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Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs. Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome. Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome. Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction  Dysembryoplastic neuroepithelial tumor (DNET) is a rare cause of intractable epilepsy, which has excellent results in terms of seizure control after surgical resection. We present one such case, because of its rarity, to highlight the effect of tumor removal on seizure control, particularly DNET. Materials and Methods/Case Summary  A 9-year-old male patient presented with sudden onset of partial seizures for the past 6 months. There were five episodes. In each episode, the patient engaged in irrelevant talk, followed by deviation of mouth to left and twitching movements. The episode lasted 5 minutes and there was no loss of consciousness. There was no aura or tongue bite, and in one of the episodes, the patient lost consciousness. There was no other significant positive history. On examination, the child was consciously alert, without focal neurological deficit or features of meningitis. There was no papilledema. The patient was on phenytoin sodium, phenobarbitone and clobazam. Magnetic resonance imaging (MRI) of brain was done with and without contrast. MRI revealed a lesion approximately 4.1 × 3.6 × 3.2 cm in the right medial temporal lobe. It was hypointense to brain on T1 and fluid-attenuated inversion recovery (FLAIR), and hyperintense on T2-weighted images. Diffusion restriction was present and there was minimal contrast uptake. There was no evidence of mass effect or midline shift After discussing the risks and benefits with parents, the patient underwent preanesthetic checkup, and was taken up for craniotomy and excision of tumor. Gross total excision was done. The child was started orally on day 1 postoperatively and ambulated. There were no further seizure episodes. The patient was continued on phenytoin and clobazam, and phenobarbitone was tapered gradually. At 6 months, the child was seizure-free. Conclusions  DNET are rare tumors occurring early in life and presenting with intractable seizures. Surgical resection offers a good and safe chance for long-term seizure control. [ABSTRACT FROM AUTHOR]

Objectives We retrospectively studied the risk factors, clinical manifestations, radiological aspects, surgical treatment, and prognostic factors in 143 patients of thoracic ossification of ligamentum flavum (OLF). Methods A total of 143 patients who underwent surgical treatment for thoracic myelopathy secondary to OLF between 1989 and 2010 were studied retrospectively. Preoperative and postoperative neurological data were reviewed and the correlation between the variables of patient characteristics, preoperative duration of symptoms, preoperative neurological status, and the functional outcome were analyzed. The male to female ratio was 1.5:1. In total, 114 patients (79.72%) were in the 4th to 6th decade of life. Only two cases (1.4%) were of less than 20-year age group. The lower thoracic region (D9-D12) was most commonly affected (61.5%). Four patients had long segment involvement (7 levels) and eight patients had two separate levels of involvement. Associated fluorosis was observed in 32 patients (22.37%). All patients underwent wide decompressive laminectomy with medial one-third facetectomy and OLF was resected. The part of dura adherent to OLF or calcified is also removed with it and duroplasty done if required. The average follow-up was 5 years. Outcome In all, 86 patients (60.13%) were able to do their job with mild neurological deficit such as spasticity and impairment of joint position sense. Twenty-eight patients (19.58%) were back to some job with limitation but were independent for their routine work. Sixteen patients (11.18%) improved but still required help for their routine work while thirteen patients (9.09%) were bed-ridden at last follow-up. Most common complications observed were cerebrospinal fluid leak (7.69%), neurological deterioration (8.39%), and infection (4.89%). Five (3.4%) patients required second surgery for ossification at other level during follow-up. [ABSTRACT FROM AUTHOR]