Browsing by Author "Dhakoji, Amit"

Now showing 1 - 4 of 4
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    Epidermoid Cyst of the Brainstem in Children: Case-Based Update
    (JOURNAL OF CHILD NEUROLOGY, 2012)
    Epidermoid cysts are rare, slow growing, space-occupying lesions of early adulthood. Among the various locations, involvement of the brainstem is quite exceptional. In children, these tumors are extremely uncommon; only 4 purely intrinsic brainstem epidermoids are reported in the literature. The pathogenesis of true intraaxial brainstem epidermoid is unclear and is usually not considered in the preoperative differential diagnosis of brainstem tumors. We report 2 additional cases of brainstem epidermoid cysts occurring in children, underlining their clinical characteristics, the difficulties faced in the diagnostic work-up, and the surgical treatment adopted. These tumors pose a surgical challenge and attempts at aggressive removal of the cyst wall are fraught with increased risks of morbidity and mortality. On the other hand, cases treated more conservatively show good or excellent results with minimal complications. Neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurologic deficits.
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    Neurenteric Cyst of the Cerebellopontine Angle With Fetal-type Posterior Circulation
    (NEUROSURGERY QUARTERLY, 2010)
    Intracranial neurenteric cysts are rare congenital tumors, which are located largely in the posterior fossa. The benign nature of the lesion allows them to attain large proportions before they are diagnosed. Histopathogenesis of neurenteric cysts is controversial and they are thought to develop during the third week of gestation as a result of endodermal dysgenesis. This is also the period during which the fetal cerebral circulation develops. The transformation from fetal-type to adult-type circulation begins from the eighth week, and theoretically, any disturbance during this process may lead to persistent fetal-type posterior cerebral circulation. We report a unique case of neurenteric cyst in the posterior fossa with bilateral full fetal-type posterior circulation. To the best of our knowledge, there has been no reported case of a congenital cyst in the posterior fossa associated with fetal-type posterior circulation. As angiography for such benign cystic lesions in the posterior fossa is not routinely practiced, the incidence of their association with persistent fetal circulation is not known. We postulate that congenital lesions in the posterior fossa can affect the normal vascular development leading to known arterial variations.
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    Spontaneous cervical epidural hematoma of idiopathic etiology: Case report and review of literature
    (JOURNAL OF SPINAL CORD MEDICINE, 2012)
    Context: Spontaneous spinal epidural hematoma (SSEH) is a rare idiopathic condition that leads to acute onset of neurological deficits, which if not recognized early can have catastrophic consequences. The definition and pathophysiology of this condition remain controversial. High index of suspicion followed by T2-weighted gradient echo sequences are particularly useful in early diagnosis. Management consists of prompt surgical decompression of the hematoma though a recent trend is toward non-surgical treatment.Findings: A 70-year-old man presented with acute onset neck pain with a radicular component and rapidly progressive quadriparesis. Magnetic resonance imaging revealed a posteriorly located cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery to near normal function occurred within 24 hours of surgery.Conclusion: SSEH in its true idiopathic form is a rare pathologic entity. Because of the high risk of poor outcome without treatment, SSEH should be a diagnostic possibility when presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma leads to a favorable neurological outcome, whereas delay in treatment can be disastrous. The role of conservative management needs to be proven and should be tailored on an individual basis.