplex study with color flow mapping helps in assessment of vascularity of structure. AIMS AND OBJECTIVE: Evaluating the efficacy of color and spectral Doppler in the diagnosis of gynecological neoplasms with histopathology as the reference. STUDY SETTING AND DESIGN: A prospective study of 50 patients was done in the department of Radio diagnosis, in association with Department of Obstetrics and Gynecology and Department of Pathology. Age, Sex, Address, Registration number was recorded in a proforma specially prepared for the purpose of our study & a brief note on presenting complaints. Any significant past history if present was noted. Significant, general, systemic & gynecological examination including P/A, P/S and P/V was done. MATERIALS AND METHODS: All patients of strong clinical suspicion of Gynecological neoplasms were taken as study subject. Patients were examined by real time Ultrasonography and color Doppler (GE-LOGIQ 3 Expert and Siemens-Sonoline 50) with convex, low frequency (2-5MHz) transducer by trans-abdominal and medium frequency (5-7MHz) transducer by trans-vaginal route. RESULT: Most of the benign neoplasm's were seen before 50 years of age and most common presenting symptom in the present study was pain in abdomen (62%). Among 50 patients, 24(48%) were of benign and 26(52%) were of malignant neoplasm. Most common clinical diagnosis was pelvic mass (22%) and ovarian mass (22%). Out of 50 cases, 24(48%) were benign and 26(52%) were malignant neoplasm. In this study 85.72% of malignant ovarian tumors had PI value <0.8 in contrast to only 50% of benign ovarian tumors. In the same way 85.72% of malignant tumors had RI <0.6 and in contrast to only 50% of benign tumors. CONCLUSION: Ultrasonography and colour Doppler are very useful investigation in differentiating between benignand malignant gynecological neoplasms. Combined use of ultrasonography and color Doppler allows more confident diagnosis with higher accuracy than that obtained any one.