Aman Singh, Awadhesh Yadav, Pritesh Yadav, B. Ojha
Abstract Ventriculoperitoneal shunt is one of the commonest neurosurgical procedures associated with a high-rate complication. Moreover, the variety of complications are nonetheless astonishing. Shunt malfunction is considered the most common complication of this procedure, but a cranial migration of shunt leading to malfunction is extremely rare. We present a case of a 6-month-old male child who was initially managed with a right-sided medium-pressure ventriculoperitoneal shunt for aqueductal stenosis with hydrocephalus at the age of 3 months and presented to us with features of shunt malfunction owing to a cranial migration of the shunt assembly. Cranial migration of a ventriculoperitoneal shunt is an extremely rare complication. Its possible mechanism includes a large subgaleal space for the chamber, larger size burr hole, inadequate anchorage of the shunt assembly, and excessive neck movements of the child in the postoperative procedure.
{"title":"Cranial Migration of a VP Shunt—A Routine Procedure with a Rare Complication!","authors":"Aman Singh, Awadhesh Yadav, Pritesh Yadav, B. Ojha","doi":"10.1055/s-0043-1777279","DOIUrl":"https://doi.org/10.1055/s-0043-1777279","url":null,"abstract":"Abstract Ventriculoperitoneal shunt is one of the commonest neurosurgical procedures associated with a high-rate complication. Moreover, the variety of complications are nonetheless astonishing. Shunt malfunction is considered the most common complication of this procedure, but a cranial migration of shunt leading to malfunction is extremely rare. We present a case of a 6-month-old male child who was initially managed with a right-sided medium-pressure ventriculoperitoneal shunt for aqueductal stenosis with hydrocephalus at the age of 3 months and presented to us with features of shunt malfunction owing to a cranial migration of the shunt assembly. Cranial migration of a ventriculoperitoneal shunt is an extremely rare complication. Its possible mechanism includes a large subgaleal space for the chamber, larger size burr hole, inadequate anchorage of the shunt assembly, and excessive neck movements of the child in the postoperative procedure.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"25 2","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139157074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daisuke Wajima, Rin Shimozato, Tomonori Takeshita, T. Nagamine
Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them. Case Description Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful. Conclusion The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.
{"title":"Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review","authors":"Daisuke Wajima, Rin Shimozato, Tomonori Takeshita, T. Nagamine","doi":"10.1055/s-0043-1777055","DOIUrl":"https://doi.org/10.1055/s-0043-1777055","url":null,"abstract":"Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them. Case Description Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful. Conclusion The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"25 21","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Shunt surgery is a very common neurosurgical procedure for hydrocephalus. It is associated with numerous complications, and intraventricular shunt migration is one of rarest. Various mechanisms have been described to explain this rare entity. Hereby we present an index case of this rare complication of shunt surgery in which patient presented with tuberculous meningitis with hydrocephalus having intraventricular shunt migration and will discuss possible mechanisms responsible for it. A 1-year old male infant, previously diagnosed case of tuberculous meningitis with hydrocephalus with right-sided ventriculoperitoneal shunt in situ, presented to the emergency department with bulging fontanelles secondary to shunt malfunction. Left-sided ventriculoperitoneal shunt was inserted. After few months, patient turned up again with left-sided shunt malfunction and right-sided intraventricular migrated shunt. Endoscopy-assisted removal of intraventricular migrated shunt and simultaneous third ventriculostomy was done. Patient improved in postoperative period. Being an extremely uncommon complication, intraventricular migration of shunt described as “once in a blue moon” phenomenon. It can be avoided by proper surgical technique with adequate-sized burr hole. Removal of shunt is preferred for prevention of infection.
{"title":"Complete Intraventricular Migration of Ventriculoperitoneal Shunt: Once in a Blue Moon Phenomenon of Shunt Surgery","authors":"Vikrant Yadav, Ravi Shankar Prasad","doi":"10.1055/s-0043-1777278","DOIUrl":"https://doi.org/10.1055/s-0043-1777278","url":null,"abstract":"Abstract Shunt surgery is a very common neurosurgical procedure for hydrocephalus. It is associated with numerous complications, and intraventricular shunt migration is one of rarest. Various mechanisms have been described to explain this rare entity. Hereby we present an index case of this rare complication of shunt surgery in which patient presented with tuberculous meningitis with hydrocephalus having intraventricular shunt migration and will discuss possible mechanisms responsible for it. A 1-year old male infant, previously diagnosed case of tuberculous meningitis with hydrocephalus with right-sided ventriculoperitoneal shunt in situ, presented to the emergency department with bulging fontanelles secondary to shunt malfunction. Left-sided ventriculoperitoneal shunt was inserted. After few months, patient turned up again with left-sided shunt malfunction and right-sided intraventricular migrated shunt. Endoscopy-assisted removal of intraventricular migrated shunt and simultaneous third ventriculostomy was done. Patient improved in postoperative period. Being an extremely uncommon complication, intraventricular migration of shunt described as “once in a blue moon” phenomenon. It can be avoided by proper surgical technique with adequate-sized burr hole. Removal of shunt is preferred for prevention of infection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"57 33","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The sphenoid sinus is an uncommon site for an encephalocele. It usually presents with cerebrospinal fluid (CSF) leak through the nasal cavity. Sternberg's canal (SC), which is a weak spot on the skull base, is one of the causes of spontaneous CSF leak. It is due to incomplete fusion of the greater wing of the sphenoid bone with the basisphenoid. Repairing these defects is challenging as the traditional external approach carries a high morbidity and a high complication rate. We present the case of a 27-year-old nonobese female patient who was diagnosed with persistent SC defect, which was repaired via an endoscopic transnasal transpterygoid approach. She has not had any recurrence following 18 months of outpatient department visits.
{"title":"Encephalocele within the Lateral Wall of the Sphenoid Sinus Presenting with Recurrent Meningitis and Cerebrospinal Fluid Rhinorrhea Repaired via Endoscopic Transnasal Transpterygoid Approach","authors":"Dipuo Masege, John Ouma","doi":"10.1055/s-0043-1777349","DOIUrl":"https://doi.org/10.1055/s-0043-1777349","url":null,"abstract":"Abstract The sphenoid sinus is an uncommon site for an encephalocele. It usually presents with cerebrospinal fluid (CSF) leak through the nasal cavity. Sternberg's canal (SC), which is a weak spot on the skull base, is one of the causes of spontaneous CSF leak. It is due to incomplete fusion of the greater wing of the sphenoid bone with the basisphenoid. Repairing these defects is challenging as the traditional external approach carries a high morbidity and a high complication rate. We present the case of a 27-year-old nonobese female patient who was diagnosed with persistent SC defect, which was repaired via an endoscopic transnasal transpterygoid approach. She has not had any recurrence following 18 months of outpatient department visits.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"52 11","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trimaan Singh Sikand, G. Goel, M. Waghralkar, A. Mahajan
{"title":"Brush Sign in Cortical Venous Sinus Thrombosis","authors":"Trimaan Singh Sikand, G. Goel, M. Waghralkar, A. Mahajan","doi":"10.1055/s-0043-1770097","DOIUrl":"https://doi.org/10.1055/s-0043-1770097","url":null,"abstract":"","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":" 536","pages":"269 - 270"},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurosurgery as a Growing Specialty","authors":"Shweta Kedia","doi":"10.1055/s-0043-1777288","DOIUrl":"https://doi.org/10.1055/s-0043-1777288","url":null,"abstract":"","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":" 20","pages":"191 - 192"},"PeriodicalIF":0.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Health Technology Assessment in India assesses, evaluates, and carries out cost-effectiveness of available health technologies in the country for evidence-based decision-making. Current study carried out a scoping review to assess clinical efficacy of poly-methyl-methacrylate (PMMA) after decompressive craniectomy using various prototyping techniques in published literature. Methods The O'Malley methodology and Preferred Reporting Items for Systematic Reviews and Metanalysis for Scoping Reviews—PRISMA-ScR—checklist were used to assess published literature from year 2008 to 2023. Results A total of 507 records were identified after searching electronic databases. After removing duplicate studies and studies that did not meet inclusion criteria, a total of 12 studies were included for review. A total of four studies were described as experimental and eight were case reports/series. The sample size of intervention studies varied between 10 and 30 patients with a mean age of 36.7 years. In a total of seven studies, cranioplasty was done by a self-made PMMA prosthesis fabricated using a novel three-dimensional-printed cranial model fabrication technique. In experimental study, objective criteria like operative Glasgow Outcome Scale, Cranial Index of Symmetry score, and Visual Analog Score for Cosmesis were employed. Conclusion Clinical assessment for cranial symmetry was observed favorable for PMMA with fewer complications, though sample size was inadequate (range: 10–30) with comparator group in two studies.
{"title":"A Scoping Review to Evaluate the Clinical Efficacy of Indigenously Produced, Patient-Specific Acrylic Cranial Prosthesis in Decompressive Craniectomy in India","authors":"Charu Guleria, S. Nalin, Dinesh Kumar","doi":"10.1055/s-0043-1777056","DOIUrl":"https://doi.org/10.1055/s-0043-1777056","url":null,"abstract":"Abstract Background Health Technology Assessment in India assesses, evaluates, and carries out cost-effectiveness of available health technologies in the country for evidence-based decision-making. Current study carried out a scoping review to assess clinical efficacy of poly-methyl-methacrylate (PMMA) after decompressive craniectomy using various prototyping techniques in published literature. Methods The O'Malley methodology and Preferred Reporting Items for Systematic Reviews and Metanalysis for Scoping Reviews—PRISMA-ScR—checklist were used to assess published literature from year 2008 to 2023. Results A total of 507 records were identified after searching electronic databases. After removing duplicate studies and studies that did not meet inclusion criteria, a total of 12 studies were included for review. A total of four studies were described as experimental and eight were case reports/series. The sample size of intervention studies varied between 10 and 30 patients with a mean age of 36.7 years. In a total of seven studies, cranioplasty was done by a self-made PMMA prosthesis fabricated using a novel three-dimensional-printed cranial model fabrication technique. In experimental study, objective criteria like operative Glasgow Outcome Scale, Cranial Index of Symmetry score, and Visual Analog Score for Cosmesis were employed. Conclusion Clinical assessment for cranial symmetry was observed favorable for PMMA with fewer complications, though sample size was inadequate (range: 10–30) with comparator group in two studies.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"6 5 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139246169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background This study aimed to investigate a minimally invasive approach to address the issue of bone loosening in patients who have undergone posterior spinal fusion surgery. If left untreated, sacral bone loosening can result in nerve damage, reduced mobility, and chronic pain. The standard surgical treatment involves replacing the loosened screw with a larger one, requiring significant surgical intervention and complete instrument disassembly. The use of polymethylmethacrylate (PMMA) to increase the strength of the vertebral body was also described, but the results were contradictory. We aim to evaluate the efficacy of filling just only the gap between bone and screw instead of the vertebral body. Methods This study included patients who had undergone posterior transpedicular stabilization but showed signs of sacral bone loosening in follow-up. The gap between the screw and the bone was targeted instead of the vertebral body and filled using PMMA. The procedure was performed under local anesthesia and fluoroscopy, and the preoperative and postoperative visual analog scale (VAS) scores were compared at 1, 3, and 12 months after the procedure. Results The study included 17 patients who underwent 28 procedures, with 11 patients receiving bilateral and 6 receiving unilateral approaches. The results showed a significant decrease in postoperative VAS scores compared to the preoperative scores, indicating reduced pain and discomfort. PMMA, as a bone filler, has been reported to provide good stability and support to the bone-implant interface, thereby reducing the risk of screw loosening and improving the outcome of spinal fusion surgery. Conclusion In conclusion, the study demonstrates the efficacy of a minimally invasive approach using PMMA to treat sacral bone loosening in patients who have undergone posterior spinal fusion surgery. The procedure is safe, minimally invasive, and provides significant pain relief, making it a viable alternative to traditional surgical methods.
{"title":"Evaluating the Necessity of Screw Replacement in Sacral Bone Loosening: A Minimally Invasive Approach for Treatment with Local Anesthesia","authors":"Murat Baloglu, Hakan Millet, S. Ercan","doi":"10.1055/s-0043-1777054","DOIUrl":"https://doi.org/10.1055/s-0043-1777054","url":null,"abstract":"Abstract Background This study aimed to investigate a minimally invasive approach to address the issue of bone loosening in patients who have undergone posterior spinal fusion surgery. If left untreated, sacral bone loosening can result in nerve damage, reduced mobility, and chronic pain. The standard surgical treatment involves replacing the loosened screw with a larger one, requiring significant surgical intervention and complete instrument disassembly. The use of polymethylmethacrylate (PMMA) to increase the strength of the vertebral body was also described, but the results were contradictory. We aim to evaluate the efficacy of filling just only the gap between bone and screw instead of the vertebral body. Methods This study included patients who had undergone posterior transpedicular stabilization but showed signs of sacral bone loosening in follow-up. The gap between the screw and the bone was targeted instead of the vertebral body and filled using PMMA. The procedure was performed under local anesthesia and fluoroscopy, and the preoperative and postoperative visual analog scale (VAS) scores were compared at 1, 3, and 12 months after the procedure. Results The study included 17 patients who underwent 28 procedures, with 11 patients receiving bilateral and 6 receiving unilateral approaches. The results showed a significant decrease in postoperative VAS scores compared to the preoperative scores, indicating reduced pain and discomfort. PMMA, as a bone filler, has been reported to provide good stability and support to the bone-implant interface, thereby reducing the risk of screw loosening and improving the outcome of spinal fusion surgery. Conclusion In conclusion, the study demonstrates the efficacy of a minimally invasive approach using PMMA to treat sacral bone loosening in patients who have undergone posterior spinal fusion surgery. The procedure is safe, minimally invasive, and provides significant pain relief, making it a viable alternative to traditional surgical methods.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"19 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139243988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Spontaneous spinal epidural hematoma (SEH) represents an extremely rare cause of spinal cord compression. Symptomatic pure extradural spinal AVMs (E-sAVM), in the absence of cavernous hemangiomas, are very rare and have rarely been reported. The clinical presentation of SEH caused by E-sAVM is often nonspecific and may lead to delayed diagnosis and treatment. We report the case of a 16-year-old adolescent girl who presented with paraparesis that rapidly evolved in paraplegia. Emergent magnetic resonance imaging (MRI) of the whole spine showed a posterior SEH, extending from C7 to T2, highly suspicious for the presence of an underlying AVM. The patient underwent emergent C7–T2 laminoplasty. An E-sAVM was intraoperatively found and subsequently excised. The patient was discharged with no neurological defects. E-sAVMs are extremely rare pathologies; they represent an extremely rare cause of spinal cord compression. If immediately diagnosed and treated, most patients recover with good prognosis.
{"title":"Spinal Epidural Hematoma Caused by Pure Epidural Spinal Arteriovenous Malformation: Case Report and Literature Review","authors":"E. Garbin, N. Cavasin, S. Magrini","doi":"10.1055/s-0043-1776360","DOIUrl":"https://doi.org/10.1055/s-0043-1776360","url":null,"abstract":"Abstract Spontaneous spinal epidural hematoma (SEH) represents an extremely rare cause of spinal cord compression. Symptomatic pure extradural spinal AVMs (E-sAVM), in the absence of cavernous hemangiomas, are very rare and have rarely been reported. The clinical presentation of SEH caused by E-sAVM is often nonspecific and may lead to delayed diagnosis and treatment. We report the case of a 16-year-old adolescent girl who presented with paraparesis that rapidly evolved in paraplegia. Emergent magnetic resonance imaging (MRI) of the whole spine showed a posterior SEH, extending from C7 to T2, highly suspicious for the presence of an underlying AVM. The patient underwent emergent C7–T2 laminoplasty. An E-sAVM was intraoperatively found and subsequently excised. The patient was discharged with no neurological defects. E-sAVMs are extremely rare pathologies; they represent an extremely rare cause of spinal cord compression. If immediately diagnosed and treated, most patients recover with good prognosis.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"151 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139245141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. S. V. Karanth, Suchanda Bhattacharjee, Ramanadha Reddy, Megha Uppin, Indian J Neurosurg, MS Mch Vishwakumar Karanth
Abstract Pleomorphic xanthoastrocytoma (PXA) was regarded as grade II tumor and considered to be associated with favorable outcome. The World Health Organization Central Nervous System 5 (WHO CNS5) has classified PXA under circumscribed astrocytic gliomas and graded 2 or 3 depending on histology. Cerebrospinal fluid (CSF) and leptomeningeal spread are observed rarely in these tumors. The present case report describes a PXA, grade 3 tumor in a young male with neoplastic meningitis. This 17-year-old male child presented with history of seizure, signs of raised intracranial pressure, and meningeal irritation. Well-defined, T2 heterogeneously hyperintense lesion (5.5*4.8 cm) was seen in right frontal lobe with mild heterogenous contrast enhancement and adjacent pachy-meningeal enhancement. Right frontal craniotomy and near total excision were done. Postoperative hydrocephalus was treated with CSF diversion. Histopathology showed epithelioid and rhabdoid morphology with significant cellular pleomorphism and atypical mitosis consistent with the PXA, grade 3. The CSF cytology showed numerous tumor cells with marked nuclear and cytoplasmic pleomorphism. PXA is a rare malignancy of children and young adults, commonly seen in the temporal lobes. BRAF point mutations of V600E type are most common in PXA, grade 2. Meningeal dissemination is uncommon in PXA and its presence marks poor outcome. PXA, grade 2 tumors could be followed with serial imaging following gross total resection. PXA, grade 3 tumors are managed with maximal-safe resection, radiotherapy, and/ or chemotherapy. PXA, grade 3 with CSF spread tends to have rapid decline in the clinical course and it is advisable to get routine baseline and follow-up craniospinal screening and needs aggressive management.
{"title":"Pediatric Pleomorphic Xanthoastrocytoma with Neoplastic Meningitis: A Case Report with Cytopathological Evidence with Literature Review","authors":"K. S. V. Karanth, Suchanda Bhattacharjee, Ramanadha Reddy, Megha Uppin, Indian J Neurosurg, MS Mch Vishwakumar Karanth","doi":"10.1055/s-0043-1774814","DOIUrl":"https://doi.org/10.1055/s-0043-1774814","url":null,"abstract":"Abstract Pleomorphic xanthoastrocytoma (PXA) was regarded as grade II tumor and considered to be associated with favorable outcome. The World Health Organization Central Nervous System 5 (WHO CNS5) has classified PXA under circumscribed astrocytic gliomas and graded 2 or 3 depending on histology. Cerebrospinal fluid (CSF) and leptomeningeal spread are observed rarely in these tumors. The present case report describes a PXA, grade 3 tumor in a young male with neoplastic meningitis. This 17-year-old male child presented with history of seizure, signs of raised intracranial pressure, and meningeal irritation. Well-defined, T2 heterogeneously hyperintense lesion (5.5*4.8 cm) was seen in right frontal lobe with mild heterogenous contrast enhancement and adjacent pachy-meningeal enhancement. Right frontal craniotomy and near total excision were done. Postoperative hydrocephalus was treated with CSF diversion. Histopathology showed epithelioid and rhabdoid morphology with significant cellular pleomorphism and atypical mitosis consistent with the PXA, grade 3. The CSF cytology showed numerous tumor cells with marked nuclear and cytoplasmic pleomorphism. PXA is a rare malignancy of children and young adults, commonly seen in the temporal lobes. BRAF point mutations of V600E type are most common in PXA, grade 2. Meningeal dissemination is uncommon in PXA and its presence marks poor outcome. PXA, grade 2 tumors could be followed with serial imaging following gross total resection. PXA, grade 3 tumors are managed with maximal-safe resection, radiotherapy, and/ or chemotherapy. PXA, grade 3 with CSF spread tends to have rapid decline in the clinical course and it is advisable to get routine baseline and follow-up craniospinal screening and needs aggressive management.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"3 4","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139256184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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