Role of Pericardial Patch in Neurosurgery: Institutional Experience

INTRODUCTION

Dural closure is an important part of neurosurgery, failure which may lead to wound infection, pseudomeningoceles, meningitis, severe morbidity to a patient, and even mortality. In cases where primary dura closure is not possible, a bovine pericardial patch is a good alternative with the benefits of suturability and the ability to provide watertight closure, hence preventing Cerebrospinal Fluid (CSF) leak. The present study demonstrates the use of the bovine pericardial patch in both cranial and spinal disorders for dural closure as well as for transposition technique in microvascular decompression.

OBJECTIVES

The aim of our study is to understand the advantages and feasibility of a bovine pericardial patch in various neurosurgical procedures.

MATERIAL METHODS

Fifty-one patients were analyzed prospectively and followed up in which glutaraldehyde-free bovine pericardial patch was used in various cranial and spinal disorders.

RESULTS

The most common indications where a bovine pericardial patch was used, in decreasing order of frequency, were meningioma excision surgery (47%), followed by Chiari malformation operated for foramen magnum decompression (17.6%), meningomyelocele (7.8%), spinal dural defects (7.8%), trigeminal neuralgia (5.8%), traumatic decompression with lax duraplasty (4%), glioma (4%), encephalocele (4%), and skull base defects (2%). Two patients had complications, one with CSF leak and the other had superficial wound infection, which were managed appropriately.

CONCLUSIONS

The use of a bovine pericardial patch as a dural substitute in various cranial and spinal disorders is feasible with good outcomes, and it can be considered an ideal dural substitute.

Extra-Axial Third Ventriculostomy Through Lamina Terminalis with Multiple Cisternostomies - Rescue Surgery for Patients with Failed Shunt Surgeries and Hydrocephalus

Background and Aim

Contemporary management of hydrocephalus involves various modes of cerebrospinal fluid (CSF) diversion, including shunt surgery and endoscopic ventriculostomy. However, there are times when either of these procedures have either failed or are not feasible. Highly invasive procedures aimed at internal CSF have been described previously, which, with the aid of modern microsurgical techniques, can be attempted in cases with very limited options. Our aim was to study the utility of extra-axial third ventriculostomy via lamina terminalis fenestration with multiple cisternostomies in the treatment of failed hydrocephalus.

Materials and Methods

Forty-five patients with hydrocephalus were operated for extra-axial trans-lamina terminalis third ventriculostomy with multiple cisternostomies from January 2017 to January 2019. A minimally invasive supraorbital craniotomy was performed with subfrontal fenestration of the lamina terminalis and trans-lamina terminalis fenestration of the floor of the third ventricle with multiple cisternostomies including the optico-carotid cistern and opening of the Liliequist membrane.

Results

Tuberculous meningitis was the most common etiology in the series, and multiple shunt procedures and incompatible CSF profiles were the most common reasons that necessitated this alternate rescue procedure. At a mean follow-up of 6 months, no patient required a revision shunt surgery. There was one death due to cardiac failure with anasarca, unrelated to the procedure.

Conclusions

Extra-axial trans-lamina terminalis ventriculostomy with cisternostomies can safely be performed using minimally invasive micro-neurosurgical techniques, adding to the armamentarium of neurosurgeons in the management of complex cases of hydrocephalus.

Metastatic Tuberculomas along a Nonfunctioning Ventricular Catheter

A unique case of tubercular meningitis, developing shunt complication, is being reported. We present a pediatric patient with disseminated tubercular granulomas along the ventricular catheter of a nonfunctional ventriculoperitoneal shunt.

Supratentorial PNET in a geriatric patient

Supratentorial PNETs are most commonly seen in children and rarely seen in adults. PNET show a proliferation of undifferentiated or poorly differentiated neuroepithelial cells and, thus, are histologically similar to medulloblastomas. They account for approximately 2.5% of brain tumours in children and only 0.4% in adults. Prognosis is poor in the pediatric age group while it shows favourable prognosis in adults. In literature, less than 100 cases of adult PNET have been reported till date with mean age of 35years. PNET in the geriatric age group is rarely been reported

Primary multiple intracranial extradural hydatid cysts: A rare entity revisited

Human hydatid disease is caused by Echinococcus granulosus. Central nervous system (CNS) echinococcosis is rare with less than 4% of cases of hydatid disease have CNS involvement. intracranial extradural hydatid cysts are rare and less than 11 case have been reported in literature. primary intracranial extradural multiple hydatid cysts are not reported as per our knowledge so we report probably the first case.

Role of Hyperbaric Oxygen Therapy in Traumatic Brain Injury—Evidence-Based Consensus

Traumatic brain injury (TBI) is a major health problem in India and worldwide, resulting in significant morbidity, mortality, and disabilities of young and productive group of society. Various treatment modalities in the immediate period following a TBI are focused on altering the acute pathophysiology. Secondary injury is precipitated by ischemia resulting from decreased cerebral blood flow leading to hypoxia and is particularly likely to occur in the first 24 hours after injury. Hyperbaric oxygen therapy (HBOT) targets TBI-induced ischemia by exposing patients to an environment that substantially increases the amount of O2 inspiration (100% O2 at >1 atmosphere absolute), producing an increased O2 concentration in the plasma and thus increased delivery of O2 for diffusion to brain tissue. Despite the capacity of HBOT to protect against secondary ischemic damage, the use of HBOT for the treatment of TBI has been controversial. To gain acceptance in routine clinical use, a clinical method of assessing its effectiveness in the individual patient, computed tomography perfusion scan, single-photon emission computed tomography scans, and other intermediate indicators of the effects of HBOT should be examined by large and high-quality studies.

Pediatric Isolated Cortical (Ectopic) Anaplastic Ependymoma

Ependymomas are tumors derived from ependymal cells lining the ventricles or from the central canal of the spinal cord. It usually arises in the ventricles with extra ventricular extension. Less than 15 cases of purely cortical ependymomas are reported. We report a rare case of purely cortical anaplastic ependymoma in a pediatric patient, which is rarely reported.

Primary pleomorphic xanthoastrocytoma of the spinal cord: A case report and review of literature

Primary pleomorphic xanthoastrocytoma (PXA) of the spinal cord is a rare slow growing tumor. To our knowledge, only five such cases have been reported in the literature till date. We report the clinical, radiological, and histopathological features of a spinal PXA in a 23-year-old female previously operated 5 years back for a spinal tumor, presented with weakness in lower limbs, sphincter incontinence and low back pain. Magnetic resonance imaging scan with contrast reveals an intramedullary lesion in the spinal cord from D8-D10 level. The patient was operated with reexploration of the previous incision, and gross total excision was achieved. Histopathology confirmed the diagnosis of PXA. Clinical and radiological follow-up is required to detect early recurrence. Adjunct radiotherapy or and chemotherapy should be considered only when there is postoperative residual or recurrence, however there are no definite guidelines in view of the rarity of this condition.

Recurrent intraventricular meningioma with malignant transformation

Benign meningioma undergoing a malignant transformation (to a chondrosarcoma) in intraventricular location is very rare and this is first case report to best of our knowledge. Herein, we report a rare case of malignant transformation of a benign intraventricular meningioma with relevant literature.

Primary aneurysmal bone cyst of the petrous temporal bone: A case report and review of literature

Aneurysmal bone cyst (ABC) arising in the petrous portion of the temporal bone is a rare entity with only five such reported cases in the literature. We report the case of a 28-year-old man who presented with a tender swelling in the right preauricular region with right ear discharge and conductive hearing loss of 4 years' duration. Computed tomography and Magnetic Resonance imaging showed a destructive lesion in the right petrous bone with cavitation consistent with the diagnosis of ABC. Gross total resection of the lesion was achieved and diagnosis was confirmed histologically. The patient had no recurrence at 12 months of follow-up. This report presents the unusual location of an uncommon bony tumor with a review of its clinical, radiological, and histopathological features as well as the treatment modalities available.

Atypical rhabdoid tumor of lateral ventricle: Report of an unusual tumor

Supratentorial atypical teratoid rhabdoid tumors (AT/RTs) of infancy and childhood are rare, highly malignant neoplasms, most common in the first 2 years of life. In spite of multiple treatment regimens consisting of surgical resection, radiation therapy, and multi-agent chemotherapy, the prognosis is very poor. The majority of these tumors are located in the cerebellum, cerebellopontine angle, pineal gland, spinal cord, and the suprasellar region; supratentorial location is relatively uncommon, and the intraventricular location is extremely rare. We report a rare case of AT/RT arising in the lateral ventricle in a 4-year-old patient.

A rare case of an isolated intraventricular tuberculoma with a dismal outcome: an unusual location of a common pathology and lessons learnt

Isolated involvement of the ventricle by tuberculosis is extremely rare and only nine cases have been reported till now. We report a 13-year-old immuno-competent boy who presented with features of raised intracranial pressure with altered sensorium. Computed Tomography showed a ring enhancing intraventricular lesion with obstructive hydrocephalus. Gross total resection of the lesion was achieved and diagnosis was confirmed histologically. The patient had medical complications in the postoperative period and succumbs five days after the surgery. This report presents the unusual location of a common disease with a review of its clinical, radiological and histopathological features as well as the treatment modalities available.