Abstract:

Arachnoid cysts are benign, congenital, cerebrospinal fluid–filled lesions, most often located in the middle cranial fossa, and usually discovered incidentally. Gliomas, in contrast, are the most common primary brain tumors of glial origin. The coexistence of dual intracranial pathologies is rare, and when reported, typically involves arachnoid cysts associated with other congenital or vascular abnormalities. To date, there are no published reports describing the coexistence of a glioma with a contralateral arachnoid cyst. We present two cases of concurrent unilateral temporal glioma with contralateral temporal arachnoid cyst. The first case involved a 15-year-old male with focal seizures and headaches, whose MRI revealed a left temporal ganglioglioma and a large right temporal arachnoid cyst. He underwent gross total excision of the tumor and cysto-cisternostomy of the arachnoid cyst, with histopathology confirming pilocytic astrocytoma. The second case involved a 45-year-old male with headaches and seizures, whose imaging demonstrated a right temporal oligodendroglioma and a contralateral left temporal arachnoid cyst. He underwent right temporal craniotomy and tumor excision with decompression of the arachnoid cyst, with histology confirming oligodendroglioma, IDH mutant, WHO grade 2. Both patients had uneventful postoperative recoveries. This is the first reported series of concurrent unilateral temporal glioma and contralateral arachnoid cyst. Although the coexistence may be incidental, a possible developmental or structural predisposition cannot be excluded. Careful radiological evaluation is essential to distinguish and appropriately manage both lesions.

Abstract:

Aneurysmal bone cysts (ABC) are benign, vascular, osseous lesions accounting for 1% of all bony tumors. Giant cervicodorsal ABC are rare. Surgical excision is the treatment of choice. Incomplete excision has a high chance of recurrence. Giant lesions of the spinal column require staged surgeries and circumferential instrumentation to avoid instability. An 18-year-old male presenting with acute onset paraplegia and urinary incontinence with features of myelopathy. On evaluation, he was diagnosed with multi-level giant ABC of the cervico-dorsal spine. He underwent tumor excision and instrumentation via staged surgery. The postoperative course was uneventful. The patient was planned for adjuvant therapy but lost to follow up. He developed torrential bleeding from the tracheostomy site and expired. Management of giant ABC poses a challenge to the neurosurgeon. Multidisciplinary approach is mandatory for successful management of these patients. Surgical excision is the treatment of choice. Complete excision is achievable using staged excision.

Abstract:

Giant cell arteritis is relatively rare in Indian subjects. A retrospective chart review of cases of giant cell arteritis (GCA) in patients with anterior ischemic optic neuropathy (AION) for last five years (2015 to 2020) in a tertiary care Institution was done. GCA cases were diagnosed on the basis of clinical criteria of new onset of headache along with marked sudden visual loss supplemented by raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and confirmed on temporal artery biopsy. Occult GCA was defined as patients presenting with predominantly ophthalmic symptoms without systemic involvement. All the clinical details of GCA cases have been described in detail. Out of 30 cases of AION, GCA was the diagnosis in 4 cases (13.33%). Among the 4 cases of GCA, 3 cases (75%) were of occult in nature. Three cases underwent superficial temporal artery biopsy which was confirmatory for GCA. GCA was rare in Indian scenario. Earlier age of presentation, male preponderance, and higher number of occult GCA with predominantly ophthalmic involvement were the findings in our study.

Abstract:

Abstract:

Chondrogenic tumors of the head and neck are exceptionally rare and pose significant diagnostic challenges due to their clinical and radiologic resemblance to more common sellar and spinal lesions. We report two unusual cases: a chondromyxoid fibroma involving the sellar region in a 32-year-old man presenting with diplopia and headache, and a cervical spine chondrosarcoma in a 42-year-old man presenting with progressive quadriparesis. Magnetic resonance imaging in the first case revealed a well-circumscribed extra-axial sellar mass that was completely excised, with histopathology demonstrating lobulated stellate-to-spindle cells in a chondromyxoid stroma and immunonegativity for EMA, GFAP, and Brachyury, confirming chondromyxoid fibroma. The second case showed an expansile C2 vertebral lesion with infiltrative chondrogenic histology, binucleated chondrocytes, and strong D2-40 positivity with SATB2 and Brachyury negativity, consistent with Grade II chondrosarcoma. While the chondromyxoid fibroma patient remains disease-free at 24-month follow-up, the chondrosarcoma patient experienced rapid progression and succumbed within eight months postoperatively. These cases highlight the critical role of integrating radiologic features, histomorphology, and targeted immunohistochemistry in distinguishing benign from malignant chondroid tumors at anatomically complex sites, enabling appropriate management and prognostication.