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Objectives: Spinal arachnoid cysts (SAC) are rare lesions. There are many uncertainties regarding details about Intradural and Extradural SAC. We present a series of 12 cases of SAC along with a comprehensive review of the literature. In this review, we discussed the differences between Intradural and Extradural SAC pertaining to demography, pathogenesis, surgical procedures and outcomes. Methods: We retrospectively collected the data of 12 patients of SAC treated at our Institute from 2012 to 2023. The age, gender, clinical, radiological, surgical data and outcome were noted. An extensive review of the literature was done to analyse and note the differences between Intradural and extradural SAC and their surgical management. Results: In our series of 12 patients, 7 had Extradural SAC(58.3%), 3 had Intradural SAC(25%) and 2 had Intramedullary SAC(16.7%). . Of the 12 patients, 4 were males and 8 were females (1:2). Age range was 9 to 64 years and the mean age was 34.42 ± 17.71 years. There were four paediatric patients in the series. The most common symptoms reported at presentation are weakness of limbs(81.9%),back pain(36.4%), sensory symptoms(36.4%), radicular pain (18.2%), and bladder disturbances(9.1%). Out of the 12 patients, surgery was done in 11 patients and one patient was managed conservatively. Conclusions: From the review of the literature, intradural SAC was twice as common as extradural SAC. Ventrally located SACs are more common in Intradural locations as compared to Extradural. The intradural SACs were more commonly located in the thoracic and cervical regions when compared to extradural SACs which were located commonly in the thoracolumbar, thoracic and lumbar regions. Extradural SACs were mostly Primary and the mainstay of treatment is complete or partial excision of the cyst with identification and ligation of the communicating pedicle. Selective laminectomy, partial excision of the cyst and wide fenestration to sustain CSF flow is the recommended treatment in Intradural SAC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low velocity penetrating head injury (PHI) is uncommon. PHI due to a stone is rare and we report a case series with a systematic review of the literature. OBJECTIVE: The aim of this study was to evaluate the clinical grade, grade of injury, type of injury and clinical outcome following penetrating head injury with stones. PATIENTS AND METHODS: We included 4 patients from this series and 21 patients from the literature review. They are grouped into 7 patients with type I injury and 18 patients with type II injury, based on the mode of injury. Type I injury is when the stone hits the head and type II injury is when the head falls on the stone and gets injured. The severity of PHI was graded into 6 grades (grade 0 to grade 5) based on depth of injury. The clinical outcome was assessed based on Glasgow outcome scale. RESULTS: The mean age was 22.6 years and 84% were males in the total 25 patients. The commonest cause of injury was road traffic accident (40%) and the commonest site of injury was the frontal region (60%). Most patients presented with mild head injury. Grade 4 was the most common grade of injury. There was a statistically significant difference noted in the clinical grade Glasgow coma scale (GCS) and outcome (p=0.03) between the two groups. CONCLUSION: From the review of the literature, two types of PHI by stones can be concluded. Type I injuries were less common, more severe in the coma scale, injury grade, and had poor outcome compared to type II injuries. [ABSTRACT FROM AUTHOR]

S100B is a biochemical marker of head injury and optic nerve sheath diameter (ONSD) is a non-invasive bedside technique to detect intracranial pressure. We aim to demonstrate whether ONSD correlates with S100B protein in head injury patients with contusions and also whether the grade of contusion correlates with S100B protein. This is a prospective study done on head injury patients aged between 18 and 75 years having isolated contusions admitted within 24 h of injury. Patients were assessed neurologically with Glasgow Coma Scale (GCS) and cranial computed tomography study on admission. Ocular sonography was done for ONSD recording, and S100B protein venous samples were collected at 24 h, 48 h, and at discharge. The outcome was evaluated with Glasgow Outcome Scale (GOS) at discharge and 3 months. Out of 42 patients, the mean age was 46.2 years and 27 were males. There were 12 patients with mild, 25 with moderate, and 5 patients with severe head injury. The mean GCS at 24 h was 12.35, the mean ONSD at 24 h was 3.9 mm, and the mean S100B at 24 h was 0.214 µg/L. There was a statistically significant correlation noted between mean S100B and contusion grade. A moderate positive correlation was noted between ONSD and S100B at 48 h in mild and moderate head injury groups. Favorable outcome (GOS 4,5) at 3 months can be predicted by GCS, contusion grade, and S100B values. Better GCS (14 and 15), focal contusion grade, and S100B values (<0.5 µg/L) predict good outcome. Although ONSD and S100B give important information in different scenarios, S100B gives better predictive information in patients with traumatic cerebral contusions. [ABSTRACT FROM AUTHOR]

Ossified hypertrophy of the facet joints in the thoracic region is very uncommon. We present a rare case of thoracic unilateral ossified hypertrophied facet joints with compressive myelopathy in a patient with scoliosis. The diagnosis is made with computed tomography and magnetic resonance imaging studies of the dorsal spine. Decompressive laminectomy and medial facetectomy was performed. Patient improved neurologically to normal status within 2 months. We present the review of the literature on the facet joint hypertrophy producing dorsal myelopathy. [ABSTRACT FROM AUTHOR]

Surgery is the standard treatment for chronic subdural hematoma (CSDH), one of the common problems in neurosurgical practice. Although medical treatment was used by some authors and found some positive results, it is not accepted by many authors. The aim of this review is to give overall view of the medical management of CSDH. Action of various drugs in the pathophysiological cascade of formation of CSDH was depicted. The review of literature is done under three headings - the primary medical treatment of CSDH, adjuvant medical treatment with surgery, and the treatment of the recurrence. Various classifications of CSDH and the factors influencing the outcome of medical treatment are discussed. There is a role of medical treatment in a selected group of patients with CSDH. Well-designed, multicenter, randomized controlled trials are required to define the indications and standard protocols for the medical treatment of CSDH., Competing Interests: There are no conflicts of interest.