Microsurgical Excision Research Articles

An invasive and diffuse cranial actinomycosis with a dura-based mass mimicking a brain tumor: illustrative case.

Actinomycosis is a chronic suppurative infection caused by non-spore-forming, anaerobic, and filamentous gram-positive bacteria. Primary central nervous system involvement is rare, with no specific clinical features, causing a clinical diagnostic dilemma. Imaging can help in localizing and characterizing the lesion; however, a definitive diagnosis relies on culture and/or histopathology. The authors describe a 29-year-old male farmer with a rare case of invasive and diffuse cranial actinomycosis with a dura-based mass mimicking a brain tumor. Brain magnetic resonance imaging showed a moderately enhanced right frontoparietal infiltrative dura-based mass with marked thickening of the skull and multiple scalp actinomycotic abscesses. He underwent microsurgical excision of the mass, orbital decompression, and debridement of the scalp abscess. Histopathology confirmed actinomycosis, and his postoperative course was uneventful. Invasive and diffuse cranial actinomycosis with a dura-based actinomycetoma is a rare presentation that poses a diagnostic challenge due to its nonspecific manifestations. Imaging is helpful in localizing and characterizing the lesion; however, histopathology remains the gold standard for diagnosing actinomycosis. A high index of suspicion is also warranted in patients with predisposing factors to promote an early diagnosis and the initiation of appropriate treatments to improve functional recovery and limit residual deficits. https://thejns.org/doi/10.3171/CASE24210.

Filum terminale infected epidermoid cysts in pediatric age group; A case series

BackgroundEpidermoid cysts are rare and account for only 1 % of primary spinal tumors. It's due to inclusion of ectodermal tissue during the third and fourth weeks of gestation. Infected epidermoid cysts are exceedingly rare with very few reports in literature. The clinical presentations include radicular symptoms, motor weakness, sphincteric disturbance, and repeated chemical meningitis. Surgery of this kind of tumor remained a challenge and of a considerable recurrence rate. MethodsThis is a retrospective study reviewing the records of six children who were treated for filum terminale infected epidermoid cysts. All patients underwent microsurgery, and the surgical outcomes were studied through a follow up period of at least 24 months. ResultsAll children had a low back dermal sinus with purulent discharge. One child was a recurrent presentation after the previous two surgeries for evacuation of pus collection, and the other five children were operated for the first time. All the six children had an associated neurological deficit; one child presented with active central nervous system infection, and one child had a history of meningitis and admission to hospital prior to our surgery. Regular follow up revealed no recurrence in any of the six patients. The five patients, who presented with motor weakness, showed significant improvement of the motor power with regular post-operative physical therapy. ConclusionEpidermoid cysts are rare benign lesions that may lead to significant morbidity when infected. The aim of microsurgical excision is to remove the cyst content and its capsule without inducing or increasing neurological deficit by the aid of intraoperative neuromonitoring and microsurgery techniques.

Optimizing the pterional approach in medial sphenoid wing meningioma: a detailed morphometric study on anterior clinoidectomy and its effect on operability score

BackgroundMedial sphenoid wing meningiomas are best treated through pterional craniotomy, as pterional craniotomy provides wide and multidirectional exposure of the anterior and middle cranial fossa. Anterior clinoidectomy can increase the exposure potential. To delineate the role of anterior clinoidectomy (AC) in the standard pterional craniotomy approach through the evaluation of operability score measures (manoeuvrability arc, depth of surgical field, and surgical angle of attack). All patients with inner sphenoidal wing meningioma who underwent microsurgical excision between February 2022 and October 2023 were enrolled in the study. Preoperative and postoperative imaging studies (MR contrast studies and 3D thin-slice CT scans of the brain) were performed to determine the tumour size, extent, and pattern of optic canal involvement by comparing pre- and postoperative operability score parameters.ResultsTwenty-five patients met our inclusion criteria: 2 males (8%) and 23 females (92%). The mean age (SD) was 49.08 ± 6.42 years, with an age range of 39–60 years. The preoperative visual manifestations were as follows: eight patients (32%) had mild visual impairment, five patients (20%) had moderate visual impairment, six patients (24%) had severe visual impairment, and five patients (20%) had blindness. There was a significant positive correlation between the operability score and extent of resection (gross total resection was correlated with a higher operability score) (r = 0.301, n = 25, p = 0.005).ConclusionsA well-planned manoeuvrable arc allows neurosurgeons to perform surgery with precision, ultimately impacting surgical outcomes and the potential for complete tumour removal with minimal patient morbidity.

Advancements in radiosurgery for the treatment of arteriovenous malformations

Arteriovenous malformations (AVMs) are complex vascular anomalies with high risks of hemorrhage and neurological deficits. The evolution of stereotactic radiosurgery (SRS) represents a significant advancement in their management, offering a less invasive alternative to traditional surgical approaches. This study aims to evaluate recent developments in SRS techniques for treating AVMs by conducting an integrative literature review. Utilizing the PICO strategy, a systematic search was performed across databases like LILACS, MEDLINE, and SCIELO, focusing on clinical trials, observational studies, meta-analyses, and systematic reviews. The analysis revealed that while microsurgical excision remains a definitive approach, SRS—particularly with advanced systems like Gamma Knife, Linac, CyberKnife, and Zap-X—has shown promising results in reducing hemorrhage rates and lesion volumes with lower complications. The findings indicate that SRS, bolstered by improved imaging and radiation precision, provides a viable alternative to invasive methods, though its effectiveness varies among different systems. This review underscores the need for a multidisciplinary approach in AVM management, emphasizing tailored treatment strategies based on lesion characteristics and patient-specific factors.

Pediatric spinal arachnoid cysts with compressive myelopathy: single-center experience and update on surgical management.

This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. There were 10 males and seven females with a mean age of 10.4years (range:6-14years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.

Stealth Autoguide as Robotic Holder for Cranial Endoscopic Surgery: Technical Note and Proof of Concept

The Stealth Autoguide (Medtronic, Minneapolis, USA) is a robotic auto-targeting device for stereotactic brain biopsy, placement of stereoelectroencephalography electrodes, and laser ablation therapy. This paper evaluates its off-label application as robotic endoscope holder in transnasal and intraventricular neurosurgery. The potential to enhance stability, reduce manual adjustments, and improve surgical precision is discussed, alongside cost-effectiveness and feasibility. Patients who underwent endoscopic endonasal, transventricular, and microsurgical endoscopic-assisted surgeries using the Stealth Autoguide as robotic holder from August 2023 to March 2024 were included. Surgical data and surgeons' remarks on advantages, disadvantages and limitations of the technique were collected. In this preliminary experience, Stealth Autoguide has proven safe and effective for several approaches. It was successfully used for patients with sellar, parasellar and suprasellar lesions. Moreover, the holder was employed in a third ventriculocisternostomy, a septostomy, and a removal of intraventricular lesion. Finally, the Autoguide has been a useful holder for the endoscope after gross total microsurgical excision of a tumor: the robot aligned the endoscope to the chosen trajectory and allowed the surgeon to "look around the corner" and confirm the extent of resection. No complications occurred in the treated cases, and the system provided great stability and usefulness throughout the surgeries. This experience proves that the Stealth Autoguide can be safely and effectively used as a robotic support for endoscopic procedures. This device ensures precise positioning and manipulation of neuroendoscopes, facilitating visualization and targeting of the desired area. Further researches are needed to verify applications and limitations.

Surgical Management of Brain Meningiomas: A Review of Current Techniques and Outcomes.

Background: Surgical treatment of brain meningiomas is a challenge because of their various sites, sizes and effects on surrounding neural structures. Objective: This review aims to integrate the current surgical techniques and results in the management of brain meningiomas. Study Design: The study is a systematic review and meta-analysis. Setting and Duration of Study: The study was carried out at the Department of Neurosurgery,Bacha khan medical college Mardan , for six months, from 8th October 2023 to 8th April 2024. Methods: A systematic literature search was undertaken to identify recent studies as well as clinical trials about surgical therapy for brain meningioma. It also highlights on microsurgical techniques, endoscopic approaches, advancement in neuro-navigation and intraoperative monitoring. Results: The inclusive criteria were met by 52 studies which consisted of 18 randomized control trials (RCT) ,24 observational studies and ten meta-analysis. The total number of patients included in these studies was 8420 who underwent surgery for brain meningiomas. Gross total resection (GTR) rates ranged between 70% -95%. Recurrence after GTR varied from5%-15% over a five year follow up period. Conclusions: Over time, management of Brain Meningiomas has changed due to advancements in technology and technique. Although microsurgical excision remains vital in therapy, endoscopic approaches as well as modern intraoperative adjuncts have widened the neurosurgeons’ armamentarium leading to improved patient outcomes. Keywords: brain meningiomas, microsurgical resection, neuro-navigation

Comparison of quality of life in vestibular schwannoma patients managed with observation, radiotherapy or microsurgery.

In decision making regarding the management of vestibular schwannomas, alongside clinical outcomes, an understanding of patient reported health-related quality of life measures is key. Therefore, the aim of this research is to compare health-related quality of life in vestibular schwannoma patients treated with active observation, stereotactic radiotherapy and microsurgical excision. A cross-sectional study of patients diagnosed with unilateral sporadic vestibular schwannomas between 1995 and 2015 at a specialist tertiary centre was conducted. Patients completed the Penn Acoustic Neuroma Quality of Life questionnaire and handicap inventories for dizziness, hearing and tinnitus. Of 234 patients, 136 responded (58.1 per cent). Management modality was: 86 observation, 23 stereotactic radiotherapy and 25 microsurgery. Females reported significantly worse dizziness; males reported significantly worse physical disability. Patients less than 65 years old reported significantly worse tinnitus and pain scores. Overall, quality of life was higher in the observation group. Conservative management, where appropriate, is favourable with higher quality-of-life outcomes in this cohort. This must be weighed against the risks of a growing tumour.

Microsurgical excision of intracranial arteriovenous malformation

Objectives: Brain Arteriovenous malformations are high-flow cerebrovascular lesions with dysplastic vascular nidus, fed by arteries and drained by veins without intervening capillaries. Prevalence is 0.2% and is an important cause of intracerebral haemorrhage in about 38% of young adults. The objective of this study is to analyze surgically managed Intracranial AV malformations with respect to their demographic features, varied clinical presentations, imaging features Spetzler Martin grading and outcome. Methods: A study of 48 patients with Intracranial Arteriovenous malformations who underwent microsurgical excision at the Institute of Neurosurgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai over a period of 5 years from July 2018 to June 2022 and extracted their data including demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, complications and outcome were assessed. Results: Of the 48 patients treated with microsurgery, the most common 51% belongs to the age group between 21 to 40years, left-sided is slightly more common with headache major symptom, involving Parietooccipital lobe 33% commonly, 28 (62.2%) patients initially presented with haemorrhage. Anterior circulation artery feeders was common 68.8% and mostly drainage involving superficial venous drainage system. Based on the Spetzler-Martin (SM) grading system, the patients were graded as follows: 6(13 %) Grade I, 10(21%) Grade II, 25(52%) Grade III, 3 (6%) Grade IV and 4(8%) Grade V. Overall, 35(73%) patients had a favorable outcome, most commonly seen in Grade I, II and Grade III. Almost complete obliteration of the AVMs were achieved in all favorable outcome cases. Conclusion: Microsurgical excision is the gold standard treatment of choice for low grade AVMs and certain high-grade AVMs with increased risk of rupture. The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Proper patient selection combined with appropriate preoperative evaluation, meticulous surgical technique and postoperative care all lead to reduced mortality and morbidity.

Fibrous dysplasia of sphenoid wing with secondary aneurysmal bone cyst: a rare case report

BackgroundAn aneurysmal bone cyst is a locally destructive benign lesion affecting mostly the long bones. Aneurysmal bone cyst of the skull bones is a very rare phenomenon and the involvement of the sphenoid bone of the skull with extension into the orbit is even rarer. We present a case of 15-year-old adolescent with fibrous dysplasia of the sphenoid wing with secondary aneurysmal bone cyst.Case presentationA 15-year-old male presented to us with chief complaints of headache with swelling in the left temporal region of the face and proptosis of the left eye associated with decreased vision for the past 2 months. NCCT showed a large heterogeneous mass in the left temporal region extending into left orbit. Gadolinium-enhanced MRI showed a well-defined multiloculated osteo-expansile lesion in the left middle cranial fossa extending into the anterior cranial fossa consistent with the fibrous dysplasia of the sphenoid bone with associated aneurysmal bone cyst. Digital subtraction angiography brain to look for any feeders to the lesion was done followed by microsurgical gross total excision of the tumor. The histopathology report confirmed it to be fibrous dysplasia secondary to aneurysmal bone cyst.ConclusionAneurysmal bone cyst is a rare entity, commonly affecting the long bones of the body. The involvement of sphenoid wing of skull is very rare occurrence. It can be primary or secondary to fibrous dysplasia, chondroblastoma, giant cell tumor, fibromyomas, etc. Fibrous dysplasia with secondary aneurysmal bone cyst should be kept in mind as one of the differential diagnoses while dealing with osteolytic bone lesions of skull.

Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery

BackgroundThe objective of this study was to explore the internal consistency and factor structure of the Oswestry Disability Index among patients undergoing spinal surgery. The sample consisted of 1,515 patients who underwent lumbar spinal surgery at a university hospital between 2018 and 2021.MethodsThe patients responded to the Oswestry Disability Index within 2 months before surgery. Cronbach’s alpha was used to assess the internal consistency. The factor structure was evaluated using exploratory and confirmatory factor analyses.ResultsThe average age of 1,515 patients was 58.5 (SD 15.8) years and 53% were women. The mean ODI score was 43.4% (SD 17.4%). Of the patients, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots. The internal consistency of the Oswestry Disability Index was found to be good, with an alpha of 0.87 (95% CL 0.86 to 0.88). Exploratory factor analysis resulted in unidimensional structure. Item loadings on this retained factor were moderate to substantial for all 10 items. One-factor confirmatory factor analysis model demonstrated an acceptable fit. The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling”, “personal care”, and “social life”. The lowest correlations were observed for the item “standing”.ConclusionsThe Oswestry Disability Index is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling,” “social life,” “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.Trial registrationNot applicable.

Microsurgical Excision of Large Cerebellopontine Angle Tumors in Limited Resource Setting: Adapted Techniques and Operative Outcomes

Microsurgical Excision of Large Cerebellopontine Angle Tumors in Limited Resource Setting: Adapted Techniques and Operative Outcomes

Microsurgery of Brainstem Cavernoma: Challenges and Outcomes

Cavernous malformation of brainstem is at increased risk of hemorrhage compared to supratentorial cavernomas. Increased morbidity associated with brainstem cavernoma (BCs) is defined by the inherent eloquence of the surrounding structures. At present watchful waiting, microsurgical resection and gamma knife surgery are the treatment modalities for symptomatic brainstem cavernoma. However, in the resource limited settings microsurgical excision by selecting an appropriate corridor can help in gross total removal in the meantime improving the neurological deficit and patient satisfaction. In this case series we have reviewed cavernomas of midbrain and pons, the technical difficulty with its management and its outcomes.

Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series

Introduction and importanceD-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. Case presentationCase 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness. Clinical discussionMagnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery. ConclusionThis case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.

Surgical excision of eyelid tumorsand subsequent ophthalmoplastic reconstruction.

In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning aprocedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master awide range of reconstructive techniques.

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis.

Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, which may spare patients the traversal of deep structures needed for microsurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

Upper cervical intramedullary schwannoma of the spinal cord presenting with myelopathy: illustrative case.

Intramedullary schwannomas account for 1.1% of all spinal schwannomas. Preoperative diagnosis is best accomplished by thoroughly evaluating clinical and radiological characteristics, accompanied by a high index of suspicion. The authors report a case of C2-3 intramedullary schwannoma in a young male who presented with neck pain and vertigo. The current literature is also reviewed. The authors reviewed the data of a young male with a 2-month history of neck pain and vertigo. Magnetic resonance imaging of the brain and cervical spine showed an intramedullary mass at C2-3 with a syrinx extending into the cervicomedullary junction. Laminectomy, myelotomy, and microsurgical excision of the mass under intraoperative neurological monitoring (IONM) were done. Postoperative pathology reported the specimen as a schwannoma. Gross-total resection of a schwannoma using IONM is the treatment of choice because of the lesion's benign nature, a better prognosis, and defined cleavage plane. Schwannomas should be included in the differential diagnosis of intramedullary spinal tumors. Because of its progressive nature, early surgery is recommended in symptomatic patients.

Epidermoid Cyst of the Brainstem in 3-Year-Old Child: A Rare Case Report.

Epidermoid cysts are infrequent lesions occupying the intracranial space, comprising approximately 1-2% of all intracranial tumors. Brainstem epidermoids are exceptionally uncommon in children; up until now, only a few scattered case reports have been documented in the literature regarding this unique location. These cysts commonly arise from the inclusion of ectodermal elements during neural tube closure. Complete excision of these cysts is challenging due to their close proximity and adherence to the brainstem, which makes it difficult to achieve. As a result, recurrence of the cysts is not uncommon. We have reported a rare case of a 3-year-old with a 5-month history of progressive headache, imbalance while walking and progressive weakness in his right upper limb and lower limb along with difficulty in swallowing. On MRI Brain imaging study he had a pre-pontine epidermoid with intra-axial extension in the pons. The patient underwent retro-sigmoid/suboccipital craniotomy and microsurgical excision of the tumor, including the tumor capsule. After completing the surgery, the cavity was irrigated using a solution containing hydrocortisone and Ringer lactate to prevent the occurrence of aseptic meningitis. In the postoperative, the patient recovered without any complications, as all symptoms showed immediate improvement, and the lower cranial nerves returned to normal functioning.

Long-term outcomes following surgical treatment of spinal arachnoid cysts: a population-based consecutive cohort study

BACKGROUND CONTEXTSpinal arachnoid cysts (SACs) are rare, cerebrospinal fluid-filled sacs lined by an arachnoid membrane in the spinal canal. Symptoms can develop due to pressure on the spinal cord or adjacent spinal nerves by the cyst itself or by interrupted flow of cerebrospinal fluid. If noninvasive management fails or neurological deterioration occurs, surgical treatment is recommended. However, data is lacking on long-term outcomes after surgery. PURPOSETo determine long-term outcomes in patients surgically treated for SACs. STUDY DESIGNPopulation-based cohort-study. PATIENT SAMPLEAll consecutive patients treated for either intra- or extradural SACs with surgery between 2005 and 2020 at the author's institution were included. OUTCOME MEASURESAmerican Spinal Injury Association Impairment Scale (AIS) and modified Japanese Orthopedic Association score (mJOA). METHODSData was primarily extracted from electronic patient medical notes. Telephone interviews were performed to assess long-term postoperative outcomes. All analyses were conducted using the statistical software program R version 4.0.5. Statistical significance was set at p<.05. RESULTSThirty-four patients were included. Cyst excision was performed in 11 (32%) cases, and fenestration in the remaining 23 (68%). The median follow-up time was 8.0 years. Surgery resulted in a significant long-term improvement in both AIS (p=.012) and mJOA (p=.005). Sensory deficit was the symptom that most often improved (81%), followed by pain (74%) and motor function (64%). AIS deteriorated in two patients, of which one case was attributed to a surgical complication. Local cyst recurrence requiring reoperation was seen in 4 (12%) cases, all of them following cyst fenestration. One patient (3%) required reoperation for progression of the cyst progression at a different level. CONCLUSIONThis study reports outcomes of surgically treated SACs with the longest follow-up time to date. Microsurgical cyst excision or fenestration were safe treatment options, and the neurological improvements seen in the immediate postoperative phase were maintained at long-term follow-up.

Surgical Treatment of Cerebral cavernous Malformations: Report of 6 Cases and pertinent Literature review

Cerebral cavernous Malformation (CCM) is a rare neurovascular malformation accounting 0.5% to 4% of all intracranial vascular malformations. People harboring CCM may be symptomatic or may present with seizure, hemorrhage or progressive neurological deficit. Asymptomatic CCM needs no treatment. The symptomatic CCM may or may not require intervention. The best treatment for symptomatic CCM is microsurgical excision. Over a period of five years we have been managing I2 patients with CCM, and out of them 6 patients who were symptomatic required microsurgical excision. Here, we discuss these 6 surgically managed patients and appropriate literature related to CCMs would be reviewed.