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Metastatic lesions of clivus are rare, usually from prostatic and renal carcinoma. Carcinoma of cervix metastasing to clivus is reported rarely after treatment of primary tumor. But clival metastatic lesion at presentation is reported only once in literature. Our patient a 61 year old female patient who presented with clival lesion later diagnosed to be a metastatic lesion from primary cervical carcinoma is rarely reported in literature.

Intracranial fungal infections are rare. Their presentation is mostly subtle, clinically atypical in presentation, and they are usually mistaken for tuberculosis or brain tumour. Aspergillosis is the most common cause of intracranial fungal infections. Fungal infection enters the brain directly from the paranasal sinuses, ear, skull bone, or haematogenous spread from the lungs and gastrointestinal tract, or direct inoculation during surgery or trauma. The pathology depends on the route of spread, host immunity, and type of fungus. Intracranially, fungal infection invades brain matter or blood vessels. [1] The rarity of brain fungal infection, with nonspecific clinical picture, and progression to a fatal outcome provides considerable challenges for both diagnosis and management. Invasive sino-orbital fungal infections are rarely reported in immunocompetent patients in literature. We could not find anything related to primary fungal granuloma of the optic tract reported in literature. We report a case of primary fungal granuloma of optic chiasm in an immunocompetent patient.[2] 13-year-old female patient presented to us with sudden onset of loss of vision in both eyes. There were no other complaints. On neurological examination, there was no vision in both eyes (no perception of light). On fundoscopy, there was bilateral optic atrophy. Rest of the neurological examination was normal. Patient was investigated for magnetic resonance imaging (MRI) of brain with contrast study. MRI of brain was suggestive of a 2.2 x 1.8 x 1.6 cm mass in suprasellar region with its epicentre in the optic chiasma and extending to both optic nerves and optic tract. The lesion was separate from the underlying pituitary gland. The lesion was iso-intense on T1 weighted images and hyper-intense on T2 weighted images. It showed homogenous post-contrast enhancement. Our primary differential diagnosis was optic nerve glioma. Patient underwent immediate surgery, right peritoneal craniotomy, for excision of lesion. Intra-operatively, a firm yellowish white colored lesion arising from the optic chiasm was seen. Safe subtotal excision was done. Post-operative, there was no improvement in vision.

Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.

Case Report GIANT LUMBO-SACRAL EXTRADURAL INTRAOSSEOUS SCHWANOMMA IN A ADOLOCENT MALE- RARE LESION Authors: 1Dr Hrushikesh Umakant Kharosekar, 2Dr Saket Saurabh, 3Prof Vernon Velho 1,2,3Associate Professor, Neurosurgery, Grant Medical College, Mumbai Corresponding Author: Prof. Vernon Velho, Associate Professor, Neurosurgery, Grant Medical College, Mumbai Article Received: 10-08-2022 Revised: 30-08-2022 Accepted: 20-09-2022 INTRODUCTION: Schwannoma are benign slow growing tumor arising from Schwann cells of the nerve sheaths of peripheral nerves and believed to originate from embryonic neural crest cells [1]. Generally, spinal schwannoma presents with pain and/or neurologic deficits when it grows and /or as a large mass extending into the vertebra body and extraspinal space. Giant spinal schwannomas are defined as lesions that extend over more than two vertebral levels or have extraspinal extension of more than 2.5 cm. Small no of cases of spinal giant schwannoma arising from the lumbosacral area have been reported in the literature with a rare incidence [2–4] and limited data. Extradural giant spinal schwannomas in the adolescent age group is of rare occurrence with a strong propensity for schwannomas to occur in neurofibromatosis (NF) type I as multiple lesions in the cervical and lumbar spine [1]. These commonly occur in the intramedullary location. Extradural spinal lesions in young age group are generally malignant with sarcoma, osteoblastoma, lymphoma, or metastasis being the common causes [2]. To date, there have only been five cases of pediatric giant spinal schwannomas, purely extradural in location, without features of NF, reported in the literature [3–7]. A similar case of giant schwannoma in a 20-year-old boy is presented which was treated successfully with an uneventful recovery. CASE REPORT: A 20-year-old boy presented to us with a history of gradually progressive back pain for 6 months. He also developed imbalance in walking and urinary incontinence for past 1 month. On neurological examination, there were no neurocutaneous marker; power was grade 4/5 in bilateral ankle dorsiflexors and 3/5 in bilateral ankle plantar flexors. The power in rest of the lower limb muscle groups was 5/5. Ankle reflex was exaggerated in both the lower limbs (4+). The sensory examination was within normal limits and patient had to be catheterized due to urinary incontinence. Magnetic resonance imaging (MRI) was done which showed a ill-defined enhancing lesion noted in the spinal canal extending D12 ( Dorsal) to S2 (sacral) level. It was extending in the left para vertebral region via left neural formina of L5 and S1 vertebrae. The extension of lesion in the left para vertebral region was measuring 7.3*7.1*11 cm. It was solid and shows heterogenous post contrast enhancement. Similar extension measuring 1.3 cm*1.1 note in the right paravertebral region at the level l5 vertebrae via right neural foramina. ( Fig 1 to 5) Patient underwent complete excision of lesion. Intraoperatively lesion was extradural exiting from the neural left L1 foramina into the retroperitoneum space. Tumour was vascular, and suckable . Skin inscion was extended lateral and retoperitonium space was entered after cutting the underlying muscle. Tumor was seen entering into the vertebral body which was excised and retorpeitoneal tumor was removed and endoscope was used to confirm complete removal of tumor from deeper areas. ( Fig 6) On histopathology, tissue revealed hypercellualr areas (Antoni A) and hypocellular areas (Antoni B). The tumor cells were arranged in fascicles and bundles. Verocay body palisading around fibrillary process are seen with hyalinated blood vessels. These findings were suggestive of a schwannoma without evidence of malignant potential. Postopeatively his power improved to 4/5 in bilateral ankle plantar flexors and 5/5 in bilateral ankle dorsiflexors and he was able to walk without support. At 1 month follow up his preoperative motor weakness recovered completely and his bladder sensation and voiding improved significantly. The follow-up MRI after 1 year showed no evidence of recurrence of the lesion (Fig. 4). Patient has been completely asymptomatic over the last 4 months with normal motor strength and bowel-bladder function DISSCUSION: The goal of retroperitoneal schwannoma surgery is to achieve a complete removal of the tumour while preserving neurological function. Intraosseous schwannomas are rare benign tumors, accounting for < 0.2% of primary bone tumors. The most common intraosseous lesions include the mandible and sacrum, while spinal lesions are less common. The first case of spinal schwannoma of a lumbar vertebral body was reported by Dickson et al[8] in 1971, where the lesion was located at the level of L3, but with extension to the spinal canal resulting in compression of the thecal sac. The tumors originally arose from the abutting nerve root, extending into the spinal canal and invading the vertebrae, suggesting that lesions likely involved intraosseous invasion of the extraosseous nerve sheath tumor originating from the spinal nerve root. Wang et al[9] described the largest series of cases of intraspinal schwannoma to date, with a retrospective analysis of the clinical features, surgical strategies, and outcomes of 20 cases . In that study, all of the lesions extended from layers A to D of the Weinstein-Boriani- Biagini classification, and all lesions exhibited extraosseous components extending into the spinal canal. In 2001, Sridhar et al[10] classified benign nerve sheath tumors, in which V-type tumors caused vertebral erosion. Park et al[11] modified this classification by adding type VI and type VII lesions; type VI is a complete intraspinal tumor, while type VII is an intraspinal tumor with vertebral erosion and expansion into the nerve foramen. Mohanty et al[12] proposed a new subtype (type VIII) involving intraosseous tumors with an exophytic component, but without any intraspinal or neural foraminal extension. Type VIII, which has an exophytic component, may present with symptoms related to compression of the surrounding structures such as dysphagia or pain, while no radicular pain or myelopathic features are present. Because the tumor does not involve the spinal canal or neuroforamina, it is not necessary to separate the tumor from the nerve root, making the operation safer. Postoperative nerve root numbness was reported in some patient. MRI has better resolution and more specificity than CT as it delineate the tumour from the surrounding structures. CT images failed to adequately reproduce a stroma heterogeneity, the main characteristic sign for the ancient Schwannomas. Schwannomas posses low signal intensity in T1- weighted images similar to muscle and a high signal on T2 weighted images similar to fat. There are recommendations beside standard T1 and T2 weighted images to make a fat suppression sequence (STIR) on which the schwannoma will maintain its high signal allowing a delineation from pure lipomatous tumours[5]. Schwannoma typically enhances dramatically with gadolinium contrast on MRI imaging. The malignancy sign can be asymmetry, irregular infiltrative borders, big tumour size, infiltration, heterogenic pattern and mixed intensity [4,5,3]. Giant invasive retroperitoneal schwannomas are defined as lesions that erode spine vertebrae and extend posterior and laterally into myofascial planes. [11-14]. Giant invasive schwannomas growing in all directions is a challenge to the surgeon. The usual objects of discussion are the surgical approaches and techniques. Even a minimal invasive surgery such as endoscope-assisted minilaparotomy or a laparoscopicsurgery of retroperitoneal tumours has been mentioned in the literature as the choice of the operative technique [11-14]. Schwannomas can cause compressions to the surrounding organs and mimic spine disc herniation, pancreatic cyst, adrenal lesion, psoas muscle abscess, hepatic tumor, bowel or urinary bladder dysfunction like pathology [5]. Different surgical approaches were mentioned: hand-assisted transperitoneal laparoscopic excision, laparoscopic resection, mini-invasive anterior retroperitoneal approach, parasagital incision, anteriorn transabdominal approach, laparotomy through a median incision, suprapubic incision, transverse suprapubic incision, external incision over the swelling, posterior approach (sacral laminectomy), oblique skin incision. In our case the tumor was approached posteriorly and endoscope was used which helped to excise complete tumor where visulisation using microscope was not possible. CONCLUSION: Complete surgical resection is the treatment of choice for giant schwannomas with the goal of symptom relief and prevention of recurrence. In our case, resection led to improvement of preoperative symptoms. Complete resection is highly effective for the prevention of recurrence. Giant lumbo sacral schwannomas are benign and slow growing, with an excellent response to complete resection and a good prognosis. REFERENCES: 1. Öğrenci A, Koban O, Şentürk S, Yaman O, SasaniM, Dalbayrak Set al (2017) Giant spinal Schwannomas. Clin Surg 2:1593 2. HsuW, Jallo GI (2013) Pediatric spinal tumors. Handb Clin Neurol 112:959–965 3. Kataria R, Kurmi DJ,Mehta J, Sinha VD (2012) Giant lumbosacral schwannoma in a child. J Pediatr Neurosci 7(2):126–128 4. Srinivas M, Sridevi H, Dikshitha K (2016) Extradural spinal schwannoma at cervical spine in 12 year old child. International Journal of Medical Research & Health Sciences 5(10):179–181 5. Gill M, Maheshwari V, Narang A (2017) Extradural spinal schwannoma in a 5 year old non NF child: a rare entity. Romanian Neurosurgery 31(2):222–225 6. Pokharel A, Rao TS, Basnet P, Pandey B, Mayya NJ, Jaiswal S (2019) Extradural cervical spinal schwannoma in a child: a casereport and review of the literature. J Med Case Rep 13(1):230 7. Agrawal A, Reddy VU, Santhi V, Sandeep Y (2019) Giant lumbar dumbbell extradural Schwannoma in a child. Asian J Neurosurg 14(2):535–537 [8] Singh V., Kapoor R., Atypical presentations of benign retroperitoneal schwannoma: Report of three cases with review of literature, Int Urol Nephrol, 2005, 37, 547-549 [9] Sharma S.K., Koleski F.C., Husain A.N., Albala D.M, Turk T.M., Retroperitoneal schwannoma mimicking an adrenal lesion, World J Urol, 2002, 20, 232-233 [10] Dede M., Yagci G., Yenen M.C., Gorgulu S., Daveci M.S., Cetiner S., et al., Retroperitoneal benign schwannoma: report of three cases and analysis of clinico-radiologic findings, Tohoku J. Exp. Med.,2003, 200, 93-97 11] Girgin C., Ozkan U., Sezer A., Tugyan N., Large pelvic schwannoma causing bilateral hydronephrosis, Int. J. Urol., 2003, 10, 616-618 12)Nooraie H, Taghipour M, Arasteh MM, Daneshbod K, Erfanie MA : In­traosseous schwannoma of T12 with burst fracture of L1. Arch Orthop Trauma Surg 116 : 440-442, 1997 13. Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, van Laarhoven EW : Intraosseous schwannoma (neurilemmoma) of the cervical spine. Sarcoma 5 : 101-103, 2001 14. Singrakhia MD, Parmar H, Maheshwari M, Fehlings M : Cervical schwannoma presenting as an expansile vertebral body lesion : report of two cases with a technical note on the surgical management. Surg Neu­rol 66 : 192-196; discussion 196, 2006 FIGURE LEGEND FIG 1- MRI Dorso Lumbar spine, saggital images, T1 contrast Fig 2- MRI T2 weighted images Fig 3 & 4 - MRI T1 contrast axial images Fig 5- MRI DL spine Coronal images Fig 6 – Tumor specimen &nbsp

Background: Over the past decade, the use of intraoperative image guidance in neurosurgery has gradually gained in importance. Apart from some sophisticated and very expensive techniques, intraoperative ultrasound (IOUS) is a simple and economical technique that allows the surgeon to localize deep-seated lesions under a real-time ultrasonic image display without dissection. The purpose of this study was to present our own preliminary experiences in various (n=1250) neurosurgical procedures carried out at our tertiary care centre in a developing country. Materials and Methods: A Prospective study was carried out in our department of neurosurgery at Grant Medical College and Sir J J Group of hospitals from January 2010 to May 2019. IOUS was used during various elective neurosurgical procedures done during this period as given in table no below. A total of 1250 patients, 850 supratentorial lesion, 290 infratentorial lesion and 110 spinal lesion, were included in this study. All studies were performed using an ultrasound machine with variable 3.5~7.5 MHz sector transducers. The echogenicity and pathomorphology between IOUS and computed tomography/magnetic resonance imaging (CT/MRI) of various disease entities were compared. Results: Intracranial structures could be well demonstrated by ultrasound once the skull was opened. Most of the intracranial lesions were hyperechoic, except those with a cystic component. IOUS was more sensitive in demonstrating non-enhanced solid lesions and lesions with a cystic component than was preoperative CT/MRI. The border between the tumor and healthy brain was better delineated on IOUS in all cases aiding in tumor resection. Conclusions: High-resolution real-time IOUS is a convenient and user-friendly method for identifying, localizing, and characterizing the pathological focus during an operation. Such information is very important and can enhance surgical results.

The presence of collision tumors without any evidence of phacomatoses, genetic syndromes, or any history of previous radiation to the brain is extremely rare. We report a case with two diverse primaries, a tentorial meningioma and a colloid cyst found in the same patient occurring in the absence of these conditions. To the best of our knowledge, a single case of a colloid cyst and meningioma found together in the same patient has been reported till date. In such cases, the surgical dilemma as to which tumor to operate first has been addressed in our case report.

A young male patient presented to our hospital with sudden onset severe headache and weakness in right hand. On neurological examination, patient was conscious but drowsy. He had right upper limb weakness, power 3/5 (on MRC scale), power in rest of the three limbs was intact. CT brain with contrast was suggestive of moderate size haematoma in left frontal parasagittal region (Figure 1, 2). Suspecting a vascular aetiology, patient was investigated with MR angio & DSA, which was not conclusive (Figure 3, 4). As patient’s consciousness was deteriorating, he underwent emergency craniotomy, intra-operatively, there was large haematoma overlying a solid reddish black coloured tumour in left frontal parasagittal area. Tumour was excised completely with haematoma (Figure 5). Post operatively patient’s condition improved well but there was minimal improvement in power in right upper limb at discharge. Histopathological report was suggestive of Gliosarcoma. Patient was planned for chemo-radiotherapy after 15 days.

Growing skull fracture (GSF), also known as leptomeningeal cyst, is a rare but significant complication of pediatric head injury. It is mainly seen in infancy and childhood. GSFs of the posterior fossa are uncommon, and intradiploic location in the posterior fossa is extremely rare. Only a few cases of pediatric GSF of the posterior fossa and intradiploic location have been reported in the literature. We report a case of a 15-year-old boy who had large intradiploic GSF of the posterior fossa, associated with cervical syringomyelia. The lesion developed progressively over a period of 5 years following a documented occipital linear fracture. This case of a GSF developing from a known occipital linear fracture demonstrates that a GSF may reach a considerable size, and although uncommon, intradiploic development and occipital localization of a GSF are possible. Syringomyelia associated with posterior fossa GSF is very unusual which makes this case even more unique.

A unique case of tubercular meningitis, developing shunt complication, is being reported. We present a pediatric patient with disseminated tubercular granulomas along the ventricular catheter of a nonfunctional ventriculoperitoneal shunt.

Background: Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity. Materials and Methods: Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh. Results: In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up. Conclusion: Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encephaloceles managed surgically over a period of only 6 years which is one of the largest series reported from Asia.

Arachnoid cysts are rare lesions of the spine and occur most commonly in the extradural location. Intramedullary location is a very rare site, and only 15 cases have been reported in literature till date. We report a series of three cases with intramedullary arachnoid cysts having diverse etiopathogenesis and clinical presentations. Recurrent cyst and cyst associated with tethering of the cord are unique to our series and have not been reported previously.

Background: The most common methods of positioning patients for suboccipital approaches are the lateral, lateral oblique, sitting, semisitting, supine with the head turn, and park bench. The literature on the positioning of patients for these approaches does not mention the use of lateral semisitting position. This position allows utilization of the benefits of both semisitting and lateral position without causing any additional morbidity to the patient. Aims: The aim of the present study is to highlight the advantages of the lateral semisitting position while operating various cerebellopontine angle (CPA) and posterior fossa lesions. Materials and Methods: The position involved placing the patient in a lateral position with torso flexed to 45° and head tilted toward opposite shoulder by 20°. The most common approach taken was retrosigmoid suboccipital craniotomy. Results: The advantages of lateral semisitting position were early decompression of cisterna magna, and the surgical field remained relatively clear, due to gravity-assisted drainage of blood and irrigating fluid. We could perform all the surgeries without the use of any retractors. The position allowed better delineation of surrounding structures resulting in achieving correct dissection plane and also permitted early caudal to cranial dissection of tumor capsule, thereby increasing chances of facial nerve preservation. Importantly, there is less engorgement of the cerebellum as the venous outflow is promoted. We have not experienced any increased rate of complications, such as venous air embolism, tension pneumocephalus with this lateral semisitting position. Conclusions: Lateral semisitting position is a relatively safe modification, which combines the benefits of semisitting and lateral position, and avoids the disadvantages of sitting position in operating CPA tumors. This position can provide quick and better exposure of the CPA without any significant complications.

Hemangioblatomas are low grade, highly vascular tumors usually associated with VHL syndrome and most commonly occurs in the cerebellum. They very rarely occur in the spinal nerve roots and an origin in the filum terminale is exceptionl. A 47 year old man presented with low back pain, paresthesias and stiffness of the both lower limbs. He also had urinary retention and constipation. MRI showed an enhancing mass at the L5 vertebral level with multiple dilated and tortuous vessels at both poles of the tumor. Digital subtraction angiogram showed the tumor to be supplied by the anterior spinal artery and dural branches of lumbar arteries. At surgery, a well-defined tumor with orange red hue was found to be arising from the filum terminale. The tumor was excised en bloc. Histopathological examination showed hemangioblastoma which was confirmed with immunohistochemistry. Clinical symptoms improved significantly after surgery. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor usually cures the patient.

Orbitofrontal foreign-body injuries comprise a major cause of all facial injuries referred to a neurosurgeon. The authors hereby present an unusual case of a pressure regulator of a domestic pressure cooker impacted into the orbit and extending through the orbital roof into the basifrontal cortex. The globe was intact externally with no obvious sign of such a large object impacted behind the globe. On imaging, the foreign body was found to have fractured the orbital roof with one end protruding into the basifrontal cortex. A transcranial approach was taken to remove the object with removal of the orbital rim and roof to reach the object. After successful retrieval of the metallic body, all displaced bone fragments were removed and the dural closure was done in a watertight manner. The vision could not be salvaged, most likely due to damage to the optic nerve. However, the globe was left intact and the ocular movements were normal. An important factor to consider in removal of such foreign bodies is that the bone fragments that get impacted should be meticulously removed and the dural tears should be sealed to prevent any intracranial infections and cerebrospinal fluid leaks. Removal of the orbital rim helps in adequate exposure of the retro-orbital space and the basifrontal dura.

Teratomas are a type of multipotential cell tumor that contain a mixture of multiple germinal layers formed by normal organogenesis and reproductive tissues the incidence of intracranial teratomas is low, approximately 0.5-2.2% of all intracranial tumors. The occurrence of teratomas in the spine is extremely rare. Except for in the sacrococcygeal region, teratomas constitute

Ependymomas are usually infratentorial and intraventricular. They originate from the ependymal cell lining of the ventricles. Cortical extraventricular supratentorial ependymomas are rare and fewer than 15 cases are reported worldwide. In pediatric age group, seven cases are reported. We report a rare case of 4-year-old boy with right frontoparietal anaplastic ependymoma who underwent gross total excision of lesion.

Benign meningioma undergoing a malignant transformation (to a chondrosarcoma) in intraventricular location is very rare and this is first case report to best of our knowledge. Herein, we report a rare case of malignant transformation of a benign intraventricular meningioma with relevant literature.

Primary pleomorphic xanthoastrocytoma (PXA) of the spinal cord is a rare slow growing tumor. To our knowledge, only five such cases have been reported in the literature till date. We report the clinical, radiological, and histopathological features of a spinal PXA in a 23-year-old female previously operated 5 years back for a spinal tumor, presented with weakness in lower limbs, sphincter incontinence and low back pain. Magnetic resonance imaging scan with contrast reveals an intramedullary lesion in the spinal cord from D8-D10 level. The patient was operated with reexploration of the previous incision, and gross total excision was achieved. Histopathology confirmed the diagnosis of PXA. Clinical and radiological follow-up is required to detect early recurrence. Adjunct radiotherapy or and chemotherapy should be considered only when there is postoperative residual or recurrence, however there are no definite guidelines in view of the rarity of this condition.

This case highlights a rare possibility of occurrence of chondroblastoma, a bony tumor, at an uncommon location. Extraosseous, soft tissue location of this bony tumor is rare and more so for intracranial intra-axial location. We report a case of an intra-axial frontal lobe lesion, histologically proven to be an extraosseous chondroblastoma. A 23-year-old male presented with a history of headache and vomiting of 1 month duration. Imaging was suggestive of left frontal lobe intra-axial calcified lesion suggestive of oligodendroglioma. Patient was operated upon by left frontal craniotomy with complete excision of the lesion. The patient recovered well postoperatively. Left sixth nerve paresis improved and ataxia decreased.Intra-axial chondroblastomas are extremely rare tumors. Differential diagnosis should be kept in mind, especially in cases of calcified lesions. Complete excision should be the aim to achieve cure.

Non-Hodgkin's lymphoma (NHL) is a rare tumor of the skull base. As the incidence of primary central nervous system (CNS) lymphoma has increased, atypical presentations involving the skull base are being reported. However, isolated involvement of middle skull base, that too predominantly the clivus and parasellar region, is rarely seen. We present a case of middle-age woman with midline skull base lesion located in the sella with invasion of the ventral part of upper part of clivus (posterior clinoid) and also the parasellar region causing involvement of optic and abducens nerve with preserved hormonal functions. She was operated endoscopically for partial resection of the lesion. Histopathology turned out to be non-Hodgkin's lymphoma of NK/T-cell variety. So far NK/T-cell lymphoma of the sella with invasion into the clivus has never been reported in literature to the best of our knowledge.

Lateral meningocele is rare disorder of unknown etiology that represents herniation of leptomeninges through enlarged neural foramina. Most patients are asymptomatic and do not need treatment. A symptomatic case with neurologic deficit requires well-planned surgical approach. We report a case of 9-year-old boy who presented with mid backache and progressive asymmetric paraparesis with urinary incontinence. The patient did not appear to have any neurologic disorder. Magnetic resonance imaging (MRI) of spine revealed bilateral multiple thoracic and lumbar paraspinal cerebrospinal fluid (CSF) intensity cystic lesions projecting from the neural foramen and extending laterally suggesting multiple bilateral meningoceles. He was surgically treated, meningocele repair was done, and thecoperitoneal shunt was inserted. Postoperatively he improved symptomatically. Bilateral multiple lateral meningoceles are very rare entity and those who are surgically treated are few. We emphasize our innovative surgical approach to this case.

Background: Mannitol has been used intravenously for decreasing cerebral edema since decades. The study was performed to evaluate the effect of its irrigation on edema in live rats. Edema was induced by artificial brain injury. We hereby present our results on the same using live rats and confirm its beneficial effect on reducing edema when used as irrigation. Aims: The aim of this study is to evaluate the effect of mannitol irrigation in reducing cerebral edema in rat brain after induction of artificial trauma and to compare the results with standard normal saline irrigation using randomized controlled study. Settings and Design: This study was a prospective randomized controlled trial. Materials and Methods: A total of 20 fully grown Albino Wistar rats were subjected to artificial trauma after a burr hole and divided randomly into two groups of ten rats each. One group was subjected to mannitol irrigation after durotomy and the other was subjected to normal saline. Tissue biopsy was sent at the end of 1 h to check for the status of edema and was classified into three grades. Statistical Analysis Used: Comparison of proportions test. Results: Mannitol irrigation produced a statistically significant difference (P = 0.022) in the grade of edema at the end of 1 h as compared to normal saline. Conclusions: Mannitol irrigation can be used during neurosurgical procedures instead of normal saline to reduce postoperative brain edema.

PRESENTATION OF CASE A 20-year-old male presented to us with complaints of urinary incontinence and right lower limb weakness. On examination the patient had continuous urinary dribbling with lower motor neuron type of bladder involvement. The lower limb weakness was limited to the dorsi-flexion of the ankle and the toes with extensor hallucis longus (EHL) weakness. The deep tendon ankle reflex was depressed on the right side and the plantar reflex was mute. Power and reflexes on the left side were normal.

Introduction: Parinaud's Syndrome is an inability to move the eyes upwards which is caused by damage to the tectal plate of midbrain. Commonest causes implicated are the Pineal tumors in children, Multiple Sclerosis in adults and stroke in elderly patients. We present a rare case of Tectal plate tuberculoma leading to Parinaud's Syndrome. Discussion: Parinaud's syndrome is caused by damage to the tectal plate or posterior commissure of midbrain. Our patient presented with upward gaze paresis and was diagnosed to have tuberculoma involving the midbrain region. He was managed conservatively and responded to the treatment. Conclusion: Tectal plate tuberculoma though a rare possibility, warrants proper diagnostic workup in order to prevent unnecessary brainstem surgery.

Ependymomas are tumors derived from ependymal cells lining the ventricles or from the central canal of the spinal cord. It usually arises in the ventricles with extra ventricular extension. Less than 15 cases of purely cortical ependymomas are reported. We report a rare case of purely cortical anaplastic ependymoma in a pediatric patient, which is rarely reported.