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Multiple meningiomas (MMs) tend to be benign with uniform histology. It is uncommon to find sporadic MMs having different histological features in the same patient. In this case series, of the four patients diagnosed with MM, two patients had different histopathology. An updated review of literature was then performed, providing the different histopathology in those cases. The first case was unique as the patient had an intradiploic meningioma with an intraparenchymal meningioma. Histology found in these cases represented WHO Grade I meningioma. After performing a literature search, it is likely that these tumors do not arise from clonal expansion, but rather have an independent origin. [ABSTRACT FROM AUTHOR]

Background: The craniovertebral junction (CVJ) is a crucial region of the spine designed for optimal movements of the head and is also a frequent site for various pathological processes. The importance of knowing the CVJ parameters in the normal population cannot be overstated when instrumentation and correction of deformities in this region is so frequently being performed. There is a paucity of data defining the craniometrics of CVJ osteology in the Indian population on the literature search. Accordingly, we present a study in an attempt to quantitate the normal craniometric indices for an anatomically normal CVJ in the Indian population and compare them with the existing literature from other regions. Aims and Objectives: The aims of this study were to quantitate the normal craniometric indices for anatomically normal CVJ in Indian population and compare them with the existing literature from other regions. Materials and Methods: Two hundred and forty computed tomography (CTs) belonging to Indians were looked at over a 6-month period retrospectively. These patients had normal CVJs and were ordered imaging for other health reasons. A total of eight parameters were analyzed for each CT. Results: There were 166 (69.2%) males and 74 (30.8%) females in our study. The values (in mm) were as follows: anterior atlantodental interval (AADI), 1.78±0.42; PADI (posterior atlantodental interval), 18.12±1.97; distance of tip of odontoid process to chamberlain's line, -2.73±2.63; distance of tip of odontoid process to McGregor's line, -2.29±2.79; distance of tip of odontoid process to McRae's line, -5.91±1.4; Clivus-canal angle, 160.82°±7.14°; basion dens interval, 5.6±1.45; and powers ratio, 0.71±0.07. No patient had an odontoid process extending beyond the McRae's line. Males were more likely to have higher AADI and PADI values than females. Our study shared significant differences between the other studies (even the studies where an Indian population was used) except one. The AADI, from our study, did not vary significantly when compared to the AADI from a Chinese study. Conclusion: Due to the significant differences from our study and the available literature, a greater compilation of studies belonging to different races will be required to understand the flexibility of the CVJ metrics. [ABSTRACT FROM AUTHOR]

Introduction  Atlantoaxial dislocation (AAD) refers to a loss of stability between the atlas and axis vertebra. The conventional transoral approach and the anterior retropharyngeal approach (ARPA) are adequate for the upper cervical vertebral segments. This study was undertaken to evaluate the usefulness of the ARPA to the odontoid in patients of AAD. Materials and Methods  The study was undertaken on 20 patients admitted in Nil Ratan Sircar Medical College and Hospital, Kolkata, India, with functional disability secondary to AAD. These patients underwent surgery through ARPA to odontoid with or without fixation. Patients were analyzed between October 2014 and September 2016. Results  Maximum number of patients belonged to third decade of life. The male to female ratio was 1.5. The mean duration of symptoms was 10.86 months. Weakness of the upper and lower limbs predominated. About 65% patients had axial neck pain. Nine patients (45%) in total had difficulty in either bowel or bladder. Five patients presented with fracture odontoid and pannus formation of the odontoid process, while six had basilar invagination. One patient underwent anterior odontoid screw fixation and the other 19 patients underwent anterior retropharyngeal odontoidectomy with posterior fixation. Two patients expired in the present study. Most of the patients had improvement in Nurick grade during follow-up. Five patients had transient throat pain and dysphagia. Three patients had superficial surgical site infection. One patient had postoperative cerebrospinal fluid leak. Conclusion  The ARPA to odontoid is a feasible approach for decompression and fixation of the odontoid in AAD cases. [ABSTRACT FROM AUTHOR]

Introduction Extradural hematoma diagnosed more than 14 days after head injury is classified as a chronic extradural hematoma (CEDH). In the present study, we presented a series of 8 patients with CEDH in a span of 6 months. Materials and Methods In this article, we reported 8 cases of CEDH who presented to Nil Ratan Sircar Medical College, Kolkata, West Bengal, India, within a span of 6 months. Discussion Extratemporal epidural hematomas (EDHs) are often due to venous bleeding from the diploic veins or dural sinuses or to delayed rupture of a middle meningeal pseudoaneurysm. In these cases, cerebrospinal fluid may redistribute from the lateral ventricles and thus allowing room for the enlarging hematoma producing vague neurological symptoms and signs. The incidence rate of CEDH reported in the literature ranges from 3.9 to 30% of all EDHs. Computed tomography (CT) scan in CEDH often shows a low-density center surrounded by a high-density margin. Calcification of the displaced dura mater may also occur. Some are identified incidentally, whereas others are diagnosed when investigating for persistent and/or progressive neurological symptoms. Symptomatic CEDH should be surgically evacuated and has an excellent outcome the earlier it is done. In patients with no or mild symptoms, normal neurological status, and a small-sized CEDH spontaneous resolution may be expected. Conclusion In the post-CT era, it is always said that CEDH is a rare entity. However, in developing countries we still encounter a large number of such cases and the question arises whether CEDH is still a rare entity. [ABSTRACT FROM AUTHOR]

Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, nontraumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures. [ABSTRACT FROM AUTHOR]

Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the dural membrane. Contact-related skull deformation causes inbending or fracturing of cranium or both, leading to separation of the dura mater from inner table. This injures the dural arteries, veins, venous sinus, or diploid channels, producing EDH. They usually occur as a result of direct impact injuries to the head, ipsilateral to impact side. Incidence of epidural hematoma is 1 to 3% of all head injuries. Contrecoup EDH cases are rare. and because of its rarity, we present a case report of a 17-year-old boy with contrecoup EDH who sustained head injury due to road traffic accident. Computed tomography of the brain showed left occipital bone fracture and large contrecoup extradural hematoma in right frontal region associated with pneumocephalus and hemorrhagic contusional edema beneath it. The EDH was operated on, and the patient was discharged uneventfully. [ABSTRACT FROM AUTHOR]

Background Orbital and periorbital injuries are significant contributors to traumatic facial injuries. Orbital fractures can occur either alone or in conjugation with other facial bone fractures and cranial and maxillofacial injuries. Objectives The study aims to find out the incidence of various types of fractures occurring in patients, mode of trauma, clinical presentation, and results of delayed surgical repair in cases of orbital fractures. Materials and Methods This is a "prospective observational study" including 12 patients. Surgical repair of orbital fractures was considered for suspected muscle entrapment in fractures, restricted ocular motility, symptomatic diplopia not improving for over 2-week period, or if enophthalmos greater than 2 mm was present. Results Regarding age incidence, the maximum number of cases, that is 41.66%, were aged between 21and 30 years. The main modes of trauma in most cases, that is, 50%, were due to road traffic accidents followed by fall from height, that is, 25%. The majority of cases presented to us with complex fractures involved one or more orbital bones, that is 33.33%. Postsurgery outcomes were good and fair in 75% and 25% patients, respectively. Conclusion Proper orbital fracture stabilization is crucial to bring out good cosmetic as well as ocular outcome. [ABSTRACT FROM AUTHOR]

Tuberculosis is responsible for 20% of the intracranial space-occupying lesions in India, and tuberculomas of the sellar and suprasellar region comprise only 1% of all intracranial tuberculomas. The clinical and radiological features of these lesions mimic a typical pituitary adenoma. Surgery is not usually indicated, except for obtaining biopsies to confirm diagnosis, as these lesions tend to resolve with appropriate antitubercular therapy. There is no consensus regarding the type of antitubercular regimen and duration of the treatment as the experience with tuberculomas of pituitary is limited. We report a rare case of hypophyseal tuberculosis in a patient as a sequela of tuberculous meningitis, which is a rare complication of tubercular meningitis. [ABSTRACT FROM AUTHOR]